Transmission of hepatitis G virus in patients with angioedema treated with steam‐heated plasma concentrates of C1 inhibitor

Abstract

BACKGROUND: Hepatitis G virus (HGV) is a blood‐borne flavivirus that may cause acute and chronic transfusion‐transmitted infections. Patients with complement component 1 (C1) inhibitor (C1‐INH) deficiency may acquire blood‐borne infections through infusion of plasma concentrates. STUDY DESIGN AND METHODS: Serum samples from 84 patients with C1‐INH deficiency (19 who received unmodified C1‐INH concentrates, 23 who received steam‐heated concentrates, and 42 untreated patients) were tested for HGV RNA and hepatitis C virus (HCV) RNA by a nested polymerase chain reaction (PCR). The samples were also tested for antibodies to the E2 envelope protein of HGV (anti‐HGV) and to HCV with enzyme‐linked immunosorbent assays. RESULTS: Nine (11%) patients had serum HGV RNA; that is, 7 (17%) of 42 patients previously treated with C1‐INH concentrates and 2 of 42 previously untreated patients. HGV RNA was as common in the 19 patients treated with unmodified concentrates as in the 23 given steam‐heated concentrates (16 vs. 17%, p = 0.60). Anti‐HGV was more common among the recipients of unmodified concentrates than among those given steam‐heated concentrates (26 vs. 0%, p = 0.014). HCV RNA was more frequently detected in treated patients than in untreated patients (33 vs. 7%, p = 0.005) and in the 19 recipients of unmodified concentrates than in the 23 treated with steam‐heated concentrates (58 vs. 16%, p = 0.003). Only one HGV RNA‐ seropositive patient had elevated serum aminotransferase activity, compared to 11 with HCV RNA. CONCLUSION: HGV was transmitted by both unmodified and steam‐heated concentrates, but it caused persistent viremia in a minority of the cases and was rarely associated with liver disease.