IS HEPATITIS-C VIRUS-RNA DETECTION BY NESTED POLYMERASE CHAIN-REACTION CLINICALLY RELEVANT IN HEMODIALYSIS-PATIENTS

We have prospectively studied in hemodialysis (HD) patients the evolut ion of hepatitis C virus (HCV) viremia and the putative relationships between the viremia and the biological markers of liver disease. For e ach of 22 HD patients having detectable antibodies to HCV (anti-HCV+), we looked four times for serum HCV-RNA by nested PCR (N-PCR), in Apri l and November 1992, November 1993 and May 1994. We checked the transa minases (Trans) and the gamma glutamyl transpeptidase (gamma GT) level s on the same day as blood tests for the N-PCR. Abnormal Trans or gamm a GT values were considered if they exceeded the upper limit of the no rmal level for our laboratory. Fifteen patients (68%) were intermitten tly N-PCR positive (N-PCR+): 3 patients were N-PCR+ at three determina tions, 7 were N-PCR+ at two determinations and 5 only one time. Two pa tients (9%) were always N-PCR+ and five (23%) always negative. No corr elation between an abnormal value of either Trans or gamma GT and vire mia was evidenced at successive determinations. In conclusion, the maj ority (68%) of the anti-HCV+ patients had intermittent HCV N-PCR+. Amo ng the anti-HCV+ patients, 77% were viremic. Since HCV viremia is ofte n transitory and since there is no correlation between N-PCR positivit y and the increase in Trans or gamma GT activities, HCV-RNA detection by N-PCR is probably not clinically relevant in anti-HCV+ HD patients.