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Lucey O, Acana S, Olupot‐Olupot P, Muhindo R, Ayikobua R, Uyoga S, Kyeyune‐Byabazaire D, Cooke G, Maitland K. High false discovery rate of the Architect anti-HCV screening test in blood donors in Uganda and evaluation of an algorithm for confirmatory testing. Vox Sang 2022; 117:1360-1367. [PMID: 36218235 PMCID: PMC10092297 DOI: 10.1111/vox.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Adequate supplies of donor blood remain a major challenge in sub-Saharan Africa. This is exacerbated by a lack of confirmatory testing for transfusion-transmitted infections by blood transfusion services (BTS), leading to significant blood disposal owing to putatively high seroprevalence rates amongst Ugandan blood donors. We aimed to ascertain the false discovery rate of the Architect anti-hepatitis C virus (HCV) screening assay and categorize screen-reactive samples into three groups: presumed false positive, active and past infection, and develop an algorithm for confirmatory testing. MATERIALS AND METHODS A total of 470 screen-reactive HCV blood donations were retested using the Architect anti-HCV assay, an alternative antibody test (SD Biosensor) and a core antigen (cAg) test. signal-to cut-off (S/CO) ratios and pre-analytical factors (centrifugation speed, haemolysis check, time between collection and testing) were recorded. Based on the S/CO ratio evaluation, we propose a testing algorithm to guide supplemental tests. RESULTS The false discovery rate of the Architect anti-HCV assay was 0.84 as 395/470 (84%) screen-reactive samples had no evidence of HCV infection (SD Biosensor and cAg negative) (presumed false positive), 38/470 (8.1%) were antigenaemic, and 32/470 (6.8%) had evidence of past infection. The median S/CO ratios of the presumed false-positive and active infection samples were 1.8 and 17.3, respectively. The positive predictive value of HCV positivity in samples with ratios above 12 was 91.8%. On retesting, 104/470 (22.1%) samples became negative. CONCLUSION The Architect anti-HCV assay has a very high false discovery rate in Ugandan BTSs, leading to excessive blood disposal. Pre-analytical factors likely contribute to this. An introduction of confirmatory testing using an algorithm based on S/CO ratio evaluation could limit unnecessary blood wastage and donor deferral.
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Affiliation(s)
- Olivia Lucey
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
| | - Susan Acana
- Ugandan Blood Transfusion ServiceKampalaUganda
| | - Peter Olupot‐Olupot
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
- Department of PaediatricsMbale Clinical Research InstituteMbaleUganda
| | - Rita Muhindo
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
- Department of PaediatricsMbale Clinical Research InstituteMbaleUganda
| | | | - Sophie Uyoga
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
- Busitema University Faculty of Health SciencesMbale Campus and Mbale Regional Referral HospitalMbaleUganda
| | | | - Graham Cooke
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
| | - Kathryn Maitland
- Department of Infectious Disease, Division of MedicineImperial CollegeLondonUK
- Kilifi County Hospital and Kenya Medical Research Institute (KEMRI)‐Wellcome Trust Research ProgrammeKilifiKenya
- Institute of Global Health and Innovation, Division of MedicineImperial CollegeLondonUK
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Laperche S, Caparros R, Kankarafou N, Lucas Q, Boizeau L. Comparative evaluation of the Geenius HCV supplemental assay and Inno-LIA HCV score assay in detecting anti-HCV antibodies. Transfus Clin Biol 2022; 29:205-208. [PMID: 35728751 DOI: 10.1016/j.tracli.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study compared two assays aimed at confirming the presence of anti-HCV antibodies (Ab) after a positive screening: Geenius HCV supplemental assay (Bio-Rad, Marne la Coquette, France) and the Inno-LIA HCV score assay (Fujirebio, Les Ulis, France). MATERIAL AND METHODS A total of 180 archived samples were investigated including 119 samples collected at different stages of HCV infection in 25 hemodialyzed patients who underwent HCV seroconversion, 14 samples from 4 commercial seroconversion panels, 47 Ab positive/HCV-RNA positive blood donations of which 7 showing an single reactivity in confirmatory assays. Samples were investigated and results were interpreted with the two assays according to the manufacturers' instructions. RESULTS Overall, Geenius and Inno-LIA were concordant for 84% (151/180) samples: 38 negative, 17 indeterminate and 96 positive. Of the 29 discrepant results, 26 were overclassified with Inno-LIA. HCV seroconversion was detected with Inno-LIA 4 and 7 days prior to Geenius in two panels. The high positive rate observed with Inno-LIA (64%) compared to Geenius (54%) was mainly due to low reactivities considered positive according to interpretation criteria, which could affect specificity. CONCLUSION Although HCV supplemental assays are not recommended for the diagnostic of HCV infection, which is primarily based on HCV-RNA testing, both assays are suitable as second line anti-HCV tests when Ab screening is positive and RNA testing cannot be performed. Moreover, Geenius system provides an objective result in less than 30minutes, which is compatible when a rapid diagnostic is required.
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Affiliation(s)
- S Laperche
- Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, 6, rue Alexandre Cabanel 75015, Paris, France.
| | - R Caparros
- Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, 6, rue Alexandre Cabanel 75015, Paris, France
| | - N Kankarafou
- Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, 6, rue Alexandre Cabanel 75015, Paris, France
| | - Q Lucas
- Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, 6, rue Alexandre Cabanel 75015, Paris, France
| | - L Boizeau
- Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, 6, rue Alexandre Cabanel 75015, Paris, France
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Atalay MA, Sağıroğlu P, Oskay M, Emir B. Comparison of samples found positive by anti-HCV screening test with line immunoassay and determination of threshold value. Rev Assoc Med Bras (1992) 2021; 67:1480-1484. [DOI: 10.1590/1806-9282.20210668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022] Open
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Ha J, Park Y, Kim HS. Signal-to-cutoff ratios of current anti-HCV assays and a suggestion of new algorithm of supplementary testing. Clin Chim Acta 2019; 498:11-15. [PMID: 31400313 DOI: 10.1016/j.cca.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND The detection of hepatitis C virus antibody (anti-HCV) is known to have high false-positive rates. Using signal-to-cutoff (S/Co) ratios in reflex supplemental testing, however, could reduce false-positive rates. Here, we analyzed the 2-year data of an anti-HCV assay to understand the significance of the S/Co ratio and make a new algorithm by confirming with a second anti-HCV assay. METHODS We reviewed 32,573 samples of the Architect assay (Abbott Diagnostics) from a tertiary hospital. Retests with the Elecsys (Roche Diagnostics) and Vitros (Ortho Clinical Diagnostics) assays were performed in 346 anti-HCV-positive samples. HCV RNA PCR and recombinant immunoblot assay (RIBA) were performed in 147 and 11 anti-HCV-positive samples, respectively. RESULTS Among 32,573 samples, 446 (1.37%) yielded positive results and 32,127 (98.6%) yielded negative results. Concordance rates in low S/Co samples (0.9-10.0) were 35.2%, 43.8%, and 81.9% for the Architect-Elecsys, Architect-Vitros, and Elecsys-Vitros comparisons, respectively. Correlation coefficients of S/Co ratios were as follows: Architect-Elecsys, 0.20; Architect-Vitros, 0.42; and Elecsys-Vitros, 0.46. In logistic regression, the S/Co value for predicting positivity with 95% probability was 3.13, while that for predicting 50% probability was 8.85. S/Co ratios of 1.70-3.34 showed one reactive antigen out of five antigens, and S/Co ratios of 13.54-17.72 showed three to five positive reactions out of five antigens used in the RIBA. CONCLUSIONS Supplementary testing of anti-HCV screening results is necessary to distinguish between true positivity and biological false positivity for anti-HCV. In this study, we presented an algorithm of supplementary testing by a retest with a second reagent, which could be useful in clinical laboratories.
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Affiliation(s)
- Jihye Ha
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Younhee Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Fletcher GJ, Raghavendran A, Sivakumar J, Samuel P, Abraham P. Diagnostic reliability of Architect anti-HCV assay: Experience of a tertiary care hospital in India. J Clin Lab Anal 2017; 32. [PMID: 28657153 DOI: 10.1002/jcla.22245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND & AIMS Anti-HCV assays are prone to false positive results. Thus, accurate detection of HCV infection is critical for the timely therapeutic management. This study ascertained the reliability of Architect anti-HCV assay (Abbott) and to estimate the agreement of this assay with Ortho HCV 3.0 ELISA Test System with Enhanced SAVe (Ortho), HCV Tri-dot (Tri-dot) and HCV-PCR in a tertiary care setting. METHODS A total of 78 788 consecutive sera were routinely screened for anti-HCV antibodies using Architect. All repeatedly reactive anti-HCV sera (n=1000) and anti-HCV negative sera (n=300) were tested in Ortho and in Tri-dot assays. Representative proportions of sera (n=500) with various signal-to-cut-off (S/Co) ratio were also compared with HCV-PCR. RESULTS When Architect was compared with Ortho, Tri-dot, and HCV-PCR, the level of agreement as assessed by kappa were .26, .16, and .27 respectively. Using Latent class analysis (LCA), we found that sensitivity and specificity were 100% and 36.1% for Architect, 93.8% and 100% for Ortho and 63.8% and 100% for Tri-dot respectively. The median S/CO ratio of Architect and Ortho anti-HCV assays were significantly different between HCV-PCR positive and negative results (P<.0001). Furthermore, Architect S/CO ratio of >8 showed higher accuracy indices in both anti-HCV assays. CONCLUSIONS Architect can be used as a screening assay because of its high sensitivity, high throughput, and short turnaround time. However, S/Co ratios of ≥1 to <8 in Architect necessitates HCV PCR to identify current infection and or EIA to distinguish true positivity from false biological positivity.
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Affiliation(s)
| | | | | | - Prasanna Samuel
- Department of Bio-statistics, Christian Medical College, Vellore, India
| | - Priya Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Evaluation of the Novel HISCL Chemiluminescence Enzyme Immunoassay for Laboratory Screening of Hepatitis C Virus. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:652-4. [PMID: 27170643 DOI: 10.1128/cvi.00078-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023]
Abstract
The hepatitis C virus (HCV) antibody assay remains the first-line screening test to identify HCV infection. The newly arrived HISCL Anti-HCV assay had a satisfactory seroconversion sensitivity. Its sensitivity and specificity were 98.97 and 100% for clinical samples. In general, the HISCL Anti-HCV assay may be a novel choice for clinical HCV screening.
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Genotype Distribution and Molecular Epidemiology of Hepatitis C Virus in Hubei, Central China. PLoS One 2015; 10:e0137059. [PMID: 26325070 PMCID: PMC4556612 DOI: 10.1371/journal.pone.0137059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
Background Little is known about the molecular epidemiology of hepatitis C virus (HCV) infection in Central China. Methodology/Principal Findings A total of 570 patients from Hubei Province in central China were enrolled. These patients were tested positive for HCV antibody prior to blood transfusion. Among them, 177 were characterized by partial NS5B and/or Core-E1 sequences and classified into five subtypes: 1b, 83.0% (147/177); 2a, 13.0% (23/177); 3b, 2.3% (4/177); 6a, 1.1% (2/177); 3a, 0.6% (1/177). Analysis of genotype-associated risk factors revealed that paid blood donation and transfusion before 1997 were strongly associated with subtypes 1b and 2a, while some subtype 2a cases were also found in individuals with high risk sexual behaviors; subtypes 3b, 6a, and 3a were detected only in intravenous drug users. Phylogeographic analyses based on the coalescent datasets demonstrated that 1b, 2a, 3b, and 6a were locally epidemic in Hubei Province. Among them, subtype 1b Hubei strains may have served as the origins of this subtype in China, and 2a and 3b Hubei strains may have descended from the northwest and southwest of China, respectively, while 6a Hubei strains may have been imported from the central south and southwest. Conclusion/Significance The results suggest that the migration patterns of HCV in Hubei are complex and variable among different subtypes. Implementation of mandatory HCV screening before donation has significantly decreased the incidence of transfusion-associated HCV infection since 1997. More attention should be paid to intravenous drug use and unsafe sexual contact, which may have become new risk factors for HCV infection in Hubei Province.
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Usefulness of a fourth generation ELISA assay for the reliable identification of HCV infection in HIV-positive adults from Gabon (Central Africa). PLoS One 2015; 10:e0116975. [PMID: 25617896 PMCID: PMC4305295 DOI: 10.1371/journal.pone.0116975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 12/17/2014] [Indexed: 02/07/2023] Open
Abstract
Background/Objectives Guidelines for optimized HCV screening are urgently required in Africa, especially for patients infected with HIV, who sometimes show false positive or false negative reactivity in anti-HCV antibody assays. Here, we assessed the usefulness of a fourth-generation HCV Ag-Ab ELISA for the identification of active HCV infection in HIV-positive patients. Methods This cross-sectional study was conducted between 03/2010 and 01/2013 and included 762 Gabonese HIV-positive adult patients. The results of ELISA (Monolisa HCV Ag-Ab ULTRA, Bio-Rad) were compared with those obtained by RT-PCR (gold standard). The optimal ELISA signal-to-cutoff (S/CO) ratio to identify patients with active hepatitis C (positive HCV RNA) was determined. Specimens were further tested by the INNO-LIA HCV Score assay (Innogenetics) and the Architect HCV Ag kit (Abbott) to define the best diagnostic strategy. Results Sixty-seven patients tested positive for HCV (S/CO ratio ≥ 1) by ELISA. Of these, 47 (70.1%) tested positive for HCV RNA. The optimal S/CO associated with active HCV infection was 1.7. At this threshold, the sensitivity of ELISA was 97.9% (95% confidence interval (CI) 90.0–99.9%), its specificity was 91.3% (95% CI 85.0–95.5%), and HCV seroprevalence rate was 7.3% (56/762) (95% CI 5.6–9.4%). Among 57 HCV-seropositive patients with available INNO-LIA results, false reactivity was identified in 14 (24.6%), resolved HCV infection in two (3.5%), possible acute HCV infections in nine (15.8%) and likely chronic HCV infections in 32 (56.1%) patients. HCV core Ag was undetectable in 14/15 (93.3%) specimens that tested negative for HCV RNA whereas it was quantified in 34 (out of 39, 87.2%) samples that tested positive for HCV RNA. Conclusions Our study provides comprehensive guidance for HCV testing in Gabon, and will help greatly clinicians to improve case definitions for both the notification and surveillance of HCV in patients co-infected with HIV.
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Yoo SJ, Wang LL, Ning HC, Tao CM, Hirankarn N, Kuakarn S, Yang R, Han TH, Chan RC, Hussain BM, Hussin H, Muliaty D, Shen L, Liu H, Wei L. Evaluation of the Elecsys(®) Anti-HCV II assay for routine hepatitis C virus screening of different Asian Pacific populations and detection of early infection. J Clin Virol 2014; 64:20-7. [PMID: 25728074 DOI: 10.1016/j.jcv.2014.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Early diagnosis of hepatitis C virus (HCV) infection is essential to allow appropriate treatment and prevent transmission. OBJECTIVES To evaluate the Elecsys(®) Anti-HCV II assay as a routine screening assay in Asia using a large number of samples from different Asian Pacific populations and compare its performance with other HCV assays routinely used in the region. STUDY DESIGN The sensitivity and specificity of the Elecsys(®) Anti-HCV II assay were determined using routine hospital samples and compared with at least one of the following comparator assays at nine independent centers: ARCHITECT™ Anti-HCV; Serodia(®)-HCV Particle Agglutination; Vitros(®) ECi Anti-HCV; Elecsys(®) Anti-HCV; ADVIA Centaur(®) HCV; InTec(®) HCV EIA; or Livzon(®) Anti-HCV. Commercially available seroconversion panels were used to assess sensitivity for early detection of infection. RESULTS The Elecsys(®) Anti-HCV II assay was more sensitive in recognizing early infection and detected acute HCV infection earlier on average than the comparator assays for all six panels tested. 7,726 routine samples were tested and 322 identified as HCV positive. Elecsys(®) Anti-HCV II had a sensitivity of 100% and a specificity of 99.66%, both of which were comparable or superior to the results obtained for competitor assays, which ranged from 87.5-100% and 98.98-100%, respectively. CONCLUSIONS The Elecsys(®) Anti-HCV II assay has the sensitivity and specificity to support its use as a routine screening method in the Asia Pacific region. Furthermore, this assay shortens the diagnostic window between infection and the detection of antibodies compared with established methods.
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Affiliation(s)
- Soo Jin Yoo
- Inje University Sanggye Paik Hospital, 1342, Dongilro, Nowon-gu, Seoul 139-707, South Korea.
| | - Lan Lan Wang
- West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, Sichuan Province 610041, China.
| | - Hsiao-Chen Ning
- Chang Gung Memorial Hospital, 5 Fusing Street, Gueishan Township, Taoyuan County 333, Taiwan ROC.
| | - Chuan Min Tao
- West China Hospital, Sichuan University, 37 GuoXue Xiang, Chengdu, Sichuan Province 610041, China.
| | - Nattiya Hirankarn
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama Road, Pathumwan, Bangkok 10330, Thailand.
| | - Sunida Kuakarn
- Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama Road, Pathumwan, Bangkok 10330, Thailand.
| | - Ruifeng Yang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Xizhimen South Street No 11, Xicheng District, Beijing 100044, China.
| | - Tae Hee Han
- Inje University Sanggye Paik Hospital, 1342, Dongilro, Nowon-gu, Seoul 139-707, South Korea.
| | - Raymond C Chan
- Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia.
| | - Baizurah Mohd Hussain
- Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000 Ampang, Selangor DE, Malaysia.
| | - Hazilawati Hussin
- Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000 Ampang, Selangor DE, Malaysia.
| | - Dewi Muliaty
- Prodia Clinical Laboratory, Kramat Raya Street No. 150, Jakarta 10430, Indonesia.
| | - Lisong Shen
- Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Hongjing Liu
- Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China.
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Xizhimen South Street No 11, Xicheng District, Beijing 100044, China.
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Mu X, Zhang L, Chang S, Cui W, Zheng Z. Multiplex Microfluidic Paper-based Immunoassay for the Diagnosis of Hepatitis C Virus Infection. Anal Chem 2014; 86:5338-44. [DOI: 10.1021/ac500247f] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Xuan Mu
- Institute
of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao Beijing, 100005 P. R. China
| | - Lin Zhang
- Department
of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, 1 Shuaifuyuan Beijing, 100730 P. R. China
| | - Shaoying Chang
- Institute
of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao Beijing, 100005 P. R. China
| | - Wei Cui
- Department
of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, 1 Shuaifuyuan Beijing, 100730 P. R. China
| | - Zhi Zheng
- Institute
of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dongdan Santiao Beijing, 100005 P. R. China
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Flichman DM, Blejer JL, Livellara BI, Re VE, Bartoli S, Bustos JA, Ansola CP, Hidalgo S, Cerda ME, Levin AE, Huenul A, Riboldi V, Treviño EMC, Salamone HJ, Nuñez FA, Fernández RJ, Reybaud JF, Campos RH. Prevalence and trends of markers of hepatitis B virus, hepatitis C virus and human Immunodeficiency virus in Argentine blood donors. BMC Infect Dis 2014; 14:218. [PMID: 24755089 PMCID: PMC4018657 DOI: 10.1186/1471-2334-14-218] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 04/08/2014] [Indexed: 12/23/2022] Open
Abstract
Background Transfusion-transmitted infections are a major problem associated with blood transfusion. The aim of this study was to determine prevalence and trends of HBV, HCV and HIV in blood donors in Argentina. Methods A retrospective study was carried out in blood donors of 27 transfusion centers covering the whole country over a period of eight years (2004-2011). Serologic screening assays for HBsAg, anti-HBc, anti-HCV, and anti-HIV were performed in all centers and nucleic acid amplification testing (NAT) was performed in 2 out of the 27 centers. Results The 2,595,852 samples tested nationwide from 2004 to 2011 showed that the prevalence of HBsAg decreased from 0.336% to 0.198% (p < 0.0001), that of anti-HBc from 2.391% to 2.007% (p < 0.0001), that of anti-HCV from 0.721% to 0.460%, (p < 0.0001) and that of anti-HIV from 0.208% to 0.200 (p = 0.075). The prevalence of HBV, HCV and HIV was unevenly distributed among the different regions of the country. Two out of 74,838 screening- negative samples were positive in NAT assays (1 HIV-RNA and 1 HCV-RNA); moreover, HBV-DNA, HCV-RNA and HIV-RNA were detected in 60.29, 24.54 and 66.67% of screening-positive samples of the corresponding assays. As regards donors age, positive HBV-DNA and HCV-RNA donors were significantly older than healthy donors (46.6, 50.5 and 39.5 y respectively, p < 0.001). Conclusions Argentina has a low prevalence of HBsAg, anti-HCV and anti-HIV in blood donors, with a decreasing trend for HBsAg, anti-HBc and anti-HCV but not for anti-HIV over the last 8 years. The uneven distribution of transfusion-transmitted infections prevalence among the different regions of the country highlights the need to implement regional awareness campaigns and prevention. The discrepancy between samples testing positive for screening assays and negative for NAT assays highlights the problem of blood donors who test repeatedly reactive in screening assays but are not confirmed as positive upon further testing. The uneven distribution of age between healthy donors and NAT-positive donors could be related to changes in risks of these pathogens in the general population and might be attributed to a longer exposure to transmission risk factors in elderly people.
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Affiliation(s)
- Diego M Flichman
- Universidad de Buenos Aires, Cátedra de Virología, Buenos Aires, Argentina.
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Sommese L, Iannone C, Cacciatore F, De Iorio G, Napoli C. Comparison between screening and confirmatory serological assays in blood donors in a region of South Italy. J Clin Lab Anal 2014; 28:198-203. [PMID: 24478048 DOI: 10.1002/jcla.21666] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/24/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Screening assays are needed in order to guarantee safety of donated blood, but a significant number of safe donations are removed from blood supply because of reactive screening results. It is important to evaluate the positive predictive value (PPV) of screening assays in order to modulate confirmatory algorithm and implement an adequate counseling. METHODS An analysis of 17,912 blood donations has been conducted at Transfusion Medicine at Second University Naples, Italy, in 2009-2012. Serological screening for syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) was performed by ARCHITECT (Abbott Diagnostics, Wiesbaden, Germany); repeatedly reactive (RR) samples were checked by respective confirmatory tests. The relationship between sample/cutoff and confirmed seropositivity were analyzed. RESULTS RR rates were low as expected in blood donors: 0.47% for syphilis, 0.42% for HBV, 0.50% for HCV, and 0.15% for HIV. The specificity on RR + gray zone (GZ) was 99.67%, 99.79%, 99.77%, and 99.88%, respectively; due to the low prevalence, PPV value was 30.6% for syphilis, 50.7% for HBV, 42.2% for HCV, and 18.5% for HIV. These values increased substantially reaching a plateau of 89.3% for syphilis, 94.6% for HBV, 85.7% for HCV, and 100% for HIV at the threshold established by receiver operating characteristics curve analysis. CONCLUSIONS Supplemental testing on samples with high signal by screening assays seems to add little information. GZ settings and confirmatory testing for positive screening results should be designed taking in account several factors, including difference in the natural history among blood-borne infections, the characteristics of first- and second-level tests, and, when available, the results of nucleic acid amplification testing.
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Affiliation(s)
- Linda Sommese
- U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology (SIMT), Azienda Universitaria Policlinico (AOU), Second University of Naples, Italy
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