Hepatitis C virus genotypes in patients on renal replacement therapy.

BACKGROUND Chronic hepatitis C virus (HCV) infection is prevalent among patients on renal replacement therapy. Viral genomic differences can contribute to diversities in clinical manifestation. The distribution of HCV genotypes depends on the geographical region and risk factors unique to the patient population. We determined the HCV genotypes in patients on renal replacement therapy in order to define the genotypic profile and examine the relationship between genotype, mode of renal replacement therapy, and the prevalence as well as severity of liver disease. METHODS HCV genotypes were determined by restriction fragment length polymorphism and sequencing of the 5'-untranslated region in 21 renal allograft recipients, 29 patients on dialysis, and 26 non-renal failure controls. RESULTS The most prevalent genotype among patients with renal failure was 1b (78%), followed by 1a (10%) and 6a (8%). 2 renal allograft recipients with 6a infection probably acquired HCV from the same donor. The relative prevalence of HCV genotypes was similar to that of controls. While renal allograft recipients demonstrated more severe liver disease than dialysis patients, the prevalence and severity of chronic hepatitis were similar between patients with 1b and non-1b infection. CONCLUSIONS Resemblance of genotype distribution in Hong Kong to that of southern China and east Asia suggests common epidemiological evolution of HCV infection in these regions. Our results imply that in addition to viral characteristics, host factors such as the immunosuppressed state play an important role in the pathogenesis of liver disease in these patients.