NEW INSIGHTS INTO HEPATITIS-C VIRUS-INFECTION OF HEMODIALYSIS-PATIENTS - THE IMPLICATIONS

The authors compared the diagnostic performance of a second-generation recombinant immunoblot assay (RIBA) (RIBA HCV 2.0 SIA) and the recent ly introduced third-generation RIBA (RIBA HCV 3.0 SIA) with that of he patitis C virus (HCV) RNA by the polymerase chain reaction (PCR) in 55 patients on chronic hemodialysis. Compared with HCV RNA by PCR, RIBA 3.0 increased the sensitivity of HCV detection to 72% as compared with 56% of RIBA 20. Both assays underestimated the prevalence of HCV infe ction as determined by PCR. However, RIBA HCV 3.0 outperformed RIBA HC V 2.0, detecting all of the RIBA 2.0-positive patients plus an additio nal eight (8 of 22 RIBA 2.0 negative; confidence interval [CI] = [17.2 %, 59.3%]). Forty-three of 51 patients with positive RIBA 3.0 or posit ive HCV RNA by PCR underwent a liver biopsy. Thirty (70%) had chronic hepatitis (three with cirrhosis), 10 (23%) had nonspecific changes, an d three (7%) had normal liver histology. Thirty of 37 patients (81%) w ith hepatitis C viremia and positive anti-HCV had chronic hepatitis, w hereas none of the viremic patients with negative anti-HCV had chronic hepatitis. Among the reactive antigens on RIBA 3.0, c33c was found to be most predictive of chronic hepatitis (P = 0.0002). Detection of HC V RNA continues to be the method of choice in the early phase of HCV i nfection. In places where a validated HCV RNA assay is not available, RIBA HCV 3.0 (soon to be commercially available) is a better alternati ve. Early detection of HCV infection and the implementation of an isol ation strategy might be important in preventing the spread of HCV infe ction among hemodialysis patients. Furthermore, the evaluation of live r histopathology of HCV-infected patients might be important for antiv iral therapy or renal transplantation or both. (C) 1995 by the Nationa l Kidney Foundation, Inc.