Sims Daniel B, Kataria Rachna, Rangasamy Sabarivinoth, Jorde Ulrich P
Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Artif Organs. 2019 Aug;43(8):791-795. doi: 10.1111/aor.13433. Epub 2019 Feb 28.
The clinical significance of positive anti-hepatitis C virus (anti-HCV) antibody tests in recipients of left ventricular assist devices remains unclear. In light of emerging evidence suggesting the possibility of persistent low-level HCV infection in patients with positive anti-HCV antibody test but negative HCV ribonucleic acid, it is very important to distinguish the truly false positive HCV antibodies, in recipients of continuous flow left ventricular assist devices, from those suggestive of a prior clinically resolved infection or one where a low-level viremia may have persisted. We conducted a retrospective analysis of left ventricular assist device recipients at our institution. While the total incidence of positive HCV antibody with concomitantly negative HCV ribonucleic acid test (19.2%) was in keeping with the incidences reported in prior cross-sectional studies, we longitudinally followed our patients and observed a 100% seroreversion. Seroreversion, which has not been reported in other studies, occurred either during continued left ventricular assist device support (10 out of 26) or after heart transplant (7 out of 26). Hundred percent seroreversion strongly suggested that the anti-HCV antibodies were truly false positive.
左心室辅助装置接受者抗丙型肝炎病毒（抗-HCV）抗体检测呈阳性的临床意义仍不明确。鉴于新出现的证据表明，抗-HCV抗体检测呈阳性但HCV核糖核酸检测呈阴性的患者可能存在持续性低水平HCV感染，对于持续血流左心室辅助装置接受者而言，区分真正的HCV抗体假阳性与提示既往临床治愈感染或可能存在低水平病毒血症的情况非常重要。我们对本机构的左心室辅助装置接受者进行了一项回顾性分析。虽然HCV抗体检测呈阳性且HCV核糖核酸检测同时呈阴性的总发生率（19.2%）与既往横断面研究报告的发生率一致，但我们对患者进行了纵向随访，观察到血清学转阴率为100%。血清学转阴在其他研究中尚未见报道，发生在持续左心室辅助装置支持期间（26例中有10例）或心脏移植后（26例中有7例）。100%的血清学转阴强烈提示抗-HCV抗体为真正的假阳性。
