HEPATITIS-C INFECTION IN PATIENTS WITH PRIMARY HYPOGAMMAGLOBULINEMIA AFTER TREATMENT WITH CONTAMINATED IMMUNE GLOBULIN

Background. In Scandinavia many patients with primary hypogammaglobuli nemia contracted non-A, non-B hepatitis after intravenous treatment wi th an immune globulin product that was later found to contain a non-A, non-B hepatitis virus. Methods. We studied the prevalence and clinica l course of hepatitis C virus (HCV) infection in a group of 55 Norwegi an patients with primary hypogammaglobulinemia and investigated its as sociation with the use of contaminated immune globulin. We used the po lymerase chain reaction to detect HCV RNA and performed HCV genotyping . We also analyzed the responses to treatment with interferon. Results . Of 20 patients who received the contaminated immune globulin, 17 wer e seropositive for HCV RNA, In addition, 1 of 35 patients not exposed to the contaminated immune globulin was HCV RNA-positive. HCV genotype V was found in all 12 patients for whom genotyping was performed, but 8 patients also had genotype II or III, or both. All HCV RNA-positive patients had abnormal results on biochemical liver tests. All liver-b iopsy specimens (from 15 patients) were abnormal, with portal inflamma tion, bile-duct damage, and focal necrosis. In six patients there was cirrhosis. Two patients died of liver failure. In 4 of the 10 patients treated with interferon there were complete, though transient, bioche mical responses, but the follow-up biopsy specimens showed evidence of histologic progression. The poorest responses to interferon were amon g the patients with multiple HCV genotypes. All but one patient remain ed positive for HCV RNA. Conclusions. In patients with primary hypogam maglobulinemia there was a high rate of HCV infection after treatment with contaminated immune globulin. In these immunocompromised patients HCV infection has a severe and rapidly progressive course, and respon ses to interferon are poor.