PREVALENCE AND CLINICAL EXPRESSION OF HCV-GENOTYPES IN HEMODIALYSIS-PATIENTS OF 2 GEOGRAPHICALLY REMOTE COUNTRIES - BELGIUM AND SAUDI-ARABIA

Hepatitis C virus is the leading cause of acute and chronic liver dise ase in hemodialysis patients. There are at least six major HCV-genotyp es. with a well documented geographical distribution in the general po pulation. Moreover, HCV-genotype is one of the major determinants of t he therapeutic response to Interferon Alpha in affected patients. Sinc e the therapeutic outcome in HCV-positive hemodialysis patients, espec ially with regard to the different HCV-genotypes, is of interest, a mu lticentre epidemiologic study was performed in HCV-antibody positive h emodialysis patients of two geographically remote countries, i.e. in F landers (Belgium) and in Saudi-Arabia 184 chronic hemodialysis patient s, with a positive second or third generation Elisa assay for HCV, wer e tested for HCV-viremia and HCV-genotype, using a 5' untranslated reg ion (UR)I nested PCR for the detection of HCV-RNA and subsequently typ e-specific probes to hybridize with HCV-RNA (Inno-Lipa((R))). Addition ally, clinical data were collected by means of a standardized question naire, thoroughly completed by the nephrologist in charge of each resp ective patient. Viremia was present in 79% of the patients (146 out of 184). The prevalence of HCV-genotypes differed significantly between Belgian and Saudi-Arabian dialysis-patients. In Belgian dialysis patie nts HCV-genotype 1b was most prevalent (i.e.62%), while in Saudi-Arabi an patients HCV-genotypes 4, 1b, and 1a were present in respectively 3 6,4%, 31,7%, and 25.8% of the HCV-PCR positive patients. Although ther e were significant differences between Belgian and Saudi-Arabian dialy sis patients, no clinical data showed any significant correlation with the HCV-genotype. Transaminases, determined over a six months period. showed normal average values. Doubling of the transaminases, in at le ast one out of six measurements over a six monthly period, occurred on ly in 14% (alanine aminotransferase, ALT) and 10% (aspartate aminotran sferase, AST) of the patients. In Belgian dialysis patients, HCV-genot ype 4 (or HCV-genotype 5) significantly correlated with a more recent start of dialysis treatment. We conclude that there is a significant d ifferent geographical prevalence of HCV-genotypes in HCV-affected hemo dialysis patients. None of the different HCV-genotypes shows any parti cular clinical expression. Transaminases are not a sensitive marker fo r ongoing HCV-replication in hemodialysis patients. In Belgian dialysi s patients, a changing pattern of HCV-infection is suggested, with an increasing prevalence of HCV-genotype 4 (or HCV-genotype 5) in more re cent years. These data suggest possible implications for the therapeut ic strategy in dialysis patients.