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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 1056-1058
Hepatitis C virus core antigen testing in the monitoring of patients on dialysis


Nephrology and Dialysis, Civic and Di Cristina Hospital, Palermo, Italy

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Date of Web Publication13-Sep-2012
 

How to cite this article:
Li Cavoli G, Zagarrigo C, Schillaci O, Tralongo A, Rotolo U. Hepatitis C virus core antigen testing in the monitoring of patients on dialysis. Saudi J Kidney Dis Transpl 2012;23:1056-8

How to cite this URL:
Li Cavoli G, Zagarrigo C, Schillaci O, Tralongo A, Rotolo U. Hepatitis C virus core antigen testing in the monitoring of patients on dialysis. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2020 Oct 31];23:1056-8. Available from: https://www.sjkdt.org/text.asp?2012/23/5/1056/100951
To the Editor,

Hepatitis C virus (HCV) infection is a persis­tent public health concern and infects approxi­mately 170 million people worldwide [1] [Figure 1]. HCV infection can detrimentally affect pa­tients throughout the spectrum of chronic kid­ney disease (CKD): it can lead to cryoglobulinemic glomerulonephritis and it has a negative effect on survival in patients on long-term dia­lysis as well as renal transplant recipients. Despite adequate screening of blood products, HCV transmission is still being observed among patients undergoing dialysis. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS) 2007, the prevalence of HCV infection among dialysis patients in Western countries ranges from 9.4% to 18.7%. [2] In this population, HCV-positive subjects have an increased mortality risk compared with HCV-negative subjects. The diagnosis of HCV infection is currently based on the detection of HCV antibody (HCVAb). However, distinguishing active from cleared infection is still difficult; enzyme immunoassays lack diagnostic usefulness in dialysis patients. The use of nucleic acid am­plification technology (NAT) techniques might help in direct detection of HCV. However, NAT is associated with several problems including relative non-availability, requirement of signi­ficant expertise, limited reproducibility and, above all, high costs. [3] Recent studies have highlighted the importance of HCV core an­tigen detection as an alternative to NAT for early diagnosis of infection, as a direct marker of viral replication in the chronic phase of infection and as a relevant marker for predic­ting and monitoring the response to therapy. [4],[5] Few studies exist about the efficacy of HCV core antigen test in the dialysis population. [6],[7],[8] The aim of this study was to assess the utility of HCV core antigen test in the monitoring of chronic dialysis patients. From September 2009 to February 2010, we screened 168 patients on long-term dialysis: 93 were on hemodialysis and 75 on peritoneal dialysis. We evaluated HCV core antigen and HCVAb by chemiluminescent assay (Architect Abbott), HCV immunoblotting by InnoLia, HCVRNA by PCR (TaqMan Roche), viral genotype by INNO-LiPA 2.0 and other routine tests. HCVRNA testing was performed on 90 sub­jects. Of the 168 patients studied, 142 were HCVAb-negative and 26 were positive. All HCVAb-negative subjects were also HCV core antigen negative. In addition, HCVRNA test was performed in 66 of the 142 HCVAb-and HCV core antigen-negative patients. The result was negative in all. Among the 26 HCVAb-positive patients, eight were HCV core antigen-negative; six of these patients were HCVRNA negative and two were lost to follow-up. We detected 18 HCVAb-positive patients who were HCV core antigen-positive and HCVRNA positive; in these patients, the minimum HCVRNA (IU/mL)/HCVAg (pg/mL) ratio was 78, the maximum was 425.000 and the mean was 64.401. The results of the liver function tests were unremarkable. The princi­pal characteristics among the 168 study pa­tients are shown in [Table 1] and the features among the HCVAb-positive patients are shown in [Table 2]. Our results suggest that serological detection of HCV core antigen may be an alternative to NAT techniques for routine monitoring of patients on chronic dialysis. It is an accurate marker for early identification of HCV infec­tion; it can improve virological monitoring and integrate the diagnosis of acute hepatitis C in the dialysis population. The low cost and easy availability make this assay useful for routine long-term dialysis treatment patients.
Figure 1: Prevalence of hepatitis C virus infection worldwide.

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Table 1: Principal characteristics of the 168 patients studied.

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Table 2: Principal features of the 26 hepatitis C antibody-positive patients.

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   References Top

1.Centers for Disease Control and Prevention: Recommendations for preventing transmission of infections among chronic haemodialysis patients. MMWR 2001;50:1-43.  Back to cited text no. 1
    
2.Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS. Kidney Int 2004;65: 2335-42.  Back to cited text no. 2
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3.Covic A, Abramowicz D, Bruchfeld A, et al. Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) hepatitis C guide­lines: a European Best Practice (ERBP) posi­tion statement. Nephrol Dial Transplant 2009; 24:719-27.  Back to cited text no. 3
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4.Laperche S, Le Marrec N, Girault A, et al. Simul­taneous detection of hepatitis C virus (HCV) core antigen and anti-HCV antibodies im­proves the early detection of HCV infection. J Clin Microb 2005;43:3877-83.  Back to cited text no. 4
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5.Veillon P, Payan C, Picchio G, Maniez-Montreuil M, Guntz P, Lunel F. Comparative evaluation of the total hepatitis C virus core antigen, branched-DNA, and amplicor monitor assays in determining viremia for patients with chronic hepatitis C during Interferon plus Ribavirin combination therapy. J Clin Microbiol 2003;41:3212-20  Back to cited text no. 5
    
6.Fabrizi F, Lunghi G, Aucella F, et al. Novel assay using total hepatitis C virus core antigen quantification for diagnosis of HCV infection in dialysis patients. J Clin Microbiol 2005;43: 414-20.  Back to cited text no. 6
[PUBMED]    
7.Bouzgarrou N, Fodha I, Othman SB, et al. Evaluation of a total core antigen assay for the diagnosis of hepatitis C virus infection in haemodialysis patients. J Med Virol 2005;77: 502-8.  Back to cited text no. 7
[PUBMED]    
8.Miedouge M, Saune K, Kamar N, Rieu M, Rostaing L, Izopet J. Analytical evaluation of HCV core antigen and interst for HCV scree­ning in haemodialysis patients. J of Clin Virol 2010;48:18-21.  Back to cited text no. 8
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Correspondence Address:
Gioacchino Li Cavoli
Nephrology and Dialysis, Civic and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.100951

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