HIGH PREVALENCE OF HEPATITIS-G VIRUS-INFECTION COMPARED WITH HEPATITIS-C VIRUS-INFECTION IN PATIENTS UNDERGOING CHRONIC-HEMODIALYSIS

A recently discovered non-A-E hepatitis virus has been designated as h epatitis G virus (HGV) and identified as a new member of the Flaviviri dae family. Infection by this virus is thought to be associated with b lood-borne hepatitis and usually in the presence of hepatitis C or hep atitis B virus (HBV) infection. In this study, the presence of HGV-RNA in serum or plasma and the prevalence of antibodies against an HGV en velope protein (E2) were investigated in patients undergoing chronic h emodialysis using a sensitive reverse-transcriptase polymerase chain r eaction and an enzyme-linked immunosorbent assay, respectively. HGV-RN A was detected in 19 of 112 patients investigated (17%) and anti-E2 an tibodies were detected in 15 of 106 patients studied (14.2%). With the exception of two patients, the appearance of anti-E2 is associated wi th the clearance of serum HGV-RNA. The total prevalence of current (HG V-RNA positivity) and/or past (anti-E2 positivity) HGV infection in th is patient population is thus 28.6% (32 of 112 patients were positive for serum HGV-RNA and/or anti-E2 antibodies), In apparently healthy bl ood donors, serum HGV-RNA was detected in four of 358 individuals (1.1 2%) and anti-Ea was not detected in 50 individuals investigated. From the 19 patients with serum HGV-RNA positivity, nine were coinfected wi th other hepatitis viruses (seven with HBV; one with HBV, hepatitis C virus [HCV], and hepatitis D virus; and one with HBV and cytomegalovir us). Thirteen of 15 patients with anti-E2 positivity (10 were positive for only anti-E2 and three were also positive for anti-HBc) had no de tectable HGV-RNA. In two patients, both HGV-RNA and anti-E2 antibodies were concomitantly present (both patients were coinfected with HCV or HBV). Of the HGV-infected patients, only three who were coinfected wi th HBV showed elevated serum alanine aminotransferase levels, The seru m HCV-RNA and/or anti-HCV were detected in five (4.5%) of 112 patients . From these findings, we conclude that there is a high prevalence of HGV infection (28.6%) compared with HCV (4.5%) in patients undergoing hemodialysis in our hospital. However, approximately 50% of patients h ad spontaneously lost the viremia and developed anti-HGV-E2 antibodies . We confirm that HGV infection alone is not associated with elevated serum transaminases, and the appearance of anti-HGV-E2 is usually acco mpanied with clearance of serum HGV-RNA. In contrast to the results of our previous study, the majority of patients infected with HGV are no t coinfected with HCV, indicating that HGV is capable of independent t ransmission. It is likely that there is a preferential HGV acquisition in the hemodialysis unit. The clinical significance of long-term infe ction with HGV remains to be established. (C) 1998 by the National Kid ney Foundation, Inc.