DOES THE HEALTHY HEPATITIS-C VIRUS CARRIER STATE REALLY EXIST - AN ANALYSIS USING POLYMERASE CHAIN-REACTION

To determine whether the presence of hepatitis C virus (HCV) viremia c orrelates with the severity of liver disease in anti-HCV-positive appa rently healthy blood donors, we studied 98 blood donors found positive for anti-HCV using enzyme linked immunosorbent assay (ELISA). Each su bject underwent a liver biopsy, a test for HCV RNA in the serum by pol ymerase chain reaction (PCR), and a panel of liver injury tests, As a result, 97% of the anti-HCV-positive blood donors had some type of his tological abnormality: 22 (22%) had minimal changes, 1 (1%) had chroni c lobular hepatitis, 40 (41%) had chronic persistent hepatitis (CPH), and 32 (33%) had chronic active hepatitis (CAH). Only 3 subjects had a normal liver histology. HCV RNA was detectable in the serum in 65% of the anti-HCV-positive donors. HCV RNA in serum was detectable in none of the donors with a normal liver histology, in 36% (confidence inter val [CI], 17% to 59%) of those with minimal changes, in 70% (CI, 53% t o 83%) of those with CPH, and in 87% (CI, 71% to 96%) of those with CA H (P = .00001). HCV RNA was detectable in 75% of the donors with eleva ted (>45 U/L) alanine transaminase (ALT) values and in 59% of those wi th normal ALT levels (P = not significant). The incidence of chronic h epatitis was higher in HCV RNA-positive than in HCV RNA-negative donor s (88% vs. 50%; P = .00005). By stepwise logistic regression, age olde r than 50 years (odds ratio = 17.5), an elevated ALT level (odds ratio = 74.4), and serum HCV RNA (odds ratio = 18.9) were independently ass ociated with the presence of chronic hepatitis. In summary, in anti-HC V-positive blood donors the prevalence of HCV RNA in serum appears to correlate with the severity of liver injury and is greatest in CAH. Th e detection of serum HCV RNA in 36% of the donors with minimal changes on biopsy, all of them with normal ALT levels, suggests that a health y HCV carrier state may exist.