A Clinical, Epidemiological, Laboratorial, Histological And Ultrasonographical Evaluation Of Anti-hcv Eia-2 Positive Blood Donors

Between 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 histopathologieal 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.423147152Alter, H.J., To C or not to C: These are the questions (1995) Blood, 85, pp. 1631-1695Alter, H.J., Conry-Cantilena, C., Melpolder, J., Hepatitis C in asymptomatic blood donors (1997) Hepatology, 26 (1 SUPPL.), pp. 29S-33SAlter, H.J., Purcell, R.H., Shih, J.W., Detection of antibodies to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis (1989) New Engl. J. Med., 321, pp. 1494-1500Alter, H.J., Tegtmeier, G., Jett, B., The use of a recombinant immunoblot assay in the interpretation of anti-hepatitis C virus reactivity among prospectively followed patients, implicated donors, and random donors (1991) Transfusion, 31, pp. 771-776Alter, M.J., Epidemiology of hepatitis C in the West (1995) Semin. Liver Dis., 15, pp. 5-14Areias, J., Pedroto, I., Freitas, T., Hepatitis C virus carriers with normal ALT activity: Viraemia, genotype and effect of interferon therapy (1996) Gastroenterology, 110, pp. A1143Choo, Q.L., Kuo, G., Weiner, A.J., Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome (1989) Science, 244, pp. 359-362Conry-Cantilena, C., Van Raden, M., Gibble, J., Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C infection (1996) New Engl. J. Med., 334, pp. 1691-1696Esteban, J.I., Esteban, R., Viladomiu, L., Hepatitis C virus antibodies among risk groups in Spain (1989) Lancet, 2, pp. 294-297Esteban, J.I., Gonzales, A., Hernandez, J.M., Evaluation of antibodies to hepatitis C virus in a contemporary study of transfusion-associated hepatitis (1990) New Engl. J. Med., 323, pp. 1107-1112Garcia-Samaniego, J., Enriquez, A., Soriano, V., Third-generation recombinant immunoblot assay to confirm hepatitis C virus-indeterminate serological samples (1993) Vox Sang., 64, pp. 191-192. , BaselHoofnagle, J.H., Hepatitis C: The clinical spectrum of disease (1997) Hepatology, 26 (1 SUPPL.), pp. 15S-20SKleinman, S., Alter, H., Busch, M., Increased detection of hepatitis C virus (HCV)-infected blood donors by a multiple-antigen HCV enzyme immunoassay (1992) Transfusion, 32, pp. 805-813Kuo, G., Choo, Q.L., Alter, H.J., An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis (1989) Science, 244, pp. 362-364Lok, A.S.F., Gunaratnam, N.T., Diagnosis of hepatitis C (1997) Hepatology, 26 (1 SUPPL.), pp. 48S-56SPrati, D., Capelli, C., Zanella, A., Influence of different hepatitis C virus genotypes on the course of asymptomatic hepatitis C virus infection (1996) Gastroenterology, 100, pp. 178-183Prieto, M., Olaso, V., Verdu, C., Does the healthy hepatitis C virus carrier state really exist? An analysis using polymerase chain reaction (1995) Hepatology, 22, pp. 413-417Prince, A.M., Brotman, B., Inchauspe, G., Patterns and prevalence of hepatitis C virus infection in posttransfusion non-A, non-B hepatitis (1993) J. Infect.Dis, 167, pp. 1296-1301Rossini, A., Gazzola, G.B., Ravaggi, A., Long-term follow-up and infectivity in blood donors with hepatitis C antibodies and persistently normal alanine aminotransferase levels (1995) Transfusion, 35, pp. 108-111Salmeron, F.J., Palacios, A., Perez-Ruiz, M., Epidemiology, serological markers, and hepatic disease of anti-HCV ELISA-2 positive blood donors (1996) Dig. Dis. Sci., 41, pp. 1933-1938Schiff, E.R., Hepatitis C and alcohol (1997) Hepatology, 26 (1 SUPPL.), pp. 39S-42SSerfaty, L., Nousbaum, J.R., Elghouzzi, M.H., Prevalence, severity, and risk factors of liver disease in blood donors positive in a second-generation anti-hepatitis C virus screening test (1995) Hepatology, 21, pp. 725-729Shakil, A.O., Conry-Cantilena, C., Alter, H.J., Volunteer blood donors with antibody to hepatitis C virus: Clinical, biochemical, virologic and histologic features (1995) Ann. Intern. Med., 123, pp. 330-337Sharara, A.I., Hunt, C.M., Hamilton, J.D., Hepatitis C (1996) Ann. Intern. Med., 125, pp. 658-668Ulrich, P., Romeo, J., Lane, P., Detection, semiquantitation, and genetic variation in hepatitis C virus sequences amplified from the plasma of blood donors with elevated alanine aminotransferase (1990) J. Clin. Invest., 86, pp. 1609-161

Hepatitis C virus infection, cryoglobulinemia, and peripheral neuropathy: a case report

Hepatitis C virus (HCV) is essentially hepatotropic but its manifestations can extend beyond the liver. It can be associated with autoimmune diseases, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders. The mechanisms that trigger these manifestations are not completely understood. We describe a 48-year-old man with chronic HCV infection (circulating HCV RNA and moderate hepatitis as indicated by liver biopsy), cryoglobulinemia, and sensory and motor peripheral neuropathy. The diagnosis of multineuropathy was confirmed by clinical examination and electromyographic tests. A nerve biopsy revealed an inflammatory infiltrate in the perineurial space and signs of demyelination and axonal degeneration. The patient had no improvement of neurological symptoms with the use of analgesics and neuro-modulators. He was then treated with interferon-alpha (3 million units subcutaneously, 3 times per week) and ribavirin (500 mg orally, twice a day) for 48 weeks. Six months after the end of therapy, the patient had sustained viral response (negative HCV RNA) and remission of neurological symptoms, but cryoglobulins remained positive. A review of the literature on the pathogenesis and treatment of neurological manifestations associated with HCV infection is presented. This report underscores the need for a thorough evaluation of HCV-infected patients because of the possibility of extrahepatic manifestations. Antiviral treatment with interferon and ribavirin can be effective and should be considered in patients with neurological complications associated with HCV infection.1729173

Corrigendum In " Virus C Genotype Predisposes To Primary Hypothyroidism During Interferon-α Treatment For Chronic Hepatitis C"

[No abstract available]17112

Hepatitis C virus infection, cryoglobulinemia, and peripheral neuropathy: a case report

Hepatitis C virus (HCV) is essentially hepatotropic but its manifestations can extend beyond the liver. It can be associated with autoimmune diseases, such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis, autoimmune thyroiditis, and lymphoproliferative disorders. The mechanisms that trigger these manifestations are not completely understood. We describe a 48-year-old man with chronic HCV infection (circulating HCV RNA and moderate hepatitis as indicated by liver biopsy), cryoglobulinemia, and sensory and motor peripheral neuropathy. The diagnosis of multineuropathy was confirmed by clinical examination and electromyographic tests. A nerve biopsy revealed an inflammatory infiltrate in the perineurial space and signs of demyelination and axonal degeneration. The patient had no improvement of neurological symptoms with the use of analgesics and neuro-modulators. He was then treated with interferon-alpha (3 million units subcutaneously, 3 times per week) and ribavirin (500 mg orally, twice a day) for 48 weeks. Six months after the end of therapy, the patient had sustained viral response (negative HCV RNA) and remission of neurological symptoms, but cryoglobulins remained positive. A review of the literature on the pathogenesis and treatment of neurological manifestations associated with HCV infection is presented. This report underscores the need for a thorough evaluation of HCV-infected patients because of the possibility of extrahepatic manifestations. Antiviral treatment with interferon and ribavirin can be effective and should be considered in patients with neurological complications associated with HCV infection

Treatment of human papillomavirus with peg-interferon alfa-2b and ribavirin

We reported one case of human immunodeficiency virus and hepatitis C virus co-infected patient who presented a significant improvement of human papillomavirus (HPV) lesions during the treatment of chronic hepatitis using peg-interferon alfa-2b and ribavirin

Elevated Alanine Aminotransferase (alt) In Blood Donors : An Assessment Of The Main Associated Conditions And Its Relationship To The Development Of Hepatitis C

The determination of aminotranferases levels is very useful in the diagnosis of hepatopathies. In recent years, an elevated serum ALT level in blood donors has been associated with an increased risk of post-transfusion hepatitis (PTH). The purpose of the study was to research the factors associated with elevated ALT levels in a cohort of voluntary blood donors and to evaluate the relationship between increased ALT levels and the development of hepatitis C (HCV) infection. 166 volunteer blood donors with elevated ALT at the time of their first donation were studied. All of the donors were questioned about previous hepatopathies, exposure to hepatitis, exposure to chemicals, use of medication or drugs, sexual behaviour, contact with blood or secretions and their intake of alcohol. Every three months, the serum levels of AST, ALT, alkaline phosphatase, gamma glutamyl transpeptidase, cholesterol, triglyceride and glycemia are assessed over a two year follow-up. The serum thyroid hormone levels as well as the presence of auto-antibodies were also measured. Abdominal ultrasound was performed in all patients with persistently elevated ALT or AST levels. A needle biopsy of liver was performed in 9 donors without definite diagnostic after medical investigation. The presence of anti-HCV antibodies in 116 donors were assayed again the first clinical evaluation. At the end of follow-up period (2 years later) 71 donors were tested again for the presence of anti-HCV antibodies. None of donors resulted positive for hepatitis B or hepatitis C markers during the follow-up. Of the 116 donors, 101 (87%) had persistently elevated ALT serum levels during the follow-up. Obesity and alcoholism were the principal conditions related to elevated ALT serum levels in 91/ 101 (90.1%) donors. Hypertriglyceridemia, hypercholesterolemia, hypothyroidism and diabetes mellitus also were associated with increased ALT levels. Only 1/101 (0.9%) had mild chronic active non A-G viral hepatitis and 3/101 (2.9%) had liver biopsy with non-specific reactive hepatitis. The determination of ALT levels was not useful to detect donors infected with HCV at donation in Brazil, including the initial seronegative anti-HCV phase.404219224Aach, R.D., Szmuness, W., Mosley, J.W., Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients (1981) New Engl. J. Med., 304, pp. 989-994Alter, H.J., Purcell, R.H., Holland, P.V., Alling, D.W., Koziol, D.E., Donors transaminase and recipient hepatitis. Impact on blood transfusion services (1981) J. Amer. Med. Ass., 246, pp. 630-634Alter, H.J., The cloning and clinical implications of HGV and HGBV-C (1996) New Engl. J. Med., 334, pp. 1536-1537Alter, H.J., Transfusion transmitted hepatitis C and non-A, non-B, non-C (1994) Vox Sang. 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Med., 107, pp. 137-144Garrow, J.S., (1988) Obesity and Related Diseases, , New York, Churchill LivingstoneGarson, J.A., Tedder, R.S., Briggs, M., Detection of hepatitis C viral sequences in blood donations by "nested" polymerase chain reaction and prediction of infectivity (1990) Lancet, 335, pp. 1419-1422Gonçales Jr., F.L., Boccato, R.S.B.S., Pedro, R.J., Prevalências do HBsAg, do anti-HBc e do anti-HCV na população de candidatos a doadores de sangue do Hemocentro-Campinas (1993) Rev. Inst. Med. Trop. S. Paulo, 35, pp. 45-51Gonçales Jr., F.L., Pedro, R.J., Silva, L.J., Hepatites póstransfusionais na cidade de Campinas, SP, Brasil. II. Presença dos anticorpos anti-HBc e anti-HCV em candidatos a doadores de sangue e ocorrência de hepatites pós-transfusionais pelo virus C nos receptores de sangue ou derivados (1993) Rev. Inst. Med. Trop. S. Paulo, 35, pp. 63-71Gonçales Jr., F.L., Pedro, R.J., Silva, L.J., Hepatites póstransfusionais na cidade de Campinas, SP, Brasil. I. Incidência, agentes etiológicos e aspectos clínico-epidemiológicos da hepatite por virus C (1993) Rev. Inst. Med. Trop. S. Paulo, 35, pp. 53-62Hultcrantz, R., Glaumann, H., Lindberg, G., Nilsson, L.H., Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases (1986) Scand. J. Gastroent., 21, p. 109Ismay, S.L., Thomas, S., Fellows, A., Post-transfusion hepatitis revisited (1995) Med. J. Aust., 163, pp. 74-77Jullien, A.M., Courouce, A.M., Massari, V., Impact of screening donor blood for alanine aminotransferase and antibody to hepatitis B core antigen on the risk of hepatitis C virus transmission (1993) Europ. J. Clin. Microbiol. Infect. Dis., 12, pp. 668-672Kahn, R.A., Johnson, G., Aach, R.D., The distribution of serum alanine aminotransferase levels in a blood donor population (1982) Amer. J. 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(Wash.), 92, pp. 3401-3405Vanderborght, B.O., Reis, A.M., Rouzere, C.D., Prevalence of anti-hepatitis C virus in the blood donor population of Rio de Janeiro (1993) Vox Sang. (Basel), 65, pp. 122-12