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Transcription‐mediated amplification (TMA) for the assessment of viremia in hemodialysis patients with hepatitis C

The diagnosis of hepatitis C virus (HCV) infection in hemodialysis patients is difficult particularly due to the presence of intermittent viremia. The aims of this study were: (a) to determine the prevalence of intermittent viremia in hemodialysis patients with anti‐HCV antibodies who tested negative for HCV RNA by PCR at the first evaluation and (b) to evaluate the contribution of the transcription‐mediated amplification method (TMA) to the diagnosis of viremia in the PCR‐negative samples. One hundred and six patients with anti‐HCV antibodies and an initial negative result for HCV RNA by PCR were included. An additional sample was collected for a second HCV RNA test by PCR after a minimum interval of 3 months and a positive result characterized intermittent viremia. HCV RNA was investigated by TMA in the PCR‐negative sample of patients with intermittent viremia, and in the most recent sample from patients with PCR‐negative results in both determinations. Intermittent viremia was observed in 60/106 (57%) patients (57% men; age: 45 ± 10 years). Fifty‐one of the 60 negative samples from patients with intermittent viremia and 29/46 double‐negative patients were tested by TMA. This assay detected viremia in 20/51 (39%) samples of intermittent viremia and in 2/29 (7%) of double‐negative samples. The results showed that intermittent viremia is frequent in hemodialysis patients who tested negative for HCV RNA by PCR. Therefore, a second HCV RNA test is necessary for all HCV RNA‐negative patients. The TMA assay appears to be the best first screening test for viremia in this population. J. Med. Virol. 84:596–600, 2012. © 2011 Wiley Periodicals, Inc.