Combined Application of the Hepatitis C Virus Serologic Testing and the Nucleic Acid Amplification Testing Simultaneously for HCV Infection Isolation Strategy in Hemodialysis Units

Fan-Yu Chen ； Yang Ho ； Ming-Tsun Tsai ； Der-Cherng Tarng

《Acta Nephrologica》 34卷3期 (2020/09) Pp. 136-141

https://doi.org/10.6221/AN.202009_34(3).0005

摘要

BACKGROUND: Hepatitis C virus (HCV) serological analysis is generally recognized as the appropriate initial test, followed by nucleic acid testing (NAT) if immunoassay is positive, if there is a concern for nosocomial transmission of HCV infections in a hemodialysis (HD) unit. However, the combined application of the HCV serologic testing and the nucleic acid amplification testing simultaneously for HCV infection isolation strategy in HD units is less applied to clinical practice. METHODS: Thirty-nine participants in a single HD unit were enrolled in the study. All of them were negative for hepatitis B surface antigen (HBsAg), anti-human immunodeficiency virus and did not have: [1] a previous history of autoimmune disease, [2] current intravenous drug use, [3] taken surgical procedure, hospitalized or transfused 6 months before the study. All patients were tested for anti-HCV and HCV ribonucleic acid (RNA) simultaneously as long as there was one patient who presented with elevation in alanine aminotransferase, and repeat testing 12 weeks later was done. Anti-HCV were screened with the third generation microparticle enzyme immunoassay. HCV RNA was quantified by a real-time polymerase chain reaction. In HCV RNA-positive patients, genotyping was also identified by using the HCV RNA Genotype DupliType assay. RESULTS: Of the 39 patients studied, 10 of 39 patients (seroprevalence rate, 25.6%) had anti-HCV positive prior to the study. Five of 29 patients were found to be newly positive with HCV antibodies (incidence rate, 17.2%). For those with anti-HCV negative, no HCV RNA was detected. HCV RNA could be detected in 9 of 15 patients with anti-HCV positive, including 2 seroconverted patients. Six patients who were initially anti-HCV positive and HCV RNA negative were retested 12 weeks later, and one of them (16.7%) were anti-HCV positive with detectable HCV RNA. According to the NAT results, the incidence rate was 10.3% (3 of 29 patients) and was less than the incidence rate of 17.2% (5 of 29 patients) on the basis of HCV serologic testing. CONCLUSION: When a new HCV infection is identified or when an outbreak of nosocomial transmission occurs in an HD unit, the usual strategy, antibody to HCV (if positive, followed by NAT) makes sense in isolation of HCV patients in the HD unit, and combined HCV serologic testing and HCV RNA testing simultaneously or frequently HCV RNA testing is unnecessary.

關鍵字

hemodialysis ； hepatitis C virus ； hepatitis C virus serologic testing ； isolation ； nucleic acid amplification testing