Antibody to hepatitis C virus and liver disease in volunteer blood donors
Hepatitis C virus (HCV) is the major cause of transfusion-associated hepatitis that is neither hepatitis A nor hepatitis B, and one screening test for the antibody to the virus (anti-HCV) is called the ELISA (enzyme-linked immunosorbent assay). ž
However, this test can give false-positive results, suggesting the presence of disease when, in fact, it does not exist. A more specific test is the recombinant immunoblotting assay or RIBA, which determines whether antiviral antibodies present are specifically directed against HCV. To learn more about the specificity of anti-HCV antibodies among blood donors, a study was carried out of a group of 50 donors found to be positive for HCV using ELISA. The subjects' blood was analyzed using the RIBA test. Results showed that 13 of the donors (26 percent) tested positive on RIBA analyses and 6 had indeterminate results with elevated levels of a liver enzyme that indicates disease.
Twenty patients had negative RIBA results and normal results on tests of liver enzymes. The 19 patients with positive or indeterminate results underwent liver biopsies to determine whether liver disease was present.
The 6 patients whose RIBA patterns were indeterminate had no signs of active hepatitis on biopsy. Of the 13 with positive RIBA tests, 8 were found to have chronic active hepatitis; in 2 cases, signs of cirrhosis (a condition in which fibrous tissue replaces liver tissue) were noted.
Blood donors who test HCV-positive with ELISA and then with RIBA should be referred for further medical follow-up, as they could have active liver disease. No statement can be made about those who are positive for HCV on ELISA and then negative on RIBA, as none of them underwent liver biopsy. The anti-HCV RIBA is a useful aid for identifying blood donors with underlying chronic liver disease.
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