Thongsawat Satawat, Maneekarn Niwat, Kuniholm Mark H, Pantip Chansom, Thungsuputi Amornrat, Lumlertkul Dusit, Bannachak Derek, Nelson Kenrad E
Faculty of Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Med Virol. 2008 May;80(5):808-15. doi: 10.1002/jmv.21126.
Control of hepatitis C virus (HCV) in hemodialysis populations is a major public health priority, but the preferred methods to prevent and rapidly detect HCV outbreaks in these populations remains subject to debate. We enrolled 231 hemodialysis patients at three dialysis centers in Chiang Mai, Thailand. Patients were followed every 6 months for 3 years and tested for the presence of serum HCV antibody and HCV RNA at each visit. We additionally isolated and tested peripheral blood mononuclear cells (PBMCs) for HCV RNA collected at the 30-month follow-up visit. Fifty-one study participants negative for anti-HCV at the baseline enrollment visit seroconverted over the course of the 3-year follow-up period. Of 11 individuals who transiently lost detectable serum HCV viremia, we were able to detect HCV RNA from the PBMCs of two individuals. Our results suggest that occult HCV infection may be common among hemodialysis patients, and serum HCV RNA testing may be supplemented with PBMC testing to maximize diagnostic sensitivity and aid in outbreak containment. Further work on the diagnostic implications of HCV compartmentalization in hemodialysis and other settings is urgently needed.
控制血液透析人群中的丙型肝炎病毒（HCV）是一项重大的公共卫生优先事项，但在这些人群中预防和快速检测HCV暴发的首选方法仍存在争议。我们在泰国清迈的三个透析中心招募了231名血液透析患者。患者每6个月随访一次，为期3年，每次随访时检测血清HCV抗体和HCV RNA的存在情况。我们还在30个月的随访中分离并检测了收集的外周血单个核细胞（PBMC）中的HCV RNA。在基线入组访视时抗HCV阴性的51名研究参与者在3年随访期间发生了血清学转换。在11名暂时失去可检测血清HCV病毒血症的个体中，我们能够从两名个体的PBMC中检测到HCV RNA。我们的结果表明，隐匿性HCV感染在血液透析患者中可能很常见，血清HCV RNA检测可能需要辅以PBMC检测，以最大限度地提高诊断敏感性并有助于控制疫情暴发。迫切需要进一步研究血液透析及其他环境中HCV分区化的诊断意义。
