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Hepatitis C Virus Prevalence Has Decreased among U.S. Blood Donors Since the Early 1990s

SUMMARY: "Baby boomers" may be the last birth cohort with a high prevalence of hepatitis C virus (HCV) infection, according to an epidemiological study of U.S. blood donors published in the July 9, 2010 online edition of the Journal of Infectious Diseases. The analysis found that the overall prevalence of chronic hepatitis C has declined since the early 1990s, but saw previously unreported associations between more pregnancies and higher HCV risk, as well as obesity and lower risk.

Edward Murphy from the University of California San Francisco and colleagues with the Retrovirus Epidemiology Donor Study performed a large cross-sectional study of blood donors at 6 U.S. blood centers during 2006-2007.

During 1992-1993, the prevalence of anti-HCV antibodies detected among U.S. blood donors was 0.36%, but more recent data on the prevalence of HCV antibodies and HCV RNA (genetic material) are lacking, the study authors noted as background.

The investigators measured HCV antibodies using an enzyme-linked immunosorbent assay (ELISA) followed by immunoblot testing. HCV RNA was measured using nucleic acid testing.


Out of 959,281 blood donors tested, HCV antibodies were detected in 695 people, for an overall prevalence of 0.072%.
Among people positive for HCV antibodies, 516 (74%) also had detectable HCV RNA, while the remainder were HCV RNA negative.
Compared with prevalence during 1992-1993, prevalence during 2006-2007 was lower and peaked in older age groups.
Obese individuals (body mass index > 30) were less likely to be HCV antibody positive (adjusted odds ratio [aOR] 0.6) and more likely to have undetectable HCV RNA (aOR 2.4).
Among women, HCV antibody prevalence was association with higher gravidity, or greater number of pregnancies (aOR 3.2 for 5 vs 0 pregnancies).
About 1 in 1000 women with 5 or more children had HCV antibodies, compared with about 1 in 3300 women with no pregnancies.
People with more than a high school education were more likely to have undetectable HCV RNA (aOR 1.6).
African-Americans had a lower likelihood of having undetectable HCV RNA (aOR 0.4).

"Decreasing HCV prevalence is most likely attributable to culling of seropositive donors and a birth cohort effect," the researchers concluded. That is, donors with detectable HCV antibodies likely have been excluded from the blood donor pool.

With regard to age, many "baby boomers" now in their 50s and 60s were infected -- for example, through experimenting with injection drug use -- during the 1960s and '70s, before HCV was discovered. Members of this birth cohort have now reached an age at which HCV-related liver damage may have progressed to an advanced stage.

"We found new associations between anti-HCV prevalence and gravidity and obesity," the authors added. "Recently discovered genetic factors may underlie differences in HCV RNA clearance in black donors."

University of California, San Francisco, CA; Blood Systems Research Institute, San Francisco, CA; Westat, Rockville, MD; American Red Cross Blood Services, New England Division, Farmington, CT; Emory University, Atlanta, GA; American Red Cross Blood Services, Southern Region, Atlanta, GA; Hoxworth Blood Center, Cincinnati, OH; Institute for Transfusion Medicine, Pittsburgh, PA; Blood Center of Wisconsin, Milwaukee, WI.


EL Murphy, J Fang, Y Tu, and others (Retrovirus Epidemiology Donor Study). Hepatitis C Virus Prevalence and Clearance among US Blood Donors, 2006-2007: Associations with Birth Cohort, Multiple Pregnancies, and Body Mass Index. Journal of Infectious Diseases (Abstract). July 9, 2010 (Epub ahead of print).






















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