HCV RNA in serum of asymptomatic blood donors involved in post-transfusion hepatitis (PTH).

A group of blood donors involved in post-transfusion hepatitis was investigated for the presence of the anti-HCV antibody and of HCV RNA as a more direct infection marker. RNA was extracted from serum, reverse transcribed and amplified using primers which belonged to the non structural region. The amplified product of the PCR reaction was 582 base pairs. Seven (25.9%) of the 27 blood donors examined were found anti-HCV-positive by ELISA; five (71.4%) of these were HCV RNA positive. Among the 20 anti-HCV-negative blood donors, four (20.0%) were HCV RNA positive. ALT levels were below 45 UI/l in 18 donors, while the other nine had ALTs over the limit accepted for transfusion. The anti-HCV-negative HCV RNA-positive blood donors had normal ALTs. Our study offers a direct explanation for the substantial proportion of residual cases of anti-HCV-positive post-transfusion hepatitis and suggests the necessity of creating a register of blood donors who have at some time presented blood enzyme abnormalities and for whom second level investigations such as HCV RNA should be used.     

Significant increase in HBV, HCV, HIV and syphilis infections among blood donors in West Bengal, Eastern India 2004-2005： Exploratory screening reveals high frequency of occult HBV infection

AIM： To evaluate the prevalence of markers of hepatitis B virus （HBV） and hepatitis C virus （HCV） and human immunodeficiency virus （HIV） among blood donors in Kolkata, Eastern India for two consecutive years and to conduct a pilot study to explore the presence of HBV DNA among hepatitis B surface antigen （HBsAg） negative but anti-HBc positive blood donors.
METHODS： Seroprevalence of HBsAg, anti-HCV and anti-HIV was studied among 113051 and 106695 voluntary blood donors screened in 2004 and 2005, respectively. Moreover, a pilot study on 1027 HBsAg negative donors was carried out for evaluating the presence of HBV DNA by PCR on HBsAg negative/anti- HBc positive donors.
RESULTS： A statistically significant increase in the prevalence of HBV （1448 vs 1768, P 〈 0.001）, HIV （262 vs 374, P 〈 0.001）, HCV （314 vs 372, P = 0.003） and syphilis （772 vs 853, P = 0.001） infections was noted among blood donors of Kolkata West Bengal in 2005 as compared to 2004. Moreover, the exploratory study on 1027 HBsAg negative donors revealed that 188 （18.3%）of them were anti-HBc positive out of which 21% were positive for HBV DNA.
CONCLUSION： The findings of this study underscore the significantly increasing endemicity of hepatitis viruses, syphilis and HIV among the voluntary blood donors of our community. The pilot study indicates a high rate of prevalence of HBV DNA among HBsAg negative/anti-HBc positive donors and thus emphasizes the need for a more sensitive and stringent screening algorithm for blood donations.     

Prevalence of antibodies against hepatitis C virus among blood donors in Lebanon, 1997–2000

Chronic hepatitis C virus (HCV) infection in many individuals is asymptomatic and the prevalence of antibodies to hepatitis C virus (anti‐HCV) among blood donors in Lebanon is scarce. This study aimed to address the prevalence of anti‐HCV in 8700 blood donors, the data obtained was compared to other world regions. Between 1997 and 2000, 8700 blood donors were screened for the presence of anti‐HCV in their sera. Initially reactive specimens were retested in duplicate, and repeatedly positive samples were subsequently retested by a third generation microplate enzyme immunoassay. Of the 8700 blood donors screened, 51 were confirmed positive for anti‐HCV, giving a prevalence rate of 0.6%. While there was no difference in anti‐HCV prevalence in relation to age or gender, higher rates were seen in non‐Lebanese compared to Lebanese subjects (6.17% vs. 0.48%, P < 0.001). None of the anti‐HCV positive individuals had an identifiable risk factor for contracting HCV (intravenous drug user, prior transfusion, etc.), and their transaminases were comparable to anti‐HCV‐negative donors, suggesting that HCV‐positive donors were asymptomatic. These results demonstrate low prevalence of anti‐HCV among Lebanese blood donors, which was comparable to those established for Western countries.     

Hepatitis B and C virus infection in Ujung Pandang, Indonesia

A survey was performed to investigate HBV and HCV infection in Ujung Pandang. The total number of subjects was 406; 196 blood donors, 78 cases of acute hepatitis, 43 of chronic hepatitis, 58 of liver cirrhosis and 31 of hepatocellular carcinoma cases. HBsAg, anti-HBs and anti-HBc as HBV markers and anti-HCV (ELISA, Ortho) as an HCV marker were tested. Positive rates of HBsAg and anti HCV among blood donors were 7.1% and 3.1% respectively, and there was no significant difference among age groups. Donors negative for all viral markers accounted for 21.4%. Of acute hepatitis cases, 18 (23.1%) cases were hepatitis A and 8 (10.3%) cases were hepatitis B, one case of which was considered to be double infection. Acute exacerbation cases of HBV carriers were 16 (20.5%), of which 6 cases were potitive for HCV antibody. Those diagnosed non-A, non-B hepatitis were 37 (47.4%), of which 3 cases where positive for HCV antibody. Blood samples from all of acute hepatitis cases were obtained within 1 week after onset of the disease, thus, it was not possible to accurately assess prevalence of hepatitis C. Positive rates on HBsAg among chronic hepatitis, liver cirrhosis and hepatocellular carcinoma were 25.4%, 32.8% and 35.5% respectively, while those for HCV antibody were 16.3%, 43.1% and 35.5% respectively. Positive rates of HBsAg and HCV antibody for overall chronic liver diseases were 31.1% and 32.6%, and 14 (10.6% ) were positive for both markers. This study was supported by a grant from The Japan Society for the Promotion of Science.     

Seroprevalence of hepatitis B and C virus infections among Lao blood donors

There have been no previous reports of the prevalence of hepatatis B virus (HBV) and hepatitis C virus (HCV) infections in Lao PDR. From 2003 to 2005, 13,897 first-time blood donors were screened for the presence of hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). The seroprevalence of HBsAg positive blood donors was 8.7%. The prevalence among males (9.7%) was higher than in females (6.2%). The prevalence of anti-HCV positive blood donors was 1.1%, with no significant differences between males (1.1%) and females (1.0%). Annual positive rates for HBsAg and anti-HCV during the years 2003 to 2005 did not differ significantly. Lao PDR has a high endemicity of HBV carriers (8.7%). Dual infection with HBV and HCV was 0.12%. For preventing HBV infection, the country introduced DPT-Hepatitis B vaccines into the National Immunization Program in 2001. The large reservoir of HBV and HCV infections will cause an enormous burden of patients with cirrhosis and hepatocellular carcinoma in the future.     

A clinical, epidemological, laboratorial, histological and ultrasonographical evaluation of anti-HCV EIA-2 positive blood donors

Between 1992 and 1997, 790 blood donors with anti-HCV EIA-2 strongly reagent (relationship between the sample optical density/cut-off > 3) detected at the blood bank serological screening, were evaluated in ambulatory environment. They were all negative for Chagas disease, syphilis, hepatitis B (HBsAg) and AIDS. Blood samples were collected at the first ambulatorial evaluation, for hemogram, biochemical tests and new serological tests for HCV (anti-HCV EIA-2). In blood samples of 226 repeatedly reagent anti-HCV EIA-2 blood donors, supplementary "immunoblot" test for HCV (RIBA-2) was used. In 209 donors, the presence of HCV-RNA was investigated by the PCR test. The abdominal ultrasonography was realized in 366 donors. In 269 patients liver biopsy was performed for the histopathological study. The follow-up of blood donors showed that 95.6% were repeatedly EIA-2 reagent, 94% were symptomless and denied any hepatitis history, with only 2% mentioning previous jaundice. In 47% of this population at least one risk factor has been detected for the HCV transmission, the use of intravenous drugs being the main one (27.8%). Blood transfusion was the second factor for HCV transmission (27.2%). Hepatomegaly was detected in 54% of the cases. Splenomegaly and signs of portal hypertension have seldom been found in the physical examination, indicating a low degree of hepatic compromising in HCV. Abdominal ultrasound showed alterations in 65% of the subjects, being the steatosis the most frequent (50%). In 83. 5% of the donors submitted to the liver biopsy, the histopathological exam showed the presence of chronic hepatitis, usually classified as active (89%) with mild or moderate grade in most of the cases (99.5%). The histopathological exam of the liver was normal in 1.5% of blood donors. The RIBA-2 test and the HCV-RNA investigation by PCR were positive in respectively 91.6 and 75% of the anti-HCV EIA-2 reagent donors. The HCV-RNA research was positive in 82% of the RIBA-2 positive subjects, in 37.5% of the indeterminate RIBA-2 donors and in 9% of the negative RIBA-2 donors. Chronic hepatitis has also been observed in 50% of the histopathological exams of the anti-HCV EIA-2 reagent donors which were indeterminate RIBA-2. Among 18 blood donors with minimal changes histopathological exam 11 (61%) were HCV-RNA positive. Our blood donors anti-HCV reagent generally had clinical, laboratorial and histopathological features observed in patients with chronic HCV hepatitis and a high proportion could be identified in interviews and medical evaluation realized in blood blanks. Generally, these HCV infected donors are identified and discharged only by the serological tests results.     

Prevalence of antibodies against hepatitis B virus and hepatitis C virus among blood donors in Lebanon, 1997-2003

The prevalence of hepatitis B virus (HBV) antigens (HBsAg) and antibody to hepatitis C virus (anti-HCV) was determined among 16,084 blood donors (14,993 males; mean age, 31.7 +/- 8.2 years and 1084 females; mean age, 31.4 +/- 8.2 years) in the period 1997-2003. Of the donors screened, 149 were HBsAg positive (0.926%), and 65 were anti-HCV positive (0.404%). There was a steady decline in HBsAg prevalence from 1.56% (1997) to 0.33% (2003) and in anti-HCV from 1.22% (1997) to 0.16% (2003). Females had a higher prevalence of anti-HCV (P = .031) and HBsAg (P = .047). Results obtained are of value in light of the occurrence of HBV and HCV transmission by nonparenteral routes.     

Performance of the serologic and molecular screening of blood donations for the hepatitis B and C viruses in a Mexican Transfusion Center

Nucleic acid-amplification testing (NAT) is not routinely practiced in blood banks from most low-income countries. We did an exploratory comparison of the performance of the standard immunoassay-based screening tests for the hepatitis B (HBV) and C (HCV) viruses with that of NAT, in blood donors. From January 1999 to March 2005, 94,806 blood donors were screened for anti-HCV antibodies and for hepatitis B surface antigen (HBsAg). Also, an exploratory period of molecular screening was carried out on 100 consecutive blood donors to detect HBV DNA and HCV RNA by home-made PCR techniques without sera pooling. In the 75-month period of serologic screening, HBsAg was detected in 219 donors (0.23%; 95% CI, 0.20- 0.26%) and anti-HCV antibodies in 922 (0.97%; 95% CI, 0.90-1.03%). The annual trend for HBsAg prevalence had a decreasing pattern over the years (p<0.001), whereas that for anti-HCV did not (p=0.19). In the molecular screening cohort, HBV DNA was detected in one donor (1%; 95% CI, 0-6%) and HCV RNA in another (1%; 95% CI, 0-6%). All these 100 donors tested negative to HBsAg and anti-HCV. Thus, the prevalence of positive results for HBV and HCV did not differ if considering immunoassays or NAT; nevertheless, these methods did not coincide in detecting HBV or HCV in the molecular screening cohort. In conclusion, NAT can detect cases of HBV and HCV infections that standard immunoassay techniques can not, even in a highly selected population at low risk, like blood donors. Large-scale studies are warranted for NAT to be considered as a systematic method for screening of HBV and HCV in Mexican blood banks.     

Seroepidemiology of hepatitis C virus infection in the Philippines: A preliminary study and comparison with hepatitis B virus infection among blood donors, medical personnel, and patient groups in Davao, Philippines

To determine the seroprevalence of hepatitis C virus in the Philippines and compare it with the seroprevalence of hepatitis B virus infection, HBV and HCV markers in 594 serum samples collected from 392 blood donors, 123 medical and paramedical personnel, and 80 patients (45 liver diseases: 25 acute hepatitis, 9 liver cirrhosis, and 11 hepatocellular carcinoma; 28 hepatitis B carriers, and 7 chronic renal failure patients undergoing dialysis) in Davao, Mindanao Island, Philippines, were examined. HBsAg was determined by RPHA, anti-HBc by HI, anti-HBs by PHA, and HBsAg subtypes, HBeAg, and anti-HBe by EIA. HCV markers determined were anti-HCV (anti-C100-3) by ELISA (Ortho Diagnostic Systems), and anti-HCV core (anti-CP9 and/ or anti-CPIO) also by ELISA. Results showed that 9 (2.2%) blood donors were anti HCV positive; 69 (15.4%) were anti-HCV core positive Nine (2.2%) were HBsAg carriers; 240 (61.3%) were anti-HBs and/or anti-HBc positive (HBsAg carriers excluded from this group). Two of 123 medical and paramedical staff (1.6% ) were anti-HCV positive; 11 (8.1%) were anti-HCV core positive; Eight (6.5%) were HBsAg carriers and 81 (65.8%) anti-HBs and/or anti-HBc positive. Five of 11 (45.4%) hepatocellular carcinoma patients were HBsAg carriers; 2 were anti-HCV core positive. Two of 9 liver cirrhosis patients were antiHCV positive (1 to anti-HCV and the other to anti-HCV core). If anti-HCV positivity means carrier state, then the HCV carrier rate of blood donors in Davao, Philippines is the same as the HBV carrier rate and prospective blood donors should be screened not only for HBV but also for HCV to prevent transfusion-associated hepatitis. Less than 50% of liver cirrhosis and hepatoHCV carcinoma cases have HBV markers and HCV markers but, when present, these markers appear at almost the same frequency; the role of HCV and HBV in the pathogenesis of these 2 diseases in Mindanao should be further investigated.     

Prevalence of antibodies against hepatitis C virus among blood donors in Lebanon, 1997-2000.

Chronic hepatitis C virus (HCV) infection in many individuals is asymptomatic and the prevalence of antibodies to hepatitis C virus (anti-HCV) among blood donors in Lebanon is scarce. This study aimed to address the prevalence of anti-HCV in 8700 blood donors, the data obtained was compared to other world regions. Between 1997 and 2000, 8700 blood donors were screened for the presence of anti-HCV in their sera. Initially reactive specimens were retested in duplicate, and repeatedly positive samples were subsequently retested by a third generation microplate enzyme immunoassay. Of the 8700 blood donors screened, 51 were confirmed positive for anti-HCV, giving a prevalence rate of 0.6%. While there was no difference in anti-HCV prevalence in relation to age or gender, higher rates were seen in non-Lebanese compared to Lebanese subjects (6.17% vs. 0.48%, P < 0.001). None of the anti-HCV positive individuals had an identifiable risk factor for contracting HCV (intravenous drug user, prior transfusion, etc.), and their transaminases were comparable to anti-HCV-negative donors, suggesting that HCV-positive donors were asymptomatic. These results demonstrate low prevalence of anti-HCV among Lebanese blood donors, which was comparable to those established for Western countries.     

Surveillance for newly acquired hepatitis C in Australia

BACKGROUND: The purpose of the present paper was to determine recent patterns of hepatitis C virus (HCV) transmission in Australia through a national system of enhanced surveillance of newly acquired hepatitis C. METHODS: Demographic, clinical, and risk behavior information on newly acquired hepatitis C cases from 1997 to 2000 was collected. Newly acquired hepatitis C included cases of HCV antibody sero-conversion within a 12 month period and acute clinical hepatitis C cases. RESULTS: Nine hundred and twelve cases of newly acquired hepatitis C were identified, representing 2.8% of all HCV notifications for this period. The majority of cases (72%) were diagnosed in people aged between 20 and 39 years. Injecting drug use was reported in the vast majority of cases (93%), with sexual transmission (2%) and tattooing (2%) reported in small numbers. HCV antibody sero-conversion was the mode of diagnosis in most cases (78%). CONCLUSIONS: Injecting drug use is the main route of HCV transmission in Australia. As only a small proportion of HCV infections are detected as newly acquired, enhanced surveillance procedures, including increased regular HCV testing of at-risk populations are required to more effectively monitor recent patterns of transmission.     

Hepatitis B and C virus co-infections in human immunodeficiency virus positive North Indian patients

INTRODUCTION Diseases of the hepatobiliary system are a major problem in patients with human immunodeficiency virus (HIV) infection. An estimated one-third of deaths in HIV patients are directly or indirectly related to liver disease. Liver diseases in HI…     

Hepatocellular carcinoma in Sweden: its association with viral hepatitis, especially with hepatitis C viral genotypes

Viral markers of chronic hepatitis were tested for in 95 frozen serum samples from 299 patients from Malm?, Sweden, with hepatocellular carcinoma (HCC), diagnosed between 1977 and 1994. Hepatitis B analysis included anti-HBc, HBsAg and, if anti-HBc positive, HBV DNA. Hepatitis C infection analysis included anti-HCV screening, RIBA, HCV RNA and HCV genotyping. HCV genotyping was also carried out in 9 HCV-viraemic HCC-patients from Gothenburg. HCV genotype distribution in HCC cases was compared with Swedish HCV-infected blood donors. Among the 95 patients from Malm?, 28 (29%) had anti-HBc, but only 5 (5%) were chronic HBV carriers, compared with 16 (17%) with chronic hepatitis C (p = 0.021). HCV-related HCC was more common among immigrants (8/16 vs. 8/79; p < 0.001). Genotyping of 25 HCV-infected cases showed genotype 1a in 6 (24%), genotype 1b in 13 (52%), genotype 2b in 4 (16%), and genotype 3a in 2 (8.0%) patients. Genotype 1b was more common among HCC patients than among blood donors (p < 0.001), but 8 of 13 genotype 1b-infected patients were from countries where genotype 1b is predominant. Among native Swedes there was no difference between the HCV genotypes infecting blood donors and those found in HCC patients.     

Markers for transfusion-associated hepatitis in north Indian blood donors: prevalence and trends

Transfusion-associated hepatitis is a great problem in developing countries including India due to endemic hepatitis infections and a lack of voluntary donors, trained personnel, and funds. The prevalence of post-transfusion hepatitis B and C in India is about 1-5% and 1%, respectively. A total of 128,589 blood donors were screened for hepatitis B surface antigen (HBsAg) and 76,089 donors were screened for anti-hepatitis C virus (HCV) from 1997 - 2002. Data were tabulated annually. Out of the total 83.6% were replacement donors. Our study concluded that the prevalence of HBsAg and antibodies for HCV ranged between 1.7 - 2.2% and 0.25 - 0.9%, respectively among all of the donors. Seropositivity was definitely higher in replacement donors than in voluntary donors. Based on these results, we recognize an urgent need to establish a non-remunerated voluntary donor base in India. A stringent deferral system should be developed. The use of sensitive laboratory tests and the addition of core antigen (anti-HBc) to the mandatory screening test list would further reduce the incidence of post-transfusion hepatitis.     

Predictive Value of Screening Tests for Persistent Hepatitis C Virus Infection Evidenced by Viraemia: Japanese Experience

In November 1989, Japanese Red Cross Blood Centres started screening for heaptitis C virus (HCV) with enzyme-linked immunosorbent assay (Elisa) for the C100-3 viral peptide as the first such nationwide programme in the world. Thereafter post-transfusion non-A non-B hepatitis (PTNANBH) was reduced by 61–80%, but this was not as complete a success as our programme to prevent post-transfusion hepatitis B by screening for high titer hepatitis B core antibody, which we began in the same period. In order to acquire more effective control of PTNANBH, the HCV core-related antigen (GOR, N14) and second-generation Elisa (Ortho2, Abbott2)and second-generation antigen agglutination (PA, PHA) tests have been employed. Among 16,500 donors in 11 blood centers, 365 were serologically positive by at least one of these tests. Among these, HCV RNA was detected in 138 units and the remaining 227 were HCV RNA negatives. The effectiveness of these serological tests to detect HCV RNA-positive status were analyzed. Passive haemagglutination and particle agglutination (PHA and PA) tests were highly effective to predict HCV viraemia among blood donors. Also, these tests can easily determine antibody titre. By either PHA or PA, all units with ≧2¹² agglutination titre (120 and 122 units) were HCV RNA positive and all agglutination-positive units with serum alanine aminotransferase level higher than 35 Karmen units were HCV RNA positive. These results have formed the basis for implementing a more effective screening for HCV viraemia in blood donors, where effectiveness is defined as enhancing the protection of patients from post-transfusion hepatitis C and providing higher quality information to achieve more effective donor counselling.     

Clinical aspects and outcomes of volunteer blood donors testing positive for hepatitis‐C virus infection in Taiwan: a prospective study

Abstract: Background/Aim: The natural history of hepatitis‐C virus (HCV) infection has been explored in volunteer blood donors, but not yet in hepatitis‐B endemic areas. Whether previous or concurrent hepatitis‐B virus (HBV) infection influences the natural history of HCV infection remains unknown. Thus, we followed the anti‐HCV‐positive blood donors who had past or concurrent HBV infection in Taiwan. Methods: From 1992 to 1993, 1588 anti‐HCV reactive volunteer blood donors were referred to us from the Taipei Blood Center and 879 (55%) repeatedly reactive for anti‐HCV were enrolled. Two hundred and forty‐three donors (HCV RNA seropositive rate 49% by polymerase chain reaction (PCR)) received regular follow‐ups (mean period: 4.9 years) with their liver disease status determined mainly by clinical and biochemical parameters, serum alpha‐fetoprotein level and imaging studies. Hepatitis‐C virus genotype and occult HBV infection were determined by PCR‐based assays. Results: Of the initial 879 subjects, 250 (28%) had chronic hepatitis, nine (1%) had liver cirrhosis (LC) and two (0.2%) had hepatocellular carcinoma (HCC) already. In the 243 regularly followed donors, 30% had repeatedly normal serum alanine aminotransferase (ALT) and 70% had more than once elevated ALT. Cirrhosis developed in four (1.6%; follow‐up period range: 2–6 years) and HCC in two (0.8%; follow‐up period: 3 and 4 years, respectively). Distribution of HCV genotype and hepatitis‐B surface antigen (HBsAg) did not differ between those with and those without elevation of ALT. Of the 15 donors with LC and/or HCC, only 1(7%) was positive for both HBsAg and HBV DNA and the other 14 were negative for both HBsAg and serum HBV DNA. Conclusions: Incidentally detected hepatitis‐C was progressive in a small proportion of anti‐HCV‐positive volunteer blood donors in Taiwan. Occult HBV infection played a minimal role in the development of LC in this donor population.     

Prevalence of hepatitis B and C markers in volunteer blood donors in Crete. A 5-year study

Greece is a country with an intermediate prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Crete, the third-largest island of the Mediterranean sea, has a different prevalence of viral hepatitis. One-eighth of the total island population, of 550000, was included in a 5-year study of blood donors from three out of four blood banks, serving three out of four prefectures of the island. Markers for HBV and HCV were studied and evaluated according to geographical area, gender and age of donor. A total of 65219 blood donors were studied. A greater number of males than females were hepatitis B surface antigen (HBsAg) positive (0.41% vs 0.28%, respectively) with a peak at a younger age for males and older age for females. Males are more frequently exposed to HBV and become carriers more often than females. For HCV, an opposite gender trend was found, females being infected more frequently (0.49%) than males (0.37%). Statistical differences were found among geographical areas of the island. Hence, Crete is an area of low endemicity for HBsAg in blood donors. The HCV infectivity is more similar to Northern Europe than to other neighbouring countries. Differences in geographical distribution within the island and during different years indicate the need for extended epidemiological surveys for valid results.     

血液病患者丙型肝炎病毒的感染

为了解血液病患者丙型肝炎病毒（ＨＣＶ）感染率，探讨相对危险因素。采用第二代ＥＬＩＳＡ检测抗－ＨＣＶ，逆转录巢式双ＰＣＲ法检测ＨＣＶＲＮＡ。结果发现：４５例血液病患者１１例抗－ＨＣＶ阳性，３４例抗－ＨＣＶ阴性患者中，３例ＨＣＶＲＮ阳性。综合评价，ＨＣＶ感染率１４／４５（３１．１％）。相关危险因素为反复大量输注注未经抗－ＨＣＶ筛选的血液及血制品和免疫功能低下。结果表明：血液病患者ＨＣＶ感染率高于普通人     

Hepatitis C

The major cause of chronic post-transfusion hepatitis, the hepatitis C virus (HCV), has been identified. HCV is a single-stranded linear RNA virus with characteristics similar to the flaviviruses. A different agent, the hepatitis E virus, is associated with epidemic (enterically-transmitted) non-A, non-B hepatitis. At present, infection with HCV is recognized by the finding of anti-HCV antibodies, positive in up to 90% of patients with chronic non-A, non-B post-transfusion hepatitis. Antibodies to HCV are detected in 1% of normal volunteer blood donors and in the majority of donors implicated in post-transfusion hepatitis. HCV antibodies are also found in patients with autoimmune liver disease and hepatocellular carcinoma. Moreover, HCV infection may contribute to the pathogenesis of liver disease in alcoholic patients. The role of HCV infection in fulminant non-A, non-B hepatitis and hepatitis-associated aplastic anemia has not been elucidated as yet. Therapy of chronic non-A, non-B hepatitis with recombinant human alpha-interferon has been shown to improve or normalize aminotransferase levels in approximately 50% of patients, most of whom have evidence of HCV infection. However, relapse after cessation of treatment is common. In the future, screening blood for evidence of HCV infection may prevent most cases of non-A, non-B post-transfusion hepatitis.     

Epidemiology,serological markers,and hepatic disease of anti-HCV ELISA-2-positive blood donors

The epidemiology associated with hepatitis C virus (HCV) infection, serologic reactivity, and hepatic disease related to anti-HCV-positive donors of Granada were researched. From 1990 through 1993, medical and epidemiological information and anti-HCV and HCV RNA testing were evaluated in 46,741 blood donors. Serum samples were obtained for anti-HCV ELISA and RIBA and HCV RNA determination. A liver biopsy was conducted in all anti-HCV positives by confirmatory second-generation RIBA to analyze the hepatic lesion and the presence of HCV RNA. The anti-HCV prevalence was 1.12%. A total of 228 anti-HCV second-generation ELISA positive blood donors were analyzed. Intrafamiliar transmission rate was 1.7%. Transfusion and intravenous drug abuse (IVDA) antecedents were associated with a higher risk of seroconversion. A RIBA-positive result was related to high second- and third-generation ELISA ratios (90%), HCV RNA positivity (89%), and elevated alanine aminotransferase (ALT) levels (88%). Approximately 50% of donors with normal ALT levels had high ELISA ratios and second-generation RIBA and HCV RNA positive results. Of the second-generation RIBA indeterminate results, 42% and 82% of the c22 and 33% and 100% of the c100 reactivities were third-generation RIBA and HCV RNA positive, respectively. Liver biopsy was conducted in 85 donors, 74% of whom had a chronic hepatitis and 83% had detectable HCV RNA levels. Chronic hepatitis was diagnosed in 88% vs 43% of donors with elevated and normal alanine aminotransferase levels, respectively. ELISA and confirmatory HCV RNA determinations should be routinely employed in donor screening. A liver biopsy should be conducted in patients with elevated ALT levels and normal ALT levels when viremic.