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Non-A, non-B posttransfusion hepatitis: comparing C and non-C hepatitis
R L Koretz1, M Brezina, A J Polito
1Department of Medicine, University of California, Los Angeles.
Insights
Hepatitis C virus (HCV) infection, identified by antibody seroconversion, was linked to more severe posttransfusion hepatitis. Most chronic cases and symptoms occurred in patients with documented HCV, particularly men.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Posttransfusion hepatitis presents diagnostic challenges, particularly non-A, non-B types.
- Serological markers are crucial for identifying viral hepatitis infections.
Purpose of the Study:
- To investigate the serological evidence of hepatitis C virus (HCV) infection in patients with non-A, non-B posttransfusion hepatitis.
- To correlate antibody seroconversion to specific HCV antigens with disease severity and chronicity.
Main Methods:
- Analysis of stored sera from 40 patients with non-A, non-B posttransfusion hepatitis.
- Detection of antibodies against HCV antigens (C-100, 5-1-1, C-22, C-33) using specific assays.
- Correlation of serological findings with clinical data, including disease severity, chronicity, and patient demographics.
Main Results:
- Twenty-eight patients showed seroconversion ('documented hepatitis C') and experienced more severe initial disease, with all 20 chronic hepatitis cases occurring in this group.
- Patients developing antibodies to C-100 were younger and received more blood transfusions compared to those with antibodies to other antigens.
- The incidence of posttransfusion hepatitis associated with antibody seroconversion declined following the adoption of an all-volunteer blood system.
Conclusions:
- Hepatitis C virus seroconversion is a strong indicator of severe and chronic posttransfusion hepatitis.
- Antibody response to specific HCV antigens may correlate with patient characteristics and transfusion history.
- Clinical significance of hepatitis in patients without serological evidence of HCV exposure is often minimal and etiology may be non-viral.
Abstract:
Using assays to detect antibodies against antigens (C-100, 5-1-1, C-22 and C-33) of the hepatitis C virus, we tested stored sera from 40 patients prospectively identified as having non-A, non-B posttransfusion hepatitis. The 28 patients who demonstrated seroconversion ("documented hepatitis C") had more severe initial disease; all 20 cases of chronic hepatitis occurred in this subgroup. Only 2 of the 12 patients who did not demonstrate such seroconversion even had symptoms. In the group of patients with documented hepatitis C, chronic hepatitis was more commonly seen in men (89%) than in women (40%). The patients in whom antibody to the C-100 antigen developed were younger and had received more blood than had those patients who had hepatitis C diagnosed by demonstration of antibodies to the 5-1-1, C-22 or C-33 antigen (or all three). The proportion of cases of posttransfusion hepatitis that could be associated with antibody sero-conversion decreased around the time that blood banks switched to an all-volunteer system. The hepatitis seen in patients who failed to demonstrate serological evidence of hepatitis C virus exposure was usually clinically unimportant; it may or may not have been due to viral infection.