Patients with chronic hepatitis C can have variable clinical progression. Hepatic histological alterations appear to be milder in asymptomatic subjects who have persistently normal ALT levels. AIMS: To evaluate the severity of histological liver alterations in blood donors with normal and elevated ALT levels. METHODS: We evaluated volunteer blood donors from the main blood bank of the city of Salvador-Brazil. Those who were anti-HCV positive were invited to participate in the study. Serum ALT and AST levels were measured at two time points, two months apart. Donors were divided into two groups: group I, individuals with ALT > 1.5 times the upper limit of normal in at least one time point and group II, individuals with normal or near normal ALT, at both time points RESULTS: We evaluated 30,232 blood donors and 528 (1.7%) of them were anti-HCV positive. Eighty-two attended our service and HCV infection was confirmed in 66 individuals. Male gender predominated in both groups; the mean age was 36 for group I, and 33 for group II. Tattoos and intravenous illicit drug use were frequently-encountered risk factors. Liver biopsy was done in 43 subjects. Among donors with elevated ALT, two (10%) had minimum alterations, while in group II normal liver or minimum alterations were observed in six (26%) subjects. Chronic hepatitis or cirrhosis was encountered in 35 (81%) individuals: three (15%) and five (21%) subjects had chronic hepatitis without inflammatory activity, 10 (50%) and 11 (48%) had minimum to moderate activity and five (25%) and one (4.3%) had cirrhosis, in groups I and II, respectively (P was not significant). CONCLUSIONS: The prevalence of anti-HCV among this population of volunteer blood donors was 1.7%, and these subjects had few liver histological alterations or chronic hepatitis and cirrhosis. Liver injury severity was significant in patients with elevated ALT, however subjects with normal levels may also present chronic hepatitis and cirrhosis.

Racional - A prevalência da infecção pelo vírus da hepatite C em pacientes sob programa de hemodiálise tem sido amplamente variável. Objetivos -- Determinar a prevalência do anticorpo contra o vírus C da hepatite (anti-VHC) em pacientes sob hemodiálise em Salvador, BA e sua associação com transfusão de sangue, duração de hemodiálise e elevação de alaninoaminotransferase. Métodos - Durante um período de 17 meses, foram avaliados todos os pacientes em programa de hemodiálise, totalizando 395 indivíduos, que responderam a questionário e forneceram soro para análise laboratorial (alaninoaminotransferase sérica e anti-VCH pelo ELISA II com confirmação pelo Immunoblotting (RIBA III). Resultados - O anti-VHC foi positivo em 23,8% (94/395). A presença de transfusão mostrou associação com o anti-VHC e quanto maior o número de transfusões, mais freqüente o anti-VHC. Dos pacientes que nunca foram transfundidos, 12,5% (6/48) foram anti-VHC positivos. A duração do tratamento dialítico foi de 53,44 ± 36,45 meses no grupo anti-VHC positivo e de 22,10 ± 22,75 meses no grupo negativo. A elevação de alaninoaminotransferase foi mais freqüente no grupo positivo para o anti-VHC. A positividade para as frações do RIBA III foi de 79,8%, 100%, 80,9% e 52,1% para o c100-3, c33, c22 e NS5, respectivamente. O anti-NS5 foi ainda menos freqüente no grupo com alaninoaminotransferase elevada. Conclusões - A prevalência do anti-VHC em pacientes sob hemodiálise crônica de Salvador, BA é elevada e está associada com transfusão de sangue, maior duração de tratamento dialítico e elevação de alaninoaminotransferase.

Background -- Hepatitis C infection in hemodialysis units has been evaluated in different grographic regions. Aims - The prevalence of anti-HCV in patients undergoing hemodialysis program in the city of Salvador, State of Bahia, Brazil, was studied and its association with transfusions, duration of hemodialysis and ALT elevation. Method - During a period of 17 months, all patients undergoing dialytic treatment, were evaluated. The total number of patients was 395, all of whom completed a questionnaire and provided serum samples for laboratory analysis. Serological levels were measured for ALT and the samples were tested for anti-HCV using ELISA II with a further confirmation using RIBA III. Results - Anti-HCV was positive in 23,8% (94/395). The presence of transfusions was associated with anti-HCV and as the number of transfusions used increased, so did the frequency of anti-HCV. Of the patients who never received transfusions, 12,5% (6/48) were anti-HCV positive. The duration of dialytic treatment lasted from 53,44 ± 36,45 months in the anti-HCV positive group and 22,10 ± 22,75 months for the group testing negative. ALT elevation was more frequent in the anti-HCV positive group. Positivity for the RIBA III fractions was 79,8%, 100%, 80,9% and 52,1%, for c100-3, c33, c22 and NS5, respectively. The anti-NS5 was even less frequent in the group with elevated ALT. Conclusions - The prevalence of anti-HCV in patients undergoing chronic hemodialysis in Salvador, Bahia, is elevated and it is associated with transfusions, a longer duration of dialytic treatment and ALT elevation.