The Incidence and Risk Factors of Community–Acquired Hepatitis C in A Cohort of Italian Blood Donors

Abstract

We performed a prospective study in a cohort of repeat To assess the incidence and source of community-acblood donors to estimate the risk of acquiring HCV infection quired hepatitis C virus (HCV) infection among subjects among individuals without parenteral exposure, and to invesat low risk for blood-borne diseases, we prospectively tigate the possible cause of infection. studied a cohort of 16,515 repeat blood donors over a mean follow-up time of 36 months. Second-and third-PATIENTS AND METHODS generation methods were used for hepatitis C virus antibody (anti-HCV) testing. HCV RNA was determined in A cohort of 18,109 anti-HCV-negative blood donors, candidates the serum of anti-HCV-positive donors by reverse-tran-for a second or subsequent donation, was enrolled between May 1991 scription polymerase chain reaction. Liver biopsy was and April 1992 in a longitudinal prospective study. Of this cohort, 16,515 subjects came to our center for further donations and were performed in the viremic subjects. Risk factors for HCV followed up for an average of 36 months (range, 3-52 months). The infection were identified by a psychosocial questionmedian interval between donations was 202 days. The male/female naire in the whole cohort. During follow-up, 5 donors ratio was 7:3, the median age was 32 years (range, 18-65 years). A became infected with HCV. The incidence was 1 per psychosocial questionnaire, based on 47 direct and indirect ques-10,000 person-years (95% confidence interval, 0.3-2.4 per tions, was routinely administered to blood donors. 16 Questions re-10,000). During the 6 months before seroconversion, four garded: 1) demographic information; 2) cigarette smoking and alcohol subjects (80%) underwent medical or surgical percutane-consumption; 3) drug use, with reference to type, frequency, and time ous procedures, compared with 26.5% in the entire donor of last assumption; 4) sexual history; 5) history of hepatitis; and 6) cohort (difference between frequencies, 53.5%; CI: 18.9-other risk factors for blood-borne infection (blood transfusion, tattooing, nosocomial exposure). At each donation, the clinical data The subjects showing confirmed anti-HCV reactivity were asked after seroconversion, and liver biopsy showed chronic to enter a follow-up program consisting of clinical and laboratory hepatitis in all cases. Thus, new cases of hepatitis C oc-evaluation, including HCV-RNA determination, at 1-to 3-month incur among individuals without a history of known risk tervals. A serum sample, collected on the blood donation preceding factors, some of which may be caused by nosocomial seroconversion, was retested for anti-HCV using a third-generation exposure. (HEPATOLOGY 1997;25:702-704.) test and was evaluated for HCV RNA. Liver biopsy was proposed to the viremic subjects. Sexual partners and household contacts of seroconverting subjects were invited for counseling and anti-HCV Chronic hepatitis C virus (HCV) infection represents a sig-testing. nificant cause of morbidity and mortality worldwide. 89.1). One seroconverti...

Age at infection affects the long-term outcome of transfusion-associated chronic hepatitis C

“…Conversely, the incidence of community-acquired HCV infection calculated in the same area in the 1990s was 1 per 10 000 person-years. 14 Even if we hypothesize a 10 times higher incidence of nontransfusional sources in the preceding decades, the cumulative frequency after a mean follow-up of 18.4 years would be 1 per 54.3. This would lead to no more than 5 cases (1.84%) being inappropriately classified as "posttransfusional.…”

Diagnosis of hepatitis C

“…25,26,79 Nevertheless, some of these studies also noted that patients with genotype 1b were data need to be confirmed.…”

“…In view of the possibility RIBA positive to 2% to 40% for those who are RIBA indeterof a false-negative EIA-2 result, modified diagnostic algominate, to none among those who are RIBA negative, giving rithms are recommended for immunocompromised patients an overall detection rate of 35% to 45% (Table 1). [24][25][26][27][28][29][30][31][32][33] Thus, and patients with acute hepatitis C.…”

Scope of worldwide hepatitis C problem

“…On a worldwide level, many cases are related to medical procedures, including blood transfusions, contaminated vaccination needles, and hemodialysis. [9][10][11] In Egypt, which has among the highest reported prevalence of HCV (15%), transmission is thought to have occurred with needle reuse during a national program of schistosomiasis vaccination. 12 Transmission has also been linked to folk remedies and other community-based needle practices, including acupuncture.…”