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Hepatitis C Virus Infection Associated With Administration of Intravenous Immune GlobulinA Cohort Study
Joseph S. Bresee, MD;
Eric E. Mast, MD, MPH;
Patrick J. Coleman, PhD;
Miriam J. Baron;
Lawrence B. Schonberger, MD;
Miriam J. Alter, PhD;
Maureen M. Jonas, MD;
Mei-ying W. Yu, PhD;
Paula M. Renzi, PhD;
Lynda C. Schneider, MD
JAMA. 1996;276(19):1563-1567.
Abstract
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Objective.
—To determine the risk of and risk factors for hepatitis C virus (HCV) infection among persons with immune deficiencies who had received intravenous immune globulin (IGIV) between March 1993 and February 1994.
Design.
—Retrospective cohort study.
Setting.
—An immunology program in a tertiary care hospital.
Patients.
—Of 341 persons who had received IGIV between March 1,1993, and February 22,1994, 278 (82%) were enrolled. The mean age for the enrolled persons was 9 years, and 99% had primary immune deficiencies.
Main Outcome Measures.
—Evidence of HCV infection by detection in sera of antibody to HCV and/or HCV RNA by reverse transcriptase polymerase chain reaction.
Results.
—Twenty-three (11%) of 210 persons who received the IGIV Gammagard (Baxter Healthcare Corporation, Deerfield, III) became infected compared with none of 52 persons who received exclusively other IGIV products (P=.01). In a multivariate analysis, HCV infection was associated only with Gammagard produced from plasma screened by second-generation (multiantigen) anti-HCV tests (P=.03). Hepatitis C virus RNA was detected in Gammagard, and the risk of transmission to recipients increased with increasing quantity of HCV RNA infused, from 0 for those who received no HCV RNA-positive lots to 29% for the quartile of patients receiving the greatest amount (P<.001). At least 9 different lots of Gammagard were required to account for all cases.
Conclusion.
—Gammagard was the only IGIV product implicated in the transmission of HCV. Infection was associated with higher quantities of HCV RNA in Gammagard produced from second-generation anti-HCV-screened plasma. Further studies are needed to determine reasons for the infectivity of Gammagard, and viral inactivation and removal steps are needed to ensure the safety of IGIV products.
Author Affiliations
From the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Bresee, Mast, Coleman, Schonberger, and Alter); Harvard Medical School, Boston, Mass (Ms Baron); Division of Gastroenterology, Children's Hospital, and Department of Pediatrics, Harvard Medical School (Dr Jonas); Division of Hematology, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Md (Drs Yu and Renzi); Division of Immunology, Children's Hospital, and Department of Pediatrics, Harvard Medical School (Dr Schneider).
Footnotes
Correspondence: Joseph S. Bresee, MD, Respiratory and Enteric Virus Branch, Centers for Disease Control and Prevention, Mailstop G17,1600 Clifton Rd NE, Atlanta, GA 30333.
Reprints: Eric E. Mast, MD, MPH, Hepatitis Branch, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Rd NE, Atlanta, GA 30333.
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