Hepatitis C virus antibody titres (anti-HCV) were measured in serum fr
om 122 patients with autoimmune liver disease (96 with primary biliary
cirrhosis and 26 with autoimmune chronic active hepatitis using three
generations of enzyme immunoassay (EIA): first generation - Ortho, EI
A1; second generation - Abbott, EIA2; and third generation - Murex, EI
A3. Anti-HCV was below the positive cut-off level in all 26 autoimmune
chronic active hepatitis patients for all tests, while seropositivity
values in primary biliary cirrhosis were 31% (EIA1), 14% (EIA2), and
0% (EIA3). In primary biliary cirrhosis, anti-HCV values as measured b
y all three tests correlated positively with serum IgG concentrations,
serum storage time, and a number of other indices of hepatic dysfunct
ion. Multiple regression analysis showed that anti-HCV values were ind
ependently affected by both serum IgG and the length of storage time,
although the magnitude of the effects varied between tests. When all t
hree multiple regression models were applied to an extreme clinical ex
ample, however, EIA3 was least likely to give a false-positive result.
The difference in test performance was emphasised further by examinat
ion of anti-HCV values in nine primary biliary cirrhosis patients (con
firmed negative by recombinant immunoblot assay 2) in whom serial samp
les were tested (seven to 14 per patient, stored for one to 138 months
). Apparent anti-HCV values (EIA1 and EIA2) increased with increasing
serum storage time, but were unchanged when measured by EIA3. A simila
r pattern was evident in a limited study of five autoimmune chronic ac
tive hepatitis patients. Thus, in the largest study reported to date,
there is no evidence of an important aetiological role for HCV in auto
immune chronic active hepatitis or primary biliary cirrhosis in the UK
. The third generation of anti-HCV EIAs is the most reliable screening
test, will avoid costly and unnecessary confirmatory testing, and may
partly clarify the existing geographical heterogeneity in anti-HCV se
roprevalence. An accurate diagnosis of past HCV infection is an import
ant determinant in the choice of treatment in autoimmune chronic activ
e hepatitis. As the second generation EIA is in widespread use and con
firmatory testing is not always available, the effect of serum storage
in addition to hyperglobulinaemia should be considered in the interpr
etation of positive results in autoimmune and in other types of chroni
c liver disease.