Travel-associated acquisition of hepatitis C virus infection in patients receiving haemodialysis.
BACKGROUND
It has been proposed that hepatitis C virus (HCV)-infected patients with end-stage renal disease undergoing maintenance haemodialysis may lack HCV antibody (anti-HCV) despite chronic HCV viraemia. This carries important implications for the design of surveillance policies.


METHODS
To characterize the prevalence of antibody-negative/RNA-positive HCV infection, patients attending seven haemodialysis units underwent anti-HCV testing using a third-generation assay and HCV RNA testing using real-time PCR.


RESULTS
At screening, anti-HCV prevalence was 12/360 (3.3%; 95% CI 1.7-5.8%); 7/12 (58.3%) anti-HCV positive samples were HCV RNA positive. Among anti-HCV-negative samples, 2/348 (0.6%; 95% CI 0.2-2.1%) tested HCV RNA positive (genotype 1a). Retrospective testing of stored sera dated the infections to a period of holiday in the Indian subcontinent. The two infections were unrelated by HCV-NS5B sequencing. Only one of the two newly infected persons showed raised transaminases. Both developed anti-HCV within 8-13 weeks of follow-up. Prospective surveillance of travellers to resource-limited countries returning to the units showed a HCV incidence of 4/153 travel episodes (2.6%; 95% CI 0.7-6.6%) among 131 persons (3.1%; 95% CI 0.8-7.6%).


CONCLUSIONS
Among haemodialysis patients in the United Kingdom, antibody-negative/RNA-positive HCV status is associated with newly acquired infection, rather than lack of antibody responses in chronic HCV infection. There is a significant risk of HCV infection associated with travel to resource-limited countries. Given that transaminase levels may be normal, HCV RNA testing is recommended in patients re-entering a dialysis unit following haemodialysis in settings where suboptimal infection control policies pose a risk of exposure to blood-borne viruses.
Ghafur
Abdul
A
Department of Virology, Royal Free Hospital and Royal Free & University College Medical School, Rowland Hill Street, London NW3 2PF, UK.
Raza
Muhammad
M
Labbett
Wendy
W
Chawla
Anuradha
A
Smith
Colette
C
Ngui
Siew Lin
SL
Davenport
Andrew
A
Geretti
Anna Maria
AM
D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D003710:Demography; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D010802:Phylogeny; D015995:Prevalence; D006435:Renal Dialysis; D017422:Sequence Analysis, DNA; D014195:Travel
D004279:DNA, Viral