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Systematic review of role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7104.333 (Published 09 August 1997) Cite this as: BMJ 1997;315:333
  1. Gregory J Dore, lecturer in epidemiologya,
  2. John M Kaldor, professor of epidemiologya,
  3. Geoffrey W McCaughan, clinical associate professorb
  1. a National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst 2010, Sydney, Australia
  2. b The AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown 2050, Sydney, Australia
  1. Correspondence to: Dr Dore
  • Accepted 19 May 1997

Abstract

Objective: To assess the role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus.

Design: Published studies of hepatitis C transmission were examined. Twenty nine studies with identified sources of hepatitis C infection who were tested for presence of hepatitis C RNA by polymerase chain reaction were reviewed, including studies of vertical transmission (n=21), transmission after transplantation (n=3), transfusion of blood components (n=3), and needlestick exposure (n=2).

Subjects: All patients identified in studies.

Results: A total of 2022 people who had been exposed to sources positive for antibody to hepatitis C were identified. Among 1148 people exposed to sources positive by polymerase chain reaction 148 cases of transmission occurred compared with no definite case among 874 people exposed to negative sources. Rates of transmission from positive sources were 6.2% for perinatal exposure, 6.1% after needlestick exposure, 78% after solid organ or bone marrow transplantation, and 83% after transfusion of blood components. Other factors influencing risk of vertical transmission were coinfection with HIV and level of hepatitis C viraemia.

Conclusions: Negative results by polymerase chain reaction indicate an extremely low probability of transmission of hepatitis C from a person with antibody to hepatitis C.

Key messages

  • Between 20% and 50% of people infected with hepatitis C virus do not progress to chronic infection

  • Polymerase chain reaction can detect ongoing hepatitis C viraemia and thus the presence of chronic infection

  • The risk of transmission from people who are positive for hepatitis C antibody but have negative results by polymerase chain reaction is extremely low

  • The rate of transmission from people who are positive for hepatitis C antibody and have positive results by polymerase chain reaction varies from 6% for mother to child transmission and occupational exposure to about 80% after transplantation or transfusion of blood components

  • Polymerase chain reaction should be used to define infectiousness among people who are positive for antibodies to hepatitis C

Footnotes

  • Accepted 19 May 1997
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