High prevalence of occult hepatitis C infection in predialysis patients

• 作者: Edmundo Pessoa de Almeida Lopes Lucila Maria Valente Luís Henrique Bezerra Cavalcanti Sette Nathália Campello Guedes dos Anjos Norma Lucena-Silva Sávio Augusto Vieira de Oliveira
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: OCCULT HEPATITIS infection CHRONIC HEPATITIS C CHRONIC kidney disease HEMODIALYSIS HEPATITIS C virus-RNA PERIPHERAL blood MONONUCLEAR cells
• 年，卷（期）: 2019,（1）
• 页码范围: 109-118
• 页数: 10页
• 分类号: R

摘要

BACKGROUND Occult hepatitis C virus (HCV) infection (OCI) may be associated with extrahepatic diseases and it is known that the patients with chronic kidney disease (CKD) who are on hemodialysis (HD) present a higher prevalence of this type of infection than the general population, with a worse clinical outcome. However, there are no data in the literature to assess the presence of OCI in patients prior to the initiation of renal replacement therapy (RRT). Therefore, this study aimed to evaluate the occurrence and epidemiological aspects of OCI in patients with Predialysis CKD. We hypothesize that this infection could occur before RRT initiation. AIM To research the status in predialysis patients when HD patients have high prevalence of OCI. METHODS A cross-sectional study was conducted between 2015 and 2017. Adults with creatinine clearance < 60 mL/min·1.73 m^2 (predialysis patients) were recruited to the study. Pregnant and postpartum women, patients with glomerulopathies, and patients showing positivity for serological markers of hepatitis B virus (HBV), HCV or human immunodeficiency virus infection were excluded. Patients were diagnosed with OCI according to test results of anti-HCV antibody negativity and HCV RNA positivity in either ultracentrifuged serum or, if serum-negative, in peripheral blood mononuclear cells. RESULTS Among the 91 total patients included in the study, the prevalence of OCI was 16.5%. Among these 15 total OCI patients, 1 was diagnosed by 14 ultracentrifuged serum results and 14 were diagnosed by peripheral blood mononuclear cell results. Compared to the non-OCI group, the OCI patients presented higher frequency of older age (P = 0.002), patients with CKD of mixed etiology (P = 0.019), and patients with markers of previous HBV infection (i.e., combined positivity for anti-hepatitis B core protein antibody and anti-hepatitis B surface protein antibody)(P = 0.001). CONCLUSION Among predialysis patients, OCI involved the elderly, patients with CKD of mixed etiology, and patients with prev