Nephron 1992;61:298-299

G. Mosconia C. Catnpieria R. Minieroh L. Colta C. 0/'.v/a G. La Manna a L /?. D? Sanctis '-' S. Stefonia G. Sprovieri'0 V. Bonomini-'

Epidemiology of Hepatitis C in a Population of Hemodialysis Patients

Institute of Nephrology, Central Laboratory. S. Orsola University Hospital, Bologna, Italy

Abstract A search for antibodies against hepatitis C virus (HCV) was performed in 185 patients on chronic hemodialysis by means of 1st and 2nd generation ELISA tests. Immunoblot assays were performed on positive sera. This study shows a 38% prevalence of HCV-positive patients in our dialysis population according to the 2nd generation ELISA test which shows a higher specificity and sensitivity when compared to the 1st generation one (38 vs. 20%). A correlation was found between the prevalence of HCV-positive patients and how long they had been on dialysis and how many blood transfusions they had received.

Introduction The identification of hepatitis C virus (HCV) by Choo et al. [1] in 1989 and the possibility of detecting specific seric antibodies [2] have broadened the diagnostic approaches and brought about a more complete epidemiological view in the field of dialysis-related infectious diseases. To date, 1st generation enzyme-linked immunosorbent assays (ELISA) have shown a prevalence ranging from 10 to 30% of HCV positives in patients on hemodialysis [3]. The latest 2nd generation ELISA tests can more accu­ rately detect previous contact of the patient with HCV. The aim of this study is to compare the prevalence of HCV-positive patients in our dialysis population and to identify the antibody pattern in these patients. Prevalence

was obtained by means of 2 laboratory ELISA HCV tests of 1st and 2nd generation. The antibody pattern in positive patients was established through a 2nd generation RIBA test.

Patients and Methods 185 patients on hemodialysis at the S. Orsola Nephrology Institute of the University of Bologna have been included in this study. Each patient was evaluated for the presence of anti-HCV antibod­ ies by means of immunoenzymatic tests of 1st and 2nd generation. The Ortho I test (1st generation) detects the antibodies against the cl00-3 antigen (not structural), while the Ortho 11 test (2nd generation) detects not only the cl00-3 antigen but also the antibodies against c33-c (not structural) and c22-3 (structural) antigens.

Giovanni Mosconi, M I) Institute o f Nephrology St. Orsola University Hospital, via Massarenti. 9 I 40138 Bologna (Italy)

© 1992 S. Karger AG. Basel 0028-2766/92/ 06I3-0298S2.75/0

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Key Words Hepatitis C Hepatitis C antibodies Hemodialysis

T a b le 1 . The prevalence of positive HCV patients (Ortho 11 and R l BA test) with respect to the number of transfusions and the length of time on dyalisis

Transfusions n

Patients n

HCV+ %

Dialysis treatment years

Patients n

HCV+ %

0 I-5 6 -I0 > I0

I2 57 32 84

8 I6 34 58


The higher the number of blood transfusions and the longer the patients have been on hemodialysis, the higher the prevalence of HCV-positive patients (table 1). The anal­ ysis of the antibodies using a 2nd generation RIBA test on 71 Ortho II positive sera showed the presence of anti c22-3 antibodies in 66/71 (93%) patients, anti c33-c in 60/71 (85%), anti cIOO-3 in 29 (41%) and 5-1-1 in 30 (42%) patients. In II ‘indeterminate’ sera (only 1 antibody) the c22-3 antibody was found in 9 cases and the c33-c in 2.

Results Conclusions



The prevalence of HCV-positive patients as revealed by 1st generation ELISA tests (Ortho II) is 20%, the same as found in the current literature [3]. 2 generation tests (Ortho II), which give a far more accurate epidemiological view of HCV, show that the prevalence of this communicable dis­ ease is almost double (38%) with respect to Ortho I results (20%). Blood transfusions and the number of years on dialysis are important factors in determining the prevalence of HCV. At present, antibodies against c22-3 and c33-c antigens are the more frequent marker of contact with HCV.

ChooQ-L, Kuo G, Weiner J.cta l: Isolation of a cDNA clone derived from a blood-borne nonA, non-B viral hepatitis. Science 1989:244: 359-362. 2 Kuo G, Choo Q-L, Halter HJ, et al: An assay for circulating antibodies to a major etiologic virus ofhum an non-A, non-B hepatitis. Science 1989: 244:362-364.


Schlipkoter U. Roggendorf M, Emsl G, et al: Hepatitis C virus antibodies in haemodialysis patients. Lancet 1990:335:14.


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36 of the 185 (20%) patients studied resulted HCV-positive following the Ortho I test; results almost doubled following the Ortho II tests where 71 of 185 (38%) patients resulted HCV positive. Confirmatory immunoblot tests showed that 34 of 36 (94%) HCV Ortho 1 positive sera were ‘reactive’ and 1 (3%) was ‘indeterminate’; while 59 of 71 (83%) HCV Ortho II positive sera were ‘reactive’ and 11 (15%) ‘indeterminate’. Confirmatory immunoblot tests also gave false-positive sera (‘not reactive’) as 1of 36 (3%) using the Ortho 1test and 1 of 71 (2%) using the Ortho II test.

Epidemiology of hepatitis C in a population of hemodialysis patients.

A search for antibodies against hepatitis C virus (HCV) was performed in 185 patients on chronic hemodialysis by means of 1st and 2nd generation ELISA...
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