Detection of hepatitis G virus (HGV) RNA and antibodies to the HGV envelope protein E2 in a cohort of hemodialysis patients

Hepatitis G virus exposure in dialysis patients and blood donors in Isfahan-Iran

BACKGROUND

Hepatitis G virus (HGV) is transmitted mainly by parenteral route and patients on maintenance hemodialysis (HD) are at risk for this infection. This study was conducted to estimate prevalence of infection through the presence of anti-HGV and to evaluate the clinical significance of HGV envelope protein E2 (anti-E2) in HD patients in compare with volunteer blood donors in Isfahan-Iran.

METHODS

In a cross-sectional study, a total of 40 HD patients as cases and 40 healthy volunteer blood donors as negative controls were selected randomly in summer 2008. The epidemiological data were obtained in all subjects, and duration of HD was obtained in HD patients as well. All samples were tested for anti-E2 antibodies, hepatitis C virus (HCV)-antibody and hepatitis B virus surface antigen (HBs-Ag) by an enzyme-linked immunosorbent assay and a recombinant immunoblot assay was employed to confirm anti-HCV reactivity. Student's t-test, Chi-square test or Fisher exact test was used for data analysis and P < 0.05 was considered as statistically significant.

RESULTS

Ten of the 40 HD patients tested positive for anti-E2 (25%) and of 40 voluntary blood donors, 10 (5%) were positive for anti-E2 (P = 0.012). Anti-HCV antibodies and HBs-Ag were found in 4 and 1 HD patients, respectively. In anti-E2-positive patients, co-infection with HCV or hepatitis B virus was not significant. Furthermore, the mean duration of hemodialysis in anti-E2 positive and anti-E2 negative patients did not have significant differences.

CONCLUSIONS

HD patients are at increased risk of HGV infection in Isfahan-Iran. Since hepatitis G is a good predictor for parenteral transmission, it is suggested to test all of the blood for transfusion for HGV infection.

GB virus C Viremia and Anti-E2 Antibody Response Among Hemodialysis Patients in Gorgan, Iran

Background:

GB Virus C is a blood-borne virus and a member of Flaviviridae, like hepatitis C that is distributed globally and puts hemodialysis patients at high risk of developing liver disease. The clinical significance of GBV-C in this population remains unclear.

Objectives:

The current study aimed to evaluate GBV-C infection among hemodialysis patients.

Patients and Methods:

Totally, 149 patients receiving hemodialysis were included in the study. The detection of GBV-C sequences in plasma was done by the nested Reverse transcription polymerase chain reaction (RT-PCR) using specific primers selected from highly conserved regions of 5' UTR of GBV-C and antibodies to the envelope protein of GBV-C (anti-E2 GBV-C antibody) were analyzed by also serological methods. In addition, Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBcAb) IgM, anti- Hepatitis C virus (HCV) and anti- hepatitis E virus (HEV) Ab was determined in patients who were GBV-C RNA and anti-E2 GBV-C antibody positive.

Results:

The total prevalence of GBV-C infection was 14.7% (95%CI: 0.09-0.21) among patients receiving hemodialysis. The rate of GBV-C viremia and anti-E2 antibody positivity were 6.04% and 10.73%, respectively. Among the subjects who were positive for GBV-C, 27.27% (95% CI: 0.02-0.09), 45.45% (95% CI: 0.03-0.11), 59.9% (95% CI: 0.06-0.16) and 0% (95% CI: 0.01-0.07) were positive for anti-HCV, anti-HBsAg, anti-HBc IgM and anti-(HEV) Ab, respectively. In addition, the rate of both anti-HBc IgM /anti-HCV/ HBsAg and anti-HBc IgM /anti-HCV positivity in GBV-C infected cases were 9.09%. The liver enzymes were normal in all of them. There was significant difference between GBV-C exposures with viral hepatitis co-infection, but there was no correlation between GBV-C exposure with gender, age, ethnicity, time on dialysis and history of blood transfusions. A relatively high frequency of positivity GBV-C-exposure among hemodialysis patients suggested that the transmission route for GBV-C may be nosocomial transmission, and via transfusions.

Conclusions:

The current study found a relatively high frequency of positivity GBV-C-exposure among the patients receiving hemodialysis in the area understudy. Nosocomial transmission seems to be the main route of GBV-C infection in the area.

GB virus C/hepatitis G virus and TT virus infections among high risk renal transplant recipients in India

BACKGROUND

GB virus C/hepatitis G virus (GBV-C/HGV) and TT virus (TTV) have been widely reported in patients with high parenteral risk such as haemodialysis and renal transplant recipients. The occurrence of these agents in association with hepatitis B virus (HBV) and hepatitis C virus (HCV), in Indian renal transplant recipients, is yet unreported.

STUDY DESIGN

Molecular and serological markers of GBV-C/HGV and TTV were examined in addition to those for HBV, HCV and hepatitis D virus (HDV) in a selected group of seventy renal transplant recipients. HGV RNA detection was achieved using primers specific for the 5'NCR and NS5a regions of the genome. Anti-GBV-C/HGV antibody was detected using the mu plate anti-HG env kit (Roche, Germany). TTV DNA PCR was performed using primers specific for the coding region (method A) of the genome. In 50% of patients, TTV DNA was also tested for using primers specific for the non-coding region (method B). Host related factors such as age, alanine aminotransferase (ALT) levels, number of transfusions, haemodialysis sessions, and months following transplantation were also studied.

RESULTS

Exposure rates to GBV-C/HGV, TTV (method A), HBV, HCV and HDV were 58.6, 32.9, 52.9, 54.3 and 2.9%, respectively. 'Active' infection as measured by viraemia and/or virus-specific antigenaemia for GBV-C/HGV, TTV, HBV and HCV was 52.9, 32.9, 15.7 and 52.9%, respectively. The majority of GBV-C/HGV and TTV infections were seen as co-infections with other hepatitis viruses. Single infection with GBV-C/HGV and TTV was seen in ten (14.2%) and eight (11.4%) patients, and was not associated with ALT elevation when compared to uninfected blood donors. Using univariate analysis, GBV-C/HGV RNA was significantly associated with > or =20 haemodialysis sessions. TTV DNA occurrence was not associated with any risk factors.

CONCLUSIONS

There is a high occurrence of GBV-C/HGV and TTV in this select group of renal transplant recipients in India. These viruses mostly occurred in the context of co-infections with other hepatitis viruses. Long term effects of multiple hepatotropic viral infections need to be carefully documented in such transplant populations.