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GB virus-C infection among chronic haemodialysis patients: clinical implications
1First Department of Medicine, Chiba University School of Medicine, Japan.
Insights
Hepatitis G virus (GBV-C) coinfection in dialysis patients with hepatitis C virus (HCV) appears to cause milder liver disease. GBV-C infection alone in dialysis patients results in very mild, self-limited hepatitis.
Area of Science:
- Virology
- Hepatology
- Infectious Diseases
Background:
- Patients on chronic hemodialysis are at high risk for hepatitis C virus (HCV) infection.
- Hepatitis G virus (GBV-C) frequently coinfects patients already infected with HCV.
- The clinical significance of GBV-C coinfection in hemodialysis patients, with or without HCV, requires further investigation.
Purpose of the Study:
- To investigate the clinical implications of GBV-C infection in hemodialysis patients.
- To determine the prevalence of GBV-C in hemodialysis patients with and without HCV.
- To assess the impact of GBV-C coinfection on liver disease severity in this population.
Main Methods:
- GBV-C RNA detection in sera of 98 anti-HCV-positive and 85 anti-HCV-negative dialysis patients using reverse transcription-polymerase chain reaction (RT-PCR).
- Monitoring of liver function tests (ALT, AST) at regular intervals.
- Analysis of patient history, including blood transfusions and potential nosocomial infections.
Main Results:
- GBV-C RNA was detected in 6.1% of anti-HCV-positive and 3.5% of anti-HCV-negative dialysis patients.
- Coinfection with HCV and GBV-C (n=6) and isolated GBV-C infection (n=3) were observed, with all patients having a history of blood transfusion.
- GBV-C infection alone caused very mild, self-limited hepatitis; coinfection with HCV resulted in a milder liver disease course compared to chronic HCV infection alone.
Conclusions:
- GBV-C infection is present in hemodialysis patients, primarily associated with past blood transfusions, with no evidence of nosocomial spread.
- Isolated GBV-C infection in this cohort is generally mild and self-limiting.
- HCV/GBV-C coinfection may lead to a milder clinical presentation of liver disease compared to chronic HCV infection.
Abstract:
It is known that patients on chronic haemodialysis are frequently infected with hepatitis C virus (HCV). It has recently been found that GB virus-C (GBV-C) and hepatitis G virus frequently coinfect patients with HCV. This study aimed at elucidating the clinical implications of GBV-C infection among haemodialysis patients who have and do not have HCV infection. GBV-C RNA was detected in sera of randomly selected 98 anti-HCV-positive and 85 -negative patients on dialysis by reverse transcription-polymerase chain reaction using two sets of amplification primers made from the reported sequences of the non-structural protein 3 and 5' untranslated regions. In these patients, liver function tests were carried out at regular intervals. There were six patients who were coinfected with HCV and GBV-C and three who had only GBV-C RNA. All had a history of past blood transfusion. The onset of mild hepatitis was identified in three HCV-negative patients; elevation of alanine aminotransferase (ALT) following blood transfusion was very mild but recognizable, and aspartate aminotransferase (AST) was higher than ALT. In two of six coinfected patients, the onset of liver disease was recognized with a peak ALT of 72 and 90 IU/L, respectively. Two of these six were Amplicore (HCV-RNA) negative and asymptomatic, two had low-grade HCV viraemia and two moderate-grade HCV viraemia. Of the 98 anti-HCV-positive cases, 41 were thought to have had nosocomial infection of HCV or non-A, non-B virus; none of them had GBV-C. GBV-C RNA was negative in nine patients who had chronic non-A-E hepatitis. GBV-C infection was detected in 6.1% of anti-HCV-positive and in 3.5% of -negative dialysis patients. All had blood transfusion in the past, and there was no evidence of patient-to-patient spread of GBV-C in hospital. The liver disease was very mild and self-limited in GBV-C infection alone. The natural history of coinfected patients may be similar to that of those with chronic HCV infection, but the liver disease appears to be milder.