A clinical, epidemological, laboratorial, histological and ultrasonographical evaluation of anti-HCV EIA-2 positive blood donors

Abstract

SUMMARYBetween 1992 and 1997, 790 blood donors with anti-HCV EIA-2 strongly reagent (relationship between the sample optical density/cut-off > 3) detected at the blood bank serological screening, were evaluated in ambulatory environment. They were all negative for Chagas disease, syphilis, hepatitis B (HBsAg) and AIDS. Blood samples were collected at the first ambulatorial evaluation, for hemogram, biochemical tests and new serological tests for HCV (anti-HCV EIA-2). In blood samples of 226 repeatedly reagent anti-HCV EIA-2 blood donors, supplementary "immunoblot" test for HCV (RIBA-2) was used. In 209 donors, the presence of HCV-RNA was investigated by the PCR test. The abdominal ultrasonography was realized in 366 donors. In 269 patients liver biopsy was performed for the histopathological study. The follow-up of blood donors showed that 95.6% were repeatedly EIA-2 reagent, 94% were symptomless and denied any hepatitis history, with only 2% mentioning previous jaundice. In 47% of this population at least one risk factor has been detected for the HCV transmission, the use of intravenous drugs being the main one (27.8%). Blood transfusion was the second factor for HCV transmission (27.2%). Hepatomegaly was detected in 54% of the cases. Splenomegaly and signs of portal hypertension have seldom been found in the physical examination, indicating a low degree of hepatic compromising in HCV. Abdominal ultrasound showed alterations in 65% of the subjects, being the steatosis the most frequent (50%). In 83.5% of the donors submitted to the liver biopsy, the histopathological exam showed the presence of chronic hepatitis, usually classified as active (89%) with mild or moderate grade in most of the cases (99.5%). The histopathological exam of the liver was normal in 1.5% of blood donors. The RIBA-2 test and the HCV-RNA investigation by PCR were positive in respectively 91.6 and 75% of the anti-HCV EIA-2 reagent donors. The HCV-RNA research was positive in 82% of the RIBA-2 positive subjects, in 37.5% of the indeterminate RIBA-2 donors and in 9% of the negative RIBA-2 donors. Chronic hepatitis has also been observed in 50% of the histopathological exams of the anti-HCV EIA-2 reagent donors which were indeterminate RIBA-2. Among 18 blood donors with minimal changes histopathological exam 11 (61%) were HCV-RNA positive. Our blood donors anti-HCV reagent generally had clinical, laboratorial and histopathological features observed in patients with chronic HCV hepatitis and a high proportion could be identified in interviews and medical evaluation realized in blood blanks. Generally, these HCV infected donors are identified and discharged only by the serological tests results.

Comparison of risk factors among blood donors, volunteers and replacement individuals, infected or not by hepatitis C virus

“…Furthermore, exposure to the virus is higher, due to ignorance about its contamination routes and risk factors, which is consistent with data about C virus world prevalence, that compare population purchasing power (22, 25,35,36). GI individuals lived in smaller cities, compared to controls, who came from larger cities with better health services.…”

“…Many studies relating severe steatosis and cirrhosis due to excessive tobacco use, reported that individuals infected by hepatitis C virus present higher prevalence of these diseases than nontobacco users (11,25,38). Pessione et al (11) observed that cigarette smokers, mostly young ones, had presented a significant augmentantion in damaged liver functions caused by chronic hepatitis.…”

“…A demographic data instrument was employed to evaluate socioeconomic conditions, hepatitis C risk factors, epidemiology as well as occurrences with needles, injections, syringes or other non-disposable material, including any transfusions received up to 1989 (see Annex 1) (25).…”

“…This type of acquisition is related to invasive hospital treatments and occurs by use of non-disinfected or incorrectly sterilized materials and equipment. Risky procedures include use of the following: surgical instruments, contaminated needles and syringes, endoscopic equipment, acupuncture, hemodialysis, as well as organ transplants (currently in a significant low incidence) and hemocomponent transfusions (2,15,(23)(24)(25). Hepatitis C virus is also transmitted through illicit parenteral and intra-nasal drug users, mirrors and inhalation straws contaminated by nasal and intranasal secretions, through shared use of personal devices such as razors and other blades, toothbrushes, cuticle nippers, as well as permanent tattoo applicators (1,2,(23)(24)(25)(26).…”

Serological, epidemiological and molecular aspects of hepatitis C virus infection in a population from Londrina, PR, Brazil, 2001-2002

“…Prevalence is lower in populations highly selected by previous screening for risk factors associated with the infection, such as blood donors, and is higher among groups highly exposed to parenteral transmission of the virus, such as intravenous drug users or hemodialysis patients 2,13,21,29 . In Brazil, available data usually refer to large centers 8,12,22 . In Londrina, Paraná, data are also very scarce.…”