Superinfection of TT virus and hepatitis C virus among chronic haemodialysis patients

Background : The TT virus (TTV), a new DNA virus found in Japan from a patient with post‐transfusion hepatitis non‐A–non‐G, is frequently positive in the sera of patients with liver disease. It is not established whether this virus causes liver damage. We studied the frequency of superinfection of this virus and hepatitis C virus (HCV) known to be endemic among haemodialysis patients, and the possible deleterious effect of TTV on HCV‐induced chronic liver disease. Methods : We used primers from a conservative region in the TTV genome (Okamoto, 1998) to detect TTV. Sera from 163 dialysis patients positive for anti‐HCV and 77 dialysis patients negative for anti‐HCV (control) were tested. Results : TT Virus positivity was 35% among HCV antibody (anti‐HCV)‐positive patients and 45.4% among anti‐HCV‐negative patients. TT Virus positivity was unrelated to the length of haemodialysis or amounts of blood the patients had received in the past. More anti‐HCV‐positive patients had a history of transfusion, but TTV positivity was not as closely associated with transfusion as anti‐HCV positivity. The severity of chronic liver disease was estimated from peak serum alanine aminotransferase levels in the preceding 6 months. Among anti‐HCV positives, TTV‐positive patients tended to have less active disease; at least there was no indication that TTV superinfection aggravated chronic hepatitic C in long‐term dialysis patients. Four of 35 anti‐HCV‐negative, TTV‐positive patients had chronic active liver disease, while none of the anti‐HCV‐negative and TTV‐negative patients did. Conclusions : TT Virus infection is prevalent among haemodialysis patients. Its transmission occurs not only by blood transfusion, but also by non‐parenteral infection. Superinfection of TTV does not exert deleterious effects on the liver disease induced by HCV. However, it may cause chronic hepatitis in a limited number of patients, but remains dormant most of the time. Triple infection, HCV and TTV plus HBV or HGV (one case each), did not cause severe liver disease.