REPLY
Blood Donors with Antibody to Hepatitis C Virus
A. Obaid Shakil, MD, and
Harvey J. Alter, MD
15 May 1996 | Volume 124 Issue 10 | Page 931
IN RESPONSE:
Dr. Klein raises the issue of selection bias, arguing that persons with a defined risk factor for liver disease or those with symptoms were more likely to participate in our study. We agree that the characteristics of persons who declined to participate in the study would have been useful information for the reader. It is probable, however, that the bias could have gone in either direction and thus did not significantly affect our conclusions.
Dr. Worman points to discrepancies between the results in our study and those in the study recently reported by Tong and colleagues [1]. We believe that most patients with chronic hepatitis C have mild and slowly progressive disease. Some patients, however, do have severe outcomes. We examined a cohort of asymptomatic volunteer blood donors who were clearly at the mild end of the spectrum. In contrast, Tong and associates studied symptomatic patients at a tertiary referral center who were directed toward therapy and thus were highly likely to have severe liver disease. Those patients therefore represented the more severe end of the disease spectrum. They were also older than the participants in our study, reflecting a longer duration of disease and thus a greater likelihood of severe disease.
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Author and Article Information
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University of Pittsburgh Medical Center; Pittsburgh, PA 15213-2582
National Institutes of Health; Bethesda, MD 20892
1. 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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