title: Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease.
  
  
  OBJECTIVE
  The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels.
  
  
  METHODS
  For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present.
  
  
  RESULTS
  The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005).
  
  
  CONCLUSIONS
  The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.
authors.affiliation: Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria.
authors.forename: Radka T
authors.initials: RT
authors.lastname: Komitova
authors.affiliation: Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Atanasova
authors.affiliation: Hemodialysis Unit, St George University Hospital, Plovdiv.
authors.forename: Toska A
authors.initials: TA
authors.lastname: Pavlova
authors.affiliation: Clinic of Gastroenterology, Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases, St Ivan Rilski University Hospital, Sofia.
authors.forename: Monica Sh
authors.initials: MS
authors.lastname: Nyagolov
authors.affiliation: Clinic of Gastroenterology, Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases, St Ivan Rilski University Hospital, Sofia.
authors.forename: Aneta V
authors.initials: AV
authors.lastname: Ivanova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002031:Bulgaria / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D016174:Hepacivirus / Q000235:genetics; D018937:Hepatitis C Antibodies / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008137:Longitudinal Studies; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D060888:Real-Time Polymerase Chain Reaction; D006435:Renal Dialysis; D016036:Seroepidemiologic Studies; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: hemodialysis; hepatitis C virus; nosocomial transmission; prevalence; viral hepatitis