Lack of seronegative hepatitis C virus infections in patients with chronic renal failure.
BACKGROUND
Recent reports have indicated that serologic testing for hepatitis C virus (HCV) in patients with chronic renal failure may be inadequate to detect infections in this patient population.


METHODS
We prospectively tested 258 patients with end-stage renal disease who were referred for evaluation for renal transplantation for anti-HCV using a second-generation enzyme immunoassay (EIA) and a second-generation qualitative reverse-transcriptase polymerase chain reaction (RT-PCR). We confirmed all positive EIAs with a third-generation recombinant immunoblot assay and genotyped RT-PCR-positive specimens.


RESULTS
We found that 22 patients (8.5%) had serological evidence of HCV infection. Nineteen (86%) of the antibody-positive patients were viremic (HCV RNA positive). All but 1 of the patients was infected with HCV genotype 1. None of the 233 HCV antibody-negative patients were shown to be viremic by RT-PCR.


CONCLUSIONS
No additional HCV cases were detected by screening all patients for HCV RNA by RT-PCR. However, RT-PCR is a valuable adjunct to serology in antibody-positive patients to distinguish resolved from active infections.
Kelley
Violet A
VA
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Everett-Kitchens
Jennifer
J
Brannon
Laura E
LE
Connor
Kathleen
K
Martinez
Enrique J
EJ
Pearson
Thomas C
TC
Nolte
Frederick S
FS
D005260:Female; D006526:Hepatitis C / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction
D018937:Hepatitis C Antibodies; D012367:RNA, Viral