Routes of Infection, Viremia, and Liver Disease in Blood Donors Found to Have Hepatitis C Virus Infection
Cathy Conry-Cantilena, M.D., Mark VanRaden, M.A., Joan Gibble, M.D., Jacqueline Melpolder, M.T.(A.S.C.P.), A. Obaid Shakil, M.B., B.S., Luis Viladomiu, M.D., Ling Cheung, M.D., Adrian DiBisceglie, M.D., Jay Hoofnagle, M.D., James W. Shih, Ph.D., Richard Kaslow, M.D., Paul Ness, M.D., and Harvey J. Alter, M.D.
Background For many people infected with the hepatitis C virus(HCV), the route of exposure, risk of transmission, and severityof associated liver disease are unknown. We studied these variablesin people who donated blood voluntarily.
Methods Blood donors who tested positive for HCV antibodieson enzyme immunoassay were classified according to whether theresults of a confirmatory second-generation recombinant immunoblotassay (RIBA) for HCV were positive, negative, or indeterminate.The evaluations also included an assessment of risk factors,a physical examination, serial determinations of alanine aminotransferaselevels and HCV serologic assays, a polymerase-chain-reactionassay for HCV RNA, testing of sexual contacts and family members,and liver biopsies in some participants who were HCV-positiveby RIBA.
Results A total of 481 donors were studied, among whom 248 werepositive for HCV by RIBA, 102 had indeterminate results, and131 were HCV-negative. In a logistic-regression analysis, significantrisk factors for HCV infection among the HCV-positive participantswere a history of blood transfusion in 66 (27 percent; P<0.001for the comparison with RIBA-negative donors), intranasal cocaineuse in 169 (68 percent, P<0.001), intravenous drug use in103 (42 percent, P = 0.001), sexual promiscuity in 132 (53 percent,P = 0.002), and ear piercing among men (P<0.05). Nine of85 sexual partners of HCV-positive donors were anti-HCV–positive;8 had used intravenous drugs or received transfusions. HCV RNAwas found in 213 HCV-positive donors (86 percent), 3 who hadindeterminate results by RIBA (2 of these 3 tested positivewith a more specific, third-generation RIBA), and none who wereHCV-negative. Of the HCV-positive donors, 69 percent had biochemicalevidence of chronic liver disease; among 77 donors positivefor HCV by RIBA who underwent liver biopsy, 5 had severe chronichepatitis or cirrhosis, 66 had mild-to-moderate chronic hepatitis,and 6 had no evidence of hepatitis.
Conclusions Among volunteer blood donors, prior blood transfusion,intranasal cocaine use, intravenous drug use, sexual promiscuity,and ear piercing in men are risk factors for HCV infection.The high frequency of intravenous drug use was unexpected, becausethese donors had denied such use when questioned directly atthe time of their blood donations.
Source Information
From the Department of Transfusion Medicine (C.C.-C., J.M., L.C., J.W.S., H.J.A.), the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (M.V., R.K.), and the National Institute of Diabetes and Digestive and Kidney Diseases (A.O.S., J.H.), National Institutes of Health, Bethesda, Md.; the Greater Chesapeake and Potomac Region American Red Cross, Baltimore (J.G., P.N.); the Hospital General Vall d'Hebron, Barcelona, Spain (L.V.); and the Department of Internal Medicine, St. Louis University Health Science Center, St. Louis (A.D.).
Address reprint requests to Dr. Conry-Cantilena at Bldg. 10, Rm. 1C711, Department of Transfusion Medicine, National Institutes of Health, Bethesda, MD 20892.
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