The course of hepatitis C viraemia in transfusion recipients prior to availability of antiviral ther

[Guest guest]

Journal of Viral Hepatitis 15 (2), 120–128.

doi:10.1111/j.1365-2893.2007.00900.x

Abstract

The course of hepatitis C viraemia in transfusion recipients prior to

availability of antiviral therapy

J. W. Mosley11Keck School of Medicine, University of Southern California, Los

Angeles, CA, E. A. Operskalski11Keck School of Medicine, University of Southern

California, Los Angeles, CA, L. H. Tobler22Blood Systems Research Institute, San

Francisco, CA, Z. J. Buskell33Veterans Affairs Medical Center, Washington, DC,

W. W. s44Chiron Corporation, Emeryville, CA, B. Phelps44Chiron

Corporation, Emeryville, CA, J. Dockter55Gen-Probe, Incorporated, San Diego, CA,

C. Giachetti55Gen-Probe, Incorporated, San Diego, CA, L. B. Seeff 3,63Veterans

Affairs Medical Center, Washington, DC6National Institute of Diabetes and

Digestive and Kidney Diseases, Bethesda, MD and M. P. Busch2,72Blood Systems

Research Institute, San Francisco, CA7University of California, San Francisco,

CA, USA for the Transfusion-transmitted Viruses Study and Retrovirus

Epidemiology Donor Study Groups1Keck School of Medicine, University of Southern

California, Los Angeles, CA; 2Blood Systems Research Institute, San Francisco,

CA; 3Veterans Affairs Medical Center, Washington, DC; 4Chiron Corporation,

Emeryville, CA; 5Gen-Probe, Incorporated, San Diego, CA; 6National Institute of

Diabetes and Digestive and Kidney Diseases, Bethesda, MD; and 7University of

California, San Francisco, CA, USA

W. Mosley, MD, 3627 Los Amigos Street, La Crescenta, CA 91214, USA.

E-mail: mosley@...

ALT, alanine aminotransferase; anti-HCV, antibody to hepatitis C virus; HCV,

hepatitis C virus; IU/L, international units of ALT activity per liter; IU/mL,

international units of RNA per milliliter; NANB, non-A, non-B hepatitis; RT-PCR,

reverse-transcription polymerase chain reaction; TMA, transcription-mediated

amplification; TTVS, Transfusion-transmitted Viruses Study; VA, Veterans Affairs

study of long-term morbidity and mortality.

Abstract

Summary. Knowing the likely distribution of intervals from hepatitis C infection

to first RNA-negativity is important in deciding about therapeutic intervention.

Prospectively collected sera and data from the Transfusion-transmitted Viruses

Study (1974–1980) provide specific dates of infection and pattern of alanine

aminotransferase (ALT) elevations. We examined frequency, timing and correlates

of spontaneous resolution for 94 acutely infected transfusion recipients

followed for a median of 9.5 months. Later, follow-up sera (>10 years) were

available for 27 of the 94 cases from a Veterans Administration (VA) Study

(1989–1990). Twenty-five (27%) of the 94 cases were classified as probably

resolved during the episode itself. First RNA negativity occurred at 6–50 weeks

(median, 19.5 weeks) after infection, and 5–43 weeks (median, 11 weeks) after

ALT elevation. Thirteen of the 25 cases remained RNA-negative subsequently; 12

others had 1–6 RNA-positive sera intercalated between first and last

RNA-negative results. RNA negativity, therefore, began variably and was

interrupted in 12 cases of 25 (48%) by transient RNA-positive sera. Five of

these 25 patients who were RNA-negative in the last study specimen had late,

Veterans Administration Study follow-up; none showed viraemia. Of the remaining

69 transfusion transmitted virus study recipients, whose last serum was

RNA-positive, two cleared viraemia after the last study serum but before late

follow-up. Eleven (16%) had 23 intercalated RNA-negative sera before last

positivity. RNA status, therefore, needs monitoring for many months before

judging the spontaneous outcome as transient negativity may occur. Resolution

was significantly more common in women and symptomatic cases; it was not

associated with viral load in the infectious donation, HCV genotype, or the

recipient’s age.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2893.2007.00900.x

_________________________________________________________________

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[Guest guest]

Journal of Viral Hepatitis 15 (2), 120–128.

doi:10.1111/j.1365-2893.2007.00900.x

Abstract

The course of hepatitis C viraemia in transfusion recipients prior to

availability of antiviral therapy

J. W. Mosley11Keck School of Medicine, University of Southern California, Los

Angeles, CA, E. A. Operskalski11Keck School of Medicine, University of Southern

California, Los Angeles, CA, L. H. Tobler22Blood Systems Research Institute, San

Francisco, CA, Z. J. Buskell33Veterans Affairs Medical Center, Washington, DC,

W. W. s44Chiron Corporation, Emeryville, CA, B. Phelps44Chiron

Corporation, Emeryville, CA, J. Dockter55Gen-Probe, Incorporated, San Diego, CA,

C. Giachetti55Gen-Probe, Incorporated, San Diego, CA, L. B. Seeff 3,63Veterans

Affairs Medical Center, Washington, DC6National Institute of Diabetes and

Digestive and Kidney Diseases, Bethesda, MD and M. P. Busch2,72Blood Systems

Research Institute, San Francisco, CA7University of California, San Francisco,

CA, USA for the Transfusion-transmitted Viruses Study and Retrovirus

Epidemiology Donor Study Groups1Keck School of Medicine, University of Southern

California, Los Angeles, CA; 2Blood Systems Research Institute, San Francisco,

CA; 3Veterans Affairs Medical Center, Washington, DC; 4Chiron Corporation,

Emeryville, CA; 5Gen-Probe, Incorporated, San Diego, CA; 6National Institute of

Diabetes and Digestive and Kidney Diseases, Bethesda, MD; and 7University of

California, San Francisco, CA, USA

W. Mosley, MD, 3627 Los Amigos Street, La Crescenta, CA 91214, USA.

E-mail: mosley@...

ALT, alanine aminotransferase; anti-HCV, antibody to hepatitis C virus; HCV,

hepatitis C virus; IU/L, international units of ALT activity per liter; IU/mL,

international units of RNA per milliliter; NANB, non-A, non-B hepatitis; RT-PCR,

reverse-transcription polymerase chain reaction; TMA, transcription-mediated

amplification; TTVS, Transfusion-transmitted Viruses Study; VA, Veterans Affairs

study of long-term morbidity and mortality.

Abstract

Summary. Knowing the likely distribution of intervals from hepatitis C infection

to first RNA-negativity is important in deciding about therapeutic intervention.

Prospectively collected sera and data from the Transfusion-transmitted Viruses

Study (1974–1980) provide specific dates of infection and pattern of alanine

aminotransferase (ALT) elevations. We examined frequency, timing and correlates

of spontaneous resolution for 94 acutely infected transfusion recipients

followed for a median of 9.5 months. Later, follow-up sera (>10 years) were

available for 27 of the 94 cases from a Veterans Administration (VA) Study

(1989–1990). Twenty-five (27%) of the 94 cases were classified as probably

resolved during the episode itself. First RNA negativity occurred at 6–50 weeks

(median, 19.5 weeks) after infection, and 5–43 weeks (median, 11 weeks) after

ALT elevation. Thirteen of the 25 cases remained RNA-negative subsequently; 12

others had 1–6 RNA-positive sera intercalated between first and last

RNA-negative results. RNA negativity, therefore, began variably and was

interrupted in 12 cases of 25 (48%) by transient RNA-positive sera. Five of

these 25 patients who were RNA-negative in the last study specimen had late,

Veterans Administration Study follow-up; none showed viraemia. Of the remaining

69 transfusion transmitted virus study recipients, whose last serum was

RNA-positive, two cleared viraemia after the last study serum but before late

follow-up. Eleven (16%) had 23 intercalated RNA-negative sera before last

positivity. RNA status, therefore, needs monitoring for many months before

judging the spontaneous outcome as transient negativity may occur. Resolution

was significantly more common in women and symptomatic cases; it was not

associated with viral load in the infectious donation, HCV genotype, or the

recipient’s age.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2893.2007.00900.x

_________________________________________________________________

Get the power of Windows + Web with the new Windows Live.

http://www.windowslive.com?ocid=TXT_TAGHM_Wave2_powerofwindows_122007