Hepatic dysfunction in a population of antibody-deficient patients: prevalence, aetiology and outcome of PCR screening for hepatitis C and G viruses.
OBJECTIVE
A group of 40 antibody-deficient patients receiving regular infusions of intravenous immunoglobulin underwent close monitoring in an attempt to identify hepatic dysfunction. The continuing risk of hepatitis virus transmission, especially hepatitis C virus via immunoglobulin products prompted this policy. We report our findings.


METHODS
Screening included measurement of transaminase levels at each infusion. The patients were also tested for evidence of infection with hepatitis viruses B, C and G.


RESULTS
Abnormal liver function tests were identified in 6 cases. However, a blood-borne viral aetiology was not found in any of these cases. Additional investigation allowed an alternative aetiology to be identified in most cases. One patient found to be positive for hepatitis G virus (HGV)-RNA by reverse transcriptase-polymerase chain reaction has no evidence to date of clinical problems as a result.


CONCLUSIONS
The results are reassuring in that definite iatrogenic hepatitis virus transmission has not been found in this cohort, despite long-term treatment with a wide range of immunoglobulin products. The source of infection of the single patient infected with HGV remains as uncertain as the pathogenic potential of this virus. However, as long as the risk of immunoglobulin-associated viral transmission continues, a strict monitoring programme such as ours should continue to facilitate prompt detection of cases with abnormal liver function. Liver dysfunction in this group requires full investigation and we cannot exclude infection with hitherto unidentified blood-borne viruses.
O'Leary
P F
PF
Regional Immunology Department, Birmingham Heartlands Hospital, Birmingham, UK.
Collingham
K
K
Skidmore
S
S
King
J
J
Bennett
C L
CL
Williams
P E
PE
Pillay
D
D
Thompson
R A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology