title: Transcription-mediated amplification (TMA) for the assessment of viremia in hemodialysis patients with hepatitis C.
abstract: The diagnosis of hepatitis C virus (HCV) infection in hemodialysis patients is difficult particularly due to the presence of intermittent viremia. The aims of this study were: (a) to determine the prevalence of intermittent viremia in hemodialysis patients with anti-HCV antibodies who tested negative for HCV RNA by PCR at the first evaluation and (b) to evaluate the contribution of the transcription-mediated amplification method (TMA) to the diagnosis of viremia in the PCR-negative samples. One hundred and six patients with anti-HCV antibodies and an initial negative result for HCV RNA by PCR were included. An additional sample was collected for a second HCV RNA test by PCR after a minimum interval of 3 months and a positive result characterized intermittent viremia. HCV RNA was investigated by TMA in the PCR-negative sample of patients with intermittent viremia, and in the most recent sample from patients with PCR-negative results in both determinations. Intermittent viremia was observed in 60/106 (57%) patients (57% men; age: 45 ± 10 years). Fifty-one of the 60 negative samples from patients with intermittent viremia and 29/46 double-negative patients were tested by TMA. This assay detected viremia in 20/51 (39%) samples of intermittent viremia and in 2/29 (7%) of double-negative samples. The results showed that intermittent viremia is frequent in hemodialysis patients who tested negative for HCV RNA by PCR. Therefore, a second HCV RNA test is necessary for all HCV RNA-negative patients. The TMA assay appears to be the best first screening test for viremia in this population.
authors.affiliation: Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Dauana O
authors.initials: DO
authors.lastname: Bastos
authors.forename: Renata M
authors.initials: RM
authors.lastname: Perez
authors.forename: Ivonete Souza
authors.initials: IS
authors.lastname: Silva
authors.forename: Lara Barros
authors.initials: LB
authors.lastname: Lemos
authors.forename: José Pascoal
authors.initials: JP
authors.lastname: Simonetti
authors.forename: José Osmar
authors.initials: JO
authors.lastname: Medina-Pestana
authors.forename: Antonio Eduardo B
authors.initials: AE
authors.lastname: Silva
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification*; D006435:Renal Dialysis; D014766:Viremia / Q000175:diagnosis*; D014773:Virology / Q000379:methods
chemical_list: D012367:RNA, Viral