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
Processing time: 90 Days and 10.5 Hours
ARTICLE HIGHLIGHTS
Research background

Patients with chronic kidney disease (CKD) and who are on hemodialysis (HD) have a higher prevalence of hepatitis C virus (HCV) infection, both in its classical form and the occult (OCI) form. However, no studies in the literature have evaluated the occurrence of OCI in predialysis patients.

Research motivation

The motivation of this study was borne of the new lines of evidence showing OCI having implications on transmissibility, prognosis and progression of CKD in patients on dialysis, and knowledge that this infection could be diagnosticated and treated before end-stage kidney disease is reached.

Research objectives

The main objective of this study was to evaluate the prevalence of OCI in predialysis CKD patients. The findings of this study could help in future efforts to trace the transmissibility of OCI and even to develop a treatment to improve these patients’ prognosis.

Research methods

This was a cross-sectional study, wherein patients were allocated if they had glomerular filtration rate < 60 mL/min·1.73 m2 and were anti-HCV negative. PCR was performed on patient samples of ultracentrifuged plasma and peripheral blood mononuclear cells.

Research results

OCI was found in 16.5% of the study population of CKD patients. It was more common in the elderly, in patients with CKD of mixed etiology, and in patients with previous hepatitis B virus infection.

Research conclusions

This study found a high prevalence of OCI among CKD patients, suggesting that patients with low kidney function may be reservoirs for HCV. This high prevalence appears to be associated with infection occurring before the beginning of dialysis. Moreover, OCI could be an important transmission route of HCV infection in dialysis centers. The collective findings from this study could help future studies evaluating the transmissibility of hepatitis infection and the progression of CKD to need for dialysis.

Research perspectives

This is the first study to evaluate the prevalence of OCI in this specific group of patients, who are more vulnerable to viral infections. Future research should evaluate the influence of this form of infection on the transmissibility of HCV in the HD setting and the role of treatment for these OCI patients. A prospective study evaluating the clinical behavior of patients with OCI will be insightful.