Clinical and diagnostic laboratory immunology, 1995
Blood is filtered for selective removal of leukocytes (WBC) to reduce the immunological and virol... more Blood is filtered for selective removal of leukocytes (WBC) to reduce the immunological and virological risks of transfusion. Exceedingly low numbers of residual WBC in leukodepleted blood cannot be enumerated by conventional hematologic methods. Therefore, we investigated the application of a DNA enzyme immunoassay (DEIA) for detecting a region of the HLA-DQ alpha gene following amplification by PCR. After hybridization with a specific probe coated onto the wells of a microtiter plate, the PCR-amplified DNA was detected by adding monoclonal antibodies to double-stranded DNA, enzyme tracer, and chromogen substrate for colorimetric measurement. The sensitivities of DEIA and radioisotopic liquid hybridization were similar in five sets of experiments performed with a known number of human WBC. The optical density and the number of spiked human WBC in the range of 1.0 to 0.05 cells per microliter showed good correlation in five calibration experiments performed with human WBC suspended ...
To evaluate the risk of transmitting blood-borne GB virus C/hepatitis G virus (GBV-C/HGV) and to ... more To evaluate the risk of transmitting blood-borne GB virus C/hepatitis G virus (GBV-C/HGV) and to define the natural course of infection, we performed a prospective study in a cohort of multitransfused β-thalassemics during a 6-year follow-up period. We analyzed serum samples of 150 patients collected at 3-year intervals from 1990 to 1996. GBV-C/HGV RNA was determined by reverse transcriptase-polymerase chain reaction and antibodies to E2-protein by an enzyme immunoassay. At baseline, 14.5% of patients had viremia and 18.5% anti-E2. None of the patients with anti-E2 in 1990 subsequently became viremic. Of the 100 GBV-C/HGV RNA−, anti-E2− patients, 10 acquired infection during follow-up, as indicated by positivity of GBV-C/HGV RNA (n = 2), anti-E2 (n = 7), or both markers (n = 1) in 1996. The incidence was 1.7 per 100 person-years (95% confidence interval [CI], 0.8 to 3). Since approximately 19,000 blood units were transfused to these patients during follow-up, the risk of infection w...
BACKGROUND: Hepatitis G virus (HGV) has been reported in patients with fulminant hepatitis and ap... more BACKGROUND: Hepatitis G virus (HGV) has been reported in patients with fulminant hepatitis and aplastic anemia, but HGV RNA has also been found in healthy individuals. The possible associations of HGV with liver function and hematologic abnormalities in asymptomatic blood donors were investigated. STUDY DESIGN AND METHODS: Serum HGV RNA was determined in 200 repeat donors (Group A), 44 subjects with elevated alanine aminotransferase (Group B), and 54 hepatitis C virus carriers (Group C). Liver histology was evaluated in Group C by using the histologic activity index. RESULTS: HGV RNA was detected in three subjects of Group A (1 5%; 95% CI: 0.3-4.3), two of Group B (4.5%; 95% CI: 0.6-15.5%), and six of Group C (1l.lY0; 95% CI: 4.2-22.6). The prevalence of leukopenia and elevated y-glutamyl transpeptidase was higher in the 1 1 viremic donors than in 88 nonviremic subjects (36% vs. 2.3%, and 55% vs. 22%, respectively; p<0.05), matched for clinical and demographic characteristics. The mean histologic activity index score * standard error was 4 * 0.7 in the HGV RNA-positive donors and 3.4 f 0.3 in the HGV RNA-negative donors. CONCLUSION: HGV is endemic in Italian blood donors, although it has a limited role in causing liver damage. Further studies are needed to clarify its role in inducing transfusion-associated disease in myelosuppression. ABBREVIATIONS: ALT = alanine aminotransferase; GGT = yglutamryl transpeptidase; HCV = hepatitis C virus; HGV = hepatitis G virus; HA1 = histologic activity index; NCR = noncoding region; NS = nonstructural (region); PCR = polymerase chain reaction; UTR = untranslated region.
Background/Aim: The 3% paraformaldehyde (PFA) method is a simple technique for counting residual ... more Background/Aim: The 3% paraformaldehyde (PFA) method is a simple technique for counting residual white blood cells (WBC) in leukocyte-depleted red blood cells (RBC). Preliminary data suggested that its sensitivity is at least equal to PCR and flow cytometry. We report the results of a multicenter study conducted by the BEST Working Party to determine precision and accuracy of the 3% PFA method. Study Design: In the 7 participating laboratories, 5 sets of samples containing nominal concentrations of 200, 100, 50, and 10 WBC/ml were prepared by diluting whole blood into 'WBC-free' RBC. Ten milliliters of each sample were processed using the 3% PFA method, which is based on erythrocyte lysis and WBC concentration into 5% of the original sample volume; a Nageotte chamber is used to count concentrated WBC. Results: The precision of the technique varied according to the nominal concentration, ranging from a CV of 12% at 200 WBC/ml to 57% at 10 WBC/ml. The technique measured fewer than the nominal WBC concentrations (mean of all laboratories,-12.4%); underestimation was probably due to cell loss during sample manipulation. Overall accuracy was however acceptable, because statistical considerations establish that the actual WBC concentration would unlikely exceed 2 times the estimated count. Conclusions: The 3% PFA method is suitable for the enumeration of residual WBC at concentrations 2 50/ml. It represents a useful tool for evaluation of high performance filters by reference laboratories.
Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represen... more Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represents a possible cause of community-acquired infections. This study describes a case of asymptomatic HCV infection acquired by a repeat blood donor from her sexual partner. A female repeat blood donor showed anti-HCV seroconversion and a slight elevation in alanine aminotransferase. She had a normal physical examination and no clinical symptoms. She admitted a sexual partnership with a man with chronic HCV infection. Genotyping showed subtype 3a infection in both. Nucleotide sequence analysis of the hypervariable region of the viral envelope was performed on five clones obtained from the donor and the partner. Five blood donors with subtype 3a infection were analyzed as controls. The mean homology among clones was 99.3 percent (95% CI, 98.9-99.7) in the donor and 96.8 percent (95% CI, 94.4-99.2) in the partner, which suggests a more recent infection in the woman. The mean homology between donor and partner was 93.4 percent (95% CI, 93.1-93.8), which is different from that between donor and controls (76.2%; 95% CI, 73.3-79.1; difference between means, 17.2%; 95% CI, 16.0-18.4). This suggests that the infection was transmitted to the donor from her sexual partner. Sexual intercourse is the most probable route of transmission, because parenteral risk factors were absent. Heterosexual transmission of HCV can occur in the absence of a long-lasting contact, and the infection can be asymptomatic. It remains to be determined whether the sexual partners of HCV-infected subjects should be deferred from blood donation.
We performed a prospective study in a cohort of repeat To assess the incidence and source of comm... more We performed a prospective study in a cohort of repeat To assess the incidence and source of community-acblood donors to estimate the risk of acquiring HCV infection quired hepatitis C virus (HCV) infection among subjects among individuals without parenteral exposure, and to invesat low risk for blood-borne diseases, we prospectively tigate the possible cause of infection. studied a cohort of 16,515 repeat blood donors over a mean follow-up time of 36 months. Second-and third-PATIENTS AND METHODS generation methods were used for hepatitis C virus antibody (anti-HCV) testing. HCV RNA was determined in A cohort of 18,109 anti-HCV-negative blood donors, candidates the serum of anti-HCV-positive donors by reverse-tranfor a second or subsequent donation, was enrolled between May 1991 scription polymerase chain reaction. Liver biopsy was and April 1992 in a longitudinal prospective study. Of this cohort, 16,515 subjects came to our center for further donations and were performed in the viremic subjects. Risk factors for HCV followed up for an average of 36 months (range, 3-52 months). The infection were identified by a psychosocial questionmedian interval between donations was 202 days. The male/female naire in the whole cohort. During follow-up, 5 donors ratio was 7:3, the median age was 32 years (range, 18-65 years). A became infected with HCV. The incidence was 1 per psychosocial questionnaire, based on 47 direct and indirect ques-10,000 person-years (95% confidence interval, 0.3-2.4 per tions, was routinely administered to blood donors. 16 Questions re-10,000). During the 6 months before seroconversion, four garded: 1) demographic information; 2) cigarette smoking and alcohol subjects (80%) underwent medical or surgical percutaneconsumption; 3) drug use, with reference to type, frequency, and time ous procedures, compared with 26.5% in the entire donor of last assumption; 4) sexual history; 5) history of hepatitis; and 6) cohort (difference between frequencies, 53.5%; CI: 18.9other risk factors for blood-borne infection (blood transfusion, tattooing, nosocomial exposure). At each donation, the clinical data 89.1). One seroconverting donor had sexual intercourse (medical history and physical examination results) and laboratory with an infected subject. Only 1 infected donor develtest results, including anti-HCV, were recorded in a relational dataoped clinically evident acute hepatitis. HCV RNA rebase management system (Oracle, Oracle Italia, Milan, Italy). 17 mained detectable in 4 of 5 subjects for 8 to 36 months The subjects showing confirmed anti-HCV reactivity were asked after seroconversion, and liver biopsy showed chronic to enter a follow-up program consisting of clinical and laboratory hepatitis in all cases. Thus, new cases of hepatitis C ocevaluation, including HCV-RNA determination, at 1-to 3-month incur among individuals without a history of known risk tervals. A serum sample, collected on the blood donation preceding factors, some of which may be caused by nosocomial seroconversion, was retested for anti-HCV using a third-generation exposure. (HEPATOLOGY 1997;25:702-704.) test and was evaluated for HCV RNA. Liver biopsy was proposed to the viremic subjects. Sexual partners and household contacts of seroconverting subjects were invited for counseling and anti-HCV Chronic hepatitis C virus (HCV) infection represents a sigtesting. nificant cause of morbidity and mortality worldwide. 1,2 After Enzyme-immunoassay tests were used for the determination of anti-HCV (Ortho Diagnostic Systems, Raritan, NJ; second-and
Background & Aims: The association of liver disease been reported. 11,12 For this reason, vaccine... more Background & Aims: The association of liver disease been reported. 11,12 For this reason, vaccines against multiwith hepatitis C virus (HCV) genotypes mainly refers to ple HCV genotypes will be necessary and, therefore, mappatients with serious liver damage; little information is ping the distribution of viral genotypes is warranted. available on symptomless carriers. The aim of this Data so far available mainly refer to patients with overt study was to investigate the correlation of genotypes liver disease. Genotype 1, which is less responsive to with clinical course, risk factors for infection, and antiantiviral therapy, 13-16 is more frequently found in pabody to HCV reactivity in asymptomatic subjects. Methtients with elevated alanine aminotransferase (ALT) levels ods: One hundred nine viremic blood donors with at and evidence of chronic liver disease. 17 Nevertheless, the least 1 year of follow-up were studied; 41 underwent prognostic significance of genotypes on disease outcome liver biopsy. Genotypes were determined by line-probe is still controversial. 8,17-19 assay. Results: Genotype 1 was found in 47 (43.1%), Little information is available thus far about viral gegenotype 2 in 48 (44%), genotype 3 in 8 (7.3%), genonotypes in symptomless HCV carriers. Recent reports type 4 in 2 (1.8%), and coinfections in 4 (3.7%). The relative risk (RR) for a raised pattern of alanine aminoseem to indicate that the mild course of liver disease transferase, aspartate aminotransferase, and g-glutaoften observed in these subjects 20,21 is due to the infection myltranspeptidase was 2.1 (confidence interval [CI], with less aggressive types. 17 If confirmed in other series, 1.4-3.2), 1.7 (CI, 1.2-2.4), and 2.8 (CI, 1.6-4.9) in these data could be useful in the counseling of symptomsubjects with genotype 1 vs. 0.4 (CI, 0.2-0.7), 0.4 free carriers. In addition, the association between viral (CI, 0.3-0.7), and 0.4 (CI, 0.2-0.8) in subjects with types and risk factors for HCV infection has been scarcely genotype 2. Chronic hepatitis was found in 68%; the investigated, although clustering has been recently de-RR of chronic hepatitis was similar for genotypes 1 and scribed in high-risk groups. 17,18,22
Background: To conduct a multicenter, prospective survey within the program of the Cooleycare Coo... more Background: To conduct a multicenter, prospective survey within the program of the Cooleycare Cooperative Group to evaluate the rate of transfusion-transmitted infections with human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV) in a cohort of patients who were homozygous for  thalassemia and underwent multiple transfusions during the 6-year follow-up.
We wish to draw more attention to the possibility of rapid communication. In manuscripts submitte... more We wish to draw more attention to the possibility of rapid communication. In manuscripts submitted for rapid communication new findings of sufficient importance must be presented to justify accelerated publication. The manuscripts must be written according to the general arrangement of original papers except that no abstract is required. Instead of an introduction a short first paragraph in which the reason for the investigations and the main results are outlined is sufficient. The length of the paper should not exceed 8 double-spaced pages including figures, tables and references. Review will be rapid and once it is accepted, the paper will be included in the next planned issue. Proofs will be checked by the publishers. C.
The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C v... more The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C virus (HCV) second-generation recombinant immunoblot assay (RIBA-2) was investigated in symptomless subjects with normal liver function tests to obtain data for their counseling and clinical management. Serum and hepatic HCV RNA were determined by the nested polymerase chain reaction, and liver histology was evaluated in 40 symptomless blood donors with stable indeterminate RIBA-2 pattern, including 38 reactive to c22-3. All but one had normal alanine aminotransferase (ALT) levels. Two new immunoblot tests, RIBA-3 and INNO-LIA HCV Ab III (LIA-III), which incorporate additional HCV antigens, were also done to assess whether they could identify the viremic subjects. Ten cases (25%, confidence interval 12 to 38) were HCV RNA positive. Three of the HCV RNA-positive and none of the HCV RNA-negative subjects had chronic hepatitis. RIBA-2 strong intensity of reaction (score &amp;amp;amp;amp;amp;amp;gt; 2+) was observed in all the HCV RNA-positive and in 12 HCV RNA-negative subjects. RIBA-3 and LIA-III gave positive results in 9 of 10 and 10 of 10 HCV RNA-positive, but also in 8 of 30 and 24 of 30 HCV RNA-negative subjects. A c-22-3 reactivity score of 4+ by RIBA-3 and E2/NS1 reactivity by LIA-III were both strongly associated with HCV RNA (P &amp;amp;amp;amp;amp;amp;lt; .001). Based on relatively high prevalence of chronic hepatitis in our series (30%), apparently healthy subjects with stable indeterminate RIBA-2 pattern and HCV RNA positivity should be considered for liver biopsy independently of ALT profile.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical and diagnostic laboratory immunology, 1995
Blood is filtered for selective removal of leukocytes (WBC) to reduce the immunological and virol... more Blood is filtered for selective removal of leukocytes (WBC) to reduce the immunological and virological risks of transfusion. Exceedingly low numbers of residual WBC in leukodepleted blood cannot be enumerated by conventional hematologic methods. Therefore, we investigated the application of a DNA enzyme immunoassay (DEIA) for detecting a region of the HLA-DQ alpha gene following amplification by PCR. After hybridization with a specific probe coated onto the wells of a microtiter plate, the PCR-amplified DNA was detected by adding monoclonal antibodies to double-stranded DNA, enzyme tracer, and chromogen substrate for colorimetric measurement. The sensitivities of DEIA and radioisotopic liquid hybridization were similar in five sets of experiments performed with a known number of human WBC. The optical density and the number of spiked human WBC in the range of 1.0 to 0.05 cells per microliter showed good correlation in five calibration experiments performed with human WBC suspended ...
To evaluate the risk of transmitting blood-borne GB virus C/hepatitis G virus (GBV-C/HGV) and to ... more To evaluate the risk of transmitting blood-borne GB virus C/hepatitis G virus (GBV-C/HGV) and to define the natural course of infection, we performed a prospective study in a cohort of multitransfused β-thalassemics during a 6-year follow-up period. We analyzed serum samples of 150 patients collected at 3-year intervals from 1990 to 1996. GBV-C/HGV RNA was determined by reverse transcriptase-polymerase chain reaction and antibodies to E2-protein by an enzyme immunoassay. At baseline, 14.5% of patients had viremia and 18.5% anti-E2. None of the patients with anti-E2 in 1990 subsequently became viremic. Of the 100 GBV-C/HGV RNA−, anti-E2− patients, 10 acquired infection during follow-up, as indicated by positivity of GBV-C/HGV RNA (n = 2), anti-E2 (n = 7), or both markers (n = 1) in 1996. The incidence was 1.7 per 100 person-years (95% confidence interval [CI], 0.8 to 3). Since approximately 19,000 blood units were transfused to these patients during follow-up, the risk of infection w...
BACKGROUND: Hepatitis G virus (HGV) has been reported in patients with fulminant hepatitis and ap... more BACKGROUND: Hepatitis G virus (HGV) has been reported in patients with fulminant hepatitis and aplastic anemia, but HGV RNA has also been found in healthy individuals. The possible associations of HGV with liver function and hematologic abnormalities in asymptomatic blood donors were investigated. STUDY DESIGN AND METHODS: Serum HGV RNA was determined in 200 repeat donors (Group A), 44 subjects with elevated alanine aminotransferase (Group B), and 54 hepatitis C virus carriers (Group C). Liver histology was evaluated in Group C by using the histologic activity index. RESULTS: HGV RNA was detected in three subjects of Group A (1 5%; 95% CI: 0.3-4.3), two of Group B (4.5%; 95% CI: 0.6-15.5%), and six of Group C (1l.lY0; 95% CI: 4.2-22.6). The prevalence of leukopenia and elevated y-glutamyl transpeptidase was higher in the 1 1 viremic donors than in 88 nonviremic subjects (36% vs. 2.3%, and 55% vs. 22%, respectively; p<0.05), matched for clinical and demographic characteristics. The mean histologic activity index score * standard error was 4 * 0.7 in the HGV RNA-positive donors and 3.4 f 0.3 in the HGV RNA-negative donors. CONCLUSION: HGV is endemic in Italian blood donors, although it has a limited role in causing liver damage. Further studies are needed to clarify its role in inducing transfusion-associated disease in myelosuppression. ABBREVIATIONS: ALT = alanine aminotransferase; GGT = yglutamryl transpeptidase; HCV = hepatitis C virus; HGV = hepatitis G virus; HA1 = histologic activity index; NCR = noncoding region; NS = nonstructural (region); PCR = polymerase chain reaction; UTR = untranslated region.
Background/Aim: The 3% paraformaldehyde (PFA) method is a simple technique for counting residual ... more Background/Aim: The 3% paraformaldehyde (PFA) method is a simple technique for counting residual white blood cells (WBC) in leukocyte-depleted red blood cells (RBC). Preliminary data suggested that its sensitivity is at least equal to PCR and flow cytometry. We report the results of a multicenter study conducted by the BEST Working Party to determine precision and accuracy of the 3% PFA method. Study Design: In the 7 participating laboratories, 5 sets of samples containing nominal concentrations of 200, 100, 50, and 10 WBC/ml were prepared by diluting whole blood into 'WBC-free' RBC. Ten milliliters of each sample were processed using the 3% PFA method, which is based on erythrocyte lysis and WBC concentration into 5% of the original sample volume; a Nageotte chamber is used to count concentrated WBC. Results: The precision of the technique varied according to the nominal concentration, ranging from a CV of 12% at 200 WBC/ml to 57% at 10 WBC/ml. The technique measured fewer than the nominal WBC concentrations (mean of all laboratories,-12.4%); underestimation was probably due to cell loss during sample manipulation. Overall accuracy was however acceptable, because statistical considerations establish that the actual WBC concentration would unlikely exceed 2 times the estimated count. Conclusions: The 3% PFA method is suitable for the enumeration of residual WBC at concentrations 2 50/ml. It represents a useful tool for evaluation of high performance filters by reference laboratories.
Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represen... more Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represents a possible cause of community-acquired infections. This study describes a case of asymptomatic HCV infection acquired by a repeat blood donor from her sexual partner. A female repeat blood donor showed anti-HCV seroconversion and a slight elevation in alanine aminotransferase. She had a normal physical examination and no clinical symptoms. She admitted a sexual partnership with a man with chronic HCV infection. Genotyping showed subtype 3a infection in both. Nucleotide sequence analysis of the hypervariable region of the viral envelope was performed on five clones obtained from the donor and the partner. Five blood donors with subtype 3a infection were analyzed as controls. The mean homology among clones was 99.3 percent (95% CI, 98.9-99.7) in the donor and 96.8 percent (95% CI, 94.4-99.2) in the partner, which suggests a more recent infection in the woman. The mean homology between donor and partner was 93.4 percent (95% CI, 93.1-93.8), which is different from that between donor and controls (76.2%; 95% CI, 73.3-79.1; difference between means, 17.2%; 95% CI, 16.0-18.4). This suggests that the infection was transmitted to the donor from her sexual partner. Sexual intercourse is the most probable route of transmission, because parenteral risk factors were absent. Heterosexual transmission of HCV can occur in the absence of a long-lasting contact, and the infection can be asymptomatic. It remains to be determined whether the sexual partners of HCV-infected subjects should be deferred from blood donation.
We performed a prospective study in a cohort of repeat To assess the incidence and source of comm... more We performed a prospective study in a cohort of repeat To assess the incidence and source of community-acblood donors to estimate the risk of acquiring HCV infection quired hepatitis C virus (HCV) infection among subjects among individuals without parenteral exposure, and to invesat low risk for blood-borne diseases, we prospectively tigate the possible cause of infection. studied a cohort of 16,515 repeat blood donors over a mean follow-up time of 36 months. Second-and third-PATIENTS AND METHODS generation methods were used for hepatitis C virus antibody (anti-HCV) testing. HCV RNA was determined in A cohort of 18,109 anti-HCV-negative blood donors, candidates the serum of anti-HCV-positive donors by reverse-tranfor a second or subsequent donation, was enrolled between May 1991 scription polymerase chain reaction. Liver biopsy was and April 1992 in a longitudinal prospective study. Of this cohort, 16,515 subjects came to our center for further donations and were performed in the viremic subjects. Risk factors for HCV followed up for an average of 36 months (range, 3-52 months). The infection were identified by a psychosocial questionmedian interval between donations was 202 days. The male/female naire in the whole cohort. During follow-up, 5 donors ratio was 7:3, the median age was 32 years (range, 18-65 years). A became infected with HCV. The incidence was 1 per psychosocial questionnaire, based on 47 direct and indirect ques-10,000 person-years (95% confidence interval, 0.3-2.4 per tions, was routinely administered to blood donors. 16 Questions re-10,000). During the 6 months before seroconversion, four garded: 1) demographic information; 2) cigarette smoking and alcohol subjects (80%) underwent medical or surgical percutaneconsumption; 3) drug use, with reference to type, frequency, and time ous procedures, compared with 26.5% in the entire donor of last assumption; 4) sexual history; 5) history of hepatitis; and 6) cohort (difference between frequencies, 53.5%; CI: 18.9other risk factors for blood-borne infection (blood transfusion, tattooing, nosocomial exposure). At each donation, the clinical data 89.1). One seroconverting donor had sexual intercourse (medical history and physical examination results) and laboratory with an infected subject. Only 1 infected donor develtest results, including anti-HCV, were recorded in a relational dataoped clinically evident acute hepatitis. HCV RNA rebase management system (Oracle, Oracle Italia, Milan, Italy). 17 mained detectable in 4 of 5 subjects for 8 to 36 months The subjects showing confirmed anti-HCV reactivity were asked after seroconversion, and liver biopsy showed chronic to enter a follow-up program consisting of clinical and laboratory hepatitis in all cases. Thus, new cases of hepatitis C ocevaluation, including HCV-RNA determination, at 1-to 3-month incur among individuals without a history of known risk tervals. A serum sample, collected on the blood donation preceding factors, some of which may be caused by nosocomial seroconversion, was retested for anti-HCV using a third-generation exposure. (HEPATOLOGY 1997;25:702-704.) test and was evaluated for HCV RNA. Liver biopsy was proposed to the viremic subjects. Sexual partners and household contacts of seroconverting subjects were invited for counseling and anti-HCV Chronic hepatitis C virus (HCV) infection represents a sigtesting. nificant cause of morbidity and mortality worldwide. 1,2 After Enzyme-immunoassay tests were used for the determination of anti-HCV (Ortho Diagnostic Systems, Raritan, NJ; second-and
Background & Aims: The association of liver disease been reported. 11,12 For this reason, vaccine... more Background & Aims: The association of liver disease been reported. 11,12 For this reason, vaccines against multiwith hepatitis C virus (HCV) genotypes mainly refers to ple HCV genotypes will be necessary and, therefore, mappatients with serious liver damage; little information is ping the distribution of viral genotypes is warranted. available on symptomless carriers. The aim of this Data so far available mainly refer to patients with overt study was to investigate the correlation of genotypes liver disease. Genotype 1, which is less responsive to with clinical course, risk factors for infection, and antiantiviral therapy, 13-16 is more frequently found in pabody to HCV reactivity in asymptomatic subjects. Methtients with elevated alanine aminotransferase (ALT) levels ods: One hundred nine viremic blood donors with at and evidence of chronic liver disease. 17 Nevertheless, the least 1 year of follow-up were studied; 41 underwent prognostic significance of genotypes on disease outcome liver biopsy. Genotypes were determined by line-probe is still controversial. 8,17-19 assay. Results: Genotype 1 was found in 47 (43.1%), Little information is available thus far about viral gegenotype 2 in 48 (44%), genotype 3 in 8 (7.3%), genonotypes in symptomless HCV carriers. Recent reports type 4 in 2 (1.8%), and coinfections in 4 (3.7%). The relative risk (RR) for a raised pattern of alanine aminoseem to indicate that the mild course of liver disease transferase, aspartate aminotransferase, and g-glutaoften observed in these subjects 20,21 is due to the infection myltranspeptidase was 2.1 (confidence interval [CI], with less aggressive types. 17 If confirmed in other series, 1.4-3.2), 1.7 (CI, 1.2-2.4), and 2.8 (CI, 1.6-4.9) in these data could be useful in the counseling of symptomsubjects with genotype 1 vs. 0.4 (CI, 0.2-0.7), 0.4 free carriers. In addition, the association between viral (CI, 0.3-0.7), and 0.4 (CI, 0.2-0.8) in subjects with types and risk factors for HCV infection has been scarcely genotype 2. Chronic hepatitis was found in 68%; the investigated, although clustering has been recently de-RR of chronic hepatitis was similar for genotypes 1 and scribed in high-risk groups. 17,18,22
Background: To conduct a multicenter, prospective survey within the program of the Cooleycare Coo... more Background: To conduct a multicenter, prospective survey within the program of the Cooleycare Cooperative Group to evaluate the rate of transfusion-transmitted infections with human immunodeficiency virus (HIV) and human T-lymphotropic virus (HTLV) in a cohort of patients who were homozygous for  thalassemia and underwent multiple transfusions during the 6-year follow-up.
We wish to draw more attention to the possibility of rapid communication. In manuscripts submitte... more We wish to draw more attention to the possibility of rapid communication. In manuscripts submitted for rapid communication new findings of sufficient importance must be presented to justify accelerated publication. The manuscripts must be written according to the general arrangement of original papers except that no abstract is required. Instead of an introduction a short first paragraph in which the reason for the investigations and the main results are outlined is sufficient. The length of the paper should not exceed 8 double-spaced pages including figures, tables and references. Review will be rapid and once it is accepted, the paper will be included in the next planned issue. Proofs will be checked by the publishers. C.
The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C v... more The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C virus (HCV) second-generation recombinant immunoblot assay (RIBA-2) was investigated in symptomless subjects with normal liver function tests to obtain data for their counseling and clinical management. Serum and hepatic HCV RNA were determined by the nested polymerase chain reaction, and liver histology was evaluated in 40 symptomless blood donors with stable indeterminate RIBA-2 pattern, including 38 reactive to c22-3. All but one had normal alanine aminotransferase (ALT) levels. Two new immunoblot tests, RIBA-3 and INNO-LIA HCV Ab III (LIA-III), which incorporate additional HCV antigens, were also done to assess whether they could identify the viremic subjects. Ten cases (25%, confidence interval 12 to 38) were HCV RNA positive. Three of the HCV RNA-positive and none of the HCV RNA-negative subjects had chronic hepatitis. RIBA-2 strong intensity of reaction (score &amp;amp;amp;amp;amp;amp;gt; 2+) was observed in all the HCV RNA-positive and in 12 HCV RNA-negative subjects. RIBA-3 and LIA-III gave positive results in 9 of 10 and 10 of 10 HCV RNA-positive, but also in 8 of 30 and 24 of 30 HCV RNA-negative subjects. A c-22-3 reactivity score of 4+ by RIBA-3 and E2/NS1 reactivity by LIA-III were both strongly associated with HCV RNA (P &amp;amp;amp;amp;amp;amp;lt; .001). Based on relatively high prevalence of chronic hepatitis in our series (30%), apparently healthy subjects with stable indeterminate RIBA-2 pattern and HCV RNA positivity should be considered for liver biopsy independently of ALT profile.(ABSTRACT TRUNCATED AT 250 WORDS)
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