Recent evidence has been accumulated showing that chronic hemodialysis (HD) patients have a very high prevalence of antibodies to hepatitis C (HCV) virus. In contrast, there is little information on the virological characteristics of HCV infection in this population. The aim of this study was to measure the HCV viral load and to correlate this with demographic, biochemical, clinical and virological features of a large cohort of HCV- infected patients on chronic HD. In addition, we prospectively measured HCV viremia and aminotransferase activity over the course of 13 months in a subset of viremic individuals. Three hundred and ninety-four chronic HD patients were tested by branched-chain DNA (bDNA) signal amplification assay (Quantiplex(TM) HCV RNA Assay), anti-HCV enzyme-linked immunosorbent assay 2.0, and on the basis of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) activity. Multivariate analysis by ordinal logistic regression model was performed: age, gender, race, time on HD, allocation of the patients along the HD units, etiology of end-stage renal disease, HBsAg status, anti-HCV positivity, HCV genotype, and AST/ALT levels were independent factors, while viremic levels of HCV in serum were assumed as dependent variables. Eighty-eight (22.3%) of the 394 patients showed serological and/or virological signs of HCV infection. Fifty-nine (15%) of the 394 had detectable HCV RNA in serum, the mean HCV load was 19.4 x 105 (95% CI, 6.06 x 107 to 6.2 x 104) Eq/mL. According to the criteria suggested by others (Gretch et al., J Infect Dis 1994; 169: 1219-1225), there were 8 (13.5%) individuals with high-titer viremia (>1 x 107 Eq/mL) in the subset of viremic patients. A small subset (8/394=2%) of individuals was seronegative but viremic; 29 (7%) of the 394 patients were seropositive without detectable HCV RNA in serum. Univariate analysis showed that the frequency of anti-HCV positivity was significantly higher in viremic patients than in individuals with no detectable HCV viremia: 51/59 (86%) vs. 29/335 (8.6%), P=0.0001. Serum AST and ALT levels were significantly higher in viremic patients than among individuals with no detectable HCV RNA in serum: 23.8 (95% CI, 60.8-9.3) vs. 17.1 (95% CI, 50.4-5.8) UI/L (P=0.009) and 14.4 (95% CI, 48.9-4.3) vs. 9.8 (95% CI, 37.3-2.5) UI/L (P=0.008). Logistic regression analysis showed an association between HCV viremia and anti-HCV positivity (P=0.00001), and ALT activity (P=0.01). The HCV RNA levels at the study entry were 1.6 x 105 (95% CI, 1.4 x 1010-1.9 x 101) vs. 0.89 x 105 (95% CI, 2.6 x 1010-3.3 x 101) Eq/mL (NS) at the end of the observation period. In the group of viremic patients, AST and ALT levels did not significantly change from the start compared to the end of the follow-up [20.5 (57.9-7.2) vs. 26.04 (81.4-8.3) UI/L, P=0.089 and 12.3 (48.9-3.1) vs. 12.4 (57.9-2.7) UI/L, P=0.895]. In summary, the HCV viral load in the HD population was relatively low, and it was associated with elevated hepatic enzyme levels and anti-HCV positivity. Seronegative but viremic patients were also found. The HCV load did not significantly change over a 13-month observation period. Longitudinal studies with longer follow-ups are necessary to evaluate the course of HCV load over time in this population.
|Number of pages||6|
|Journal||Giornale Italiano di Nefrologia|
|State||Published - Jan 1 1999|
- Viral load
ASJC Scopus subject areas