Nephron 1992:61:322 323
M. Pluvia A. Suggest’ D. Cirillo P. Castellino R. Pempinello M.D. lannece D. Guarnaccia P. Tassinaro C. Pluvia T Cicchella C. De Pasquale
Hepatitis C Virus-Related Acute and Chronic Hepatitis in Hemodialysis Patients
lstituto di Medicina Interna e Nefroiogia, I'1Facoltádi MedicinaeChirurgiadi Napoli; Divisione di Nefroiogia, Ia Divisione e Pronto Soccorso, Ospedale D. Cotugno, Napoli, Italy
Abstract The incidence of HCV antibodies has been evaluated in 123 chronic hemodialy sis (HD) patients (Group A; 55 M and 68 F) and in 37 consecutive HD patients (group B) admitted to our hospitals for acute hepatitis. In group A, HCV antibodies were present in 27% of the patients. 20 of 36 (55%) had previously received blood transfusions. 21 patients (58%) were also positive for HBV Ab. In 8 patients, ALT were significantly increased. In group B, the diagnosis of HCV-related acute hepatitis was made in 11 patients. 8 of them had previously received blood transfusions. Seroconversion occurred 2-3 months after onset of the disease.
Introduction The recent development of a specific methodology to identify HCV-positive subjects has allowed a more accurate assessment of the incidence of HCV infection among dialy sis patients [1,2], Identification of HCV carriers is important since HCV infection can be transmitted to hemodialysis patients both by blood and/or blood derivative transfu sions and by contaminations related to the dialysis treat ment [3]. Preliminary studies indicate that anti-HCV Ab are present in 10-20% of hemodialysis patients. Their role with respect to the clinical and laboratory signs of chronic hepa titis has not been clarified [4]. In order to evaluate the role of
HCV in the development of chronic hepatitis, we examined the correlation between the prevalence of anti-HCV Ab and the aminotransferase levels. In a group of chronic hemodi alysis patients, the following risk factors were also evaluat ed: dialysis age, previous transfusions and surgery, positive markers for HBV and HDV [5]. Furthermore, it is well known that hemodialysis patients are often affected by acute viral hepatitis. The incidence of HCV Ab in hemodial ysis patients with acute hepatitis has been evaluated.
M. Pluvio lstituto di Medicina Interna e Nefroiogia IJ Facoltti di Medicina e Chirurgia di Napoli 1-80131 Napoli (Italy)
©1992 S. Karger AG, Basel 0028 2766/92 06I3-O322S2.75/0
Downloaded by: King's College London 137.73.144.138 - 1/24/2019 10:29:15 AM
Key Words Hepatitis C virus Hepatitis Hemodialysis
Patients and Methods
Discussion
Two groups of patients were studied. Group A: 123 chronic hemo dialysis patients (55 males and 68 females), age ranging from 33 to 90 years: all patients had been on hemodialysis for more than 12 months (range 15-180 months). Group B: 37 consecutive hemodialysis patients admitted for acute hepatitis to the Cotugno Hospital for Infectious Diseases, Napoli, Italy (27 males and 10 females, aged between 36 and 80 years; all patients had been on dialysis for more than 12 months at the time of admission). Patients were screened for HAV, HBV, HDV, CMV, EBV and HCV antibodies. Diagnosis of HCV-related acute viral hepatitis was based on both clinical and serologic parameters. HCV antibodies were evaluated by ELISA (Ortho HCV Antibody Elisa Test System, Ortho Diagnostics). HAV, HBV and HDV were evaluated by routine diagnostic methods (Abbott Diagnostics).
Results In group A, HCV antibodies were present in 36 of 123 patients (27%). 20 o f36 (55%) had previously received blood transfusions. 21 patients (58%) were also positive for HBV Ab (HBsAb, HBcAb, HBeAb). In 8 patients, ALT were significantly increased (2-3 times above 40 UI). None of the patients was coinfected by HBV or HDV viruses. In group B, the diagnosis of HCV-related acute hepatitis was made in 11 of 37 patients. 8 of II patients had previously received blood transfusions. Serological conversion of HCV Ab was observed 8-16 weeks after the clinical onset of acute hepati tis.
The present results indicate a high incidence of HCV infection in H D patients. The correlation with positive H BV Ab and previous blood transfusion seems to suggest a parenteral transmission of HCV infection in hemodialysis patients. A recent study suggests that the presence of HCV Ab is associated with an active viral replication as evaluated by the detection of C viral RNA sequences. These data as well as our observations on a significant correlation be tween positive anti-HCV Ab and increased aminotransfer ase levels indicate that HCV infection is an important cause of chronic hepatitis in hemodialysis patients. The possible role of a-interferon in the treatment and prevention of chronic hepatitis in these patients is at present almost unex plored and may deserve further attention. With regard to the role of HCV Ab in acute hepatitis, our data confirm that blood transfusions represent the major route of transmission of the disease. However, it should be pointed out that other intrahospital and hemodialysis-relat ed routes of transmission cannot be rouled out. In conclu sion, our preliminary data indicate that a significant share of hemodialysis patients have been exposed to HCV. This is often associated with a positive history of multiple blood transfusion. The use of erytropoietin and the attendant reduction in the number of blood transfusion may represent a preventive strategy against the diffusion of the disease.
References 3
4
Esteban JL, Esteban R, Viladomin L, Lopez Talavera JC, Gonzales A. Hernandez A. Genesca J, Buti M, Guardia S: Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989:0:294-297. Alter MS. Sampliner RE: Hepatitis C: Miles to go before we sleep. N Engl J Med 1989:321: 1538-1540.
5
Koretz RL. Stone O. Mousa M. Gitnick GL: Non-A. non-B. post-transfusion hepatitis a decade later. Gastroenterology 1985:88: 1251-1254.
323
Downloaded by: King's College London 137.73.144.138 - 1/24/2019 10:29:15 AM
1 C'hoo 0 1 . Kuo G. Weiner AJ, Overby R, Brad ley DW. Houton M : Isolation o fa c-DNA done derived from a blood-borne non-A. non-B viral hepatitis genome. Science 1989;244:359-362. 2 Editorial: Will a real hepatis C stand up? Lancet 1989:0:307-308.
M. Pluvia A. Suggest’ D. Cirillo P. Castellino R. Pempinello M.D. lannece D. Guarnaccia P. Tassinaro C. Pluvia T Cicchella C. De Pasquale
Hepatitis C Virus-Related Acute and Chronic Hepatitis in Hemodialysis Patients
lstituto di Medicina Interna e Nefroiogia, I'1Facoltádi MedicinaeChirurgiadi Napoli; Divisione di Nefroiogia, Ia Divisione e Pronto Soccorso, Ospedale D. Cotugno, Napoli, Italy
Abstract The incidence of HCV antibodies has been evaluated in 123 chronic hemodialy sis (HD) patients (Group A; 55 M and 68 F) and in 37 consecutive HD patients (group B) admitted to our hospitals for acute hepatitis. In group A, HCV antibodies were present in 27% of the patients. 20 of 36 (55%) had previously received blood transfusions. 21 patients (58%) were also positive for HBV Ab. In 8 patients, ALT were significantly increased. In group B, the diagnosis of HCV-related acute hepatitis was made in 11 patients. 8 of them had previously received blood transfusions. Seroconversion occurred 2-3 months after onset of the disease.
Introduction The recent development of a specific methodology to identify HCV-positive subjects has allowed a more accurate assessment of the incidence of HCV infection among dialy sis patients [1,2], Identification of HCV carriers is important since HCV infection can be transmitted to hemodialysis patients both by blood and/or blood derivative transfu sions and by contaminations related to the dialysis treat ment [3]. Preliminary studies indicate that anti-HCV Ab are present in 10-20% of hemodialysis patients. Their role with respect to the clinical and laboratory signs of chronic hepa titis has not been clarified [4]. In order to evaluate the role of
HCV in the development of chronic hepatitis, we examined the correlation between the prevalence of anti-HCV Ab and the aminotransferase levels. In a group of chronic hemodi alysis patients, the following risk factors were also evaluat ed: dialysis age, previous transfusions and surgery, positive markers for HBV and HDV [5]. Furthermore, it is well known that hemodialysis patients are often affected by acute viral hepatitis. The incidence of HCV Ab in hemodial ysis patients with acute hepatitis has been evaluated.
M. Pluvio lstituto di Medicina Interna e Nefroiogia IJ Facoltti di Medicina e Chirurgia di Napoli 1-80131 Napoli (Italy)
©1992 S. Karger AG, Basel 0028 2766/92 06I3-O322S2.75/0
Downloaded by: King's College London 137.73.144.138 - 1/24/2019 10:29:15 AM
Key Words Hepatitis C virus Hepatitis Hemodialysis
Patients and Methods
Discussion
Two groups of patients were studied. Group A: 123 chronic hemo dialysis patients (55 males and 68 females), age ranging from 33 to 90 years: all patients had been on hemodialysis for more than 12 months (range 15-180 months). Group B: 37 consecutive hemodialysis patients admitted for acute hepatitis to the Cotugno Hospital for Infectious Diseases, Napoli, Italy (27 males and 10 females, aged between 36 and 80 years; all patients had been on dialysis for more than 12 months at the time of admission). Patients were screened for HAV, HBV, HDV, CMV, EBV and HCV antibodies. Diagnosis of HCV-related acute viral hepatitis was based on both clinical and serologic parameters. HCV antibodies were evaluated by ELISA (Ortho HCV Antibody Elisa Test System, Ortho Diagnostics). HAV, HBV and HDV were evaluated by routine diagnostic methods (Abbott Diagnostics).
Results In group A, HCV antibodies were present in 36 of 123 patients (27%). 20 o f36 (55%) had previously received blood transfusions. 21 patients (58%) were also positive for HBV Ab (HBsAb, HBcAb, HBeAb). In 8 patients, ALT were significantly increased (2-3 times above 40 UI). None of the patients was coinfected by HBV or HDV viruses. In group B, the diagnosis of HCV-related acute hepatitis was made in 11 of 37 patients. 8 of II patients had previously received blood transfusions. Serological conversion of HCV Ab was observed 8-16 weeks after the clinical onset of acute hepati tis.
The present results indicate a high incidence of HCV infection in H D patients. The correlation with positive H BV Ab and previous blood transfusion seems to suggest a parenteral transmission of HCV infection in hemodialysis patients. A recent study suggests that the presence of HCV Ab is associated with an active viral replication as evaluated by the detection of C viral RNA sequences. These data as well as our observations on a significant correlation be tween positive anti-HCV Ab and increased aminotransfer ase levels indicate that HCV infection is an important cause of chronic hepatitis in hemodialysis patients. The possible role of a-interferon in the treatment and prevention of chronic hepatitis in these patients is at present almost unex plored and may deserve further attention. With regard to the role of HCV Ab in acute hepatitis, our data confirm that blood transfusions represent the major route of transmission of the disease. However, it should be pointed out that other intrahospital and hemodialysis-relat ed routes of transmission cannot be rouled out. In conclu sion, our preliminary data indicate that a significant share of hemodialysis patients have been exposed to HCV. This is often associated with a positive history of multiple blood transfusion. The use of erytropoietin and the attendant reduction in the number of blood transfusion may represent a preventive strategy against the diffusion of the disease.
References 3
4
Esteban JL, Esteban R, Viladomin L, Lopez Talavera JC, Gonzales A. Hernandez A. Genesca J, Buti M, Guardia S: Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989:0:294-297. Alter MS. Sampliner RE: Hepatitis C: Miles to go before we sleep. N Engl J Med 1989:321: 1538-1540.
5
Koretz RL. Stone O. Mousa M. Gitnick GL: Non-A. non-B. post-transfusion hepatitis a decade later. Gastroenterology 1985:88: 1251-1254.
323
Downloaded by: King's College London 137.73.144.138 - 1/24/2019 10:29:15 AM
1 C'hoo 0 1 . Kuo G. Weiner AJ, Overby R, Brad ley DW. Houton M : Isolation o fa c-DNA done derived from a blood-borne non-A. non-B viral hepatitis genome. Science 1989;244:359-362. 2 Editorial: Will a real hepatis C stand up? Lancet 1989:0:307-308.
