Oesterreicher C, Hammer J, Koch U, Pfeffel F, Sunder-Plassman G, Petermann D, Muller C
HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chronic hemodialysis

Kidney Int (Dec) 48:1967-1971 1995

The prevalence of hepatitis B virus infection in patients on dialysis has been steadily declining due to the introduction of screening of blood products for HBsAg, vaccination of susceptible patients, isolation of HBsAg positive patients and a ban on reuse of dialyzers from these patients. Consequently, hepatitis C is the major cause of hepatitis in patients on dialysis and transplant recipients. Although tests to detect HBV DNA are widely available for clinical use, all tests for HCV that are licenced for clinical use are antibody tests. For both HBV and HCV, there has been a long held suspicion that serum tests may not identify all infections. The current study sheds new light on the potential sites of viral presence/replication.

In this study, the authors studied the presence of HBV DNA and HCV RNA by PCR in peripheral blood mononuclear cells (PBMC) from hemodialysis patients with an without serum markers for HCV and HBV. While none of the 67 patients were HBsAg positive, the authors detected HBV DNA in PBMC in five. Likewise, ten of 67 patients were anti-HCV positive, and three anti-HCV negative patients had HCV RNA (total 13). HCV RNA was detected in PBMC in five of 13 patients with HCV markers and one of 54 patients without HCV markers. The paper validated the reliability of these results by testing for HBV and HCV in PBMC from healthy controls (all neagtive) and non-dialysis patients with chronic liver disease due to HBV or HCV (majority, but not all positive).

These results are interesting and add a new dimension to our understanding of sites where HBV and HCV reside and possibly replicate. Clearly, the major impact of these observations would be on:

1) Is the presence of HBV or HCV in PBMC preceded or followed by a serum phase?

2) Are patients who are positive for HBV or HCV in PBMC, but not in the serum, infectious?

3) Strategies to reduce the transmission of HCV and HBV in dialysis units - is isolation of patients with serum markers alone enough?

4) Does immunosuppression due to natural events or following transplantation lead to reappearance of infection in the serum?

Clearly, these issue need to be addressed before these findings are translated into clinical practice. (Brian J.G. Pereira and Teresa L. Wright)

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CRF by organ system : GI/Liver, Hepatitis