Sir,
Despite the control of hepatitis C virus (HCV) transmission, hepatitis C is still being observed among patients undergoing dialysis [1]. 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 detection of HCVAb, but enzyme immunoassays cannot distinguish between active and cleared infection, and aminotransferase activities lack diagnostic usefulness in dialysis patients. The direct detection of HCV depends on nucleic acid amplification technology (NAT) techniques with several problems: frequent unavailability, considerable skill requirement, limited reproducibility and overall important costs. Few studies exist about the efficacy of HCV core antigen test in the dialysis population [2,3]. From September 2009 to February 2010, we screened 168 long-term dialysis patients: 93 underwent haemodialysis and 75 peritoneal dialysis. We evaluated HCV antigen by chemiluminescent assay (Architect Abbott) and HCVRNA by PCR (TaqMan Roche). HCVRNA testing was performed on 90 subjects. We detected 142 HCVAb-negative and 26 HCV-positive patients. All HCVAb-negative subjects were HCVAg negative. HCVRNA testing was performed in 66 of the 142 HCVAb-/HCVAg-negative patients. The result was always negative. Among the 26 HCVAb-positive patients, we detected 18 who were HCVAg positive. All these HCVAb-/HCVAg-positive patients were HCVRNA positive; eight HCVAb-positive patients were HCVAg negative; six of these HCVAb-positive/HCVAg-negative patients were HCVRNA negative; we could not perform an HCVRNA test in two HCVAb-positive/HCVAg-negative subjects. Therefore, in 90 patients, the HCVAg test did not show any discrepancy towards the HCVRNA test. We think serological detection of HCVAg may be an alternative to NAT techniques; it can improve virological monitoring and integrate the diagnosis of acute hepatitis C in the dialysis population. The minimal cost and its easiness make this assay useful for routine long-term dialysis treatment patients.
Conflict of interest statement. None declared.
References
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