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Challenges in hepatitis B detection among blood donors
Jean-Pierre Allain1, Laura Cox
1Department of Haematology, University of Cambridge, Cambridge, UK. jpa1000@cam.ac.uk
Current Opinion in Hematology
|September 14, 2011
Summary
Nucleic acid testing (NAT) significantly enhances hepatitis B virus (HBV) blood safety by detecting window period and occult HBV infections (OBIs). Combined NAT and HBsAg screening are crucial for eliminating infectious donations.
Area of Science:
- Virology
- Blood Transfusion Safety
- Infectious Diseases
Background:
- Hepatitis B virus (HBV) nucleic acid testing (NAT) is implemented globally for blood screening.
- NAT detects window period and occult HBV infections (OBIs), which HBsAg screening misses.
- OBIs are characterized by undetectable HBsAg, low viral load, and specific serological markers.
Purpose of the Study:
- To review the impact of NAT on HBV blood safety.
- To understand the characteristics and detection of OBIs.
- To assess the effectiveness of current screening methods.
Main Methods:
- Review of studies on HBV NAT implementation and OBI detection.
- Analysis of OBI donor characteristics and infectivity.
- Evaluation of HBV screening strategies.
Main Results:
- NAT implementation varies in effectiveness based on prevalence and assay sensitivity.
- OBI donors are often older, with low viral loads and normal liver enzymes.
- Infectivity is higher in window period infections than OBIs; HBsAg escape mutants exist.
Conclusions:
- NAT for HBV DNA improves blood safety, especially when used on individual donations.
- Combined NAT and HBsAg screening are necessary for optimal blood safety.
- Characterizing OBIs provides new insights into HBV natural history.
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