RESUMEN

This study examines the relationship between HCV-RNA levels and disease severity in 60 individuals with chronic hepatitis C virus infection. HCV-RNA levels were quantified by the branched DNA (bDNA) assay in 445 samples (median: eight samples per patient) obtained over a median of 40.4 months (95% confidence interval (CI): 37.0-42.5). The median log HCV-RNA level was 6.77 (95% CI: 6.62-6.92) molecular equivalents/mL (MEQ/mL). The median log range of HCV-RNA levels in individual patients over the course of the study was 0.89 (95% CI: 0.69-1.16). HCV-RNA level varied over time by less than one log in 62% of patients, by 1-1.5 logs in 22% and by greater than 1.5 logs in only 17%. Univariate analysis, revealed an inverse association between HCV-RNA levels and ALT levels (P=0.037). Univariate and logistic regression analysis showed no significant association between HCV-RNA levels and either the degree of inflammation or fibrosis. In contrast, there was a significant positive association between alanine aminotransferase (ALT) levels and histological activity especially in individuals with ALTs> 100 IU/L. Hence, HCV-RNA levels: (i) almost always fell within the dynamic range of the bDNA assay; (ii) were stable in asymptomatic chronically infected patients, with only a small proportion of patients exceeding a range of 1.5 logs; (iii) did not correlate with either the extent of inflammation or degree of fibrosis. In contrast, there was a strong association between ALT level and the histological severity of liver disease.

Asunto(s)

Hepacivirus/genética , Hepatitis C Crónica/virología , ARN Viral/sangre , Adulto , Alanina Transaminasa/metabolismo , Femenino , Genotipo , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/sangre , Hepatitis C Crónica/fisiopatología , Humanos , Hígado/enzimología , Hígado/patología , Cirrosis Hepática/sangre , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Análisis de Regresión

RESUMEN

This study was performed to compare the vigor and phenotype of virus-specific CD4(+) and CD8(+) T-cell responses in patients with different virologic and clinical outcomes after hepatitis C virus (HCV) infection. The results show that a vigorous and multispecific CD4(+) proliferative T-cell response is maintained indefinitely after recovery from HCV infection whereas it is weak and focused in persistently infected patients. In contrast, the HCV-specific CD8(+) T-cell response was quantitatively low in both groups despite the use of sensitive direct ex vivo intracellular interferon gamma (IFN-gamma) staining. Furthermore, although HCV-specific cytolytic CD8(+) memory T cells were undetectable ex vivo, they were readily expanded from the peripheral blood of chronically HCV-infected patients but not from recovered subjects after in vitro stimulation, suggesting that ongoing viremia is required to maintain the HCV-specific memory CD8(+) T-cell response. HCV-specific CD8(+) T cells displayed a type 1 cytokine profile characterized by production of IFN-gamma despite persistent HCV viremia. The paradoxical observation that HCV-specific CD4(+) T cells survive and CD8(+) T cells are lost after viral clearance while the opposite occurs when HCV persists suggests the existence of differential requirements for the maintenance of CD4(+) and CD8(+) T-cell memory during HCV infection. Furthermore, the relative rarity of circulating CD8(+) effector T cells in chronically infected patients may explain the chronic insidious nature of the liver inflammation and also why they fail to eliminate the virus.

Asunto(s)

Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Hepatitis C Crónica/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Linfocitos T CD4-Positivos/patología , Linfocitos T CD4-Positivos/fisiología , Linfocitos T CD8-positivos/metabolismo , Linfocitos T CD8-positivos/patología , Linfocitos T CD8-positivos/fisiología , Línea Celular , Supervivencia Celular , Citocinas/metabolismo , Femenino , Hepacivirus/inmunología , Hepatitis C Crónica/patología , Humanos , Memoria Inmunológica , Interferón gamma/metabolismo , Masculino , Persona de Mediana Edad , Péptidos/farmacología

RESUMEN

The mechanisms by which hepatitis C virus (HCV) induces chronic infection in the vast majority of infected individuals are unknown. Sequences within the HCV E1 and E2 envelope genes were analyzed during the acute phase of hepatitis C in 12 patients with different clinical outcomes. Acute resolving hepatitis was associated with relative evolutionary stasis of the heterogeneous viral population (quasispecies), whereas progressing hepatitis correlated with genetic evolution of HCV. Consistent with the hypothesis of selective pressure by the host immune system, the sequence changes occurred almost exclusively within the hypervariable region 1 of the E2 gene and were temporally correlated with antibody seroconversion. These data indicate that the evolutionary dynamics of the HCV quasispecies during the acute phase of hepatitis C predict whether the infection will resolve or become chronic.

Asunto(s)

Evolución Molecular , Hepacivirus/genética , Hepatitis C Crónica/virología , Hepatitis C/virología , Proteínas del Envoltorio Viral/genética , Enfermedad Aguda , Adulto , Anciano , Anticuerpos Antivirales , Progresión de la Enfermedad , Femenino , Genes Virales , Variación Genética , Hepacivirus/inmunología , Hepacivirus/fisiología , Hepatitis C/inmunología , Anticuerpos contra la Hepatitis C/biosíntesis , Hepatitis C Crónica/inmunología , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Filogenia , Estudios Prospectivos , Selección Genética , Factores de Tiempo , Proteínas del Envoltorio Viral/inmunología , Replicación Viral

RESUMEN

Serologic, biochemical, and molecular analyses were used to study hepatitis G virus (HGV), antibody to the HGV envelope protein (anti-E2), risk factors, clinical significance, and the impact of HGV on coexistent hepatitis C virus (HCV). Among 329 donors with confirmed HCV infection, 12% were HGV RNA-positive and 44% were anti-E2-positive (total exposure, 56%). HGV RNA and anti-E2 were mutually exclusive except in 9 donors (1.5%); 8 of 9 subsequently lost HGV RNA but anti-E2 persisted. HGV had little impact on alanine aminotransferase, aspartate aminotransferase, or gamma-glutamyl transpeptidase in donors with HGV infection alone or those coinfected with HCV. A multivariate analysis showed that intravenous drug abuse was the leading risk factor for HGV transmission, followed by blood transfusion, snorting cocaine, imprisonment, and a history of sexually transmitted diseases. In summary, HGV and HCV infections were frequently associated and shared common parenteral risk factors; HGV did not appear to cause hepatitis or to worsen the course of coexistent hepatitis C.

Asunto(s)

Flaviviridae/aislamiento & purificación , Anticuerpos Antihepatitis/sangre , Hepatitis C/complicaciones , Hepatitis Viral Humana/complicaciones , Hepatitis Viral Humana/transmisión , ARN Viral/sangre , Adulto , Donantes de Sangre , Digoxigenina , Femenino , Flaviviridae/genética , Flaviviridae/inmunología , Hepacivirus/inmunología , Hepatitis C/transmisión , Hepatitis C/virología , Hepatitis Viral Humana/inmunología , Hepatitis Viral Humana/virología , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Proteínas del Envoltorio Viral/inmunología

Asunto(s)

Donantes de Sangre , Trastornos Relacionados con Sustancias/epidemiología , Administración Intranasal , Adulto , Cocaína/administración & dosificación , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Maryland/epidemiología , Minnesota/epidemiología , Trastornos Relacionados con Sustancias/sangre

RESUMEN

Among 248 asymptomatic blood donors positive for antibody to hepatitis C virus (anti-HCV) enrolled in a long-term prospective study, 86% had chronic HCV infection and 14% appeared to have recovered as assessed by serial determinations of serum alanine aminotransferase (ALT) levels and HCV RNA by polymerase chain reaction. Established parenteral risk factors for HCV transmission were identified in 75% of donors. In addition, there was a strong independent association between HCV positivity and cocaine snorting, suggesting that shared snorting devices may be a covert route of parenteral transmission. Ear piercing in males was also significantly associated with transmission. There was no evidence for sexual spread. Although the majority of HCV carriers had both biochemical and histological evidence of chronic viral hepatitis, the extent of liver injury was generally mild. Among a larger population of 280 HCV RNA-positive donors, 17% had repeatedly normal ALT levels, 45% had levels that did not exceed twice, and only 22% had levels that exceeded five times the upper limit of the normal range. Among 81 patients who underwent liver biopsy, only 13% had evidence of severe hepatitis (8%) or cirrhosis (5%), despite a duration of infection that generally exceeded 15 years. No severe histological lesions were observed in blood donors with chronic HCV infection who had repeatedly normal ALT levels. In both donors and blood recipients, the frequency of severe morbidity or mortality related to HCV infection was less than 10% during the first two decades of infection. Further long-term studies are required to see if the progression to severe outcomes continues to accrue at this slow pace or whether it accelerates during subsequent decades.

Asunto(s)

Donantes de Sangre , Hepatitis C/transmisión , Portador Sano , Hepatitis C/genética , Hepatitis C/inmunología , Anticuerpos contra la Hepatitis C/análisis , Humanos , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Viremia/virología

RESUMEN

To develop a rapid and sensitive means of detecting cell-associated human immunodeficiency virus (HIV), donor cells from HIV seropositive patients were treated with the potent viral activator sodium-n-butyrate (NaB) and subsequently assayed by both in situ RNA hybridization and a reverse transcriptase polymerase chain reaction (RT-PCR). The sensitivity of RT-PCR was estimated to be equivalent to 1 x 10(-16) grams (0.1 fg) or approximately 64 copies of the input standard viral RNA per reaction. The present study takes advantage of the ability of NaB to introduce changes in chromatin structure of latently infected cells, leading to increased HIV gene expression. Human ACH-2 and U1 cell lines were used as representatives of T-lymphocytic and monocytoid cells harboring latent inducible proviruses. HIV gene expression was readily detected when these cells were treated with NaB. Viral gag RNA was detected by both in situ and RT-PCR assays. When peripheral blood mononuclear cells (PBMCs) from acquired immunodeficiency syndrome (AIDS) patients, who were all negative for in situ hybridization and serum/plasma p24 assays, were used for detection of viral gene expression, four categories with distinct patterns of induction were observed. The first set of patients showed HIV-positive PBMCs by RT-PCR without any added NaB, and suppression by added NaB or PHA. The second set of samples showed induction of viral RNA by NaB alone. The third set could be induced with PHA, but not NaB, and the fourth set required both NaB and PHA for induction of HIV gene expression. Our results suggest that direct treatment of the cells with HIV activators may be useful in increasing sensitivity of the RT-PCR intended to be used for detection of cell-associated viral RNAs. This approach may be used to confirm true status of the HIV infection when p24 results are negative or HIV RNAs in serum/plasma are below the threshold of detection. Moreover, this method may identify the presence of latent proviral genomes possibly reflecting the true rate of cell-associated viral load in vivo and without possible mutations brought about by long-term co-cultivation assays with cells from seronegative donors.

Asunto(s)

Butiratos/farmacología , VIH-1/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Activación Viral/efectos de los fármacos , Latencia del Virus , Ácido Butírico , Colorantes , Etidio/química , Productos del Gen gag/genética , Seropositividad para VIH/virología , VIH-1/genética , VIH-1/fisiología , Humanos , Leucocitos Mononucleares/citología , Leucocitos Mononucleares/virología , ARN Viral/análisis , Sensibilidad y Especificidad , Transcripción Genética , Células Tumorales Cultivadas

RESUMEN

BACKGROUND: The role of hepatitis G virus (HGV) in transfusion-associated infection and its relation to liver disease are not well understood. METHODS: Serum samples collected between 1972 and 1995 from 357 transfusion recipients, 157 controls who did not receive transfusions, 500 randomly selected volunteer blood donors, and 230 donors of blood received by HGV-infected patients were tested for HGV RNA by qualitative and quantitative polymerase-chain-reaction assays. Samples obtained before transfusion and serially after transfusion from 79 of the 81 transfusion recipients who had transfusion-associated non-A, non-B hepatitis were available for testing. RESULTS: Of the 79 patients with transfusion-associated hepatitis, 63 (80 percent) had infections related to the hepatitis C virus (HCV) and 3 had preexisting HCV and the cause of their acute hepatitis could not be determined; of the remaining 13 patients, 3 had acute HGV infection, and 10 were infected with unidentified agents. Six of the 63 patients with HCV infection who were tested (10 percent) were also infected with HGV. The three patients infected only with HGV had mild hepatitis (mean peak alanine aminotransferase level, 198 U per liter; none had jaundice); the levels of alanine aminotransferase and HGV RNA were not well correlated. The combined HCV and HGV infections were no more severe than HCV infections alone; the alanine aminotransferase values paralleled the levels of HCV RNA, but not those of HGV RNA. There were 35 HGV infections among the 357 transfusion recipients; only 3 had hepatitis with HGV as the sole viral marker. One of the 157 controls and 7 of the 500 randomly selected blood donors (1.4 percent) had detectable HGV RNA. In all eight instances in which a transfusion recipient had acute HGV infection after transfusion and samples from all donors could be tested, at least one HGV-positive donor was identified. CONCLUSIONS: HGV was common in a group of volunteer blood donors, and it can be transmitted by transfusion. Most HGV infections were not associated with hepatitis. HGV did not worsen the course of concurrent HCV infection. No causal relation between HGV and hepatitis has been established.

Asunto(s)

Flaviviridae/aislamiento & purificación , Hepatitis Viral Humana/transmisión , Reacción a la Transfusión , Enfermedad Aguda , Alanina Transaminasa/sangre , Donantes de Sangre , Flaviviridae/genética , Flaviviridae/patogenicidad , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C/clasificación , Hepatitis C/complicaciones , Hepatitis C/transmisión , Hepatitis C/virología , Hepatitis Viral Humana/clasificación , Hepatitis Viral Humana/epidemiología , Hepatitis Viral Humana/virología , Humanos , Incidencia , Prevalencia , Estudios Prospectivos , ARN Viral/sangre , Distribución Aleatoria , Índice de Severidad de la Enfermedad , Carga Viral

Asunto(s)

Encefalopatía Hepática/microbiología , Hepatitis C/complicaciones , Viremia/complicaciones , Anciano , Secuencia de Bases , Biopsia , Procedimientos Quirúrgicos Cardíacos , ADN Viral/sangre , Resultado Fatal , Hepacivirus/aislamiento & purificación , Encefalopatía Hepática/sangre , Anticuerpos Antihepatitis/sangre , Hepatitis C/diagnóstico , Hepatitis C/transmisión , Antígenos de la Hepatitis C/análisis , Virus de Hepatitis/aislamiento & purificación , Humanos , Hígado/microbiología , Hígado/patología , Masculino , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , ARN Viral/sangre , Reacción a la Transfusión , Viremia/diagnóstico , Viremia/transmisión

RESUMEN

BACKGROUND: For many people infected with the hepatitis C virus (HCV), the route of exposure, risk of transmission, and severity of associated liver disease are unknown. We studied these variables in people who donated blood voluntarily. METHODS: Blood donors who tested positive for HCV antibodies on enzyme immunoassay were classified according to whether the results of a confirmatory second-generation recombinant immunoblot assay (RIBA) for HCV were positive, negative, or indeterminate. The evaluations also included an assessment of risk factors, a physical examination, serial determinations of alanine aminotransferase levels and HCV serologic assays, a polymerase-chain-reaction assay for HCV RNA, testing of sexual contacts and family members, and liver biopsies in some participants who were HCV-positive by RIBA. RESULTS: A total of 481 donors were studied, among whom 248 were positive for HCV by RIBA, 102 had indeterminate results, and 131 were HCV-negative. In a logistic-regression analysis, significant risk factors for HCV infection among the HCV-positive participants were a history of blood transfusion in 66 (27 percent; P < 0.001 for the comparison with RIBA-negative donors), intranasal cocaine use in 169 (68 percent, P < 0.001), intravenous drug use in 103 (42 percent, P = 0.001), sexual promiscuity in 132 (53 percent, P = 0.002), and ear piercing among men (P < 0.05). Nine of 85 sexual partners of HCV-positive donors were anti-HCV-positive; 8 had used intravenous drugs or received transfusions. HCV RNA was found in 213 HCV-positive donors (86 percent), 3 who had indeterminate results by RIBA (2 of these 3 tested positive with a more specific, third-generation RIBA), and none who were HCV-negative. Of the HCV-positive donors, 69 percent had biochemical evidence of chronic liver disease; among 77 donors positive for HCV by RIBA who underwent liver biopsy, 5 had severe chronic hepatitis 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, because these donors had denied such use when questioned directly at the time of their blood donations.

Asunto(s)

Donantes de Sangre , Hepatitis C/etiología , Adulto , Cocaína/administración & dosificación , Oído Externo/cirugía , Femenino , Hepacivirus/inmunología , Hepacivirus/aislamiento & purificación , Hepatitis C/diagnóstico , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C/sangre , Humanos , Immunoblotting , Hepatopatías/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Factores de Riesgo , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa , Trastornos Relacionados con Sustancias , Viremia/diagnóstico

Asunto(s)

Donantes de Sangre , Hepatitis C/complicaciones , Porfiria Cutánea Tardía/complicaciones , Adulto , Humanos , Masculino , Estudios Prospectivos

RESUMEN

We have evaluated the clinical and histopathological outcomes of patients who contracted chronic non A, non B hepatitis as a result of transfusions administered during heart surgery at the National Institutes of Health. Posttransfusion hepatitis developed in 65 of 1,070 (6.1%) patients and became chronic in 45 (69%) of those cases. Antibody to hepatitis C virus was detectable in 53 patients (82%) with posttransfusion non A, non B hepatitis. Thirty-three patients with chronic non A, non B hepatitis agreed to liver biopsy (group 1). In addition, six other patients with chronic posttransfusion non A, non B hepatitis were evaluated (group 2). These 39 patients were followed between 1 and 24 yr (mean = 9.7 yr). Cirrhosis developed in 8 patients (20%) between 1.5 and 16 yr after blood transfusion. Of the 33 patients in group 1, 11 (33%) died during follow-up. In two cases (6%), this was related to liver failure. At this writing, two additional patients (6%) have decompensated cirrhosis and one (3%) had debilitating fatigue. Twenty of 33 patients (61%) with histological evidence of chronic active hepatitis or cirrhosis are asymptomatic and have no clinical evidence of liver disease. Thus chronic non A, non B posttransfusion hepatitis appeared to be due to hepatitis C virus infection in most cases. It was associated with the development of cirrhosis in approximately 20% of cases and end-stage liver disease in 12% of patients followed prospectively. Most patients with histological evidence of cirrhosis or chronic active hepatitis, however, had minimal clinical evidence of liver disease within the time frame of this study.

Asunto(s)

Hepatitis C/etiología , Reacción a la Transfusión , Adulto , Anciano , Alanina Transaminasa/metabolismo , Biopsia , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Hepatitis C/enzimología , Hepatitis C/patología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Factores de Tiempo

Asunto(s)

Portador Sano , Hepatitis C/transmisión , Hepatitis Viral Humana/transmisión , Parejas Sexuales , Alanina Transaminasa/sangre , Antígenos Virales/inmunología , Pruebas Enzimáticas Clínicas , Familia , Femenino , Anticuerpos Antihepatitis/análisis , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Antígenos de la Hepatitis C , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos

RESUMEN

We measured antibody (anti-HCV) to hepatitis C virus, which causes non-A, non-B hepatitis, by radioimmunoassay in prospectively followed transfusion recipients and their donors. Of 15 patients with chronic non-A, non-B hepatitis documented by liver biopsy, all seroconverted for the antibody; of 5 with acute resolving non-A, non-B hepatitis, 3 (60 percent) seroconverted. The development of anti-HCV was delayed (mean delay, 21.9 weeks after transfusion, or 15 weeks after the onset of clinical hepatitis) and took approximately one year in one patient. Antibody has persisted in 14 of the 15 patients with chronic disease (mean follow-up, greater than or equal to 6.9 years; maximum, greater than or equal to 12), but has disappeared in the 3 with acute resolving disease after a mean of 4.1 years. Anti-HCV was detected in samples of donor serum given to 14 (88 percent) of the 16 anti-HCV-positive patients for whom all donor samples were available. Only 33 percent of the anti-HCV-positive donors tested had an elevated serum concentration of alanine aminotransferase; 54 percent were positive for antibody to the hepatitis B core antigen (anti-HBc). We conclude that hepatitis C virus is the predominant agent of transfusion-associated non-A, non-B hepatitis and that screening of donors for anti-HCV could prevent the majority of cases of the disease. "Surrogate" assays for anti-HBc and alanine aminotransferase would have detected approximately half the anti-HCV-positive donors involved in the transmission of hepatitis that we identified.

Asunto(s)

Anticuerpos Antihepatitis/análisis , Hepatitis C/inmunología , Hepatitis Viral Humana/inmunología , Reacción a la Transfusión , Enfermedad Aguda , Adulto , Anciano , Alanina Transaminasa/sangre , Donantes de Sangre , Enfermedad Crónica , Femenino , Antígenos del Núcleo de la Hepatitis B/inmunología , Hepatitis C/diagnóstico , Hepatitis C/transmisión , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo

RESUMEN

Of 693,000 volunteer blood donors in Washington, D.C., who were screened for infection with human immunodeficiency virus type 1 (HIV-1) from July 1985 through December 1988, 284 tested positive on both enzyme immunoassay and Western blot assay. To determine the clinical importance of confirmed positive test results in asymptomatic blood donors, we followed 156 donors with positive Western blot assays and 80 donors with positive enzyme immunoassays but negative or indeterminate Western blots at 6-month intervals for a mean of 28 months. As compared with Western blot-negative persons, those with positive Western blots were significantly more likely to be black, male, and first-time donors and to have a history of venereal disease, generalized lymphadenopathy on examination, CD4-cell counts lower than 0.4 x 10(9) per liter, IgG levels higher than 18 g per liter, and antibody to hepatitis B core antigen on initial evaluation. In 17 (11 percent) of the Western blot-positive donors, the disease progressed to Class IV (symptomatic disease), according to the Centers for Disease Control system. CD4 counts below 0.2 x 10(9) per liter, IgA levels above 4 g per liter, abnormal proliferative responses to tetanus toxoid, and positive viral cultures were the strongest predictors of disease progression. Among the 80 donors with repeatedly reactive assay results but either negative or indeterminate Western blot assays, there was no evidence of HIV exposure in their histories, physical examinations, or laboratory evaluations, and manifestations of HIV infection developed in none of them. We conclude that a small number of persons with HIV infection continue to donate blood, despite attempts to exclude them, but that donors who test positive on enzyme immunoassay but persistently negative or indeterminate on Western blot assay probably do not represent a risk for the transmission of HIV.

Asunto(s)

Donantes de Sangre , Seropositividad para VIH/diagnóstico , Complejo Relacionado con el SIDA , Síndrome de Inmunodeficiencia Adquirida/transmisión , Western Blotting , Linfocitos T CD4-Positivos , District of Columbia , Etnicidad , VIH/aislamiento & purificación , Humanos , Técnicas para Inmunoenzimas , Inmunoglobulina A/análisis , Inmunoglobulina G/análisis , Masculino , Estudios Prospectivos , Enfermedades de Transmisión Sexual/complicaciones

RESUMEN

The relationship between the presence of antibody to hepatitis B core antigen (anti-HBc) in donor blood and the development of hepatitis in recipients of that blood was studied in 6293 blood donors and 481 recipients who were followed for 6 to 9 months after transfusion. Of 193 recipients of at least 1 unit of blood positive for anti-HBc, 23 (11.9%) developed non-A, non-B hepatitis compared with 12 (4.2%) of 288 recipients of only anti-HBc-negative blood (p less than 0.001). Donor anti-HBc status was not significantly associated with the development of hepatitis B in the recipient and was negatively associated with the development of cytomegalovirus hepatitis. The relationship of donor anti-HBc status and the development of non-A, non-B hepatitis in the recipient was independent of transfusion volume and elevated donor transaminase level. Although 88% of anti-HBc-positive blood units were not associated with recipient non-A, non-B hepatitis, calculation of maximal corrected efficacy predicted that exclusion of anti-HBc-positive donors might have prevented 43% of the cases of non-A, non-B hepatitis with a donor loss of 4%. Because of the serious chronic consequences of non-A, non-B hepatitis, surrogate tests for non-A, non-B virus carriers must be seriously considered.

Asunto(s)

Anticuerpos contra la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/inmunología , Hepatitis C/inmunología , Hepatitis Viral Humana/inmunología , Reacción a la Transfusión , Alanina Transaminasa/sangre , Procedimientos Quirúrgicos Cardíacos , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/transmisión , Hepatitis B/inmunología , Hepatitis B/transmisión , Hepatitis C/enzimología , Hepatitis C/transmisión , Hepatitis Viral Humana/transmisión , Humanos , Complicaciones Posoperatorias/inmunología , Estudios Prospectivos