title: Patterns of hepatitis C viremia in patients receiving hemodialysis.
abstract: OBJECTIVE
  Chronic hepatitis C virus (HCV) infection is common in patients who receive hemodialysis (HD). The aim of this study was to determine the natural history of hepatitis C viremia and the clinical utility of quantitation and genotyping of HCV in this population of patients.
  
  
  METHODS
  Consecutive sera from two groups of HD patients who were HCV RNA positive, a group of 33 patients treated with interferon alfa (5 MU, three times a week for 4 months) and a group of 31 untreated patients, were analyzed by qualitative polymerase chain reaction, quantitative polymerase chain reaction, and a line probe assay for genotyping.
  
  
  RESULTS
  Serum HCV RNA was detected continuously in 20 of 31 untreated patients (65%), and 11 patients (35%) showed a fluctuating pattern of viremia with virus-free intervals of up to 4 wk. Twenty-five of 33 patients (76%) treated with interferon alfa became HCV RNA negative during therapy; eight of these 25 patients had a breakthrough, which was transient in seven patients and persistent in one. Of the remaining 24 end-of-treatment responders, 17 relapsed after completion of therapy, and seven (21%) had a sustained response with undetectable serum HCV RNA for 1 yr of follow-up. Initial serum HCV RNA levels in HD patients were generally low (median, 1 x 10(5) genome eq/ml). Sustained responders had significantly lower median levels of viremia (4 x 10(4) eq/ml) than relapsers and nonresponders (9 x 10(4) and 1.8 x 10(5) eq/ml, respectively). Genotyping revealed a predominance of genotype 1a (33%) and 1b (48%).
  
  
  CONCLUSIONS
  This study documents that fluctuating hepatitis C viremia with periods of undetectable HCV RNA is common and that low viral load predicts a sustained response to interferon therapy in HD patients. Diagnosis of chronic hepatitis C and monitoring of interferon therapy in HD patients should include initial HCV RNA quantitation and repeated qualitative measurements of HCV RNA.
authors.affiliation: Department of Internal Medicine, University of Innsbruck, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Umlauft
authors.forename: K
authors.initials: K
authors.lastname: Gruenewald
authors.forename: G
authors.initials: G
authors.lastname: Weiss
authors.forename: H
authors.initials: H
authors.lastname: Kessler
authors.forename: M
authors.initials: M
authors.lastname: Urbanek
authors.forename: M
authors.initials: M
authors.lastname: Haun
authors.forename: B
authors.initials: B
authors.lastname: Santner
authors.forename: P
authors.initials: P
authors.lastname: Koenig
authors.forename: E B
authors.initials: EB
authors.lastname: Keeffe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D006526:Hepatitis C / Q000628:therapy / Q000821:virology*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood*; D006435:Renal Dialysis; D014766:Viremia / Q000628:therapy / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral