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Patterns of hepatitis C viremia in patients receiving hemodialysis
F Umlauft1, K Gruenewald, G Weiss
1Department of Internal Medicine, University of Innsbruck, Austria.
Insights
Fluctuating hepatitis C viremia is common in hemodialysis patients. Low viral load predicts sustained response to interferon therapy, highlighting the need for viral load monitoring in chronic hepatitis C management.
Area of Science:
- Hepatology
- Virology
- Nephrology
Background:
- Chronic hepatitis C virus (HCV) infection is prevalent among patients undergoing hemodialysis (HD).
- Understanding the natural history of HCV viremia and the utility of viral load monitoring is crucial in this population.
Purpose of the Study:
- To determine the natural history of hepatitis C viremia in hemodialysis patients.
- To assess the clinical utility of HCV RNA quantitation and genotyping in this patient group.
Main Methods:
- Analysis of consecutive sera from HCV RNA-positive HD patients, including an interferon alfa-treated group and an untreated control group.
- Utilized qualitative and quantitative polymerase chain reaction (PCR) for HCV RNA detection and a line probe assay for genotyping.
Main Results:
- 65% of untreated patients showed continuous viremia, while 35% had fluctuating patterns.
- Interferon alfa therapy led to undetectable HCV RNA in 76% during treatment, with a 21% sustained response rate.
- Lower initial serum HCV RNA levels correlated with sustained response to interferon therapy.
Conclusions:
- Fluctuating hepatitis C viremia is common in hemodialysis patients.
- Low baseline viral load is a predictor of sustained response to interferon therapy.
- Initial HCV RNA quantitation and repeated qualitative measurements are recommended for diagnosing chronic hepatitis C and monitoring interferon therapy in HD patients.
Objectives:
Chronic hepatitis C virus (HCV) infection is common in patients who receive hemodialysis (HD). The aim of this study was to determine the natural history of hepatitis C viremia and the clinical utility of quantitation and genotyping of HCV in this population of patients.
Methods:
Consecutive sera from two groups of HD patients who were HCV RNA positive, a group of 33 patients treated with interferon alfa (5 MU, three times a week for 4 months) and a group of 31 untreated patients, were analyzed by qualitative polymerase chain reaction, quantitative polymerase chain reaction, and a line probe assay for genotyping.
Results:
Serum HCV RNA was detected continuously in 20 of 31 untreated patients (65%), and 11 patients (35%) showed a fluctuating pattern of viremia with virus-free intervals of up to 4 wk. Twenty-five of 33 patients (76%) treated with interferon alfa became HCV RNA negative during therapy; eight of these 25 patients had a breakthrough, which was transient in seven patients and persistent in one. Of the remaining 24 end-of-treatment responders, 17 relapsed after completion of therapy, and seven (21%) had a sustained response with undetectable serum HCV RNA for 1 yr of follow-up. Initial serum HCV RNA levels in HD patients were generally low (median, 1 x 10(5) genome eq/ml). Sustained responders had significantly lower median levels of viremia (4 x 10(4) eq/ml) than relapsers and nonresponders (9 x 10(4) and 1.8 x 10(5) eq/ml, respectively). Genotyping revealed a predominance of genotype 1a (33%) and 1b (48%).
Conclusions:
This study documents that fluctuating hepatitis C viremia with periods of undetectable HCV RNA is common and that low viral load predicts a sustained response to interferon therapy in HD patients. Diagnosis of chronic hepatitis C and monitoring of interferon therapy in HD patients should include initial HCV RNA quantitation and repeated qualitative measurements of HCV RNA.