Sir,
Hepatitis C virus (HCV) is a major life threat among hemodialysis (HD) patients with prevalence of 4.3%-45.2% in India.[1] Major challenge is that anti-HCV which is usually a reliable marker for HCV is often negative in HD patients despite the presence of significant viremia, making molecular tests the most reliable tests for screening HCV infection in HD patients.[2] Goal of this study was to find out the utility of HCV RNA as a screening marker for HCV infection in HD patients.
In this one year retrospective study, blood samples of 410 chronic kidney disease (CKD) patients were included. Anti-HCV was tested by chemiluminescence microparticle immunoassay (Architect i1000SR, Abbott Diagnostics, USA), and HCV RNA was tested by real-time PCR (Abbott m2000rt). Institutional Ethics Committee of our institute approved the study protocol.
Among 410 CKD patients, 128 (31%) were on HD and overall HCV infection among 128 HD patients was seen in 17 (13.3%) patients with 12 (9.4%) patients positive for anti-HCV and 12 (9.4%) patients positive for HCV RNA. A total of 7 (5.5%) patients were positive for both anti-HCV and HCV RNA suggesting active infection. A total of 5 (4%) patients were HCV RNA negative but anti-HCV positive with low signal/cut-off ratio who persistently remained HCV RNA negative till 1 year follow-up, thus suggesting false anti-HCV positivity.[3] Totally 5 (4%) asymptomatic HD patients with undetectable antibodies were HCV RNA positive proving that anti-HCV alone is not a good screening marker for HCV detection among HD patients table 1. Our study results correlate well with two other studies.[4,5]
Table 1.
Hepatitis C virus viral markers in hemodialysis patients in the study group (n=128)
Seronegative HCV infection among HD patients can be due to longer window period in these immunocompromised individuals[4] or due to the presence of antigen-antibody immune complexes, resulting in low anti-HCV response.[2] Hence, we recommend that all HD patients should be screened by both anti-HCV and HCV RNA to rule out HCV infection with high sensitivity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Saha D, Agarwal SK. Hepatitis and HIV infection during haemodialysis. J Indian Med Assoc. 2001;99:194–9. [PubMed] [Google Scholar]
- 2.Kazmierczak J, Pawelczyk A, Cortes KC, Radkowski M. Seronegative hepatitis C virus infection. Arch Immunol Ther Exp (Warsz) 2014;62:145–51. doi: 10.1007/s00005-013-0257-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Gupta E, Bajpai M, Choudhary A. Hepatitis C virus: Screening, diagnosis, and interpretation of laboratory assays. Asian J Transfus Sci. 2014;8:19–25. doi: 10.4103/0973-6247.126683. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Jindal N, Soin D, Grover P, Bansal R, Malhotra R, Singh S, et al. Hepatitis C virus (HCV) infection among seronegative patients undergoing haemodialysis in a remotely located tertiary care hospital of Northern India: Value of HCV-RNA and Genotypes. J Clin Diagn Res. 2015;9:DC 10–2. doi: 10.7860/JCDR/2015/15310.6952. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Moini M, Ziyaeyan M, Aghaei S, Sagheb MM, Taghavi SA, Moeini M, et al. Hepatitis C virus (HCV) infection rate among seronegative hemodialysis patients screened by two methods; HCV core antigen and polymerase chain reaction. Hepat Mon. 2013;13:e9147. doi: 10.5812/hepatmon.9147. [DOI] [PMC free article] [PubMed] [Google Scholar]