Nephron 1992;61:350-351
lstituto di Clínica delle Malattie lnfettive, IRCCS Policlinico S. Maneo; Divisione di Nefrologia-Emodialisi, Fondazione Clínica del Lavoro, Pavia. Italy
Key Words Alanine aminotransferase Anti-HCV Hemodialysis Hepatitis C virus Non-A, non-B hepatitis
High Prevalence of Antibodies to Hepatitis C Virus in Hemodialysis Units Using a Second Generation Assay
Abstract We studied the prevalence and significance of antibodies to hepatitis C virus (HCV) in patients and staff from 3 dialysis units, using a 2nd generation assay (2nd g.a.; Ortho HCV). Of 277 patients, 151 (55%) were positive by 2nd and 85 (31%) by 1st g.a. Significant associations with the anti-HCV carrier status were: blood transfusions, retrospective finding of elevated ALT and duration of dialysis treatment, independently of transfusions. Of the 74 staff members, 5 were positive by 2nd and 3 by 1st g.a. Our data suggest that the 2nd g.a. is more sensitive in detecting HCV exposure in dialysis units and that duration of dialysis is a significant factor in acquiring HC'V infection.
Previous studies reported variable prevalences of expo sure to hepatitis C virus (HCV) in hemodialysis patients using a 1st generation assay that detects antibodies to a nonstructural protein, clOO-3 [1-3]. Circulating anti-cl00-3 is thought to be a sensitive indicator of viremia, as shown by the good correlation with HCV RN A [4], however, its role as a reliable marker of exposure to the virus remains question able. To determine whether the actual rate of exposure to HCV in dialysis units is underestimated, we have studied the prevalence and significance of antibodies to HCV in patients and staff from 3 dialysis units, using a 2nd genera tion assay (Ortho HCV, 2nd generation) which incorporates polypeptides derived from the putative nucleoprotein re gion (c22-3) and from the nonstructural regions NS3 and NS4 (c200). Of 277 patients, 151 (55%) were repeatedly positive by 2nd generation assay, compared to 85 (31%) with 1st generation test. Statistically significant associations with
the anti-HCV carrier status were: duration of dialysis treat ment, blood transfusions and the retrospective finding of abnormally elevated ALT on at least I occasion (table 1). Although these associations were also found using the 1st generation assay [3], this study revealed that duration of dialysis was an independent risk factor of acquiring HCV infection, irrespective of blood transfusions (table 1). Thirty-seven anti-HCV-positive patients were also tested by 2nd generation recombinant immunoblot assay (RI BA). Of these, 26 (70%) were confirmed positive by the supplemen tary assay, 10 (27%) were indeterminate (i.e., they showed reactivity with only 1of the 4 antigen bands) and 1(3%) was negative. The 2nd generation assay was also more sensitive in detecting exposure to HCV in dialysis staff members. Thus, of the 74 subjects tested, 5 (7%) were positive by 2nd generation assay, compared with 3 (4%) positive by 1st generation assay.
Mario Mondelli Islituto di Clínica delle Maladie lnfettive IR C O S Policlinico S. Mattco 1-27100 Pavia (Italy)
© 1992 S. Karger AO . Basel 0028-2766/92/ 06I3-0350S2.75/0
Downloaded by: Leiden University Medisch Centrum 132.229.13.63 - 10/23/2018 12:26:28 PM
M. U. Mondelli G. Cristina V. Piazza A. Ceriño G. Villa A. Sal vadeo
Table 1. Clinical findings in 277 hemo dialysis patients
Anti-HCV-r (n=15l)
Anti-HCV(n= 126)
74(1-252)
22(1-207)
lstituto di Clínica delle Malattie lnfettive, IRCCS Policlinico S. Maneo; Divisione di Nefrologia-Emodialisi, Fondazione Clínica del Lavoro, Pavia. Italy
Key Words Alanine aminotransferase Anti-HCV Hemodialysis Hepatitis C virus Non-A, non-B hepatitis
High Prevalence of Antibodies to Hepatitis C Virus in Hemodialysis Units Using a Second Generation Assay
Abstract We studied the prevalence and significance of antibodies to hepatitis C virus (HCV) in patients and staff from 3 dialysis units, using a 2nd generation assay (2nd g.a.; Ortho HCV). Of 277 patients, 151 (55%) were positive by 2nd and 85 (31%) by 1st g.a. Significant associations with the anti-HCV carrier status were: blood transfusions, retrospective finding of elevated ALT and duration of dialysis treatment, independently of transfusions. Of the 74 staff members, 5 were positive by 2nd and 3 by 1st g.a. Our data suggest that the 2nd g.a. is more sensitive in detecting HCV exposure in dialysis units and that duration of dialysis is a significant factor in acquiring HC'V infection.
Previous studies reported variable prevalences of expo sure to hepatitis C virus (HCV) in hemodialysis patients using a 1st generation assay that detects antibodies to a nonstructural protein, clOO-3 [1-3]. Circulating anti-cl00-3 is thought to be a sensitive indicator of viremia, as shown by the good correlation with HCV RN A [4], however, its role as a reliable marker of exposure to the virus remains question able. To determine whether the actual rate of exposure to HCV in dialysis units is underestimated, we have studied the prevalence and significance of antibodies to HCV in patients and staff from 3 dialysis units, using a 2nd genera tion assay (Ortho HCV, 2nd generation) which incorporates polypeptides derived from the putative nucleoprotein re gion (c22-3) and from the nonstructural regions NS3 and NS4 (c200). Of 277 patients, 151 (55%) were repeatedly positive by 2nd generation assay, compared to 85 (31%) with 1st generation test. Statistically significant associations with
the anti-HCV carrier status were: duration of dialysis treat ment, blood transfusions and the retrospective finding of abnormally elevated ALT on at least I occasion (table 1). Although these associations were also found using the 1st generation assay [3], this study revealed that duration of dialysis was an independent risk factor of acquiring HCV infection, irrespective of blood transfusions (table 1). Thirty-seven anti-HCV-positive patients were also tested by 2nd generation recombinant immunoblot assay (RI BA). Of these, 26 (70%) were confirmed positive by the supplemen tary assay, 10 (27%) were indeterminate (i.e., they showed reactivity with only 1of the 4 antigen bands) and 1(3%) was negative. The 2nd generation assay was also more sensitive in detecting exposure to HCV in dialysis staff members. Thus, of the 74 subjects tested, 5 (7%) were positive by 2nd generation assay, compared with 3 (4%) positive by 1st generation assay.
Mario Mondelli Islituto di Clínica delle Maladie lnfettive IR C O S Policlinico S. Mattco 1-27100 Pavia (Italy)
© 1992 S. Karger AO . Basel 0028-2766/92/ 06I3-0350S2.75/0
Downloaded by: Leiden University Medisch Centrum 132.229.13.63 - 10/23/2018 12:26:28 PM
M. U. Mondelli G. Cristina V. Piazza A. Ceriño G. Villa A. Sal vadeo
Table 1. Clinical findings in 277 hemo dialysis patients
Anti-HCV-r (n=15l)
Anti-HCV(n= 126)
74(1-252)
22(1-207)
