Systematic review of role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus

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Abstract
Objective: To assess the role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus. Design: Published studies of hepatitis C transmission were examined. Twenty nine studies with identified sources of hepatitis C infection who were tested for presence of hepatitis C RNA by polymerase chain reaction were reviewed, including studies of vertical transmission (n=21), transmission after transplantation (n=3), transfusion of blood components (n=3), and needlestick exposure (n=2). Subjects: All patients identified in studies. Results: A total of 2022 people who had been exposed to sources positive for antibody to hepatitis C were identified. Among 1148 people exposed to sources positive by polymerase chain reaction 148 cases of transmission occurred compared with no definite case among 874 people exposed to negative sources. Rates of transmission from positive sources were 6.2% for perinatal exposure, 6.1% after needlestick exposure, 78% after solid organ or bone marrow transplantation, and 83% after transfusion of blood components. Other factors influencing risk of vertical transmission were coinfection with HIV and level of hepatitis C viraemia. Conclusions: Negative results by polymerase chain reaction indicate an extremely low probability of transmission of hepatitis C from a person with antibody to hepatitis C. Between 20% and 50% of people infected with hepatitis C virus do not progress to chronic infection Polymerase chain reaction can detect ongoing hepatitis C viraemia and thus the presence of chronic infection The risk of transmission from people who are positive for hepatitis C antibody but have negative results by polymerase chain reaction is extremely low The rate of transmission from people who are positive for hepatitis C antibody and have positive results by polymerase chain reaction varies from 6% for mother to child transmission and occupational exposure to about 80% after transplantation or transfusion of blood components Polymerase chain reaction should be used to define infectiousness among people who are positive for antibodies to hepatitis C