Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients.

Folia Med (Plovdiv)

Clinic of Gastroenterology, Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases, St Ivan Rilski University Hospital, Sofia.

Published: March 2017

AI Article Synopsis

  • Hepatitis C virus (HCV) is common among dialysis patients and is usually diagnosed through lab tests due to the unique progression of the disease.
  • A study was conducted with 93 dialysis patients to determine the accurate prevalence of HCV by testing for both anti-HCV antibodies and HCV RNA levels over time.
  • Results showed a 20.6% prevalence of HCV, with longer dialysis duration linked to higher chances of being viremic, indicating that a dual testing approach could improve diagnosis in this patient group.

Article Abstract

Background: Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease.

Aim: The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels.

Materials And Methods: For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present.

Results: The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005).

Conclusions: The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.

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Source
http://dx.doi.org/10.1515/folmed-2017-0012DOI Listing

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