LETTERS

TO THE EDITOR

411

HEPAT 00998

In their recent Leader on liver transplantation in carriers of the HBsAg (l), Rizzetto et al. cite our 1978 paper (2) in support of their coniention that ‘short-term passive prophylaxis with immunoglobulins against I-I sAg have not proven effective’. This is doubly unfortunate. First, the paper is incorrectly cited (it was published in the British Medical Journal, not the Lancet). Second, and more importantly, it does in fact describe a caJe in which this approach was demonstrably highly effective. As documented in th,e paper, the immunoglobulin was administered during the anhepatic phase of the operation after which the titre of I-IBsAg (by haemagglutination) fell from 16400 to 1:32 at which titre it remained for 6

eferences 1 Rizzetto M, Recchia S. Saliioni carriers of the HFkAg. i hepatol

M. Liver transplantation 19%; 13: 5-7.

in

days. A further 600 ml of immunoglobulin was then administered and the titre fell to zero within 2 h. Subsequent studies have shown that the patient became negative for NBsAg by radioimmunoassay at the same time but that I-IBsAb remained detectable for a further 3 months. He remains alive, well and negative for all markers of HBV infection more than 15 years later. The authors may be right in arguing that short-term passive prophylaxis with immunoglobulin is ineffective; our paper cannot, however, be used to support this conclusion. P.J. Johnson Institute of Liver Studies, Ying’s CoHege Hospital, London SE5 8RX. U.K.

2 Johnson PJ, Wansbrough-Jones MH, Portmann B, et al. Familial HBsAg-positive hepatoma: treatment with orthotopic liver transplantation and specific immunoglobulin. Br Med J 1975; 1: 216.

HEPAT 01010

unobloa assay We read with interest the recently published ‘Leader’ article from Alberti about hepatitis C (1). We are quite interested in the diagnostic problems not yet obviated with the current techniques and especially in the significance of the antibodies directed against the ~100-3 antigen. At present, HCV accounts for 90% of posttransfusional hepatitis (2). We studied a population of 410 children who received blood transfusions due to congenital heart disease. A screening test for the detection of antibodies against HCV was performed using the immunoenzymatic method (HCV Elisa test, second generation, Ortho diagnostic). All positive sera were confirmed by immunoblot assay (Chiron RIBA HCV test system). Eleven patients (2.6%) were repeatedly ELISA positive and all were RIBA positive according to the manufacturer’s criteria. Interestingly, all sera presented bands (intensity 3-t or greater) to the c22-c antigen and,

with one exception, to the c33c antigen. We found no response to the ~100-3 antigen in $0 samples (72%) and the intensity to the 5-l-l antigen band was 2+ or less in nearly all sera. We agree with the author’s suggestion that ‘anti-HCV (anti-c100) testing is not the ideal marker for the diagnosis of acute hepatitis. . .‘. Although more studies are needed to understand the real signiticance of the bands on the RIBA test, we can say that the detection of antibodies LOthe ~22-4~fragment is the most sensitb,e (3) and persistent marker of HCV infection. Its irclusion on the second generation tests (ELISA and XIBA) is a step forward in resolving some diagnostic problems of the “first generation’ techniques (4). M. Mateos’. I. Martos’, R. Moreno Departments of ‘Microbiology and ‘Peduhcs, Cajal, Madrid 28034, Spain

and C. Carnero’ Iiospital Ramdn )

LETTERS TO THE EDITOR

412 References 1 Alberti A. Diagnosis of hepatitis C. Facts and perspectives. J Hepatol 1991; 12: 279-82. 2 Alter HJ, Holland PV, Morrow AG, et al. Clinical and SerOlOgical analysis of transfusion-associated hepatitis. Lancet 1975; ii

(7940):838-41. 3 Van der Poe1 CL, Cuypers HTM, Reesink HW, et al. Confirmation of hepatitis C virus infection by new four antigen recombinant immunoblot assay. Lancet 1991; 337: 317-g. 4 Le6n A, CantBn R. Elia M, Mateos M. Second generation RIBA to confirm diagnosis of HCV infection. Lancet 1991; 337: 912. -

HEPAT 01016

hepatitis and concomitant Treatment of chronic type immunodeficiency infectio with a-interferon Clinical trials have shown that the response to interferon therapy in patients with chronic type D hepatitis is not uniform (1). Concomitant human immunodeficiency virus (HIV) infection, a fairly common situation among delta-infected patients, is usually associated with poor response to treatment in chronic type B hepatitis. To determine whether HIV infection and secondary disturbances on cell-mediated immunity may worsen the TOTAL 20

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Immunoblot assay as diagnostic test for hepatitis C virus infection.

LETTERS TO THE EDITOR 411 HEPAT 00998 In their recent Leader on liver transplantation in carriers of the HBsAg (l), Rizzetto et al. cite our 1978...
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