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TITLE: Acquisition of hepatitis C virus in hemodialysis
patients: A prospective study by branched DNA signal amplification
assay
Abstract: Serological data indicate that hepatitis C virus (HCV)
infection is very common among chronic hemodialysis (HD) patients,
Circumstantial evidence suggests that hemodialysis per se is an
important risk factor for 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 the rate of acquisition
of HCV infection in 274 anti-HCV-negative patients undergoing HD
treatment in four hemodialysis units, Moreover, we used bDNA
testing to analyze the dynamics of HCV acquisition among HD
patients, a high-risk group for HCV infection with immune
compromise conferred from uremia, Two patients were identified with
de novo acquisition 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 transaminase (ALT) activity
and that preceded the anti-HCV seroconversion. This was followed by
HCV RNA clearance and normalization of ALT activity, Anti-HCV
positivity occurred 1 and 2 months after the ALT increase in the
first and second patients, respectively, Although HCV incidence was
low (0.73%), further research is warranted to set the optimal
policy for eliminating the risk of nosocomial transmission of HCV
in the HD setting. Our findings show the pattern of HCV acquisition
in chronic HD patients and emphasize the need to screen the HD
population for ALT measurement combined with anti-HCV testing for
detecting hepatitis C, HCV RNA testing can identify HCV before
seroconversion in individuals with deranged liver function tests.
The acquisition of HCV in HD patients without identifiable risk is
confirmed. (C) 1998 by the National Kidney Foundation, Inc.
AUTHOR: Fabrizi F, Martin P, Dixit V, Brezina M, Cole MJ,
Gerosa S, Mousa M, Gitnick G; SOURCE: AMERICAN JOURNAL OF KIDNEY
DISEASES 31: (4) 647-654 APR 1998
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