Detection of anti-hepatitis C virus antibodies in patients undergoing dialysis by utilizing a hepatitis C virus 3.0 assay: correlation with hepatitis C virus RNA.

Hepatitis C virus (HCV) infection is endemic in long-term dialysis units. We assessed the performance of a recently developed HCV 3.0 assay for the detection of HCV antibodies in patients undergoing dialysis. The study evaluated 128 patients undergoing long-term maintenance hemodialysis. Anti-HCV was detected by 2.0 and 3.0 enzyme immunoassay (EIA). Results were confirmed with recombinant immunoblot assays (RIBA 2.0 and RIBA 3.0). HCV RNA was detected by using reverse transcriptase-polymerase chain reaction (RT-PCR). Thirty-two patients (25%) were HCV EIA 2.0 positive. Of these, 1 was RIBA 2.0 negative (PCR positive), 3 were indeterminate (3 PCR positive), and 28 were positive (23 PCR positive). Thirty-five (27%) were HCV EIA 3.0 positive. One was RIBA 3.0 negative (PCR positive), 1 was indeterminate (c33c, PCR positive), and 33 were positive (27 PCR positive) by RIBA 3.0. Thus only 1 PCR-positive patient was negative with RIBA 2.0 and 3.0 assays. Two of the 3 RIBA 2.0 indeterminate samples were positive with RIBA 3.0. One remained indeterminate but was HCV RNA positive. In summary, HCV 3.0 EIA detected 4 additional viremic patients but was positive in 6 PCR-negative subjects. A high correlation of the presence of antibody to c33c with HCV RNA (28 of 34, 82%) was found, and it was found in all anti-HCV positive samples and in 1 indeterminate sample. We conclude that the HCV EIA 3.0 test with the supplemental confirmatory RIBA 3.0 test may improve the sensitivity for the detection of anti-HCV. Nevertheless, in potentially immunocompromised patients undergoing dialysis, PCR continues to be the only reliable test for detecting viremia.

Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients.

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ) are well-accepted procedures for long-term enteral alimentation. PEG has replaced surgical gastrostomy at many institutions because of its safety and ease. This study was undertaken to evaluate the indications for PEG and PEJ, as well as their success rates, complications with special attention to aspiration, and long-term follow-up. We were specifically interested in reviewing the problem of aspiration in patients with PEG and PEJ. A retrospective review of 79 patients at Brooke Army Medical Center over a 3-year period was done. PEG or PEJ was successful in 79 of 81 patients (97%). The most common indications were neurologic disorders in 46 patients (58%) and cancer in 20 (25.3%). Complications other than aspiration occurred in 11 patients (14%). Aspiration occurred in nine patients after PEG or PEJ (11.4%); six patients had experienced aspiration prior to PEG or PEJ. Six patients had a jejunostomy tube placed through the PEG for prevention of aspiration, and three died of continued aspiration. We conclude that aspiration is not prevented by PEJ, continues to be a major problem after PEJ, and becomes manifest for the first time after PEG.