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Comparison of three different tests for assessment of hepatitis C virus in dialysis patients
C Castelnovo1, G Lunghi, A De Vecchi
1IRCCS Ospedale Maggiore, Milano, Italy.
Insights
Hepatitis C virus (HCV) viremia is more common in hemodialysis patients than in continuous ambulatory peritoneal dialysis patients. Antibody testing may miss recent or low-level HCV infections.
Area of Science:
- Nephrology
- Virology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection is a significant concern in dialysis patients.
- Understanding the prevalence of HCV antibodies (HCV-Ab) and viremia is crucial for patient management.
Purpose of the Study:
- To determine the relationship between HCV antibodies and viremia.
- To compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.
Main Methods:
- Cross-sectional study involving 48 HD and 79 CAPD patients.
- HCV-Ab testing using ELISA II and RIBA II.
- HCV viremia detection via polymerase chain reaction (PCR).
Main Results:
- HCV-Ab positivity was higher in HD (52% ELISA II, 48% RIBA II) than CAPD patients (14% ELISA II, 11% RIBA II).
- HCV viremia prevalence was 41.6% in HD and 12% in CAPD patients.
- Two PCR-positive patients lacked detectable HCV-Ab, suggesting recent or low-level infections.
Conclusions:
- Hemodialysis patients exhibit a higher prevalence of HCV viremia compared to CAPD patients.
- The absence of antibodies in some viremic patients may indicate recent infection, weak viral replication, or poor immune response.
Objective:
To evaluate the relationship between hepatitis C virus antibodies (HCV-Ab) and viremia and to compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.
Design:
Cross-sectional study.
Setting:
Dialysis unit of a nephrology division in a public university hospital.
Patients:
All dialysis patients who came for routine clinic visits during the study period. None denied informed consent. Forty-eight patients on HD and 79 on CAPD were examined.
Intervention:
Blood samples were tested by second-generation enzyme-linked immunosorbent assay (ELISA II) and recombinant immunoblot assay (RIBA II) to look for HCV-Ab and by the polymerase chain reaction (PCR) to look for HCV viremia.
Results:
ELISA II was positive in 52% of HD patients and in 14% of CAPD patients. RIBA II was positive in 48% of HD patients and in 11% of CAPD patients. HCV viremia was positive by PCR in 41.6% of HD patients and in 12% of CAPD patients. Two of these PCR-positive patients did not show HCV-Ab by ELISA II and RIBA II. The sensitivity and specificity of ELISA II were 93% and 92%, the sensitivity and specificity of RIBA II were 86% and 94%.
Conclusions:
Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.