NDT Advance Access originally published online on May 29, 2007
Nephrology Dialysis Transplantation 2007 22(9):2640-2644; doi:10.1093/ndt/gfm202
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Travel-associated acquisition of hepatitis C virus infection in patients receiving haemodialysis
1Department of Virology, Royal Free Hospital and Royal Free & University College Medical School, 2Department of Primary Care and Population Sciences, Royal Free & University College Medical School, London, 3Virus Reference Department, Health Protection Agency, Colindale and 4Department of Renal Medicine, Royal Free Hospital and Royal Free & University College Medical School, London, UK
Correspondence and offprint requests to: A. M. Geretti, Department of Virology, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK. Email: a.geretti{at}medsch.ucl.ac.uk
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Abstract |
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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.
Keywords: haemodialysis; hepatitis C virus; HCV antibody; HCV RNA; seroconversion; seroprevalence
*The authors wish it to be known that, in their opinion, the first two authors contributed equally to the work.
Received for publication: 6. 3.07
Accepted in revised form: 15. 3.07
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  D. Parsons, R. A. Coward, and A. Woywodt Travel-associated acquisition of hepatitis C-- implications for the renal transplant waiting list Nephrol. Dial. Transplant., June 1, 2008; 23(6): 2104 - 2104. [Full Text] [PDF]
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A. M. Geretti and A. Davenport Reply Nephrol. Dial. Transplant., June 1, 2008; 23(6): 2104 - 2105. [Full Text] [PDF]
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