CLINICAL AND VIROLOGICAL FEATURES OF HEPATITIS-C VIRUS-INFECTION ASSOCIATED WITH INTRAVENOUS IMMUNOGLOBULIN

Objective. To characterize the clinical features of hepatitis C virus (HCV) infection associated with the administration of intravenous immu noglobulin (IVIG) in patients with varied immunodeficiencies. Design. Prospective collection of clinical and virologic data in patients dete rmined to have HCV exposure associated with Gammagard. Setting. Outpat ient department of Children's Hospital, Boston. Patients. Twenty-one p atients with evidence of HCV infection were identified during a screen ing program initiated to detect infection in exposed individuals. They ranged from 5 to 53 years of age; 14 were children under age 18. Resu lts. Six patients presented with severe clinical hepatitis before dete ction by screening, 13 were detected by screening only, and 2 were fir st detected by screening and subsequently developed symptomatic hepati tis. Follow-up is available on 20 patients; 4 without viremia at ident ification have remained clinically well. Hepatitis and viremia have re solved in 2, 2 additional subjects have developed normal alanine amino transferase (ALT) values with persistent viremia, and 13 have biochemi cal and/or virologic evidence of chronic hepatitis. Eight patients (7 children) have undergone liver biopsies; 7 have histologic findings of chronic hepatitis, 5 have mild fibrosis, and 2 have moderate fibrosis . HCV genotypes 1a and Ib were observed with equal frequency in this g roup. Conclusions. Some HCV infections associated with IVIG had a more severe, acute course than is ordinarily described. This may be attrib utable to host factors, such as immunodeficiencies, or virologic facto rs, such as inoculum or genotype. Although a large percentage (87.5%) of these individuals developed chronic infection, the natural history is not as yet completely defined.