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Diagnosis of hepatitis C virus infection in patients on dialysis

Authors
Svetlozar Natov, MD
Brian JG Pereira, MD
Section Editors
Jeffrey S Berns, MD
Martin S Hirsch, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

In 1989, the hepatitis C virus (HCV) was cloned and identified as the major cause of parenterally transmitted non-A, non-B hepatitis (NANBH) [1,2]. The transmission of HCV by transfusion of blood products and by sharing of needles among intravenous drug abusers has been unequivocally demonstrated. Horizontal transmission by sexual and/or household exposure and vertical transmission from mother to fetus have also been reported. Tests are now available that detect antibodies to multiple HCV antigens (anti-HCV), and the presence and titer of HCV RNA [3].

The basic biology of HCV, the limitations and types of methods used to detect the presence of the virus, and the clinical course of infected patients, with an emphasis on issues relevant to the patient with end-stage renal disease (ESRD), are reviewed here. Issues relating to HCV infection in patients on maintenance dialysis or receiving a renal transplant are discussed separately. (See "Hepatitis C virus infection in patients on maintenance dialysis" and "Hepatitis C virus infection in kidney donors".)

STRUCTURE OF HCV GENOME

The hepatitis C virus (HCV) is a small 40 to 60 nm virus with a lipid envelope and a single-stranded RNA viral genome comprising approximately 9500 nucleotides [1,4]. The N-terminus encodes the basic nucleocapsid (C), followed by two glycoprotein domains, the envelope (E1) and second envelope/non-structural-1 (E2/NS1) regions. Downstream to this region are the nonstructural genes NS2, NS3, NS4, and NS5, respectively.

Several HCV genotypes have been identified, and significant genetic heterogeneity has been observed over the entire viral genome. The regions encoding the E1 and E2/NS1 are the most variable sequences of the viral genome, while the 5' noncoding region (5'NCR) represents the most conserved one.

A universal system for the nomenclature of HCV genotypes has defined six major groups (1 to 6), designated as HCV types [5]. Each major type consists of one or more closely related variants, designated as subtypes and named a, b, c, etc, in order of discovery. Finally, each subtype includes individual isolates. (See "Characteristics of the hepatitis C virus".)

                

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