LETTER
Blood Donors with Antibody to Hepatitis C Virus
Howard J. Worman, MD, MD
15 May 1996 | Volume 124 Issue 10 | Pages 930-931
TO THE EDITOR:
The clinical presentation of patients with chronic hepatitis C can range from the absence of symptoms to the presence of cirrhosis and hepatocellular carcinoma. Several studies on the natural history of hepatitis C have been published [1-3], but conflicting data exist on the presentation and progression of patients with this disease. Thus, physicians are often unsure about prognosis, management, and treatment. In this regard, discrepancies in the results of two recent studies [4, 5] deserve comment.
In a recent report published in Annals, Shakil and colleagues [4] reported that of 60 asymptomatic blood donors with antibodies against HCV (mean age, approximately 40 years), 54 had chronic hepatitis, including 14 of 20 with normal serum aminotransferase values. Only 1 of these 60 patients had cirrhosis. In contrast, Tong and associates [5] described 131 primarily symptomatic patients (mean age, 57 years) who had chronic posttransfusion hepatitis C and were referred to a center specializing in liver diseases. In their study, 67 of 131 patients had cirrhosis, and several also had hepatocellular carcinoma.
The conflicting data in these two reports emphasize the need for additional studies on the prognosis, management, and treatment of patients with chronic hepatitis C. They suggest that symptomatic patients found by specialists to have substantial liver disease may benefit from aggressive treatment. In contrast, asymptomatic patients may have a good prognosis. These studies also highlight our current ignorance of host, environmental, and viral factors that influence disease activity. The results also emphasize that drug trials for chronic hepatitis C should evaluate patients referred to liver clinics and patients whose conditions are diagnosed by screening methods as two distinct treatment groups.
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Author and Article Information
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Columbia University College of Physicians and Surgeons; New York, NY 10032
1. Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med. 1992; 327:1899-905.
2. Seeff LB, Buskell-Bales Z, Wright EC, Durako SJ, Alter HJ, Iber FL, et al. Long-term mortality after transfusion-associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. N Engl J Med. 1992; 327:1906-11.
3. Koretz RL, Abbey H, Coleman E, Gitnick G. Non-A, non-B posttransfusion hepatitis. Looking back in the second decade. Ann Intern Med. 1993; 119:110-5.
4. Shakil AO, Conry-Cantilena C, Alter HJ, Hayashi P, Kleiner DE, Tedeschi V, et al. Volunteer blood donors with antibody to hepatitis C virus: clinical, biochemical, virologic, and histologic features. Ann Intern Med. 1995; 123:330-7.
5. Tong MJ, El-Farra NS, Reikes AR, Co RL. Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med. 1995; 332:1463-6.
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