INFLUENCE OF HEPATITIS-C VIRUS (HCV) VIREMIA UPON SERUM AMINOTRANSFERASE ACTIVITY IN CHRONIC DIALYSIS PATIENTS

Background. There are many reports concerning HCV in dialysis patients and most of them conclude that the clinical and biochemical features of hepatitis C are often silent in chronic dialysis patients. Elevated levels of serum alanine aminotransferase activity are a sensitive mea sure of hepatocellular injury, but so far the relationship between ant i-HCV and ALT among chronic dialysis patients has been considered impe rfect. To our knowledge, however, such an issue has not been adequatel y addressed. Methods. Demographic, biochemical, and virological data f rom 506 patients undergoing chronic dialysis treatment in four dialysi s units in Lombardy, northern Italy were collected in order to assess the influence of virological and host factors on serum aminotransferas e values. Results. Analysis of covariance showed that positivity for a nti-HCV antibody was significantly associated with raised serum AST (P = 0.0001) and ALT (P = 0.0001) levels in the dialysis patients of the whole study group. Logistic regression analysis performed in the subs et of patients tested for HCV viraemia and genotype showed that detect able HCV RNA in serum is a strong predictor of raised AST (P = 0.0001) and ALT (P = 0.000001) values. Gender showed an independent weak infl uence on AST levels (P = 0.055), serum levels of ferritin were signifi cantly (P = 0.042) associated with AST values, the coexistence of HBsA g infection and positivity for anti-HCV antibody was independently ass ociated with raised ALT levels (P = 0.016). The other factors (includi ng positivity for anti-HCV) showed no independent effect on serum amin otransferase levels when they were matched with HCV viraemia in our mu ltivariate analysis. HCV RNA positive patients showed serum AST (P<0.0 08) and ALT levels (P<0.0001) higher than HCV RNA negative patients. T here was no relationship between HCV genotypes and liver enzymes. Conc lusions. Our data show that detectable HCV RNA in serum is a strong in dependent predictor of raised aminotransferase values in chronic dialy sis patients; the relationship between serum aminotransferase values a nd anti-HCV antibody was exclusively related to the association betwee n raised aminotransferase values and HCV viraemia; HCV RNA positive pa tients show higher hepatic enzyme levels than dialysis patients with n o detectable HCV RNA; no association between HCV genotype and serum am inotransferase activity was apparent.