A new four‐antigen recombinant immunoblot assay (4‐RIBA) for confirmation of hepatitis C virus (HCV) C‐100 enzyme‐linked immunosorbent assay (ELISA) reactivity was tested in stored serum samples (1984–86) of blood donors and recipients and compared with results from polymerase chain reaction (PCR) analysis of fresh (1990) plasma samples in donors and recipients from the original study. Of 37 HCV C‐100 ELISA‐positive blood products, 8 were 4‐RIBA positive, of which 7 were implicated in post‐transfusion non‐A, non‐B hepatitis (PT‐NANBH) and/or PCR confirmed recipient HCV infection. Of 9 recipients with PTNANBH, 8 were reactive in 4‐RIBA (6 positive and 2 indeterminate). With fresh plasma samples, 3 donors and 6 recipients who were 4‐RIBA positive were also PCR positive. 4 4‐RIBA indeterminate and 78 4‐RIBA negative samples of donors and recipients were PCR negative. Of 6 4‐RIBA positive recipients, 5 were PCR positive four to six years later. 1.6% of the 383 recipients became chronically infected with HCV. The new 4‐RIBA represents a candidate confirmation test to discriminate between infective and non‐infective HCV C‐100 ELISA‐positive blood donors.
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