HEPATITIS-C VIRUS-INFECTION IN CHRONIC LIVER-DISEASE IN NATAL

The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodies to hepatitis C virus (HCV) (anti-HCV) in patients with cirrhosis, hepatocellular carcinoma (HCC) and chronic ac tive hepatitis (CAH) attending a referral hospital in a hepatitis B vi rus (HBV)-endemic area in South Africa. One hundred and ten patients w ith suspected cirrhosis, 44 with suspected HCC and 6 with chronic hepa titis were initially included. The diagnoses were confirmed in 77 pati ents with cirrhosis (histologically or macroscopically at peritoneosco py), 33 patients with HCC (histologically or elevated alpha-fetoprotei n levels plus focal lesion on hepatic imaging) and 6 patients with CAH (histologically) without antinuclear antibodies. All patients were te sted for anti-HCV with the Abbott second-generation enzyme immunoassay combined with a supplemental neutralisation assay, and hepatitis B su rface antigen (HBsAg). Anti-HCV seroprevalence for cirrhosis, HCC and CAH were 18/77 (23%), 8/33 (24%) and 2/6 (33%) respectively. HBsAg was detected in serum in 16 (21%), 15 (46%) and 1 (17%) patient respectiv ely. Only 1 patient (with cirrhosis) was positive for both anti-HCV an d HBsAg. Of those who were anti-HCV-positive, 4/18 (22.2%) cirrhotics, none with HCC and 1/2 (50%) with CAH, had previously received blood t ransfusions, resulting in a cumulative frequency of 5/28 (18%). Our re sults indicate that HCV is an important aetiological agent in the path ogenesis of chronic liver disease in our patients. In the majority of patients (82%), the infection was not transfusion-related. Thus, scree ning of blood donors for anti-HCV would not prevent the majority of ca ses of chronic liver disease secondary to HCV. It appears as if HCV an d HBV have different modes of transmission in southern Africa.