ACQUISITION OF HEPATITIS-C VIRUS IN HEMODIALYSIS-PATIENTS - A PROSPECTIVE-STUDY BY BRANCHED DNA SIGNAL AMPLIFICATION ASSAY

Serological data indicate that hepatitis C virus (HCV) infection is ve ry common among chronic hemodialysis (HD) patients, Circumstantial evi dence suggests that hemodialysis per se is an important risk factor fo r this infection, We used a novel methodology, the branched DNA (bDNA) signal amplification assay, which is capable of detecting HCV RNA and of quantifying HCV viral load in serum, to prospectively determine th e rate of acquisition of HCV infection in 274 anti-HCV-negative patien ts undergoing HD treatment in four hemodialysis units, Moreover, we us ed bDNA testing to analyze the dynamics of HCV acquisition among HD pa tients, a high-risk group for HCV infection with immune compromise con ferred from uremia, Two patients were identified with de novo acquisit ion during 1 year of prospective bDNA testing, Thus, the HCV incidence was 0.73% per year, De novo acquisition of HCV infection was observed in the absence of identifiable parenteral risk factors, Both patients showed the same pattern of HCV acquisition: they underwent an initial viremic phase that was associated with an increase in alanine transam inase (ALT) activity and that preceded the anti-HCV seroconversion. Th is was followed by HCV RNA clearance and normalization of ALT activity , Anti-HCV positivity occurred 1 and 2 months after the ALT increase i n the first and second patients, respectively, Although HCV incidence was low (0.73%), further research is warranted to set the optimal poli cy for eliminating the risk of nosocomial transmission of HCV in the H D setting. Our findings show the pattern of HCV acquisition in chronic HD patients and emphasize the need to screen the HD population for AL T measurement combined with anti-HCV testing for detecting hepatitis C , HCV RNA testing can identify HCV before seroconversion in individual s with deranged liver function tests. The acquisition of HCV in HD pat ients without identifiable risk is confirmed. (C) 1998 by the National Kidney Foundation, Inc.