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.