A PROSPECTIVE STUDY OF ANTI-HCV POSITIVE BLOOD DONORS

该方案旨在研究自然史， 无症状丙型肝炎病毒（HCV）感染的流行病学 献血者人群中发现抗-HCV阳性时， 常规献血。迄今为止，已入组560例受试者 其中重组生物免疫测定（RIBA）阳性305例，RIBA阳性143例， 不确定组和112个RIBA阴性对照组。应计数据 最近已发表（New Engl J Med 1996; 334：1691），并且可以 总结如下：HCV感染献血者的特征 与对照组相比， 教育水平较低。HCV的独立相关危险因素 输血、静脉注射毒品、吸食可卡因、 性滥交，以及穿耳洞的男性。虽然 预计IVDU将是一个风险因素，这是一个主要的 令人惊讶的是，42%的RIBA阳性志愿者血液 捐赠者承认在某些时候使用过静脉注射药物， 他们的生命，一般是在捐赠前10年或更长时间。另一 令人惊讶的是， 吸食可卡因和丙肝病毒阳性共享用具， 伴随着频繁的可卡因相关的鼻出血的鼻喷鼻可能有助于 作为肠胃外病毒传播的隐蔽载体八十六 %的RIBA阳性供体是病毒血症，证实了 这是一种持久性的药物。相反，13%的受试者 似乎已从HCV感染中恢复， 重复阴性聚合酶链反应检测HCV RNA， 丙氨酸转氨酶持续正常。66%的人 肝脏疾病的生化证据，86%的人 活检有严重的组织学病变，尽管长期感染 尽管有轻度至中度慢性 肝炎然而，只有6%的人有严重的组织学病变， 尽管长期感染。尽管与性有关， 当我们检测HCV的直接伴侣时， 感染者，我们没有发现HCV的性 传输

This protocol is designed to study the natural history and epidemiology of hepatitis C virus (HCV) infection in an asymptomatic blood donor population found to be anti-HCV positive at the time of routine blood donation. Thus far, 560 subjects have been enrolled including 305 recombinant bioimmunassay (RIBA) positives, 143 RIBA indeterminates, and 112 RIBA negative controls. The accrued data have been published recently (New Engl J Med 1996; 334:1691) and can be summarized as follows: Characteristics of HCV-infected donors compared with controls were younger, African-American, and had a lower education level. Independently associated risk factors for HCV were transfusion, intravenous drug use (IVDU), cocaine snorting, sexual promiscuity, and being male with pierced ears. Although it was anticipated that IVDU would be a risk factor, it was a major surprise to find that 42 percent of RIBA positive volunteer blood donors admitted to having used intravenous drugs at some point in their lives, generally 10 or more years before the donation. Another major surprise was the strong independent association between cocaine snorting and HCV positivity. Shared paraphernalia for snorting accompanied by frequent cocaine-related epistaxis may serve as a covert vehicle for parenteral viral transmission. Eighty-six percent of RIBA positive donors were viremic, confirming the persistent nature of this agent. In contrast, 13 percent of subjects appeared to have recovered from HCV infection as evidenced by repeatedly negative polymerase chain reaction for HCV RNA and by persistently normal alanine aminotransferase. Sixty-six percent had biochemical evidence of liver disease, and 86 percent of those biopsied had a severe histologic lesion despite prolonged infection despite an association evidence of mild to moderate chronic hepatitis. However, only 6 percent had a severe histologic lesion despite prolonged infection. Despite an association with sexually promiscuous practices, when we tested the direct partners of HCV- infected individuals, we found no evidence for HCV's sexual transmission.