4 research outputs found
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HIV-1 and HTLV-I infection in renal transplant recipients
The prevalence of retroviral infection in renal transplantation remains poorly defined. We tested retrospectively sera from 224 of 331 patients undergoing renal transplantation between 1979 and 1985. Viral antigen based EIA was used for screening IgG antibodies to human immunodeficiency virus (HIV-I) and human T-cell leukemia virus type I (HTLV-I). Positive EIAs were confirmed by Western blot. Six patients (2.7%) were found to have retroviral infection, four with HIV-1 and two with HTLV-I. The four patients with HIV-1 infection were negative before and became EIA and Western blot positive following transplantation. All patients had transient HIV-1 antigenemia documented before antibody was detected. One patient died of Kaposi's sarcoma 2 years posttransplantion with a functioning graft. One is alive and asymptomatic 4 years posttransplant, and two rejected their grafts and are asymptomatic on maintenance hemodialysis. Six patients tested positive for HTLV-I by EIA. Only two patients, however, were also positive for HTLV-I by Western blot, RIPA, and p24 antigen RIA, one prior to and one after transplantation. Both had HTLV-I-positive lymphocyte cultures and remain asymptomatic of retroviral infection 3 years after renal transplantation. A third patient, positive for HTLV-I by EIA, had indeterminate Western blot and negative RIPA, RIA, and lymphocyte culture. Intravenous drug use was not a risk factor for retroviral infection in this patient population. It is likely that patients became infected peritransplantation from blood transfusions. Contamination by donor kidneys, however, cannot be excluded
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Detection of hepatitis C virus RNA in hemodialysis patients
The clinical significance of the high prevalence of antibodies to hepatitis C virus (HCV) in dialysis patients remains undefined. In order to assess the relationship between seropositivity and potential infectivity, 63 patients undergoing maintenance hemodialysis were evaluated between April and May 1990. The mean duration of maintenance hemodialysis was 45 mo (range, 13 to 144). Eighty-two percent (52 of 63) had received blood transfusions, and 16% (10 of 63) had a history of iv drug abuse. Serum samples were analyzed by HCV-cDNA polymerase chain reaction; antibodies to HCV structural (core) and nonstructural regions NS3 and NS4 were determined by enzyme immunoassay. Specimens repeatedly reactive for anti-HCV and HCV-RNA-positive samples were tested by HCV MATRIX dot immunoblot assay and HBV-DNA PCR. Twenty-five percent (16 of 63) were anti-HCV-positive. Of the 16 anti-HCV-positive patients, HCV-RNA was detected in 5 (31%) with the NS3 primers and in 12 (75%) with 5'-noncoding primers. Among the anti-HCV-negative patients, HCV-RNA was detected in 2 (4.3%) of 47 patients. Eleven of the 18 patients with HCV infection (anti-HCV and/or HCV-RNA-positive) had evidence of additional present or past viral infections (human immunodeficiency virus and/or hepatitis B virus). In summary, HCV-RNA is present in at least 75% of anti-HCV-positive patients, suggesting that they may be infectious. The detection of HCV-RNA in anti-HCV-negative patients may indicate early or chronic HCV infection not detected by current antibody assays or the inability of these patients to mount or sustain a significant antibody response