HEPATITIS-C VIRUS-INFECTION IN HEMODIALYSIS-PATIENTS IN SOUTHERN SWEDEN - EPIDEMIOLOGIC, CLINICAL, AND DIAGNOSTIC ASPECTS

A prevalence of hepatitis C virus (HCV) antibodies of 12% was found in 276 patients from 11 dialysis units. Between zero and 22% of the pati ents in the different units were anti-HCV positive. The epidemiology o f HCV was studied in two units during a 2 year period by antibody assa ys and the polymerase chain reaction and correlated with clinical mani festations. Two types of epidemiologic patterns were found that may ex plain the wide difference of HCV prevalence described in different dia lysis units. In one unit there was no evidence of spread within the un it, and the prevalence of HCV was dependent on the status of the patie nts entering for treatment. In the other unit, a clustering of infecte d patients could be seen in which 13 of 36 were infected during a 3 ye ar period. Some patients who had not received blood transfusions were among the infected. Hepatitis C infection was the most common explanat ion for repeated abnormal transferase levels. Most of the HCV-infected patients reacted both for anti-HCV and HCV RNA. HCV RNA was in genera l detected earlier than anti-HCV seroconversion. Among 20 HCV RNA-posi tive serum samples that were anti-HCV ELISA-positive 18 had indetermin ate and two negative reactions by immunoblot (RIBA 2). Thus the RIBA 2 test should be used with caution as a confirmatory antibody test in t his group of patients. (C) 1993 Wiley-Liss, Inc.