[Follow-up of blood donors with positive serology for hepatitis C virus and their recipients is insufficient].

OBJECTIVES

Our aim was to study the characteristics of blood donors with serum anti-HCV antibodies, their medical follow-up based on a questionnaire, and the follow-up of their recipients who were transfused before systematic screening of anti-HCV antibodies had begun.

METHODS

From March 1990 to January 1992, 25,255 blood donors were tested by ELISA 1 or ELISA 2 serum tests and confirmed by RIBA 2 test in case of positivity: 126 (0.5%) were ELISA positive of whom 40 (0.16%) were RIBA 2 positive (n = 18) or indeterminate (n = 22); among the latter, 13 were retested by RIBA 3 which was positive in 2 cases. Thus, the prevalence of blood donors with truly positive HCV antibodies testing was shown to be between 0.08 and 0.12%. Among the 126 ELISA positive blood donors, 90 had given blood before systematic screening had begun, involving 232 patients and 50 non nominative products.

RESULTS

In donors with positive ELISA test, the prevalence of serum ALT activity > 2N was 17% if the RIBA test was positive vs 1% if the test was negative or indeterminate (P = 0.0007). The rate of donors with serum ALT activity > N before March 1990 was 62.5% if the RIBA test was positive vs 17.5% if it was negative (P = 0.01). The follow-up at 2 years of 34 out of 40 donors with a positive or indeterminate RIBA test showed that 88% had had at least two serum ALT activity tests, that 12% had had a serologic test, that 6% had sought the advice of a specialist, and that a liver biopsy was performed in 3%. The follow-up of recipients showed that the response rate of physicians or recipients was 37% (47% at public hospital and 12% in private hospital, P < 0.01). The rate of recipients positive for HCV was 25%, that is 2% of the entire group, yielding an estimated 8% efficiency of the survey. Lack of screening was due to the lack of responses from physicians or recipients in 64% of cases and to the death of the recipient in 36% of cases.

CONCLUSION

HCV seroprevalence among blood donors in France is closed to that observed in Northern Europe. In this population, there is a great discrepancy between the ELISA and RIBA tests. During the survey period, the follow-up of HCV positive blood donors seemed to be very insufficient. The screening of their recipients was poorly effective, thus emphasizing the importance of the systematic and prospective follow-up of blood donors.