High rate of infectivity and liver disease in blood donors with antibodies to hepatitis C virus. Ann Intern Med 1991;
ABSTRPlCT 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 casecontrol 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% CI, 1.6 to 4.8), previous blood transfusion (odds ratio, 6.1; 95% CI, 3 to 12.5), and a history of tattooing or intravenous drug abuse (odds ratio, 8.4; 95% CI, 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%; CI, 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-S; most of these donors appear to be chronic carriers of HCV and have substantial liver disease.