Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2019; 11(1): 109-118
Published online Jan 27, 2019. doi: 10.4254/wjh.v11.i1.109
High prevalence of occult hepatitis C infection in predialysis patients
Luís Henrique Bezerra Cavalcanti Sette, Edmundo Pessoa de Almeida Lopes, Nathália Campello Guedes dos Anjos, Lucila Maria Valente, Sávio Augusto Vieira de Oliveira, Norma Lucena-Silva
Luís Henrique Bezerra Cavalcanti Sette, Nathália Campello Guedes dos Anjos, Lucila Maria Valente, Nephrology-Department of Clinical Medicine, Federal University of Pernambuco, Pernambuco 50670-901, Brazil
Edmundo Pessoa de Almeida Lopes, Gastroenterology-Department of Clinical Medicine, Federal University of Pernambuco, Pernambuco 50670-900, Brazil
Sávio Augusto Vieira de Oliveira, Norma Lucena-Silva, Laboratory of Immunogenetics of the Aggeu Magalhães Institute - Fiocruz Pernambuco, Pernambuco 50670-420, Brazil
Author contributions: Sette LHBC conceived of the presented idea, designed the report, collected and analyzed the clinical data, and wrote the paper; Lopes EPA conceived of the presented idea, designed the report, analyzed the data and wrote the paper; Guedes dos Anjos NC designed the report and collected the clinical data; Valente LM conceived of the presented idea, and analyzed the data; Vieira de Oliveira SA performed the biochemical and PCR testing; Lucena-Silva N conceived of the presented idea, performed the biochemical and PCR testing, analyzed the data, and wrote the paper.
Supported by the National Council for Scientific and Technological Development (CNPq), No. 429736-2016/9.
Institutional review board statement: The Federal University of Pernambuco Institutional Review Board provided approval for this study (IRB No. 50121315.3.0000.5208).
Informed consent statement: Written informed consent was given by each study participant.
Conflict-of-interest statement: All of the authors declare no conflicts of interest.
Data sharing statement: The dataset is available upon request made to the main investigator, Luis Henrique Bezerra Cavalcanti Sette (luis.sette@ufpe.br).
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luís Henrique Bezerra Cavalcanti Sette, MD, PhD, Research Assistant Professor, Nephrology-Department of Clinical Medicine, Federal University of Pernambuco, 1235 Moraes Rego avenue, Recife, Pernambuco 50670-901, Brazil. luis.sette@ufpe.br
Telephone: +55-819-97477777 Fax: +55-812-1263733
Received: October 30, 2018
Peer-review started: October 31, 2018
First decision: December 9, 2018
Revised: December 20, 2018
Accepted: January 3, 2019
Article in press: January 4, 2019
Published online: January 27, 2019
Abstract
BACKGROUND

Occult hepatitis C virus (HCV) infection (OCI) may be associated with extrahepatic diseases and it is known that the patients with chronic kidney disease (CKD) who are on hemodialysis (HD) present a higher prevalence of this type of infection than the general population, with a worse clinical outcome. However, there are no data in the literature to assess the presence of OCI in patients prior to the initiation of renal replacement therapy (RRT). Therefore, this study aimed to evaluate the occurrence and epidemiological aspects of OCI in patients with Predialysis CKD. We hypothesize that this infection could occur before RRT initiation.

AIM

To research the status in predialysis patients when HD patients have high prevalence of OCI.

METHODS

A cross-sectional study was conducted between 2015 and 2017. Adults with creatinine clearance < 60 mL/min·1.73 m2 (predialysis patients) were recruited to the study. Pregnant and postpartum women, patients with glomerulopathies, and patients showing positivity for serological markers of hepatitis B virus (HBV), HCV or human immunodeficiency virus infection were excluded. Patients were diagnosed with OCI according to test results of anti-HCV antibody negativity and HCV RNA positivity in either ultracentrifuged serum or, if serum-negative, in peripheral blood mononuclear cells.

RESULTS

Among the 91 total patients included in the study, the prevalence of OCI was 16.5%. Among these 15 total OCI patients, 1 was diagnosed by 14 ultracentrifuged serum results and 14 were diagnosed by peripheral blood mononuclear cell results. Compared to the non-OCI group, the OCI patients presented higher frequency of older age (P = 0.002), patients with CKD of mixed etiology (P = 0.019), and patients with markers of previous HBV infection (i.e., combined positivity for anti-hepatitis B core protein antibody and anti-hepatitis B surface protein antibody) (P = 0.001).

CONCLUSION

Among predialysis patients, OCI involved the elderly, patients with CKD of mixed etiology, and patients with previous HBV infection.

Keywords: Occult hepatitis infection, Chronic hepatitis C, Chronic kidney disease, Hemodialysis, Hepatitis C virus-RNA, Peripheral blood mononuclear cells

Core tip: Evaluation of patients with chronic renal disease and glomerular filtration rate lower than 30 mL/min·1.73 m2 showed high occurrence of occult hepatitis C virus infection (OCI). In addition, the study population showed higher occurrence of OCI among patients who were older, had chronic kidney disease (CKD) of multifactorial etiology, and had prior contact with the hepatitis B virus. Further studies will be needed to clarify the pathophysiology of renal injury caused by OCI, the influence of this type of infection on the transmissibility of hepatitis C virus, and the role of treatment for patients with OCI and CKD.