Infection with Hepatitis GB Virus C in Patients on Maintenance Hemodialysis

Abstract

Background. A recently discovered non-A– E hepatitis virus has been designated hepatitis GB virus C (HGBV-C), but little is known about its mode of trans-mission and its clinical manifestations. We studied 519 patients on maintenance hemodialysis to determine whether they were infected with HGBV-C. Methods. HGBV-C RNA was identified in serum by a reverse-transcription–polymerase-chain-reaction assay with nested primers deduced from a nonstructural region. A nucleotide sequence of 100 bp in the nonstructural re-gion was determined on HGBV-C clones. Results. HGBV-C RNA was detected in 3.1 percent of the patients on hemodialysis (16 of 519), as compared with 0.9 percent of healthy blood donors (4 of 448, P Ͻ 0.03). None of the 16 patients had evidence of active liver dis-ease, although 7 were also infected with hepatitis C virus. Eight patients with HGBV-C infection were followed for 7 to 16 years. In two patients the virus was present at the start of hemodialysis. One had a history of transfusion, and HGBV-C RNA persisted over a period of 16 years; the other became free of HGBV-C after 10 years. In five pa-tients, HGBV-C RNA was first detected 3 to 20 weeks after blood transfusion and persisted for up to 13 years. One patient with no history of transfusion was infected with an HGBV-C variant with the same sequence as in two of the patients with post-transfusion HGBV-C infections. Conclusions. Patients on maintenance hemodialysis are at increased risk for HGBV-C infection. This virus pro-duces persistent infections, which may be transmitted by transfusions but may also be transmitted by other means.