A clinical, epidemological, laboratorial, histological and ultrasonographical evaluation of anti-HCV EIA-2 positive blood donors

RESUMO

Between 1992 and 1997, 790 blood donors with anti-HCV EIA-2 strongly reagent (relationship between the sample optical density/cut-off > 3) detected at the blood bank serological screening, were evaluated in ambulatory environment. They were all negative for Chagas disease, syphilis, hepatitis B (HBsAg) and AIDS. Blood samples were collected at the first ambulatorial evaluation, for hemogram, biochemical tests and new serological tests for HCV (anti-HCV EIA-2). In blood samples of 226 repeatedly reagent anti-HCV EIA-2 blood donors, supplementary "immunoblot" test for HCV (RIBA-2) was used. In 209 donors, the presence of HCV-RNA was investigated by the PCR test. The abdominal ultrasonography was realized in 366 donors. In 269 patients liver biopsy was performed for the histopathological study. The follow-up of blood donors showed that 95.6 percent were repeatedly EIA-2 reagent, 94 percent were symptomless and denied any hepatitis history, with only 2 percent mentioning previous jaundice. In 47 percent of this population at least one risk factor has been detected for the HCV transmission, the use of intravenous drugs being the main one (27.8 percent). Blood transfusion was the second factor for HCV transmission (27.2 percent). Hepatomegaly was detected in 54 percent of the cases. Splenomegaly and signs of portal hypertension have seldom been found in the physical examination, indicating a low degree of hepatic compromising in HCV. Abdominal ultrasound showed alterations in 65 percent of the subjects, being the steatosis the most frequent (50 percent). In 83.5 percent of the donors submitted to the liver biopsy, the histopathological exam showed the presence of chronic hepatitis, usually classified as active (89 percent) with mild or moderate grade in most of the cases (99.5 percent). The histopathological exam of the liver was normal in 1.5 percent of blood donors. The RIBA-2 test and the HCV-RNA investigation by PCR were positive in respectively 91.6 and 75 percent of the anti-HCV EIA-2 reagent donors. The HCV-RNA research was positive in 82 percent of the RIBA-2 positive subjects, in 37.5 percent of the indeterminate RIBA-2 donors and in 9 percent of the negative RIBA-2 donors. Chronic hepatitis has also been observed in 50 percent of the histopathological exams of the anti-HCV EIA-2 reagent donors which were indeterminate RIBA-2...