Hepatitis C Virus in the Hemodialysis Setting: A Review with Recommendations for Control

Hepatitis C virus (HCV) is the causative agent of most cases of bloodborne non-A, non-B (NANB) hepatitis in the United States and throughout the wodd (1-3). Nationally, the Centers for Disease Control and Prevention (CDC) estimates that 150,000 new infections with HCV occur each year and account for an estimated 21% of all acute viral hepatitis in the United States (CDC, unpublished data). Of particular concern are the chronic consequences that frequently occur as a result of HCV infection, potentially leading to chronic active hepatitis, cirrhosis, and liver cancer (4). Second-generation serologic assays for the detection of antibody to HCV (anti-HCV) contain recombinant proteins derived from both structural (core) and nonstructural regions of the HCV genome. These assays have detected anti-HCV in 70%-mo of patients with NANB hepatitis ( 5 , 6). Among patients with HCV infection, second generation assays detect anti-HCV in approximately W o (5). One of the major advantages of second generation assays is detection of antibody earlier in the course of infection (7): five to six weeks after onset of hepatitis in WO ofpatients compared with W64090 with earlier assays (5 ; HJ Alter, personal communication). For some patients with hepatitis C, however, semconversion may not occur for six to nine months after exposure or onset of symptoms, and a negative test early in the course of the infection does not exclude the diagnosis of hepatitis C (5). Some patients with NANB hepatitis remain persistently negative for anti-HCV but have hepatitis C; in these patients, HCV infection can only be detected with the use of research-based assays such as polymerase chain reaction (PCR) or immunofluorescence techniques ( 5 ) . Other patients with NANB hepatitis who remain persistently negative for anti-HCV may be infected with another viral hepatitis agent (non-ABCDE) or their liver idammation may be due to another cause (5 , 8, 9). For these reasons, the diagnosis of hepatitis C should