Introduction
From March to October 1990 a referral hospital in Riyadh screened polyclinic patients and blood donors for antibodies to hepatitis C virus (anti-HCV). The test was done repeatedly by ELISA (Abbott and Ortho) and once by RIBA. Because of the high seroprevalence in polyclinic patients (4.8%) compared with blood donors (1%) and with rates in other countries, we began a case-control study of polyclinic patients to identify risk factors and hepatic disease that might be associated with anti-HCV.
Methodology
We reviewed the medical records of anti-HCV-positive polyclinic patients (case-patients) for symptoms and signs of hepatitis, transfusions of blood or blood products, operations, liver function test, and hepatitis B markers before the anti-HCV screening test. We interviewed the patients about chronic hepatitis symptoms, previous hospitalizations, blood transfusions, operations, travel, extramarital sex, intravenous drug addiction and family history of liver diseases. Polyclinic physicians recruited consecutive patients (control-patients) for the same interview and tests as case-patients
Results
We compared 54 case-patients with 83 control-patients with no anti-HCV. Case-patients were not more likely than control-patients to have had prior symptoms of hepatitis (OR=1.8, 95% CI 0.7, 4.3). HBsAg was found in 35% of the case-patients and 13.3% of control patients (OR=2.7; 95% CI 0.9, 8.8). After stratifying by HBsAg status case-patients were more likely than control-patients to have an enlarged liver (OR=8.4, 95% CI 2, 35.5), alanine aminotransferase >45 IU/L (OR=9.8; 95% CI 3.4, 29), albumin <3.5 g/dl (OR=12.5; 95% CI 2.2, 71) and platelet count <150,000 per microliter (OR=22; 95% CI 2.1, 226). Prior blood transfusion was identified in 40% of the case-patients and 7% of control-patients (OR=8.4; 95% CI 2.7, 27.2). After stratifying by transfusion, previous major operations excluding cardiac surgery (OR=3.1; 95% CI 1.2, 8.2) and childbirth (without transfusion) in a hospital other than this referral hospital (OR=3.8; 95% CI 0.93, 15.1) were also associated with anti-HCV. Social and community risk factors had no association with HCV.
Conclusion
Blood transfusion represented a major risk for HCV infection and disease in Saudi Arabia. To prevent transfusion-related HCV infection, Saudi Arabia is now screening donors for anti-HCV. Since only 40% of anti-HCV patients reported transfusions, other risk factors for nosocomial spread need consideration