The clinical significance of the detection of hepatitis GBV-C RNA in the serum of patients with fulminant, presumed viral, hepatitis

In a significant number of cases of fulminant (presumed viral) hepatitis worldwide, no aetiological agent has been identified. Recently, it has been suggested that a newly described flavivirus, GBV‐C, is responsible for some of these cases. This study aimed to assess the clinical significance of GBV‐C RNA, demonstrated by reverse transcriptase–polymerase chain reaction (RT–PCR), in the serum of patients with fulminant non‐A to E hepatitis. Twenty‐three consecutive cases of non‐A to E fulminant hepatitis were included in the study. GBV‐C RNA was reverse transcribed and amplified using two RT–PCR based detection methods. Medical records were examined to assess clinical history, duration and mode of infection, transfusion history, liver histology and clinical outcome. Five (three female, two male; mean age 21.2 years) of 23 patients had GBV‐C RNA detected in their serum by RT–PCR; all five patients were RT–PCR positive following amplification by primers specific for the 5' non‐coding region (NCR), whilst four were positive by primers for the NS3 region. Prior to the onset of illness, two patients had risk factors for transmission of an infectious agent; however, all five patients had been transfused during their illness, prior to testing for GBV‐C. Of these, two (of two in whom serum was available) were negative for GBV‐C after the onset of fulminant hepatitis but before their first transfusion. This study does not support the hypothesis that the detection of hepatitis G virus (HGV)/GBV‐C RNA in the serum of patients with fulminant hepatitis indicates a causal association. However, it does demonstrate that a careful transfusion history and screening of blood products is vital before the importance of GBV‐C in the aetiology of fulminant hepatitis can be established.