HCV-RNA qualitative assay based on transcription mediated amplification improves the detection of hepatitis C virus infection in patients on hemodialysis: results from five hemodialysis units in central Greece.

BACKGROUND: End-stage renal disease patients (ESRD) on maintenance hemodialysis (HD) are at increased risk of acquiring hepatitis C virus (HCV) infection. An early and accurate diagnosis of HCV infection is important for the prevention of viral transmission and the management of ESRD patients on HD but conventional ELISA and PCR have often failed to reveal active HCV infection. OBJECTIVES: This study evaluated the prevalence of HCV infection in ESRD patients from all HD units in central Greece using a sensitive HCV-RNA transcription mediated amplification (TMA) assay and compared its sensitivity with that of anti-HCV ELISA. STUDY DESIGN: Anti-HCV antibody (third generation ELISA), HCV-RNA (TMA) and HCV genotypes (HCV TMA-LiPA) were determined in 366 ESRD Greek patients. RESULTS: In total, 132 (36%) ESRD patients were HCV positive by ELISA or TMA; 44 by TMA alone, 16 by ELISA alone and 72 positive by both assays. More than half of the viraemic patients had genotype 3a. CONCLUSIONS: HCV-RNA (TMA) assay appears to increase the accuracy in the diagnosis of HCV infection in HD patients compared to the anti-HCV ELISA and could serve as an additional screening tool in these patients.

Intrafamilial spread of hepatitis B virus infection in Greece.

OBJECTIVE: No study has investigated the intrafamilial spread of hepatitis B virus (HBV) in Greece. We conducted a 9-year prospective study to determine the rate of HBV spread in family members when a member is identified as an HBV carrier, the possible routes and risk factors for transmission of HBV and the family members with the highest risk of infection according to kinship degrees. METHODS: A total of 387 family members of 166 hepatitis B surface antigen (HBsAg) carriers were investigated for the detection of HBV infection markers using standard enzyme immunoassays; 6.696 blood donors from the same area were used as controls. RESULTS: Serological markers of past or current HBV infection were detected significantly more frequently among family members of HBsAg carriers (23.2 and 15.8%, respectively) compared with blood donors (14.1 and 0.85%, respectively). The prevalence of the above markers was higher among siblings, husbands and parents of the carriers. Offspring of the female index cases had higher rates of current or past infection. HBV infection markers were significantly increased in family members who reported common use of syringes (P<0.001), birth in rural areas (P<0.001) and a low level of education (P<0.001). CONCLUSIONS: We demonstrated a high risk of HBV transmission among family members of HBsAg carriers, which was associated with special risk factors for contracting HBV. Our findings indicate the need for strict adherence to the universal guidelines of vaccination against HBV and also the need for an immediate investigation of other potentially infected relatives among family members of HBsAg carriers.