Acute hepatitis C among Japanese hemodialysis patients: a prospective 9-year study.
OBJECTIVE
The aims of this prospective survey were to determine the incidence and clinical characteristics of newly acquired hepatitis C virus (HCV) infection in hemodialysis patients after the start of antibody to HCV (anti-HCV) screening for blood products in Japan in 1989.


METHODS
In serial serum samples from 269 hemodialysis patients who were followed over a mean period of 6.6 yr (+/- 2.1 yr) from 1990 to 1998, HCV RNA and anti-HCV were detected by reverse transcription-polymerase chain reaction and second generation ELISA, respectively.


RESULTS
During the observation period, newly acquired HCV infection was found in 26 (15.4%) of the 169 hemodialysis patients without anti-HCV or HCV RNA at entry, an annual incidence rate of 2.59%. Of these 26, only four had a history of blood transfusion, one of whom had received the blood transfusion after 1992, the year in which screening of blood products for anti-HCV by second-generation ELISA was introduced in Japan. Persistent HCV viremia was found in 17 (65.4%) of the 26 patients; the other nine (34.6%) had transient HCV infection. The mean period of continuous ALT abnormality was significantly longer in the former (12.4+/-13.6 months) than in the latter (1.9+/-3.5 months) (p = 0.0067). However, only three (17.6%) of 17 patients with chronic HCV viremia had continuous ALT abnormality for more than 24 months; in all of them, ALT eventually normalized.


CONCLUSIONS
These findings indicate that newly acquired HCV infection has continued to occur in hemodialysis patients after the initiation of anti-HCV screening of blood products and that the abnormal ALT found in these patients is related to HCV chronicity.
Furusyo
N
N
Department of General Medicine, Kyushu University Hospital, Fukuoka, Japan.
Hayashi
J
J
Kakuda
K
K
Ariyama
I
I
Kanamoto-Tanaka
Y
Y
Shimizu
C
C
Etoh
Y
Y
Shigematsu
M
M
Kashiwagi
S
S
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000954:Antigens, Surface / Q000032:analysis; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000453:epidemiology* / Q000503:physiopathology*; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D015994:Incidence; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D006435:Renal Dialysis; D013997:Time Factors
D000954:Antigens, Surface; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase