Juan Ignacio Esteban, MD; Juan Carlos López-Talavera, MD; Juan Genescà, MD; Pedro Madoz, MD; Luis Viladomiu, MD; Eduardo Muñiz, MD; Carmen Martin-Vega, MD; Manuel Rosell, MD; Helena Allende, MD; Xavier Vidal, MD; Antonio González, MD; Jose Manuel Hernández, MD; Rafael Esteban, MD; Jaime Guardia, MD
▪Objective: To determine the epidemiologic, clinical, serologic, and histologic importance of antibodies to hepatitis C virus (anti-HCV) in blood donors.
▪Design: Cross-sectional identification and prospective evaluation of seropositive donors; retrospective assessment of infectivity; and nested case-control study for risk factors.
▪Setting: Liver unit of a referral-based university hospital.
▪Subjects: Of 30 231 consecutive donors, 368 (1. 2%) were found to be anti-HCV-reactive by enzyme-linked immunosorbent assay (ELISA). Two hundred and fifty-four of these 368 donors were evaluated for risk factors by comparison with 284 age- and sex-matched controls. Eighty-six spouses of seropositive donors were also evaluated.
▪Measurements and Main Results: Twenty-four percent of the seropositive donors had a history of percutaneous exposure to blood. This rate increased to 45% when only those donors confirmed to be anti-HCV positive by a second-generation recombinant immunoblot assay (RIBA-2) were considered. A family history of liver disease (odds ratio, 2.8; 95% Cl, 1.6 to 4.8), previous blood transfusion (odds ratio, 6.1; 95% Cl, 3 to 12.5), and a history of tattooing or intravenous drug abuse (odds ratio, 8.4; 95% Cl, 2.3 to 31) were associated with anti-HCV seropositivity. An elevated alanine aminotransferase (ALT) level was found in 58% of the seropositive donors. Of the 150 donors tested, 104 (69%; Cl, 62% to 77%) were confirmed by RIBA-2 to be anti-HCV positive. Of the 105 donors who had a biopsy, 16% had normal histologic findings, 11 % had minimal changes, 21% had chronic persistent hepatitis, 45% had chronic active hepatitis, and 7% had active cirrhosis. All 77 donors with RIBA-2-confirmed seropositivity had histologic abnormalities. Of 43 donors evaluated in an infectivity study, 82% were implicated in previous HCV transmission. Only 2.3% of the spouses were anti-HCV positive. The ELISA, RIBA-2, and ALT results correlated with infectivity and abnormal histologic findings.
▪Conclusions: In our geographic area, almost 70% of donors who are anti-HCV positive by ELISA are confirmed to be positive by RIBA-2; most of these donors appear to be chronic carriers of HCV and have substantial liver disease.
Esteban JI, López-Talavera JC, Genescà J, Madoz P, Viladomiu L, Muñiz E, et al. High Rate of Infectivity and Liver Disease in Blood Donors with Antibodies to Hepatitis C Virus. Ann Intern Med. ;115:443–449. doi: 10.7326/0003-4819-115-6-443
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Published: Ann Intern Med. 1991;115(6):443-449.
Gastroenterology/Hepatology, Infectious Disease, Liver Disease, Viral Hepatitis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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