P. Wantzin

Results of serologic tests were correlated with hepatitis C virus (HCV) viremia, determined by a cDNA polymerase chain reaction assay to detect HCV RNA, in 340 Danish dialysis patients; of these, 28 (8.2%) were positive for antibodies to HCV (anti-HCV) with second-generation ELI-SAs. HCV RNA was found in sera from 27 of these 28 anti-HCV-positive patients. However, 8 dialysis patients had detectable levels of HCV RNA but were anti-HCV-negative with second-generation ELISAs. Among the 35 HCV-infected dialysis patients 16 were positive, 7 indeterminate, and 12 negative with the second-generation RIBA. More than 60% of patients with evidence of ongoing liver disease had HCV infection. Thus, current commercially available antibody tests did not accurately reflect the HCV status in dialysis patients. A relatively high prevalence (> 10%) of HCV RNA, closely associated with liver disease, was found among dialysis patients in a low-prevalence area of the world.

OBJECTIVE: To determine the prevalence, incidence, and persistence of positivity for antibodies to hepatitis C virus (anti-HCV) and the potential for sexual transmission of the virus. DESIGN: A cohort analysis covering 1981-9 comparing estimated cumulative incidences of and seroconversion rates for anti-HCV with those of hepatitis B core antibody (anti-HBc) and antibodies to the human immunodeficiency virus (anti-HIV). SETTING: Copenhagen and Aarhus, Denmark. SUBJECTS: 259 Male members of a Danish homosexual organisation. MAIN OUTCOME MEASURES: Correlations of prevalence and incidence with a wide range of sexual lifestyle variables. RESULTS: Only four (1.6%) subjects were positive for anti-HCV in 1981. The estimated cumulative incidence of positivity for anti-HCV was 4.1% in 1984 (seroconversion rate during 1981-4 (2.5%)) and remained at 4.1% in 1989 (seroconversion rate nil during 1984-9). In contrast, positivity for anti-HBC rose from 44.0% in 1981 to 52.7% in 1984 (seroconversion rate 15.5%) and 58.8% in 1989 (seroconversion rate 12.9%), and that for anti-HIV rose from 8.8% to 24.0% (seroconversion rate 16.7%) and 30.1% (seroconversion rate 8.0%) respectively. Three anti-HCV positive patients seroreverted three to five years later. None of the anti-HCV positive subjects had had a transfusion and only one gave a past history of intravenous drug use. Variables in sexual lifestyle correlated with the presence of anti-HBc but not with that of anti-HCV. CONCLUSIONS: In contrast with hepatitis B virus and HIV, sexual transmission of hepatitis C virus seems to be a rare event. Furthermore, antibodies to the virus may become undetectable after several years.

We investigated hepatitis B virus (HBV) DNA in liver samples from 22 patients with acute benign hepatitis (AH) and 26 with acute fulminant hepatitis (FH) and compared the results with those obtained by detection of serum HBV DNA and HBV serological markers. Free HBV DNA forms were detected in 11 patients with AH and one with FH, a reflection of active HBV DNA replication in three patients and the end of viral multiplication in nine. Free monomeric HBV DNA was present in three patients with AH and six with FH, and free oligomers were identified in three patients with AH. Results from two pa-tients with AH and seven with FH suggested the presence of dimeric or multimeric HBV DNA. Thus, the various forms of HBV DNA previously described in chronic HBV car-riers may be observed at the acute stage of the viral infection. After comparing serologi-cal and hybridization data, we found that nine of 19 patients (one with AH and eight with FH) lacking serum HBV surface antigen might have had acute hepatitis related to infection with HBV or HBV variants. Studies of hepatitis B virus (HBV) DNA molecules in infected liver cells provide insight into the patho-