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High Rate of Infectivity and Liver Disease in Blood Donors with Antibodies to Hepatitis C Virus

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; and Jaime Guardia, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by grants 88/0221 from the Comisión Interministerial de Ciencia y Tecnologia and 84/849 and 89/0399 from the Fondo de Investigaciones Sanitarias de la Seguridad Social.

Requests for Reprints: Juan I. Esteban, MD, Liver Unit, Hospital General Universitari Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Current Author Addresses: Drs. J. Esteban, López-Talavera, Genescá, Rosell, Gonzalez, R. Esteban, and Guardia; Liver Unit, Department of Medicine, Hospital General Universitari Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Drs. Madoz and Muñiz: Blood Bank, Hospital Santa Creu i Sant Pau, Avenida San Antoni Maria Claret 167, 08025 Barcelona, Spain.

Dr. Viladomiu: Department of Transfusion Medicine, Clinical Center, Building 10, Room 5256, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

Dr. Martin-Vega: Blood Bank, Institut Catalá de la Salut, Hospital General Universitari Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Dr. Allende: Department of Pathology, Hospital General Universitari, Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Dr. Vidal: Department of Clinical Pharmacology, Hospital General Universitari, Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Dr. Hernandez: Hematology-Hemotherapy Service, Department of Medicine, Hospital General Universitari, Vall d'Hebrón, Passeig Vall d'Hebrón s/n, 08035 Barcelona, Spain.

Ann Intern Med. 1991;115(6):443-449. doi:10.7326/0003-4819-115-6-443
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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.





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