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Recombinant immunoblot assay reaction patterns and hepatitis C virus RNA in blood donors and non‐A, non‐B hepatitis patients

To establish the value of the second‐generation recombinant immunoblot assay (RIBA‐2) and cDNA polymerase chain reaction (cDNA PCR) for confirmation of hepatitis C virus (HCV) infection, anti‐HCV reaction patterns and the presence of HCV RNA were examined in 610 blood donors and 255 non‐A, non‐B hepatitis patients who were positive or indeterminate in RIBA‐2. Of RIBA‐2‐positive donors (n = 191) and patients (n = 224), 75.4 and 89.7 percent, respectively, were HCV RNA positive. The most frequently observed anti‐HCV recognition patterns in HCV RNA‐positive donors and patients were c22, c33c, and c100 and/or 5‐1‐1 (67.3%, 57.7%) and c22, c33c (24.8%, 29.3%). Among subjects with a RIBA‐2‐indeterminate result, HCV RNA was detected more often in patients (n = 31) than in donors (n = 419): 67.7 and 2.1 percent, respectively. In viremic persons with single‐band reactivity in RIBA‐2, this reactivity was always directed against either c22 or c33c. HCV RNA was detected by cDNA PCR in none of 162 persons with only anti‐c100 and/or anti‐5‐1‐1 reactivity. Therefore, RIBA‐2 reactivity against c100 in combination with 5‐1‐1 should not be considered positive but indeterminate. In RIBA‐2‐indeterminate persons, HCV RNA detection is necessary for reliable confirmation of HCV infection.