Volume 5, Number 3—June 1999
Hepatitis C Virus RNA Viremia in Central Africa
To the Editor: Epidemiologic serosurveys have demonstrated high prevalence (6%-15%) of hepatitis C virus (HCV) infection in adults in sub-Saharan Africa (1-4). Although possible false-positive HCV serologic test results have been reported in Africa, HCV prevalence rates suggest a high rate of chronic infection among persons with anti-HCV antibodies (5,6). We have focused on HCV RNA infectivity of blood from donors attending the National Blood Center in Bangui, Central African Republic.
We prospectively tested all blood donors between February and April 1998 for serum anti-HCV antibodies by both an HCV third-generation enzyme-linked immunosorbent assay (ELISA) (Abbott HCV EIA 3.0 test, Abbott, Chicago, IL, USA), which was chosen as a reference test for immunoglobulin (Ig) G antibodies to HCV, and by a simple membrane immunoassay system (Ortho HCV Ab Quik Pack, Ortho Diagnostic Systems Inc., Tokyo, Japan) (7). Anti-HCV-positive serum samples were further subjected to qualitative detection of HCV RNA by reverse transcription-polymerase chain reaction (AMPLICOR-HCV, Roche Diagnostic Systems, Inc., Branchburg, NJ, USA) (8). Of 163 serum samples (mean age ± standard deviation, 30±8 years), 155 were from male blood donors, 83 (51%) from first-time donors, and 125 (77%) from donors in the recipient's family. Fifteen (9.2%; 95% confidence interval [CI] 5%-15%) samples contained IgG to HCV by ELISA. Of the ELISA-positive samples, 14 were positive by the Quik Pack assay (sensitivity, 93.0%); of the 148 remaining ELISA-negative samples, 147 were negative by the Quik Pack assay (specificity, 99.3%). The agreement between the results of the two methods was 98.7%. Of the 163 samples, 10 (6.1%; CI 95%: 3%-11%) were positive for HCV antibodies (by ELISA and rapid test) and for HCV RNA.
We confirmed a high prevalence of HCV-seropositivity among blood donors in Bangui and the subsequent high rate of HCV RNA viremic blood donations. To offset the major risk for transfusion-acquired HCV in Central Africa we recommend screening donated blood for anti-HCV. When laboratory facilities to perform ELISA are not available, the Quik Pack system, a simple reliable method for detecting anti-HCV antibodies in human serum that requires neither complex reagent preparation nor expensive instrumentation, could prove useful.
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