HEPATITIS-C VIRUS-INFECTION IN THE ASYMPTOMATIC BRITISH BLOOD-DONOR

Blood donor screening for hepatitis C virus (HCV) antibodies is now ro utine. Most blood transfusion services recommend that seropositive don ors are referred for further investigation. Southern European studies suggest that many asymptomatic seropositive donors have clinically sig nificant liver disease. Seropositive donors in areas of high prevalenc e may not, however, be representative of British donors. We have prosp ectively examined the prevalence and severity of HCV infection in a Br itish volunteer blood donor population. During a 14 month period, only 0.35% (999/287332) of all donors in the West Midlands were anti-HCV ( screening assay) positive. Only 5% (52/999) of these were confirmed tr ue seropositive. Nearly 80% (41/52) of seropositive donors were referr ed to the Queen Elizabeth Hospital Liver Unit for further investigatio n. Most underwent complete investigation, including liver biopsy. Fort y of forty-one donors had biochemical, histological, or virological ev idence of persistent viral infection. Histological changes were genera lly mild and none was cirrhotic. Covertly infected patients had less s evere disease than those with an overt risk factor for HCV exposure. I n the British Midlands, the prevalence of blood donor seropositivity i s low. In contrast with seropositive Southern European donors, the Bri tish donor is more likely to belong to an at-risk group for parenteral exposure and is less likely to have severe histological changes. This study highlights the importance of developing locally relevant guidel ines for the counselling and investigation of anti-HCV-positive blood donors.