Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Environ Sci Pollut Res Int. 2018 Feb;25(6):5459-5464. doi: 10.1007/s11356-017-0897-y. Epub 2017 Dec 6.
Occult hepatitis C virus infection (OCI) is a newly defined type of infection by the chronic hepatitis virus (HCV) distinguished by the existence of HCV RNA in liver tissue and/or peripheral blood mononuclear cells (PBMCs) in patients whose plasma are devoid of both positive serology and RNA. Patients on maintenance hemodialysis evince a higher HCV prevalence than the general population due to high nosocomial transmission by the dialysis units. We investigated the prevalence of occult HCV infection in patients attending our university hemodialysis centers for maintenance hemodialysis. Sixty-two CHD patients negative for serum HCV tests were enrolled in the study. PMNCs were tested by real-time PCR for the presence of HCV RNA. For the 62 patients, the average duration since starting dialysis was 32.7 months and the mean (SD) alanine transaminase and aspartate transaminase were 25.74 ± 9.75 and 28.81 ± 11.32 IU/l, respectively. Out of the 62 CHD patients negative for serum anti-HCV and HCV RNA patients, only three (4.84%) were shown to have HCV RNA in their PBMCs implying the diagnosis of OCI; their viral load range was 1.24-4.15 IU/ml. All three OCI-proven patients gave no history of hepatic disease. In this study, we found that patients considered to be free of HCV can have HCV replicating in their PBMCs. This awareness points to the possibility of HCV being transmitted from apparently uninfected persons. A positive HCV RNA detection in PBMCs is dependable in determining OCI among high-risk subjects particularly when a liver biopsy is not an option. HCV transmission can occur through hemodialysis units signaling incorrect application of infection control measures in our Egyptian dialysis units. Additional studies on hemodialysis patients are necessary to realize the true magnitude of OCI among this patient group and to highlight the importance of incorporating HCV viral assays in PBMCs into the diagnostic algorithm.
隐匿性丙型肝炎病毒感染（OCI）是一种新定义的慢性肝炎病毒（HCV）感染类型，其特征在于患者的血浆既无阳性血清学也无 RNA 时，其肝组织和/或外周血单个核细胞（PBMC）中存在 HCV RNA。由于透析单位的医院内传播较高，维持性血液透析患者的 HCV 患病率高于一般人群。我们调查了在我们大学血液透析中心接受维持性血液透析的患者中隐匿性 HCV 感染的流行情况。共有 62 例 HCV 血清学检测阴性的 CHD 患者入组本研究。通过实时 PCR 检测 PMNC 中 HCV RNA 的存在。对于这 62 例患者，开始透析的平均时间为 32.7 个月，平均（SD）丙氨酸转氨酶和天冬氨酸转氨酶分别为 25.74 ± 9.75 和 28.81 ± 11.32 IU/L。在 62 例 HCV 血清学和 HCV RNA 均阴性的 CHD 患者中，只有 3 例（4.84%）的 PBMC 中存在 HCV RNA，提示 OCI 诊断；其病毒载量范围为 1.24-4.15 IU/ml。所有 3 例 OCI 确诊患者均无肝病病史。在本研究中，我们发现被认为没有 HCV 的患者可能会在其 PBMC 中复制 HCV。这种认识表明 HCV 可能从看似未感染的人传播。在高危人群中，当不能进行肝活检时，PBMC 中 HCV RNA 的阳性检测可可靠地确定 OCI。HCV 传播可能通过血液透析单位发生，表明我们埃及透析单位的感染控制措施应用不当。有必要对血液透析患者进行更多研究，以了解这一患者群体中 OCI 的真实程度，并强调将 HCV 病毒检测纳入 PBMCs 纳入诊断算法的重要性。
