Intraspousal transmission of GB virus C/hepatitis G virus in an hepatitis C virus hyperendemic area in Japan

High prevalence of GBV-C/HGV among relatives of GBV-C/HGV-positive blood donors in blood recipients and in patients with aplastic anemia

BACKGROUND

The prevalence of GB virus C (GBV-C)/HGV is high in individuals with parenteral risk factors. The frequency of GBV-C/HGV in blood donors is significantly lower, however it is still far above other parenterally transmitted viruses like HBV and HCV. Therefore, transmission routes apart from parenteral transmission must be considered.

STUDY DESIGN AND METHODS

The purpose of the study was to evaluate the prevalence of GBV-C/HGV in blood donors and relatives of GBV-C/HGV-positive and -negative blood donors. Prevalence was also analyzed in aplastic anemia patients. Samples were tested by RT-PCR and partially by ELISA. Positive isolates were sequenced and phylogenetically analyzed.

RESULTS

A total of 5733 blood donors were PCR tested and 90 were positive (1.6%). Of these, 98 relatives could be tested. Viremia was found in 14.3 percent and anti-E2 in 29.5 percent, whereas only 1.1 percent of the relatives of PCR-negative donors were viremic and 8.5 percent were anti-E2 positive. Probable virus transmission could be shown in two couples and in six mother-child pairs by sequencing of isolates indicating horizontal and vertical virus transmission, respectively. Recipients of GBV-C/HGV RNA-positive blood products were shown to be infected at a rate of 58 percent (18/31). Aplastic anemia patients were positive at a rate of 32 percent (17/53).

CONCLUSION

The high percentage of 14.3 percent of GBV-C/HGV PCR-positive relatives of GBV-C/HGV-positive blood donors suggests intrafamilial transmission. Sequence analyses revealed vertical and horizontal transmission. Although parenteral transmission is highly efficient for GBV-C/HGV (58% of recipients of GBV-C/HGV RNA-positive blood products and 32% of aplastic anemia patients), it appears that sexual and vertical transmission are the most common transmission routes.

Which agents threaten blood safety in the future?

The safety of the blood supply is critical to many parts of modern medicine. In a time when prescriber's and the public's expectations are increasing, it is essential that transfusion services globally ensure the safety of the blood supply. There are, however, many threats to this safety, one being the appearance of new infectious agents. Such agents may be truly 'novel', or may be existing agents, known but not routinely screened for, posing a new or increased threat. However, before an agent is considered to be a true threat to blood safety it must be well characterized, and evidence must be presented that (i) transfusion transmission is a significant route of spread, and (ii) the agent causes significant clinical disease. If either of these criteria are not met, the question has to be asked as to whether the agent is truly a threat to blood safety.

Full-length GB virus C (Hepatitis G virus) RNA transcripts are infectious in primary CD4-positive T cells

GB virus C (GBV-C or hepatitis G virus) is a recently described flavivirus which frequently leads to chronic viremia in humans. Although GBV-C is associated with acute posttransfusion hepatitis, it is not clear if the virus is pathogenic for humans. We constructed a full-length cDNA from the plasma of a person with chronic GBV-C viremia. Peripheral blood mononuclear cells (PBMCs) transfected with full-length RNA transcripts from this GBV-C clone resulted in viral replication. This was demonstrated by serial passage of virus from cell culture supernatants, detection of increasing concentrations of positive- and negative-sense GBV-C RNA over time, and the detection of the GBV-C E2 antigen by confocal microscopy. In addition, two types of GBV-C particles were identified in cell lysates; these particles had buoyant densities of 1.06 and 1.12 to 1.17 g/ml in sucrose gradients. PBMCs sorted for expression of CD4 contained 100-fold-more GBV-C RNA than CD4-negative cells. Taken together, these data demonstrate that RNA transcripts from GBV-C full-length cDNA are infectious in primary CD4-positive T cells. In contrast, RNA transcripts from an infectious hepatitis C virus clone did not replicate in the same cell culture system. Infectious RNA transcripts from GBV-C cDNA should prove useful for studying viral replication and may allow identification of differences between GBV-C and hepatitis C virus cultivation in vitro.