ORIGINAL ARTICLES

Effect of screening for hepatitis C virus antibody and hepatitis B virus core antibody on incidence of post-transfusion hepatitis

Anti-HCV immunoassays remain the primary serologic test for HCV screening among blood donors. Since 1990s, Anti-HCV assays have evolved and those currently available detect infection earlier and have improved sensitivity and specificity compared with older generation assays. The new Alinity s Anti-HCV II assay, with its innovative design, has improved sensitivity, which shall further enhance safety of blood.

Alinity s Anti-HCV II assay was evaluated at 2 blood services (HKRCBTS & SNBTS). The overall sensitivity was evaluated using known positive samples (n = 5 at HKRCBTS; 50 at SNBTS) and 3 seroconversion panels (panel members =14 at each site). A total of 7,532 blood donor samples were tested to determine the clinical specificity.

The clinical sensitivity of the new assay was found to be 100% at both sites. HCV seroconversion panel detection rates were 57.1% (8/14) and 14.3% (2/14) for the Alinity s Anti-HCV II and Anti-HCV assays respectively, resulting in an improvement in seroconversion sensitivity of 42.8% for the Anti-HCV II assay over the Anti-HCV assay. The specificity of the Anti-HCV II assay was 100% at HKRCBTS, and 99.95% at SNBTS.

The Anti-HCV II assay detected all known positive specimens and was able to detect samples in seroconversion panels earlier compared to the Anti-HCV assay. The assay showed excellent clinical specificity and generated fewer false-reactive results and was found to be suitable for routine blood donor screening.

It has been suggested that Japanese subjects categorized as having normal weight (body mass index [BMI] <25.0) as defined by WHO (2000) have a tendency toward increased incidence of dyslipidemia and diabetes. Our objective was to assess the suitability for Japanese subjects of the Regional Office for the Western Pacific Region of WHO criteria pertaining to obesity (WPRO criteria, 2000) by analyzing cardiovascular risk factors relative to gender and age in overweight Japanese with BMI of 23.0–24.9.

There were 3,608 subjects (2,387 men: 42.3 ± 0.2 years and 1,221 women: 41.6 ± 0.3 years) who participated in a community setting and cross-sectional study and were not using any prescription drugs for obesity-related diseases. BMI and cardiovascular risk factors (blood pressure, plasma levels of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, Lp(a), glucose, HbA1C, uric acid, white blood cell count, AST, ALT and γ-GTP) were compared by BMI classes and by gender and age group.

The subjects were categorized as 21% “overweight” (23.0–24.9 BMI), 17% “obese I” (25.0–29.9 BMI) and 2% “obese II” (over 30.0 BMI), all based on WPRO criteria. Graded increases in BMI classes based on these WPRO criteria were positively associated with frequency and values of cardiovascular risk factors, and the “overweight” had a significantly higher risk of cardiovascular disease than did the “normal” subjects.

While a relationship between BMI and cardiovascular risk factors is gender and age specific, our investigation, highlighting the increasing risks of “overweight” with a BMI of 23.0–24.9, suggests that WPRO criteria are more relevant and therefore suitable for Japanese subjects.

The persistence of hepatitis B virus (HBV) genomes in HBV surface antigen (HBsAg) negative individuals is termed occult HBV infection. Occult HBV status is associated in some cases with mutant viruses undetectable by HBsAg assays, but more frequently it is due to a strong suppression of viral replication and gene expression. Occult HBV infection is an entity with world-wide diffusion, although the available data of prevalence in various categories of individuals are often contrasting because of the different sensitivity and specificity of the methods used for its detection in many studies. Occult HBV may impact in several different clinical contexts, including the transmission of the infection by blood transfusion or organ transplantation and its acute reactivation when an immunosuppressive status occurs. Moreover, much evidence suggests that it can favour the progression of liver fibrosis and above all the development of hepatocellular carcinoma.

Controversy over the selection of patients and optimum therapeutic method for acute hepatitis C has continued. The aims of this study were to investigate the source of infection, and to evaluate the timing of interferon (IFN) therapy in patients with acute hepatitis C in Japan.

The records of 102 patients from 12 facilities in Japan who developed acute hepatitis C after 1990 were investigated. In the patients treated with IFN, we performed multivariate analysis to investigate factors related to sustained virological response (SVR).

Medical procedure was the most common source of infection, accounting for 32.4% in the 102 patients (33/102). Of 81 patients treated with IFN, 71 patients were followed after IFN therapy, and 57/71 (80.3%) had SVR. The SVR rate was significantly higher in patients treated with IFN within 24 weeks from onset of symptoms than the SVR rate in those treated after 25 weeks (P = 0.0016). Multivariate analysis revealed that only the duration between onset of symptoms and initiation of IFN therapy (within 24 weeks) was related to SVR.

Our multicenter cooperative survey revealed that medical procedure was the most frequent source of infection in acute hepatitis C. As concerns the therapy, interferon treatment should be initiated within 24 weeks after onset of symptoms.

Background: In spite of the progress made in the prevention of transfusion-transmitted infections over the last years, these still occur.It was considered that infection by hepatitis B (HBV) and C (HCV) viruses could be a major problem in Uruguay, especially among high-risk individuals, such as multi-transfused patients.

Objectives: To assess the prevalence of HBV and HCV infection among multi-transfused Uruguayan patients and the impact of serological screening; to evaluate the role of number of transfusions and other potential risk factors for the acquisition of HBV and HCV infection.

Study design: Cross-sectional study of HCV antibodies, HBV surface antigen (HBsAg) and HBV core antibodies (HBcAc) in 409 multi-transfused patients.

Results: Of 409 patients studied, 147 (35.9%) received blood products due to acute bleeding, 118 (28.9%) were hemato-oncological, 75 (18.3%) hemophiliacs, 64 (15.6%) were on hemodialysis and 5 (1.2%) suffered sickle cell anemia. Prevalence of HCV antibody was 12.7%. Of the HCV positive patients, 45 were hemophiliacs, for a prevalence rate of 60.0%. The prevalence rates for hemodialysis and acute bleeding patients were 6.3% and 2.0%, respectively. Prevalence of HBsAg was 1.0%; 16.6% of subjects were positive for HBcAc. The prevalence rates of HBcAc were 48.0%, 15.0% and 3.1% among hemophiliacs, acute bleeding and hemodialysis patients, respectively. There was a direct relationship between the number of products transfused and prevalence of both hepatitis C antibodies and HBcAc. Higher prevalence of HCV and HBcAc was observed among the group of patients who received transfusions before the systematic screening of blood donors.

Conclusions: Exposure to blood transfusions was the main risk factor for HCV and HBV infection. The systematic serological screening of blood donors was highly effective in reducing transfusion transmitted infections.