LIVER HISTOLOGY IN ANTI-HCV-POSITIVE PERSONS WITH NORMAL OR MINIMALLYELEVATED AMINOTRANSFERASES

The significance of a positive hepatitis C virus (HCV) screening test in asymptomatic blood donors with normal or near normal aminotransfera ses was studied along with the usefulness of HCV RNA polymerase chain reaction (PCR) testing for predicting chronic hepatitis in these indiv iduals. One hundred and thirty-nine volunteer blood donors who were fo und positive by second generation ELISA for antibodies to HCV agreed t o participate in the study. Thirty-one of them were supplemental test positive, had ALT values less than twice normal, and were followed ove r a minimum of 12 months. Thirteen consented to percutaneous liver bio psy and also had HCV RNA determination by PCR. Ten of the 13 subjects were positive for HCV RNA by PCR. Of the nine who were positive for HC V RNA and had adequate tissue for evaluation, seven had evidence of ch ronic hepatitis, three with limiting plate necrosis. Lobular inflammat ion was similar in severity to that found in the portal region. In add ition, two had periportal fibrosis, and one had bridging fibrosis. Of the three subjects who were negative for HCV RNA, only one had portal inflammation which was limited to the portal region. None of these thr ee had lobular changes, or periportal or bridging fibrosis. Of the thr ee normal biopsies, two were from subjects who were negative for HCV R NA. The sensitivity and specificity of HCV RNA testing for chronic hep atitis was 87.5% and 50%, respectively, yielding an overall accuracy o f 75%. We conclude that asymptomatic blood donors with antibodies to H CV, normal or mildly elevated liver tests, and HCV RNA may have abnorm al liver histology indicating the potential for progressive liver dise ase. HCV RNA testing by PCR may be clinically useful as a noninvasive means to discriminate between those with and without chronic liver dis ease.