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Infection with hepatitis GB virus C in patients on maintenance hemodialysis
Insights
Patients on maintenance hemodialysis have a higher risk of hepatitis GB virus C (HGBV-C) infection. This persistent HGBV-C infection can be transmitted through transfusions or other routes.
Area of Science:
- Virology
- Hepatology
- Infectious Diseases
Background:
- Hepatitis GB virus C (HGBV-C), a recently identified virus, has poorly understood transmission and clinical features.
- Maintenance hemodialysis patients represent a population with potential exposure risks.
Purpose of the Study:
- To investigate the prevalence of HGBV-C infection in patients undergoing maintenance hemodialysis.
- To explore the transmission routes and persistence of HGBV-C in this patient group.
Main Methods:
- Serum samples from 519 hemodialysis patients were tested for HGBV-C RNA using reverse-transcription-polymerase-chain-reaction (RT-PCR) with nested primers.
- Nucleotide sequencing of the non-structural region of HGBV-C was performed on selected clones.
Main Results:
- HGBV-C RNA was detected in 3.1% of hemodialysis patients, significantly higher than the 0.9% in healthy blood donors (P<0.03).
- None of the HGBV-C infected patients showed active liver disease, though 7 were co-infected with hepatitis C virus.
- HGBV-C infections were persistent, with evidence of transmission via blood transfusion in some cases, and potential transmission through other means in others.
Conclusions:
- Patients on maintenance hemodialysis are at an elevated risk for acquiring HGBV-C infection.
- HGBV-C establishes persistent infections, with blood transfusions identified as a potential transmission vector, alongside other unconfirmed routes.
Background:
A recently discovered non-A-E hepatitis virus has been designated hepatitis GB virus C (HGBV-C), but little is known about its mode of transmission and its clinical manifestations. We studied 519 patients on maintenance hemodialysis to determine whether they were infected with HGBV-C.
Methods:
HGBV-C RNA was identified in serum by a reverse-transcription-polymerase-chain-reaction assay with nested primers deduced from a non-structural region. A nucleotide sequence of 100 bp in the nonstructural region was determined on HGBV-C clones.
Results:
HGBV-C RNA was detected on 3.1 percent of the patients on hemodialysis (16 of 519), as compared with 0.9 percent of healthy blood donors (4 of 448, P<0.03). None of the 16 patients had evidence of active liver disease, although 7 were also infected with hepatitis C virus. Eight patients with HGBV-C infection were followed for 7 to 16 years. In two patients the virus was present at the start of hemodialysis. One had a history of transfusion, and HGBV-C persisted over a period of 16 years; the other became free of HGBV-C after 10 years. In five patients, HGBV-C RNA was first detected 3 to 20 weeks after blood transfusion and persisted for up to 13 years. One patient with no history of transfusion was infected with an HGBV-C variant with the same sequence as in two of the patients with post-transfusion HGBV-C infections.
Conclusions:
Patients on maintenance hemodialysis are at increased risk for HGBV-C infection. This virus produces persistent infections, which may be transmitted by transfusions but may also be transmitted by other means.