Significance of Hepatitis B, Hepatitis C and GBV-C in ANCA-Positive Hemodialysis Patients

Birgit Kallinowski, MD, Department of Medicine IV, University Hospital of Heidelberg, Bergheimer Strasse 58, D-69115 Heidelberg (Germany), Tel.+49 6221 568611, fax+49 6221 565255 Table 1. Prevalence of viral hepatitis B, C and G in ANCA-positive and ANCA-negative hemodialysis patients ANCA positive ANCA negative Dear Sir, Patients on maintenance hemodialysis run a high risk of acquiring a viral hepatitis, such as hepatitis B, C or the newly discovered hepatitis G. Recently, a new parenteral-ly transmissible RNA virus, designated GB-C virus (GBV-C), has been isolated [1]. As HBsAg plays an important role in the etiology of polyarteritis nodosa and the role of the hepatitis C virus (HCV) still remains under-termined, we wanted to know if GBV-C is of any relevance for ANCA-positive vasculitis patients on maintenance hemodialysis. To investigate the clinical importance of this virus we determined the prevalence of hepatitis B (HBV), hepatitis C (HCV) and the GBV-C by PCR in ANCA-positive hemodialysis patients. We then correlated these data with age, duration of dialysis and ALT levels. After all we compared these results with prevalence data of ANCA-negative hemodialysis patients to clarify the role of ANCA positivity for various forms of viral hepatitis. GBV-C was detected by RT-PCR using primers derived from the helicase region NS3 sequence deposited in Genbank (emnewl: hg 25538). All PCR products were then cloned into blunt-ended pUC18 plas-mids and sequenced partially using the T7 sequencing kit to confirm GBV-C. We investigated 73 (38 male, 35 female) ANCA-positive hemodialysis patients with a mean age of 64 years and an average duration of dialysis of 4.7 years. All patients were negative for anti-HIVl/2. None of these paHBsAg positive HCV RNA positive GBV-C RNA positive tients was HBsAg positive. 5/73 individuals were positive for HCV RNA resulting in an overall prevalence of 6.8%. However, 4/5 HCV-RNA-positive patients were anti-HCV negative. 7/73 (9.6%) ANCA-positive patients were positive for GBV-C RNA. 5/7 GBV-Cpositive patients were p-ANCA positive. 1/7 GBV-C-positive patients were coinfected with