HEPATITIS-C VIRUS-RNA IN ANTI-HCV POSITIVE HEMODIALYZED PATIENTS - SIGNIFICANCE AND THERAPEUTIC IMPLICATIONS

About 25% of French hemodialysis patients have antibodies against the hepatitis C virus (HCV), which may reflect either past or active HCV i nfection. It is important to evaluate the significance of these antibo dies, as most hemodialysis patients are candidates for kidney transpla ntation and have normal transaminase activities despite biopsy-proven chronic hepatitis. We prospectively assayed HCV viremia with the neste d polymerase chain reaction in 61 patients on maintenance hemodialysis who had anti-HCV antibodies detectable in second generation tests (EL ISA2 or RIBA2). HCV RNA was repeatedly detected in the serum of 52 (85 .2%) patients. Liver biopsy, which was performed in 17 cases, revealed chronic hepatitis in 16 cases (including 2 of cirrhosis) and steatosi s in one. Hypertransaminasemia was observed in only 31.3% and 30.8% of patients with chronic hepatitis and HCV viremia, respectively. Anti-H CV antibodies are frequently associated with HCV viremia, resulting us ually in chronic hepatitis, although hypertransaminasemia is uncommon. HCV viremia reflects both post-transfusional and community-acquired H CV infection. These findings suggest a need for liver biopsy and antiv iral treatment before kidney transplantation. The isolation of anti-HC V positive subjects in the dialysis setting should be evaluated to red uce patient-to-patient transmission of HCV.