ABSENCE OF HCV VIREMIA IN ANTI-HCV-NEGATIVE HEMODIALYSIS-PATIENTS

Background. Immunologic alterations have been reported in chronic haem odialysis (HD) patients. Some HD patients may have, therefore, an inab ility to produce detectable amounts of serum antibodies to hepatitis C virus (anti-HCV). Previous studies have shown the presence of HCV vir aemia in anti-HCV-negative I-ID patients (ranging from 1 to 15%). Howe ver, the universal epidemiologic impact of these cases remains uncerta in since there are conflicting results. In this context, we conducted a study in an attempt to investigate the presence of HCV viraemia amon g anti-HCV-negative HD patients in a well-defined geographic area of t he northwestern part of Greece. Methods. During a 6 month period, 81 a nti-HCV-negative HD patients were tested twice for the presence of HCV RNA, using the reverse transcriptase polymerase chain reaction (RT-PC R) combined with a DNA enzyme immunoassay (DEIA). At the same time, pe riodic testing for anti-HCV by two commercially available third genera tion assays was done. In addition, 15 anti-HCV-positive HD patients an d 20 non-HD patients with well established chronic HCV infection used as internal controls were tested for the presence of HCV RNA and anti- HCV. Results. None of the anti-HCV-negative HD patients were shown to be viraemic by the combined RT-PCR and DEIA method. During the same li me period, all remained anti-HCV negative by the third generation assa ys. By contrast, all the patients with known HCV-infection were positi ve by the two enzyme immunoassays, whereas 13 anti-HCV-positive HD pat ients (86.7%) and 18 non-HD patients (90%) were viraemic by RT-PCR. Co nclusions. This study demonstrated that routine HCV RNA testing in ant i-HCV-negative I-ID patients appears not to be necessary particularly when third generation assays are used for the detection of anti-HCV.