GASTROENTEROLOGY

1992;103:609-616

Posttransfusion Hepatitis Revisited by Hepatitis C Antibody Assays and Polymerase Chain Reaction JIN TOWN WANG, TEH-HONG WANG, JIN-CHUAN SHEU, JAW-TOWN LIN, CHANG-YI WANG, and DING-SHINN CHEN Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; and United Biomedical Inc., Lake Success, New York

Sera of 40 patients with posttransfusion non-A, non-B hepatitis were tested for hepatitis C and B viral genomes by polymerase chain reaction and for hepatitis C antibodies by synthetic peptide immunoassays. Five were then considered to have chronic hepatitis before transfusion. Six patients without hepatitis C markers and hepatitis B virus DNA recovered. In 28 recipients who became positive for hepatitis C virus RNA, posttransfusion hepatitis C was diagnosed. Of them, 5 were hepatitis B surface antigen carriers. Synthetic peptide immunoassays detected 28 whereas anti-Cl00 assay detected 23 of the 29 acute hepatitis C patients. Anticapsid antibody appeared earlier than the antinonstructural antibody in 10 seroconverters. They appeared simultaneously in 15 seroconverters but anticapsid antibody appeared later then the antinonstructural antibody in 3 hepatitis B carriers. Transient suppression of hepatitis B surface antigenemia was found in 2, whereas elevated hepatitis B virus DNA was found in 3 carriers during acute hepatitis C superinfection. In 2 carriers whose hepatitis C became chronic, both hepatitis B and C viral genomes persisted throughout 2 years of followup. Therefore these assays define posttransfusion hepatitis C more precisely, and there seems no significant interference between chronic hepatitis B and C virus infections.

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on-A, non-B hepatitis (NANBH) is a disease found world wide.’ The diagnosis has been based on exclusion of other etiologic agents until recent development of an antibody assay (anti-ClOO) for hepatitis C virus (HCV).2*3Although by the antiCl00 assay we have found HCV to be the major cause of posttransfusion hepatitis (PTH) in a prospective study,4 as much as 40% of the posttransfusion NANBH was negative. HCV infection has also been shown to be the next common cause of chronic liver diseases in Taiwan, an area hyperendemic for hepatitis B virus (HBV) infection,5 and a significant number of patients were infected by both viruses5 In other

series, the coexisting infection of HBV and HCV is also not uncommon.“s7 Therefore the interactions between HBV and HCV should be important in such patients. Recent studies of hepatitis C virus (HCV) RNA by polymerase chain reaction (PCR) revealed both inadequate sensitivity and specificity of the existing anti-HCV assay in detecting HCV viremia,8xg and HCV RNA appears early in HCV infection.” Cloning of the 5’ terminal sequences of HCV has shown that the 5’ noncoding and the capsid region are highly conserved.“-‘3 Therefore, we adopted the PCR technique using primers from both the 5’noncoding region and nonstructural (NS) region and an enzyme immunoassay (EIA) based on synthetic peptide antigens from capsid and NS proteins of HCV14 to again further study HCV infection in patients with posttransfusion NANBH. We also studied hepatitis B surface antigen (HBsAg), HBV DNA, and HCV RNA in HBsAg carriers superinfected with HCV to explore the possible interactions between HBV and HCV. Patients and Methods Patients Beginning in June 1987, we conducted a prospective study of PTH in Taiwan.4 Patients who received blood transfusion and met the following criteria were included: normal liver function tests before transfusion; no transfusion in the preceding year; and no previous history of liver diseases, alcoholism, drug addiction, or exposure to hepatotoxic drugs. Those positive for HBsAg but negative for hepatitis B e antigen (HBeAg) were not excluded. Patients received blood transfusion from volunteer donors negative for HBsAg and with serum alanine aminotransferase activities (ALT)

Posttransfusion hepatitis revisited by hepatitis C antibody assays and polymerase chain reaction.

Sera of 40 patients with posttransfusion non-A, non-B hepatitis were tested for hepatitis C and B viral genomes by polymerase chain reaction and for h...
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