High rate of infectivity and liver disease in blood donors with antibodies to hepatitis C virus

Article Abstract:

Generally, the presence of antibodies against a virus in the blood of patients suggests previous exposure to that virus with immunity to it. Antibodies against hepatitis C virus (HCV), the major cause of transfusion-induced hepatitis, do not suggest immunity to HCV, but indicate ongoing infectivity. Only in recent months has a test been available to detect these antibodies, but because some research has suggested that only approximately 20 percent of HCV-positive donors will infect recipients, this test may not be cost-effective to perform on all donated blood. A study of over 30,000 blood donors was done to determine (retrospectively) the prevalence of HCV antibodies and the rate of hepatitis C transmission. A total of 368 donors were identified as HCV-positive, but only 254 were available for follow-up study. Factors found to be significant risks for HCV infection in the donors were having family members with chronic liver disease, a history of blood transfusion or major surgery, a history of hepatitis, a history of intravenous drug use or tattooing, and a history of acupuncture. None of the positive donors in the follow-up study had symptoms of liver disease at the time of donation or at follow-up. However, 9 percent had physical signs of liver disease, such as an enlarged liver. Nearly 40 percent of the donors had abnormal liver blood tests, and out of over 100 subjects who underwent liver biopsy, 84 percent had microscopic abnormalities. Evaluation of those donors for whom sufficient information was available to determine how infectious they were showed that 84 percent of the donors infected their recipients with HCV. This study demonstrates that HCV generally produces liver disease, at least on biopsy, and that it is more infectious than originally assumed. Potential blood donors identified as HCV-positive should be monitored carefully, as they may be at higher risk for liver disease than previously believed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Blood donors, Blood donation

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Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis

Article Abstract:

Hepatitis is a known risk of blood transfusions. It has recently been determined that most cases of hepatitis caused by blood transfusion are of the type known as non-A non-B (NANB) hepatitis. This name was chosen because the disease was found to be different from hepatitis A and hepatitis B, but the actual causative agent had not been identified. It now appears likely that the cause of NANB hepatitis is the hepatitis C virus (HCV). The risk of transmission of hepatitis has been estimated at between 2.5 to 15 percent of transfused patients. Recently the exclusion of high-risk donors and testing of blood have decreased the risk of becoming infected with the virus following a transfusion. In approximately 50 percent of patients who do become infected, the condition becomes chronic. Laboratory tests can identify both the virus itself and the antibodies that infected individuals develop against the virus. It is important to understand that the presence of anti-HCV antibodies indicates infection by the virus rather than immunity to it. A group of 280 patients who received 1,109 units of blood had an NANB infection rate of 9.6 percent (27 cases detected). Of this group, 24 were found to have anti-HCV antibodies (seroconverted). When an analysis of 1,044 samples of the transfused blood was performed, 16 units or 1.5 percent were seen to be positive for the anti-HCV antibody. Of those 16 patients who had been transfused with this contaminated blood, 14 (88 percent) had hepatitis and had seroconverted. The other two patients remained seronegative and did not develop hepatitis. The data establish that blood donors who test positively for the HCV antibody indeed have HCV infections. Routine screening for anti-HCV antibody should greatly reduce the number of transfusion-related infections. However, there remain some donors who do not seroconvert, but who are nevertheless infected with HCV. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Antigen-antibody reactions

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Transmission of hepatitis C virus by a cardiac surgeon

Article Abstract:

Surgical patients may contract hepatitis C virus (HCV) from their surgeon. Investigators tracked down 222 other patients of a HCV-positive surgeon after two patients contracted hepatitis C following heart surgery. Six patients had become infected with HCV within 6 to 12 weeks after surgery, and none had been transfused with infected blood products. Genetic analysis revealed that five of the six shared the same viral subtype with the heart surgeon. Transmission may have occurred when the surgeon sutured the breastbone closed with wire, a procedure known to cause glove perforations. This speculation is supported by the fact that HCV transmission only occurred when he was the primary surgeon and not when he was the assisting surgeon.

Surgeons, Nosocomial infections, Cross infection

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