Hepatitis C virus RNA in anti-HCV positive hemodialyzed patients: significance and therapeutic implications.

About 25% of French hemodialysis patients have antibodies against the hepatitis C virus (HCV), which may reflect either past or active HCV infection. It is important to evaluate the significance of these antibodies, as most hemodialysis patients are candidates for kidney transplantation and have normal transaminase activities despite biopsy-proven chronic hepatitis. We prospectively assayed HCV viremia with the nested polymerase chain reaction in 61 patients on maintenance hemodialysis who had anti-HCV antibodies detectable in second generation tests (ELISA2 or RIBA2). HCV RNA was repeatedly detected in the serum of 52 (85.2%) patients. Liver biopsy, which was performed in 17 cases, revealed chronic hepatitis in 16 cases (including 2 of cirrhosis) and steatosis in one. Hypertransaminasemia was observed in only 31.3% and 30.8% of patients with chronic hepatitis and HCV viremia, respectively. Anti-HCV antibodies are frequently associated with HCV viremia, resulting usually in chronic hepatitis, although hypertransaminasemia is uncommon. HCV viremia reflects both post-transfusional and community-acquired HCV infection. These findings suggest a need for liver biopsy and antiviral treatment before kidney transplantation. The isolation of anti-HCV positive subjects in the dialysis setting should be evaluated to reduce patient-to-patient transmission of HCV.