Clinical significance of hepatitis C antibodies in blood donors

The clinical significance of hepatitis C antibodies (anti‐HCV) in a healthy population was studied by liver function tests and liver biopsies. The patient population consisted of 195 (96.1%) of the 203 blood donors found to be either anti‐HCV positive or indeterminate by a recombinant im‐munoblot assay (RIBA) during the first year of anti‐HCV screening of 307,606 donors in Finland using a first generation enzyme‐linked immunosorbent assay. Alanine aminotransferase (ALT) levels in 67 donors reacting positively and in 128 reacting indeterminately by a second generation RIBA (RIBA‐4) were monitored to evaluate the prevalence of liver damage. Serum N‐terminal type III procollagen (PIIINP) concentrations were measured in all donors who fulfilled our criterion for possible hepatitis C (ALT values over two times the normal upper limit on two occasions or over five times the normal upper limit on one occasion) and in 23 randomly selected RIBA‐4 positive donors without ALT abnormalities (control group). Two (1.6%) of the RIBA‐4 indeterminate donors had ALT values compatible with possible hepatitis C (negative by polymerase chain reaction) whereas there were 25 (37.3%) such individuals among the RIBA‐4 positive donors (P< 0.0005). Twenty (80%) of the latter 25 RIBA‐4 positive donors with possible hepatitis C consented to liver biopsy. Of these 20 donors, 11 (55.0%) were found to have chronic persistent hepatitis, four (20.0%) mild, three (15.0%) moderate, and two (10.0%) severe chronic active hepatitis. Serum PIIINP concentrations did not correlate with histological score even though the mean concentration was significantly higher in RIBA‐4 positive donors with possible hepatitis C than in the control group (P