THE CLINICAL-SIGNIFICANCE OF THE DETECTION OF HEPATITIS GBV-C RNA IN THE SERUM OF PATIENTS WITH FULMINANT, PRESUMED VIRAL, HEPATITIS

In a significant number of cases of fulminant (presumed viral) hepatit is worldwide, no aetiological agent has been identified. Recently, it has been suggested that a newly described flavivirus, GBV-C, is respon sible for some of these cases, This study aimed to assess the clinical significance of GBV-C RNA, demonstrated by reverse transcriptase-poly merase chain reaction (RT-PCR), in the serum of patients with fulminan t non-A to E hepatitis. Twenty-three consecutive cases of non-A to E f ulminant hepatitis were included in the study. GBV-C RNA was reverse t ranscribed and amplified using two RT-PCR based detection methods. Med ical records were examined to assess clinical history, duration and mo de of infection, transfusion history, liver histology and clinical out come. Five (three female, two male; mean age 21.2 years) of 23 patient s had GBV-C RNA detected in their serum by RT-PCR; all five patients w ere RT-PCR positive following amplification by primers specific for th e 5' non-coding region (NCR), whilst four were positive by primers for the NS 3 region, Prior to the onset of illness, two patients had risk . factors for transmission of an infectious agent; however, all five p atients had been transfused during their illness, prior to testing for GBV-C. Of these, two (of two in whom serum was available) were negati ve for GBV-C after the onset of fulminant hepatitis but before their f irst transfusion, This study does not support the hypothesis that the detection of hepatitis G virus (HGV)/GBV-C RNA in the serum of patient s with fulminant hepatitis indicates a causal association. However, it does demonstrate that a careful transfusion history and screening of blood products is vital before the importance of GBV-C in the aetiolog y of fulminant hepatitis can be established.