FOLLOW-UP OF BLOOD-DONORS POSITIVE FOR HC V SEROLOGY AND OF THEIR RECIPIENTS IS INSUFFICIENT

Objectives. - Our aim was to study the characteristics of blood donors with serum anti-HCV antibodies, their medical follow-up based on a qu estionnaire, and the followup of their recipients who were transfused before systematic screening of anti-HCV antibodies had begun. Methods. - From March 1990 to January 1992, 25255 blood donors were tested by ELISA 1 or ELISA 2 serum tests and confirmed by RIBA 2 test in case of positivity: 126 (0.5 %) were ELISA positive of whom 40 (0.16 %) were RIBA 2 positive (n = 18) or indeterminate (n = 22); among the latter, 13 were retested by RIBA 3 which was positive in 2 cases. Thus, the pr evalence of blood donors with trully positive HCV antibodies testing w as shown to be between 0.08 and 0.12 %. Among the 126 ELISA positive b lood donors, 90 had given blood before systematic screening had begun, involving 232 patients and 50 non nominative products. Results. - In donors with positive ELISA test, the prevalence of serum ALT activity > 2N was 17 % if the RIBA test was positive vs 1 % if the test was neg ative or indeterminate (P = 0.0007). The rate of donors with serum ALT activity > N before March 1990 was 62.5 % if the RIBA test was positi ve vs 17.5 % if if was negative (P = 0.01). The follow-up at 2 years o f 34 out of 40 donors with a positive or indeterminate RIBA test showe d that 88 % had had at least two serum ALT activity tests, that 12 % h ad had a serologic test, that 6 % had sought the advice of a specialis t, and that a liver biopsy was performed in 3 %. The follow-up of reci pients showed that the response rate of physicians or recipients was 3 7 % (47 % at public hospital and 12 % in private hospital, P < 0.01). The rate of recipients positive for HCV was 25 %, that is 2 % of the e ntire group, yielding an estimated 8 % efficiency of the survey. Lack of screening was due to the lack of responses from physicians or recip ients in 64 % of cases and to the death of the recipient in 36 % of ca ses. Conclusion. - HCV seroprevalence among blood donors in France is closed to that observed in Northern Europe. In this population, there is a great discrepancy between the ELISA and RIBA tests. During the su rvey period, the follow-up of HCV positive blood donors seemed to be v ery insufficient. The screening of their recipients was poorly effecti ve, thus emphasizing the importance of the systematic and prospective follow-up of blood donors.