Abstract
The prevalence of HCV RNAs, genotypes, HCV second generation antibodies, C100-3 antibodies, N14 antibodies and GOR antibodies was assessed in 59 patients with chronic renal failure undergoing hemodialysis. HCV RNAs, whose 5'-noncoding region was detected by a nested polymerase chain reaction (PCR), were positive in 12 patients (20.3%). Second generation antibodies, assayed using an EIA kit (Dinabot Coop.), were positive in 27 patients (45.8%). C100-3 antibodies, assayed using an ELISA test (Ortho Diagnostics), were positive only in 10 patients (16.9%). N14 antibodies, assayed using an EIA kit (Eiken), were positive in 18 patients (30.5%). GOR antibodies, assayed using an EIA kit (Special Immunological Research), were positive in 15 patients (25.4%). Although all of the HCV RNA-positive patients were second generation antibody-positive too, they were not always positive for the other HCV antibodies. Thus, second generation antibodies appear to be the most sensitive index of HCV infection.
Second generation antibodies and HCV RNAs were assessed in 37 patients again six months later. Five patients whose second generation antibodies were positive and HCV RNAs were negative converted to HCV RNA-positive. One patient who was second generation antibody- and HCV RNA-negative converted to positive. This suggests that HCV RNAs should be assessed repeatedly. HCV RNAs were positive in 17 patients, and the detectable genotypes were type II (12 patients), types II+III (1 patient) and type III (2 patients). These genotypes are quite similar to those of patients with chronic hepatitis C.
More than 90% of the second generation antibody-positive patients had a history of blood transfusion, and most of them had been on hemodialysis for more than 5 years. However, we were unable to detect any differences in hepatic dysfunction during the preceding 6 months in the groups with and without HCV antibodies.
According to the multi-logistic method, the prevalence of HCV second generation antibody-positive patients increased, first, as the duration of hemodialysis became longer, and second, as the amount of blood transfusions increased. These findings suggest that assay of second generation antibodies is the most useful assay for screening HCV carriers and that very careful hemodialysis technique is required to prevent horizontal infection.
