Anti-HCV positivity in sexual partners and offspring of patient with chronic hepatitis C

We investigated the seroprevalence of HCV in stable sexual partners and offspring of chronic hepatitis C patients, and aimed to determine the risk factors involved. 191 anti-HCV and HCV RNA positive subjects who coinhabited with their spouse and/or offspring were included. Risk factors of index cases for disease transmission, liver biopsy results, anti-HCV and HCV-RNA in spouses and/or offspring were evaluated. Together with index cases, a total of 404 family members including 174 stable sexual partners and 230 offspring were included. The most common risk factors among index cases were dental procedures (73.8%), history of surgery (64.9%), and blood transfusions (24.1%). Anti-HCV positivity was established in 11 (2.7%) of the total 404 family contacts--6 sexual partners and 5 offspring. HCV seropositivity was significantly higher in the spouses of index cases with severe hepatitis C compared to those with mild to moderate hepatitis C (p=0.008), but there was no statistically significant correlation between the severity of liver disease in index cases and anti-HCV positivity in their offspring. In conclusion, anti-HCV seropositivity in the spouses and children of patients who are HCV-RNA positive HCV carriers does not appear to be higher than the HCV seroprevalence in our country.     

Prevalence of Antibodies to Hepatitis C Virus among Hemodialysis Patients in Damascus, Syria

Background: Evaluation of the epidemiology of hepatitis C virus (HCV) infection was made possible by the development of a serological assay to detect antibodies to epitopes of HCV. Hemodialysis (HD) is considered to be one of the main risk factors of HCV transmission. Therefore, the prevalence of antibodies to HCV (anti-HCV) was studied in patients undergoing maintenance dialysis therapy. Patients and Methods: Anti-HCV were detected using a third-generation assay. The study group consisted of HD patients, transplant recipients and staff members from two dialysis units in Damascus, Syria. Results: The overall prevalence of anti-HCV among HD patients was 48.9%; 24,4% in one center (Al-Mouassat Hospital) and 88,6% in the other (Kidney Hospital). There was a significant correlation between prevalence of anti-HCV and duration of HD. The prevalence was 36.7% for patients on HD for < 3 years and 65% in patients on HD for > 3 years (p < 0.05). There was a significant correlation beteen anti-HCV positivity and elevated liver enzymes: alanine aminotransferase (ALT) and asparate aminotransferase (AST). However, there was no significant correlation between anti-HVC positivity and history of blood transfusion, exposure to hepatitis B virus, age and sex. The prevalence of anti-HCV among kidney transplant recipients was 48%, among staff members of the dialysis units it was 5.8%. Conclusion: Factors related to infrastructure and operational system might be responsible for the very high prevalence of anti-HVC found in one of the two units. There was no data available on anti-HCV status of transplant recipients prior to transplantation. However, the prevalence among those patients, which is very similar to that of HD patients, suggests that HD may be responsible for such high prevalence among this group. An intensive educational program for staff members and proper evaluation of the HD situation in the two units are needed. Received: November 27, 1999 · Revision accepted: March 2, 2001     

Positive predictability and predictive factors of the third generation anti-hepatitis C virus (HCV) ELISA test for HCV infection]

BACKGROUND/AIMS: Anti-HCV positivity suggests past or present infection of HCV, or false positivity. The positive predictability of this test can differ according to the subjects. This study examines the positive predictability of the third generation anti-HCV ELISA and factors predicting HCV infection with special emphasis on the significance of the anti-HCV sample/cut-off (S/CO) ratio. METHODS: One hundred and ninety patients who were anti-HCV positive were enrolled, from November 1998 to January 2002 in Kyung Hee University Hospital. RT-PCR was performed to confirm HCV infection. RESULTS: One hundred and seven patients were RT-PCR positive (56.3% positive predictability). The positive predictability changed with the S/CO ratio: 17.9% in cases below 6, 58.3% between 6 and 50, 78.6% between 51 and 75, and 60% over 75. Those with the S/CO ratio more than 6 showed significantly higher predictability, but it did not increase further when the ratio got higher. Factors predicting HCV infection were the presence of liver cirrhosis (OR 5.5, p=0.000), hepatocellular carcinoma (OR 11.67, p=0.004), liver diseases (OR 2.99 p=0.001), and increase of AST (OR 2.49, p=0.002), ALT (OR 2.32, p=0.005), alpha-FP (OR 3.49, p=0.040), and the S/CO ratio of more than 6 (OR 7.82, p=0.000). However, liver cirrhosis was the sole factor in multivariate analysis (OR 8.32, p=0.02). CONCLUSIONS: The positive predictability of the third generation anti-HCV test was 56.3% with a significant difference between those with the S/CO ratio below 6 (18%) and above 6 (63%). In liver cirrhosis, positive predictability of anti-HCV test was relatively high as 85%.     

Superinfection with hepatitis C virus in patients with symptomatic chronic hepatitis B.

11/323 patients (3.4%) with symptomatic chronic hepatitis B were positive for antibody to hepatitis C virus (anti-HCV). The positive rate of anti-HCV in patients with serum alanine aminotransferase (ALT) levels greater than 200 U/l (n = 219) did not exceed that of the patients with ALT less than or equal to 200 U/l (n = 104) (2.7% vs. 4.8%). Of the 219 patients who were positive for hepatitis B e antigen (HBeAg) and/or hepatitis B virus-DNA (HBV-DNA), 5 (2.3%) had anti-HCV, while 6/104 patients (5.8%) who were positive for antibody to HBeAg (anti-HBe) had anti-HCV (p greater than 0.1). In contrast to the anti-HCV-negative patients, the patients with anti-HCV had a higher percentage of cirrhosis in their liver histological findings (36.4% vs 5.4%, p less than 0.005). In conclusion, the prevalence of HCV superinfection in symptomatic chronic hepatitis B patients is low and HCV superinfection is not an important factor in acute exacerbation of chronic hepatitis B. However, the superinfection with HCV may exacerbate the existing liver disease and accelerate its progression.     

Hepatitis C virus infection in chronic hepatitis B virus carriers.

One hundred eighty-four patients with hepatitis B surface antigen-positive chronic hepatitis were evaluated for antibodies to hepatitis C virus (anti-HCV). Only 11 (8%) of 136 patients with hepatitis B virus (HBV) replication (HBV-DNA-positive in serum) while 7 (35%) of 20 positive for antibody to hepatitis B e antigen (anti-HBe) but HBV-DNA-negative were positive for anti-HCV. By contrast, anti-HCV was never found in 30 anti-HBe-positive "healthy" carriers. Anti-HCV was more frequent in hepatitis D virus (HDV)-positive than in HDV-negative cases (32% vs. 12%). During 1-11 years of follow-up, anti-HCV persisted in 90% of cases, who showed continuing alanine aminotransferase elevation. Liver histology deteriorated in 2 of 4 anti-HCV-positive, anti-HBe-positive, HBV-DNA-negative patients. These results demonstrate the existence of a subgroup of patients with anti-HBe-positive, HBV-DNA-negative, HDV-negative chronic hepatitis B, where HCV may play a leading role in causing liver disease.     

The prevalence of anti-HCV antibodies in hemodialysis patients

The prevalence of antibodies to hepatitis C virus (anti-HCV) was assessed in 489 hemodialysis patients and 152 members of the staff of dialysis units, using an Ortho HCV Ab ELISA Test. Of the 489 patients, 100 (20.4%) had anti-HCV, a significantly greater rate than was found in either staff members (0.7%, P<0.01) or local healthy blood donors (1.1%, P<0.001). Anti-HCV positivity was apparently related to the duration of hemodialysis.     

Early appearance of antibodies to hepatitis C virus in community acquired acute non-A, non-B hepatitis is associated with progression to chronic liver disease. The Copenhagen Hepatitis Acuta Programme

24 consecutive patients (14 females; median age 36, range 18-77) with liver biopsy proven acute non-A, non-B hepatitis (NANBH) were assayed for antibodies to hepatitis C virus (HCV). 14 (58%) were positive initially or during follow-up. Three patients were positive within 4 weeks following onset of symptoms and 7 patients in a serum sample obtained 4-8 weeks after clinical onset. Seroconversion was documented in 7/8 patients in paired sera from the acute phase of the disease. Anti-HCV was detected in 6% and 13% of control patients with acute hepatitis A and toxic hepatitis. NANBH in 6/14 patients (43%) with anti-HCV progressed to chronic liver disease (CLD). In contrast none of the anti-HCV negative patients developed CLD (p = 0.02). In addition, 2 anti-HCV positive patients developed fulminant and fatal hepatitis. The predominant route of HCV transmission was intravenous drug abuse. It is concluded that hepatitis may be ascribed to HCV infection in more than half of patients with community aquired NANBH, that seroconversion occurs in the majority within 8 weeks following onset of symptoms and that seropositive individuals often progress to CLD.     

Hepatitis C virus infection in anti-HIV positive and negative French homosexual men with chronic hepatitis: comparison of second- and third-generation anti-HCV testing

ABSTRACT— To determine the prevalence of hepatitis C virus (HCV) infection in homosexuals with chronic hepatitis, we tested for anti-HCV antibodies 113 (47 anti-HIV positive) French non-drug-addicted homosexual men admitted for chronic viral hepatitis. Anti-HCV were detected with second- and third-generation ELISAs (ELISA2 and ELISA3) and RIBAs (RIBA2 and RIBA3). Chronic hepatitis was related to non-A, non-B infection in four, to hepatitis D virus (HDV) infection in five and to hepatitis B virus (HBV) infection in 104 patients. Anti-HCV positivity was found in 50.4% and 12.4% of the 113 patients, with ELISA2 and ELISA3, respectively. Positivity with RIBA2 and RIBA3 was found in only six of the 57 ELISA2 positive patients (all six were ELISA3 positive). The high prevalence of positivity with ELISA2 not confirmed by RIBA2 or RIBA3 suggests false-positive results. ELISA2 positive results were more frequent with frozen serum samples than with fresh serum samples (62% vs 23.5%, p = 0.0003). However, even with fresh serum, ELISA2-positive RIBA-negative results remained frequent in anti-HIV positive patients. ELISA3 seems to give more specific results. We conclude that the prevalence of HCV infection, as assessed with RIBA, was 5.3% among French homosexual men with chronic hepatitis (3.8% after exclusion of transfused patients). This low prevalence suggests that homosexual transmission of HCV is relatively uncommon.     

Studies on hepatitis C virus infection in haemodialysis patients]

To examine the prevalence of hepatitis C virus (HCV) in haemodialysis patients without blood transfusion in Hiroshima Prefecture, antibody to HCV (anti-HCV) was studied by the Ortho ELISA Kit in sera from 393 consecutive haemodialysis patients and in sera from 510 age and sex matched healthy members of the general population (control). An additional confirmatory test was done by a recombinant immunoblot assay. 1) Anti-HCV was detected in 70 of the 393 dialysis patients and 3 of the 510 healthy controls (17.8% vs 0.6%, p less than 0.01). Prevalence of anti-HCV in haemodialysis patients sera was increased by the volume of blood transfusion, and even in dialysis patients who had no blood transfusion, the frequency of anti-HCV positivity (9.2%) was greater than the healthy controls (p less than 0.01). Thus, the major route of HCV transmission in haemodialysis patients without blood transfusion may be via the haemodialysis treatment. 2) The prevalence of anti-HCV increased significantly with the ALT level and abnormal ALT activity of the anti-HCV positive group were significantly greater than that of the negative group. Thus, it is suggested that HCV infection may be an etiologic factor of liver dysfunction in haemodialysis patients.     

Seroprevalence of antibody against hepatitis C virus (anti-HCV) in various groups of individuals in Korea

We studied the prevalence of anti-HCV in 585 sera from various individuals, using enzyme immunoassay (ElA, Abbott Lab.). Anti-HCV was detected in 16 (10.7%) out of the 150 patients with HBsAg positive liver diseases diagnosed by liver biopsy and they consisted of none out of 10 acute viral hepatitis, 3 out of 15 chronic persistent hepatitis, 4 out of 50 chronic active hepatitis, 2 out of 32 liver cirrhosis, and 7 out of 43 hepatocellular carcinoma. Anti-HCV was detected in 43 (45.3%) out of 95 patients with HBsAg negative liver diseases diagnosed by liver biopsy and they consisted of 5 out of 8 acute viral hepatitis, 2 out of 10 chronic persistent hepatitis, 17 out of 30 chronic active hepatitis, 4 out of 15 liver cirrhosis, and 15 out of 32 hepatocellular carcinoma. Anti-HCV was detected in 22 (38.6%) out of 57 hemodialysis patients, in 3 (6.7%) out of 45 kidney transplants, in 2 (11.1%) out of 18 fatty liver diagnosed by liver biopsy, in 2 (1.3%) out of 150 healthy blood donors, in none out of 40 healthy volunteers, in 6 (31.6%) out of 19 rheumatoid arthritis and in 6 (54.5%) out of 11 systemic lupus erythematosis cases. There were familial clusters of chronic liver diseases in 4.7% of patients with HBsAg negative/anti-HCV positive chronic liver diseases, while in 19.4% of patients with HBsAg positive/anti-HCV negative liver diseases. Incidence of anti-HCV within patients with HBsAg positive liver diseases was higher in HBsAg negative patients than in HBsAg positive patients (17.6% and 10.3%, respectively). In hemodialysis patients, the number of hemodialysis procedures was significantly higher in anti-HCV positive patients than in anti-HCV negative patients (P<0.009), but the amount of blood transfusion showed no difference between anti-HCV positive and negative patients. We concluded that HCV might be an important cause of various types of HBsAg negative liver diseases in Korea, and intrafamilial transmission of HCV might be less common than of hepatitis B virus (HBV), and long duration of hemodialysis might be related to the increment of incidence of anti-HCV in hemodialysis units, and the high frequency of false positive anti-HCV in autoimmune disorders without evidence of any liver diseases might limit the use of the current anti-HCV tests.     

Anti-Hepatitis C Antibodies in Patients with Chronic Non-A, Non-B Hepatitis: Relation to Disease Progression and Effect of Interferon α

The activity of antibodies to hepatitis C virus (anti-HCV) was investigated in 80 patients with chronic non-A, non-B liver diseases. Serum anti-HCV titer was determined by the "Ortho-HCV" enzyme-linked immunosorbent assay with some modifications to quantify the activity. Anti-HCV was positive in 82.5% of cases (66/80). Anti-HCV occurred significantly less often in the patients with chronic persistent hepatitis (8/13, 61.5%) than in those with chronic active hepatitis (42/49, 85.7%) (p less than 0.05). Anti-HCV titer of the patients with chronic persistent hepatitis and that with chronic active hepatitis was significantly higher than that with liver cirrhosis (p less than 0.01 and p less than 0.05). There was no correlation between anti-HCV titer and histology activity index in chronic hepatitis. Serial study demonstrated that anti-HCV titer decreased more frequently in the patients who responded to IFN alpha therapy (11/22, 50.0%) than in those who did not respond to IFN alpha therapy (0/10, 0%) (p less than 0.01). These results indicate that anti-HCV level does not correlate with the activity of hepatitis, but that it decreases in accordance with the disease progression to liver cirrhosis or with the response to IFN alpha therapy.     

Prevalence of hepatitis C virus antibodies in hemodialysis patients and dialysis staff.

To estimate the prevalence of hepatitis C virus (HCV) infection in dialysis patients, serum anti-HCV antibodies were evaluated in 489 Japanese patients undergoing hemodialysis, and 152 members of the hospital dialysis staff by enzyme-linked immunosorbent assays for anti-C100, anti-KCL-163 (HCV nonstructural protein), and anti-JCC (translation product of the presumptive HCV core gene). Of the 489 hemodialysis patients, 100 (20.4%) were positive for anti-C100, 107 (21.9%) for anti-KCL-163, and 168 cases (34.4%) for anti-JCC. These rates were significantly higher than those for either the hospital staff or the healthy blood donors. Forty-two per cent of the dialysis patients were anti-HCV positive by at least one assay, suggesting that HCV infection is more common among this population than previously thought. Positivity for anti-HCV was related to the duration of hemodialysis. Elevated alanine aminotransferase levels were present in 12.5% of the dialysis patients, 77% of whom were also anti-HCV positive. The positivity rates among the 152 members of the hospital staff were 0.7% for anti-C100, 2.6% for anti-KCL-163, and 8.6% for anti-JCC, with the anti-JCC rate of positivity exceeding that of the healthy blood donors.     

Hepatitis C viremia and anti-HCV antibodies in alcoholics

We determined serum hepatitis C status using a RIBA2 kit and a sensitive PCR procedure in 62 chronic alcoholics, 36 of whom had anti-HCV antibodies (Ab) detectable in an ELISA1 assay. Anti-HCV antibodies were detected in 22 patients using RIBA2. HCV RNA was detected by means of PCR in 18 patients who were RIBA2 positive and in none who were RIBA2 negative. Liver biopsies, available for 12 HCV RNA-positive patients, revealed histological features of purely alcohol-related lesions in seven and mixed alcohol-viral lesions in five. These results indicate that HCV replication is maintained in most alcoholics who score positive for anti-HCV Ab in the RIBA2 test, and that HCV viremia can be associated with histological features typical of alcoholic liver disease.     

Hepatitis C in the general adult population of Oslo: prevalence and clinical spectrum

BACKGROUND: The prevalence of hepatitis C (HCV) in Northern Europe has not been well described. This study aimed to estimate the prevalence and spectrum of hepatitis C infection in the general adult population of Oslo, Norway. METHODS: The study was part of the Oslo Health Study 2000-2001 and included a random selection of individuals older than 30 years living in Oslo County. Sera from 11,456 participants were screened for anti-HCV (EIA-3), positive samples were confirmed (RIBA-3) and examined for HCV RNA (PCR). All anti-HCV positive patients were offered clinical evaluation. Routine biochemical liver tests were performed. Candidates for HCV treatment were asked to undergo a percutanous liver biopsy. RESULTS: Among 11,456 participants HCV RNA was detected in 62 (0.5%) and HCV RNA with raised serum alanine aminotransferase (ALT) in 46 (0.4%). Anti-HCV was detected in 78 (0.7%) with a peak prevalence of 1.5% among subjects 40 and 45 years old. Being anti-HCV positive was associated with being unmarried, unemployed and having low education. Anti-HCV prevalence was higher among subjects with alcohol-related problems compared to those without (4.4% versus 0.6%, P < 0.001). It was also higher among smokers compared to non-smokers (2.0% versus 0.2%, P < 0.001). In 33 liver biopsies, bridging fibrosis was seen in 8 (24%) and cirrhosis in 1 (3%). The route of transmission was injecting drug use in 67%, transfusion in 6% and unknown in 27%. CONCLUSION: In this population-based survey the prevalence of chronic hepatitis C was 0.5% and ALT was raised in 80% of those with chronic infection.     

Antibodies to hepatitis C virus in community-acquired acute non-A, non-B hepatitis.

Circulating antibodies to the recently identified hepatitis C virus (anti-HCV) have been investigated by ELISA in a series of 129 adult Italian patients with acute, community-acquired non-A, non-B hepatitis. Anti-HCV was detected in 50 (38%) cases with a prevalence rate which increased from 19%, in sera taken during the first 2 weeks of illness to 52% in samples obtained 5-6 weeks after onset, indicating a rather late appearance of the antibody. Anti-HCV positivity was independent of risk factors in the clinical history, but correlated with the outcome of the disease. Eighteen (26%) of 68 patients who recovered were anti-HCV positive compared to 10 of 14 (71%) who progressed to chronicity (p less than 0.01). In this latter group the antibody persisted for more than 12 months after the onset of the illness. Conversely, in 12 (85%) of 14 serially tested patients who recovered, anti-HCV positivity was transient, lasting from a few weeks to a few months. These findings indicate that HCV is implicated in a consistent proportion of acute community-acquired non-A, non-B hepatitis cases, particularly cases which progress to chronicity. A large proportion of cases remained unclassified, however, and it will be important to define whether they represent cases of HCV infection with poor serologic response, or are due instead to other, as yet unidentified, non-A, non-B agents.     

Increasing serum levels of IgM anti-HCV are diagnostic of recurrent hepatitis C in liver transplant patients with ALT flares

Summary.  Recurrent hepatitis and acute rejection share common features which make difficult for diagnosis in liver transplant hepatitis C virus (HCV) positive patients. We studied the usefulness of quantitative monitoring of HCV RNA and immunoglobulin (Ig)M anti-HCV in the differential diagnosis between recurrent hepatitis and acute rejection in 98 consecutive anti-HCV positive liver transplant patients. Aminotransferase levels, serum HCV RNA and IgM anti-HCV were measured at the time of transplantation and monthly thereafter. A liver biopsy (LB) was obtained when serum aminotransferase levels increased to twice or more than normal. During a mean follow-up of 16 months 86 aminotransferase flares were observed. Histology was compatible with recurrent hepatitis C in 44 cases and with acute rejection in 28, doubtful in 14. The fluctuations of HCV RNA serum levels were not significantly different in the three groups. Serum IgM anti-HCV levels increased (from negative to positive or with value variations ≥ 0.18) in 36 of 44 cases with recurrent hepatitis C at the time of alanine aminotransferase (ALT) flare. IgM anti-HCV remained unchanged in all rejection cases ( P  < 0.001), but increased in 10 of 11 histologically doubtful cases that were diagnosed as hepatitis at the second LB. Increasing serum levels of IgM anti-HCV at the time of ALT flares are significantly associated with recurrent hepatitis C in liver transplant patients. The quantitative monitoring of IgM anti-HCV appears to be an additional diagnostic tool for distinguishing recurrent hepatitis C from acute graft rejection with a 100% specificity; 100% positive predictive value and 88.9% diagnostic accuracy.     

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.     

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.     

Antibody to hepatitis C virus and liver disease in volunteer blood donors

OBJECTIVE: To evaluate the specificity of antibodies to hepatitis C virus (anti-HCV) and their relation to liver disease in blood donors. DESIGN: Case series of consecutive blood donors found positive for anti-HCV by enzyme-linked immunosorbent assay (ELISA). Patients were evaluated for antibody specificity using a recombinant immunoblotting assay (RIBA) and were evaluated for biochemical evidence of liver disease. Patients showing increased alanine aminotransferase (ALT) levels had a liver biopsy. SETTING: University hospital. PARTICIPANTS: Fifty consecutive blood donors found to be anti-HCV positive on both an initial and repeat ELISA. Inclusion criteria were as follows: an absence of hepatitis B surface antigens and non-organ-specific autoantibodies; a daily alcohol intake of less than 50 g; no history of recent hepatotoxic drug use; and normal serum levels of alpha 1 antitrypsin, ceruloplasmin, and copper. MAIN RESULTS: Anti-HCV positivity was confirmed by RIBA in only 13 of 50 donors (26%) who had positive ELISA results. These 13 donors had an elevated ALT level and histologic evidence of chronic hepatitis, which was active in 8 patients (62%) and had already produced cirrhosis in 2 patients (15%). In contrast, the 17 donors with an intermediate RIBA pattern had only mild and often nonspecific histologic liver abnormalities. The 20 patients with a negative RIBA result had normal ALT levels. CONCLUSION: In blood donors, the anti-HCV RIBA is not only more specific than the anti-HCV ELISA, but is also useful in identifying patients who have an underlying chronic liver disease.     

Prevalence of hepatitis C virus antibody in an area endemic for hepatitis B virus and human T cell leukaemia virus

To clarify the prevalence of concurrent infection with hepatitis C virus (HCV), hepatitis B virus (HBV) and human T cell leukaemia virus (HTLV), we measured HCV antibody in the population of a district endemic for HBV and HTLV infection. Blood samples were collected in June 1990 from 579 inhabitants of four islands of Uwa Bay in the southwest of Ehime Prefecture in Japan. Anti-HCV antibody against C100-3 protein was detected using an enzyme-linked immunosorbent assay kit (Ortho Diagnostics). Thirteen of the 579 inhabitants (2.2%) were positive for anti-HCV, and this prevalence rate was not significantly different from the frequency of anti-HCV in Tokyo blood donors. A total of 11% (64 of 579) of the subjects were positive for HBsAg and 3.3% (19 of 579) were positive for anti-HTLV. These frequencies of HBsAg and anti-HTLV positivity were distinctly higher than the respective means of Japanese. All anti-HCV positive individuals were negative for HBsAg and anti-HTLV, while 54% (7 of 13) had increased alanine aminotransferase levels. These data suggest that the prevalence of HCV infection is not high even in an area endemic for HBV and HTLV infection.