Prevalence of Hepatitis C and G Virus Infection in Chronic Hemodialysis Patients Maria de Medina, MSPH, Melanie Ashby, BS, Volker Schlu ¨ ter, MD, Mary Hill, BS, Baudouin Leclerq, MD, J. Phillip Pennell, MD, Lennox J. Jeffers, MD, K. Rajender Reddy, MD, Eugene R. Schiff, MD, Georg Hess, MD, and Guido O. Perez, MD ● An RNA virus designated hepatitis G virus (HGV) has been recently identified in patients with acute and chronic liver disease. HGV is transfusion transmissible, it has global distribution, and it is present in the volunteer blood donor population in the United States. One hundred sixty patients undergoing maintenance hemodialysis at the University of Miami-affiliated unit were evaluated. There were 99 men and 61 women ranging in age from 22 to 80 years. Sixty percent had a history of blood transfusion, 6% had a history of drug abuse, and 9% were infected with the human immunodeficiency virus. HGV-RNA was detected by reverse-transcriptase polymerase chain reaction with amplification of two independent regions (5’-nontranslated region and NS5a coding region). Detection of digoxigenin-labeled amplification products with specific capture probes to the coding and noncoding regions was performed with the Enzymun-test DNA on an ES-300 Immunoassay System (Boehringer-Mannheim, Mannheim, Germany). Hepatitis C antibodies were measured with anti-hepatitis C virus enzyme-linked immunosorbent third-generation assays and hepatitis C virus RNA by reverse-transcriptase polymerase chain reaction. There were 32 (20%) patients with detectable HGV RNA with both primer pairs. Because of possible mutations, the HGV virus may be detectable only with one primer pair. We considered the latter as indeterminate: 12 had detectable levels to the NS5a region only, seven to the 5’-nontranslated region, and six had borderline results. Detectable and indeterminate samples were confirmed by repeat measurements in a new blood sample. Seven of 24 (29%) patients with detectable hepatitis C virus RNA had coexisting HGV with one or both HGV primer pairs (four with both and three with one). Five patients were hepatitis B surface antigen positive and HGV negative. We conclude that HGV infection is prevalent in our dialysis patients. The clinical significance of HGV infection remains to be established.  1998 by the National Kidney Foundation, Inc. INDEX WORDS: Hepatitis G virus; hemodialysis; polymerase chain reaction; hepatitis C virus. Editorial, p 366 A N RNA VIRUS of the flaviviridae family, designated hepatitis G virus (HGV), has been recently identified in patients with acute and chronic liver disease. 1 The virus is present in the volunteer blood donor population in the United States and is transmitted by blood transfu- sions. Recently, a closely related virus (HGBV- C), was detected in 3.1% of the chronic hemodi- alysis patients in Japan. 2 We used reverse- transcriptase polymerase chain reaction to detect the prevalence of HGV-RNA in our inner-city chronic dialysis population. MATERIALS AND METHODS Patients We evaluated 160 patients on chronic hemodialysis at the University of Miami-affiliated dialysis unit. There were 99 men and 61 women ranging in age from 22 to 80 years. Sixty percent had a history of blood transfusion, 6% had a prior history of intravenous drug abuse, and 9% were infected with the human immunodeficiency virus (HIV). Hemodialy- sis was performed three times a week for 3 to 5 hours, with synthetic membranes and bicarbonate solutions of standard composition. Artificial kidneys were used in a single patient an average of five times. Universal blood precautions were instituted, and anti-hepatitis C virus (HCV)-positive patients were not isolated. Laboratory Methods HGV RNA was detected by reverse-transcriptase polymer- ase chain reaction with amplification of two independent regions, 5’-nontranslated region (5’NCR) and NS5a coding region. Primers and capture probe are complementary to the coding and noncoding strands, respectively. For the HGV NS5a coding region, NS5a-primer 1 = 5’-CTC TTT GTG GTA GTA GCC GAG AGAT-3’, NS5a-primer 2 = 5’-CGA ATG AGT CAG AGG ACG GGG TAT-3’; and NS5a capture probe = 5’-biotin GTT ACT GAG AGC AGC TCA GAT-3’. Primers and capture probe for the HGV 5’NCR: 5’NCR primer 1 = 5’-CGG CCA AAA GGT GGT GGA TG-3’, 5’NCR primer 2 = 5’-CGA CGA GCC TGA CGT CGG G-3’, and 5’NCR capture probe = 5’-biotin GGT AGC CAC TATAGG TGG G-3’. Detection of the digoxigenin-labeled From the Divisions of Hepatology and Nephrology, Uni- versity of Miami School of Medicine and Veterans Adminis- tration Medical Center, Miami, FL. Received May 23, 1997; accepted in revised form August 1, 1997. Address reprint requests to Guido O. Perez, MD, Dialysis Unit (111-C), Veterans Administration Medical Center, 1201 NW 16 St, Miami, FL 33125. E-mail (M de Medina): mednet.med.miami.edu  1998 by the National Kidney Foundation, Inc. 0272-6386/98/3102-0005$3.00/0 224 American Journal of Kidney Diseases, Vol 31, No 2 (February), 1998: pp 224-226