GBV-C/HGV infection in end-stage renal disease

Recently, two independent teams detected presumed hepatitis agents, which were designated HGV and hepatitis GB virus C; they represent a new genus in the family Flaviviridae. The most accurate way to assess the epidemiology of GBV-C/HGV infection remains the combination of RT-PCR and anti-GBV-C/HGV E2 techniques, to detect respectively current and past GBV-C/HGV infection. Preliminary data from blood donors and healthy individuals have shown that GBV-C/HGV is distributed globally and can induce persistent viremia in humans. Numerous reports have been published about the epidemiology of GBV-C/HGV by RT-PCR in end-stage renal disease (ESRD) but many of them regarded small populations. Chronic dialysis patients are a high-risk group for GBV-C/HGV infection; the prevalence ranges between 3% and 57%. Time on dialysis, transfusion requirement, and renal transplantation are risk factors for GBV-C/HGV infection and the association of GBV-C/HGV and HCV has been frequently observed. A low (3.07%-4%) but significant incidence rate of GBV-C/HGV infection among HD patients has been calculated. No clear relationship has yet been established between GBV-C/HGV and acute or chronic liver disease in dialysis patients and information on the GBV-C/HGV load in patients on dialysis is scant. The prevalence of GBV-C/HGV epidemiology among individuals undergoing renal transplantation is between 8% and 27%. The post-transplantation prevalence of liver disease, and graft and patient survival did not significantly differ between recipients of organs from GBV-C/HGV-positive or negative donors. The clinical significance of GBV-C/HGV in ESRD patients remains unclear although the hepatotropism of this virus appears to be very weak. GBV-C/HGV testing is used mostly as an investigative or epidemiological tool but the spread of the virus in HD units may serve as a marker of unrecognized parenteral exposure, suggesting a need for strict adservance of 'universal precautions'.