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.
King, L. A., Le Strat, Y., Meffre, C., Delarocque-Astagneau, E., Desenclos, J.-C.
(2009). Assessment and proposal of a new combination of screening criteria for hepatitis C in France. Eur J Public Health
19: 527-533
[Abstract][Full Text]
Freudenreich, O., Gandhi, R. T., Walsh, J. P., Henderson, D. C., Goff, D. C.
(2007). Hepatitis C in Schizophrenia: Screening Experience in a Community-Dwelling Clozapine Cohort. Psychosomatics
48: 405-411
[Abstract][Full Text]
Armstrong, G. L., Wasley, A., Simard, E. P., McQuillan, G. M., Kuhnert, W. L., Alter, M. J.
(2006). The Prevalence of Hepatitis C Virus Infection in the United States, 1999 through 2002. ANN INTERN MED
144: 705-714
[Abstract][Full Text]
Dienstag, J. L.
(2006). Hepatitis C: A Bitter Harvest. ANN INTERN MED
144: 770-771
[Full Text]
Wong, T., Lee, S. S.
(2006). Hepatitis C: a review for primary care physicians. CMAJ
174: 649-659
[Abstract][Full Text]
Zhang, M., Rosenberg, P. S., Brown, D. L., Preiss, L., Konkle, B. A., Eyster, M. E., Goedert, J. J., for the Second Multicenter Hemophilia Cohort Study,
(2006). Correlates of spontaneous clearance of hepatitis C virus among people with hemophilia. Blood
107: 892-897
[Abstract][Full Text]
Bair, R. M., Baillargeon, J. G., Kelly, P. J., Lerand, S. J., Williams, J. F., Lyerla, R., Alter, M. J.
(2005). Prevalence and Risk Factors for Hepatitis C Virus Infection Among Adolescents in Detention. Arch Pediatr Adolesc Med
159: 1015-1018
[Abstract][Full Text]
Vecchiet, J., Falasca, K., Cacciatore, P., Zingariello, P., Dalessandro, M., Marinopiccoli, M., D'Amico, E., Palazzi, C., Petrarca, C., Conti, P., Pizzigallo, E., Guagnano, M. T.
(2005). Association between Plasma Interleukin-18 Levels and Liver Injury in Chronic Hepatitis C Virus Infection and Non-Alcoholic Fatty Liver Disease. Annals of Clinical & Laboratory Science
35: 415-422
[Abstract][Full Text]
Nguyen, M. T., Herrine, S. K., Laine, C. A., Ruth, K., Weinberg, D. S.
(2005). Description of a New Hepatitis C Risk Assessment Tool. Arch Intern Med
165: 2013-2018
[Abstract][Full Text]
MENDES-CORREA, M. C. J., BARONE, A. A., GIANINI, R. J.
(2005). RISK FACTORS ASSOCIATED WITH HEPATITIS C AMONG PATIENTS CO-INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS: A CASE-CONTROL STUDY. Am J Trop Med Hyg
72: 762-767
[Abstract][Full Text]
Lo Re, V III, Kostman, J R
(2005). Management of chronic hepatitis C. Postgrad. Med. J.
81: 376-382
[Abstract][Full Text]
Yovtcheva, S. P., Rifai, M. A., Moles, J. K., Van Der Linden, B. J.
(2005). Psychiatric Comorbidity Among Hepatitis C-Positive Patients. Focus
3: 261-265
[Abstract][Full Text]
Bigger, C. B., Guerra, B., Brasky, K. M., Hubbard, G., Beard, M. R., Luxon, B. A., Lemon, S. M., Lanford, R. E.
(2004). Intrahepatic Gene Expression during Chronic Hepatitis C Virus Infection in Chimpanzees. J. Virol.
78: 13779-13792
[Abstract][Full Text]
DiMartini, A., Dew, M. A., Javed, L., Fitzgerald, M. G., Jain, A., Day, N.
(2004). Pretransplant Psychiatric and Medical Comorbidity of Alcoholic Liver Disease Patients Who Received Liver Transplant. Psychosomatics
45: 517-523
[Abstract][Full Text]
Matthews, J. D., Bini, E. J.
(2004). Epidemiology, Diagnosis, and Treatment of Chronic Hepatitis C. Journal of Pharmacy Practice
17: 229-238
[Abstract]
Chou, R., Clark, E. C., Helfand, M.
(2004). Screening for Hepatitis C Virus Infection: A Review of the Evidence for the U.S. Preventive Services Task Force. ANN INTERN MED
140: 465-479
[Abstract][Full Text]
Zwahlen, M., Vlahov, D.
(2003). Commentary: Modelling and understanding differences in human immunodeficiency and hepatitis C virus epidemiology in injection drug users. Int J Epidemiol
32: 715-716
[Full Text]
Pappalardo, B. L
(2003). Influence of maternal human immunodeficiency virus (HIV) co-infection on vertical transmission of hepatitis C virus (HCV): a meta-analysis. Int J Epidemiol
32: 727-734
[Abstract][Full Text]
Turner, N. C., Dusheiko, G., Jones, A.
(2003). Hepatitis C and B-cell lymphoma. Ann Oncol
14: 1341-1345
[Abstract][Full Text]
Henderson, D. K.
(2003). Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting. Clin. Microbiol. Rev.
16: 546-568
[Abstract][Full Text]
Haley, R. W., Fischer, R. P.
(2003). The Tattooing Paradox: Are Studies of Acute Hepatitis Adequate to Identify Routes of Transmission of Subclinical Hepatitis C Infection?. Arch Intern Med
163: 1095-1098
[Abstract][Full Text]
Sulkowski, M. S., Thomas, D. L.
(2003). Hepatitis C in the HIV-Infected Person. ANN INTERN MED
138: 197-207
[Abstract][Full Text]
Weisbord, J S, Trepka, M J, Zhang, G, Smith, I P, Brewer, T
(2003). Prevalence of and risk factors for hepatitis C virus infection among STD clinic clientele in Miami, Florida. Sex. Transm. Infect.
79: e1-1
[Abstract][Full Text]
Felker, B. L., Sloan, K. L., Dominitz, J. A., Barnes, R. F.
(2003). The Safety of Valproic Acid Use for Patients With Hepatitis C Infection. Am. J. Psychiatry
160: 174-178
[Abstract][Full Text]
Murray, K. F., Richardson, L. P., Morishima, C., Owens, J. W. M., Gretch, D. R.
(2003). Prevalence of Hepatitis C Virus Infection and Risk Factors in an Incarcerated Juvenile Population: A Pilot Study. Pediatrics
111: 153-157
[Abstract][Full Text]
Lanford, R. E., Guerra, B., Lee, H., Averett, D. R., Pfeiffer, B., Chavez, D., Notvall, L., Bigger, C.
(2002). Antiviral Effect and Virus-Host Interactions in Response to Alpha Interferon, Gamma Interferon, Poly(I)-Poly(C), Tumor Necrosis Factor Alpha, and Ribavirin in Hepatitis C Virus Subgenomic Replicons. J. Virol.
77: 1092-1104
[Abstract][Full Text]
Tanaka, Y., Hanada, K., Mizokami, M., Yeo, A. E. T., Shih, J. W.-K., Gojobori, T., Alter, H. J.
(2002). Inaugural Article: A comparison of the molecular clock of hepatitis C virus in the United States and Japan predicts that hepatocellular carcinoma incidence in the United States will increase over the next two decades. Proc. Natl. Acad. Sci. USA
99: 15584-15589
[Abstract][Full Text]
Prati, D., Taioli, E., Zanella, A., Torre, E. D., Butelli, S., Del Vecchio, E., Vianello, L., Zanuso, F., Mozzi, F., Milani, S., Conte, D., Colombo, M., Sirchia, G.
(2002). Updated Definitions of Healthy Ranges for Serum Alanine Aminotransferase Levels. ANN INTERN MED
137: 1-10
[Abstract][Full Text]
Herrine, S. K.
(2002). Approach to the Patient with Chronic Hepatitis C Virus Infection. ANN INTERN MED
136: 747-757
[Abstract][Full Text]
Page-Shafer, K. A., Cahoon-Young, B., Klausner, J. D., Morrow, S., Molitor, F., Ruiz, J., McFarland, W.
(2002). Hepatitis C Virus Infection in Young, Low-Income Women: The Role of Sexually Transmitted Infection as a Potential Cofactor for HCV Infection. AJPH
92: 670-676
[Abstract][Full Text]
Yovtcheva, S. P., Rifai, M. A., Moles, J. K., Van Der Linden, B. J.
(2001). Psychiatric Comorbidity Among Hepatitis C-Positive Patients. Psychosomatics
42: 411-415
[Abstract][Full Text]
Patrick, D. M., Tyndall, M. W., Cornelisse, P. G.A., Li, K., Sherlock, C. H., Rekart, M. L., Strathdee, S. A., Currie, S. L., Schechter, {d.{d., O'Shaughnessy, M. V.
(2001). Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. CMAJ
165: 889-895
[Abstract][Full Text]
Nelson, K. E., Thomas, D. L.
(2001). Reciprocal Interaction of Human Immunodeficiency Virus and Hepatitis C Virus Infections. CVI
8: 867-870
[Full Text]
Walsh, K, Alexander, G J M
(2001). Update on chronic viral hepatitis. Postgrad. Med. J.
77: 498-505
[Abstract][Full Text]
Lauer, G. M., Walker, B. D.
(2001). Hepatitis C Virus Infection. NEJM
345: 41-52
[Full Text]
Mohsen, A H, Group, T. H. S.
(2001). The epidemiology of hepatitis C in a UK health regional population of 5.12 million. Gut
48: 707-713
[Abstract][Full Text]
ROSENBERG, W
(2000). Screening and shouting about HCV. Gut
47: 165-166
[Full Text]
Strickland, D. K., Riely, C. A., Patrick, C. C., Jones-Wallace, D., Boyett, J. M., Waters, B., Fleckenstein, J. F., Dean, P. J., Davila, R., Caver, T. E., Hudson, M. M.
(2000). Hepatitis C infection among survivors of childhood cancer. Blood
95: 3065-3070
[Abstract][Full Text]
Murphy, E. L., Bryzman, S., Williams, A. E., Dore, G. J., Law, M. G., Kaldor, J. M., Stroffolini, T., D'Argenio, P., Mele, A., Alter, M. J., Kruszon-Moran, D., McQuillan, G. M.
(1999). Prevalence of Hepatitis C Virus Infection in the United States. NEJM
341: 2093-2095
[Full Text]
Vogt, M., Lang, T., Frosner, G., Klingler, C., Sendl, A. F., Zeller, A., Wiebecke, B., Langer, B., Meisner, H., Hess, J.
(1999). Prevalence and Clinical Outcome of Hepatitis C Infection in Children Who Underwent Cardiac Surgery before the Implementation of Blood-Donor Screening. NEJM
341: 866-870
[Abstract][Full Text]
Alter, M. J., Kruszon-Moran, D., Nainan, O. V., McQuillan, G. M., Gao, F., Moyer, L. A., Kaslow, R. A., Margolis, H. S.
(1999). The Prevalence of Hepatitis C Virus Infection in the United States, 1988 through 1994. NEJM
341: 556-562
[Abstract][Full Text]
Beld, M., Penning, M., van Putten, M., van den Hoek, A., Damen, M., Klein, M. R., Goudsmit, J.
(1999). Low Levels of Hepatitis C Virus RNA in Serum, Plasma, and Peripheral Blood Mononuclear Cells of Injecting Drug Users During Long Antibody-Undetectable Periods Before Seroconversion. Blood
94: 1183-1191
[Abstract][Full Text]
Bellentani, S, Pozzato, G, Saccoccio, G, Crovatto, M, Croce, L S, Mazzoran, L, Masutti, F, Cristianini, G, Tiribelli, C
(1999). Clinical course and risk factors of hepatitis C virus related liver disease in the general population: report from the Dionysos study. Gut
44: 874-880
[Abstract][Full Text]
Kenny-Walsh, E., The Irish Hepatology Research Group,
(1999). Clinical Outcomes after Hepatitis C Infection from Contaminated Anti-D Immune Globulin. NEJM
340: 1228-1233
[Abstract][Full Text]
Stapleton, J. T., Klinzman, D., Schmidt, W. N., Pfaller, M. A., Wu, P., LaBrecque, D. R., Han, J.-q., Phillips, M. J. P., Woolson, R., Alden, B.
(1999). Prospective Comparison of Whole-Blood- and Plasma-Based Hepatitis C Virus RNA Detection Systems: Improved Detection Using Whole Blood as the Source of Viral RNA. J. Clin. Microbiol.
37: 484-489
[Abstract][Full Text]
Goodnough, L. T., Brecher, M. E., Kanter, M. H., AuBuchon, J. P.
(1999). Transfusion Medicine -- Blood Transfusion- First of Two Parts. NEJM
340: 438-447
[Full Text]
Beld, M., Penning, M., McMorrow, M., Gorgels, J., van den Hoek, A., Goudsmit, J.
(1998). Different Hepatitis C Virus (HCV) RNA Load Profiles Following Seroconversion among Injecting Drug Users without Correlation with HCV Genotype and Serum Alanine Aminotransferase Levels. J. Clin. Microbiol.
36: 872-877
[Abstract][Full Text]
Callen, J. P.
(1998). Cutaneous Vasculitis: What Have We Learned in the Past 20 Years?. Arch Dermatol
134: 355-357
[Full Text]
Bronowicki, J.-P., Venard, V., Botte, C., Monhoven, N., Gastin, I., Chone, L., Hudziak, H., Rhin, B., Delanoe, C., LeFaou, A., Bigard, M.-A., Gaucher, P.
(1997). Patient-to-Patient Transmission of Hepatitis C Virus during Colonoscopy. NEJM
337: 237-240
[Full Text]
Hoofnagle, J. H., Di Bisceglie, A. M.
(1997). The Treatment of Chronic Viral Hepatitis. NEJM
336: 347-356
[Full Text]
Holland, P. V.
(1996). Viral Infections and the Blood Supply. NEJM
334: 1734-1735
[Full Text]
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