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Athalye S, Patil A, Khargekar N, Shinde S, Chavan S, Dixit A, Shankarkumar A, Madkaikar M, Banerjee A. Efficacy of combined HBsAg, anti-HBc and anti-HBs screening in minimizing transfusion transmission risk of hepatitis B infection in low resource setting. Heliyon 2024; 10:e25805. [PMID: 38356514 PMCID: PMC10865305 DOI: 10.1016/j.heliyon.2024.e25805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Hepatitis B Virus (HBV), and occult Hepatitis B in particular, is a major concern in the transfusion scenario, especially in endemic countries. This study attempted to estimate the prevalence of occult Hepatitis B infection (OBI) among voluntary blood donors in Maharashtra and to evaluate the role of combined screening strategy with implications in minimizing the current transfusion risks of seropositive OBI. Methods Donor samples were collected from 80 eligible blood banks from various districts of Maharashtra between 2014 and 2017. ELISA based screening of HBsAg, anti-HBc (total and IgM), anti-HBs titres. Real-time quantitative PCR for Hepatitis B Virus DNA (HBV DNA) were performed for all HBsAg and or anti-HBc positive samples. Results Out of 2398 samples tested, 20 (0.83%) samples were positive for HBsAg, whereas 547 (22.81%) were positive for anti-HBc. Out of 547 samples, 16 (2.92%) were positive for HBV DNA with median level at 247.89 IU/mL (IQR: 126.05-666.67 IU/mL). Anti-HBs levels were positive in 35.83% of OBI cases. ROC curve analysis showed that combined HBsAg, anti-HBc and anti-HBs (>50 mIU/mL) screening can more efficiently detect HBV infection in blood donors than HBsAg alone. Conclusions A combined HBsAg, anti-HBc and anti-HBs screening for donor samples could be an alternative achievable strategy to minimize the HBV transmission as well as financial burden. In resource limited setup, the proposed combined strategy could be helpful in minimizing the risk of OBI transmission.
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Affiliation(s)
- Shreyasi Athalye
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Amruta Patil
- Department of Medical Biotechnology, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Naveen Khargekar
- Hematogenetics Department, ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Shailesh Shinde
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Shreya Chavan
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Abhay Dixit
- Project ACCELERATE, YRGCARE, Mumbai, Maharashtra, India
| | - Aruna Shankarkumar
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Manisha Madkaikar
- Paediatric Immunology and Leukocyte Biology, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Anindita Banerjee
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
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Damiani AS, Holzmayer V, Galli C, De Nuzzo M, Anderson M, Cloherty G, Di Renzo N. Serological and Molecular Characterization of Occult HBV Infection in Blood Donors from South Italy. Viruses 2023; 16:71. [PMID: 38257771 PMCID: PMC10819115 DOI: 10.3390/v16010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Despite good vaccine coverage and careful blood donor selection policies, hepatitis B virus (HBV) is still the most frequent viral infection among blood donors (BDs) in Italy, mostly in the occult form (OBI). We studied the virological features of OBI in BDs from South Italy by serology, molecular testing for HBV-DNA, and sequencing for HBV genotypes and mutations. One hundred and two samples from 95 BDs (22.1% first time, 87.9% regular, median age 57 years) positive for HBV-DNA and negative for HBsAg were retrospectively analyzed. HBV biomarkers were detected in 96.9% (anti-HBc in 44.2%, anti-HBc plus anti-HBs in 49.5%, anti-HBs alone in 3.2%). No risk factor was declared by 45.3% of donors. HBV-DNA levels were very low (median: 7 IU/mL). All samples harbored HBV genotype D and single or multiple mutations in the S gene were found in 28/36 sequences analyzed and in 75% of donors. Mutations were unrelated to gender, donor group or serological patterns. An HBsAg assay with enhanced sensitivity was positive in samples from seven donors (7.4%), two of which negative for HBV-DNA by real-time PCR. OBI still represents a risk for HBV transmission from blood donations; screening by highly sensitive serological and molecular assays is warranted.
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Affiliation(s)
| | - Vera Holzmayer
- R&D, Abbott Diagnostics, Chicago, IL 60064, USA; (V.H.); (M.A.); (G.C.)
| | | | - Mariangela De Nuzzo
- Servizio Immunotrasfusionale, A.O. Vito Fazzi, 73100 Lecce, Italy; (M.D.N.); (N.D.R.)
| | - Mark Anderson
- R&D, Abbott Diagnostics, Chicago, IL 60064, USA; (V.H.); (M.A.); (G.C.)
| | - Gavin Cloherty
- R&D, Abbott Diagnostics, Chicago, IL 60064, USA; (V.H.); (M.A.); (G.C.)
| | - Nicola Di Renzo
- Servizio Immunotrasfusionale, A.O. Vito Fazzi, 73100 Lecce, Italy; (M.D.N.); (N.D.R.)
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Sauleda S, Bes M, Piron M, Ong E, Coco SB, Carrió J, Linnen JM. Clinical performance of a new multiplex assay for the detection of HIV-1, HIV-2, HCV, HBV, and HEV in blood donations in Catalonia (Spain). Transfusion 2023; 63:2098-2105. [PMID: 37767741 DOI: 10.1111/trf.17518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Commercial multiplex nucleic acid tests (NATs) for HIV-1/HIV-2/HCV/HBV are widely used in developed countries to screen blood donations. HEV NAT screening has been implemented in some blood banks but is tested with a different assay. STUDY DESIGN AND METHODS This study describes the clinical sensitivity and specificity of the Procleix® UltrioPlex E (UPxE) assay on the automated Procleix Panther® system for the simultaneous detection of HIV-1/HIV-2/HCV/HBV/HEV. To evaluate routine performance, 10,138 donations were tested in parallel with UPxE (in ID-NAT) and current assays (Procleix Ultrio Elite [UE] assay in ID-NAT and Procleix HEV assay in pool of 16). To assess clinical sensitivity, archived donations positive for HCV, HIV-1, HBV, HEV, or occult HBV infection (OBI) were tested (n = 104-186). RESULTS Five donations were initially reactive (IR) with UPxE; none of them were reactive with current assays. Two of the three samples IR for HIV-1/HIV-2/HCV/HBV were confirmed positive for HBV (HBV NAT and/or anti-HBV core positive) and classified as OBI. The two samples IR for HEV were confirmed positive (Procleix HEV assay in ID-NAT and in-house RT-PCR HEV assay). One sample IR for HIV-1/HIV-2/HCV/HBV with UPxE and another with UE were not confirmed. UPxE showed a specificity of 99.99% for HIV-1/HIV-2/HCV/HBV and 100% for HEV. Comparable sensitivities were observed for HIV-1, HCV, HBV, OBI, and HEV samples tested in the UPxE, UE, and Procleix HEV assays. DISCUSSION UPxE may provide an efficient solution for the simultaneous detection of HIV-1, HIV-2, HCV, HBV, and HEV in blood donations in a single test.
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Affiliation(s)
- Silvia Sauleda
- Banc de Sang i Teixits de Catalunya (Blood and Tissue Bank of Catalonia, BST), Transfusion Safety Laboratory, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusional Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marta Bes
- Banc de Sang i Teixits de Catalunya (Blood and Tissue Bank of Catalonia, BST), Transfusion Safety Laboratory, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusional Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maria Piron
- Banc de Sang i Teixits de Catalunya (Blood and Tissue Bank of Catalonia, BST), Transfusion Safety Laboratory, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Madrid, Spain
- Transfusional Medicine Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Edgar Ong
- Grifols Diagnostic Solutions Inc., San Diego, California, USA
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Pandey HC, Varghese M, Rana A, Kumar R, Jain P. Residual risk estimates of transfusion transmissible hepatitis B, hepatitis C and human immunodeficiency virus using nucleic acid testing yield/window period model in an Indian setting. Transfus Med 2022; 32:492-498. [DOI: 10.1111/tme.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 07/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Hem Chandra Pandey
- Main Blood Bank, Department of Transfusion Medicine All India Institute of Medical Sciences New Delhi India
| | - Mariamma Varghese
- Main Blood Bank, Department of Transfusion Medicine All India Institute of Medical Sciences New Delhi India
| | - Arvind Rana
- Main Blood Bank, Department of Transfusion Medicine All India Institute of Medical Sciences New Delhi India
| | - Raj Kumar
- Main Blood Bank, Department of Transfusion Medicine All India Institute of Medical Sciences New Delhi India
| | - Pankaj Jain
- Main Blood Bank, Department of Transfusion Medicine All India Institute of Medical Sciences New Delhi India
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Ye X, Liu L, Chen L, Nie X, Huang L, Ye D, Zeng J, Li T, Li B, Xu M, Chen L. High-Frequency Notable HBV Mutations Identified in Blood Donors With Occult Hepatitis B Infection From Heyuan City of Southern China. Front Immunol 2022; 13:754383. [PMID: 35634299 PMCID: PMC9136029 DOI: 10.3389/fimmu.2022.754383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background All Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine donor screening since 2015. The prevalence of occult hepatitis B virus infection (OBI) in donors from different regions varies, and the molecular characterization of the HBV DNA and clinical outcomes of these OBIs remain largely unexplored. Methods Blood donations from Heyuan city in Southern China were screened by HBsAg ELISA and HBV MP8 NAT. Donations with HBsAg-/HBV DNA+ were collected for this study. Molecular characterizations of HBV DNAs were further analyzed by various DNA amplification assays including quantitative PCR (qPCR) and nested PCR, amplifying the basic core and pre-core promoter regions (BCP/PC). The HBsAg (S) region from HBV DNA was isolated by high-volume nucleic acid extraction. Notable mutations were identified by comparison to the HBV reference sequences. The clinical outcomes of the donors with OBIs were further followed for nearly 3 years. Results Seventy OBIs from 44,592 donations (0.15%) that we identified and reported previously were enrolled for this current study. HBV sequences were obtained from 44/70 OBIs, and genotyping analysis showed that 42/44 (95.2%) OBIs were genotype B, and 2/44 (4.8%) were genotype C. Interestingly, mutation analysis revealed that various mutations including M133L/T, F134L, P142L, V168A, R169H, S174N, L175S, and V177A of HBV DNA affecting HBsAg detection were observed in genotype B OBIs. Two notable mutations, T47K and L53S, were identified in genotype C OBIs. Follow-up studies showed that 3/31 (9.7%) OBIs converted to HBsAg+ as chronic infections while 1/31 (3.2%) HBV DNA was undetectable (classified as recovery) and 27/31 (87.1%) remained as OBIs. Conclusion Various notable mutations affecting HBsAg detection were observed in blood donors with OBIs in Heyuan city of Southern China. Follow-up studies showed that most OBIs remained as OBIs with fluctuating or low viral loads. Higher sensitive HBV ID NAT is recommended for donor screening to further reduce the transmission risk of OBIs.
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Affiliation(s)
- Xianlin Ye
- Department of Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Lihua Liu
- Department of Laboratory, Heyuan Blood Center, Heyuan, China
| | - Lina Chen
- Department of Laboratory, Heyuan Blood Center, Heyuan, China
| | - Xianghui Nie
- Department of Laboratory, Heyuan Blood Center, Heyuan, China
| | - Lu Huang
- Department of Laboratory, Heyuan Blood Center, Heyuan, China
| | - Denghuang Ye
- Department of Laboratory, Heyuan Blood Center, Heyuan, China
| | - Jinfeng Zeng
- Department of Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Tong Li
- Department of Laboratory, Shenzhen Blood Center, Shenzhen, China
| | - Bin Li
- The Joint Laboratory on Transfusion-Transmitted Diseases (TTDs) between Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Nanning Blood Center, Nanning Blood Center, Nanning, China
- *Correspondence: Bin Li, ; Min Xu, ; Limin Chen,
| | - Min Xu
- Provincial Key Laboratory for Transfusion-Transmitted Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Chengdu, China
- *Correspondence: Bin Li, ; Min Xu, ; Limin Chen,
| | - Limin Chen
- The Joint Laboratory on Transfusion-Transmitted Diseases (TTDs) between Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Nanning Blood Center, Nanning Blood Center, Nanning, China
- Provincial Key Laboratory for Transfusion-Transmitted Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Chengdu, China
- *Correspondence: Bin Li, ; Min Xu, ; Limin Chen,
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Hao Q, Wang Q, Qian H, Jiang J, Liu X, Xia W. Identification and functional characterization of miR-451a as a novel plasma-based biomarker for occult hepatitis B virus infection. Microb Pathog 2021; 161:105233. [PMID: 34626767 DOI: 10.1016/j.micpath.2021.105233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/07/2021] [Accepted: 10/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Numerous studies have indicated that miRNAs might play significant roles in the development of hepatitis B virus (HBV) infection. while the miRNAs in occult HBV infection (OBI) are still largely unknown. METHODS Initially, 15 HBV infection-related miRNAs in plasma of 10 OBI and 10 healthy controls (HCs) was analyzed by qRT-PCR. Significantly dysregulated miRNAs were subsequently validated in another 64 OBI, 20HCs, 31 chronic hepatitis B (CHB) and 20 asymptomatic HBsAg carriers (ASC). Furthermore, the potential biological functions and molecular mechanisms of miR-451a in HBV infection were investigated using HBV-expressing hepatoma cell lines. RESULTS Compared to HCs, plasma miR-451a and miR-340-3p were significantly up-regulated in OBI, ASC and CHB patients, while no significant difference was found among OBI, ASC and CHB patients. ROC curve analysis indicated that both plasma miR-451a and miR-340-3p could moderately distinguish OBI from HCs, with AUCs of 0.76 and 0.78, respectively. When combined, the differentiation efficiency of this miRNA panel was better, with an AUC of 0.82. While, they both could not specifically separate the stage of chronic HBV infection. Functional experiments showed that overexpression of miR-451a might suppress HBV replication and gene expression in hepatoma cell lines. Mechanistically, miR-451a might inhibit HBV replication and gene expression by directly targeting ATF2. CONCLUSIONS A plasma panel, including miR-340-3p and miR-451a that might suppress HBV replication by targeting ATF2, has the potential as biomarkers for HBV infection. In the setting of blood donations, this panel would be more practical to moderately differentiate OBI in HBsAg-negative donors.
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Affiliation(s)
- Qingqin Hao
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China
| | - Qinghui Wang
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China
| | - Huizhong Qian
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China
| | - Jian Jiang
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China
| | - Xiao Liu
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China.
| | - Wei Xia
- Department of Clinical Laboratory, Wuxi Blood Center, Wuxi, 214000, China.
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Hao Q, Wang Z, Wang Q, Chen B, Qian H, Liu X, Cao H, Xia W, Jiang J, Lu Z. Identification and characterization of lncRNA AP000253 in occult hepatitis B virus infection. Virol J 2021; 18:125. [PMID: 34112188 PMCID: PMC8194241 DOI: 10.1186/s12985-021-01596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent studies suggest that lncRNAs may play significant roles in the development of hepatitis B virus (HBV) infection. However, as a special stage of HBV infection, the lncRNA expression in occult HBV infection (OBI) remains unclear. METHODS The plasma level of 15 HBV infection-related lncRNAs was initially detected using qRT-PCR in 10 OBI and 10 healthy controls (HCs) in discovery phase. Significantly dysregulated lncRNAs were subsequently validated in another 64 OBI, 20 HCs, 31 chronic hepatitis B (CHB) and 20 asymptomatic HBsAg carriers (ASC). Moreover, the AP000253 expression in liver tissues and its potential biological functions in HBV infection were further investigate with public transcriptomic data and HBV-expressing cell lines. RESULTS Among candidate lncRNAs, the plasma level of AP000253 decreased significantly in OBI, ASC and CHB patients compared to HCs, while no difference was found among OBI, ASC and CHB patients. In liver tissues, similar AP000253 expression was also observed from the GSE83148 dataset, while that in HBV-expressing hepatoma cells was opposite. ROC curve analysis indicated that plasma AP000253 yielded an AUC of 0.73 with 60% sensitivity and 75% specificity when differentiating OBI from HCs, but it could not specifically separate the stage of chronic HBV infection. Furthermore, functional experiments suggested that AP000253 could promote HBV transcription and replication in hepatoma cell lines. CONCLUSIONS AP000253 might be involved in HBV replication, and be served as a potential biomarker for HBV infection. In the setting of blood donations, plasma AP000253 would be more useful to moderately distinguish OBI in HBsAg-negative donors. However, the AP000253 expression in liver tissues and associated molecular mechanism of HBV infection deserve further study in future.
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Affiliation(s)
- Qingqin Hao
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China
| | - Zheng Wang
- Department of Liver Disease, Wuxi No.5 People's Hospital Affiliated to Jiangnan University, 1215 Guangrui Road, Wuxi, 214000, China
| | - Qinghui Wang
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China
| | - Bo Chen
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China
| | - Huizhong Qian
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China
| | - Xiao Liu
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China
| | - Hong Cao
- Department of Liver Disease, Wuxi No.5 People's Hospital Affiliated to Jiangnan University, 1215 Guangrui Road, Wuxi, 214000, China
| | - Wei Xia
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China.
| | - Jian Jiang
- Department of Clinical Laboratory, Wuxi Red Cross Blood Center, 109 Xinmin Road, Wuxi, 214000, China.
| | - Zhonghua Lu
- Department of Liver Disease, Wuxi No.5 People's Hospital Affiliated to Jiangnan University, 1215 Guangrui Road, Wuxi, 214000, China.
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van de Laar TJ, Hogema BM, Molenaar-de Backer MW, Marijt-van der Kreek T, Zaaijer HL. Blood donor screening in the Netherlands: Universal anti-HBc screening in combination with HBV nucleic acid amplification testing may allow discontinuation of hepatitis B virus antigen testing. Transfusion 2021; 61:2116-2124. [PMID: 33899233 DOI: 10.1111/trf.16420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the Netherlands, blood donor screening for hepatitis B virus (HBV) consists of HBsAg screening since the 1970s, HBV DNA minipool testing (MP-NAT) since 2008, and anti-HBc screening since 2011. Anti-HBc reactivity causes deferral only if anti-HBs titers are <200 IU/mL, or when anti-HBc was acquired during follow-up. STUDY DESIGN AND METHODS Over 5.5 million donations from 582,459 Dutch donors were screened for HBV DNA, HBsAg, anti-HBc, and, if anti-HBc positive, also for anti-HBs. The added value, expressed as the yield of (potentially) infectious and/or recent HBV infections versus unnecessary donor loss, was evaluated for each of the three HBV screening tests. RESULTS HBV donor screening identified 89 HBV-infected donors with at least two reactive HBV markers (MP-NAT, HBsAg and/or anti-HBc). Single HBV-marker yield was: 5 MP-NAT-only, 0 HBsAg-only, and 20 anti-HBc-only donors. In addition, anti-HBc screening yielded 1,067 potentially infectious donors at risk for occult HBV infection (OBI). In total, 4,126 (0.71%) donors were anti-HBc-reactive at first-time screening, and 1,098 (0.19%) seroconverted during follow-up. Anti-HBc-related donor loss was limited to 2,627 (0.45%) donors using anti-HBs titers and two-strike programs. Donor loss due to MP-NAT and HBsAg screening was extremely low: 0 and 128 donors, respectively. CONCLUSION HBV donor screening could be limited to MP-NAT and anti-HBc screening. MP-NAT and anti-HBc improved blood safety by intercepting infectious donations from donors with recent infection or OBI, while HBsAg did not. Unnecessary donor loss related to anti-HBc screening is substantial but does not endanger the continuity of the blood supply.
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Affiliation(s)
- Thijs J van de Laar
- Department of Donor Medicine Research, Laboratory of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Virology and MAT Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Laboratory of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Boris M Hogema
- Department of Donor Medicine Research, Laboratory of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Virology and MAT Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | | | | | - Hans L Zaaijer
- Department of Donor Medicine Research, Laboratory of Blood-borne Infections, Sanquin Research, Amsterdam, The Netherlands.,Department of Clinical Virology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Occult hepatitis B infection and hepatocellular carcinoma: Epidemiology, virology, hepatocarcinogenesis and clinical significance. J Hepatol 2020; 73:952-964. [PMID: 32504662 DOI: 10.1016/j.jhep.2020.05.042] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
Occult hepatitis B infection (OBI) refers to a condition where replication-competent HBV DNA is present in the liver, with or without HBV DNA in the blood, in individuals with serum HBsAg negativity assessed by currently available assays. The episomal covalently closed circular DNA (cccDNA) in OBI is in a low replicative state. Viral gene expression is mediated by epigenetic control of HBV transcription, including the HBV CpG island methylation pathway and post-translational modification of cccDNA-bound histone, with a different pattern from patients with chronic HBV infection. The prevalence of OBI varies tremendously across patient populations owing to numerous factors, such as geographic location, assay characteristics, host immune response, coinfection with other viruses, and vaccination status. Apart from the risk of viral reactivation upon immunosuppression and the risk of transmission of HBV, OBI has been implicated in hepatocellular carcinoma (HCC) development in patients with chronic HCV infection, those with cryptogenic or known liver disease, and in patients with HBsAg seroclearance after chronic HBV infection. An increasing number of prospective studies and meta-analyses have reported a higher incidence of HCC in patients with HCV and OBI, as well as more advanced tumour histological grades and earlier age of HCC diagnosis, compared with patients without OBI. The proposed pathogenetic mechanisms of OBI-related HCC include the influence of HBV DNA integration on the hepatocyte cell cycle, the production of pro-oncogenic proteins (HBx protein and mutated surface proteins), and persistent low-grade necroinflammation (contributing to the development of fibrosis and cirrhosis). There remain uncertainties about exactly how, and in what order, these mechanisms drive the development of tumours in patients with OBI.
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Styles CE, Cheng A, Hoad VC, Kiely P, Watson M, Seed CR. Excluding Occult Hepatitis B Infection before Assigning False-Positive Status to Non-Repeatable NAT Reactivity: Concerning Stolz et al. "Safe-Testing Algorithm for Individual-Donation Nucleic Acid Testing: 10 Years of Experience in a Low-Prevalence Country" [Transfus Med Hemother. 2019 Apr;46(2):104-10]. Transfus Med Hemother 2020; 47:272-274. [PMID: 32595432 PMCID: PMC7315221 DOI: 10.1159/000502552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Claire E. Styles
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Washington, Australia
| | - Anthea Cheng
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Washington, Australia
| | - Veronica C. Hoad
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Washington, Australia
| | - Philip Kiely
- Clinical Services and Research, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Michael Watson
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Washington, Australia
| | - Clive R. Seed
- Clinical Services and Research, Australian Red Cross Blood Service, Perth, Washington, Australia
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Dodd RY, Crowder LA, Haynes JM, Notari EP, Stramer SL, Steele WR. Screening Blood Donors for HIV, HCV, and HBV at the American Red Cross: 10-Year Trends in Prevalence, Incidence, and Residual Risk, 2007 to 2016. Transfus Med Rev 2020; 34:81-93. [PMID: 32178888 DOI: 10.1016/j.tmrv.2020.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
Prevalence, incidence and residual risk of HIV, HCV and HBV are critical indicators of the safety of the blood supply. The American Red Cross routinely monitors these markers. Herein the results of testing over 58 million donations from 2007 to 2016 are reported. The prevalence and incidence of these infections has declined or remained essentially stable over the 7.5 to 10-year period. In 2015 to 2016, the prevalence of HIV, HCV and HBV were respectively: 1.65, 11.47 and 5.85 per hundred thousand (pht) donations with a significant decrease over the 10-year study only for HCV. Weighted incidence rates for all positives were 1.98 pht person years (py) for HIV, 2.20 pht py for HCV and 1.25 pht py for HBV. Estimates of residual risk using these incidence rates were: HIV, 1:2.3 million; HCV, 1:2.6 million; and HBV, 1:1.5 million donations, reflecting very low risk to recipients. There have been increases in the safety of the blood supply compared to prior published estimates. Demographic factors were shown to be associated with variations in infection prevalence and incidence. Continuing changes in the structure of the donor population or changes in policy could impact these measures of safety.
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Affiliation(s)
- Roger Y Dodd
- American Red Cross, Scientific Affairs, Rockville, MD, USA.
| | | | - James M Haynes
- American Red Cross, Scientific Affairs, Rockville, MD, USA.
| | | | - Susan L Stramer
- American Red Cross, Scientific Affairs, Gaithersburg, MD, USA.
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Zhang Z, Wang C, Liu Z, Zou G, Li J, Lu M. Host Genetic Determinants of Hepatitis B Virus Infection. Front Genet 2019; 10:696. [PMID: 31475028 PMCID: PMC6702792 DOI: 10.3389/fgene.2019.00696] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is still a major health problem worldwide. Recently, a great number of genetic studies based on single nucleotide polymorphisms (SNPs) and genome-wide association studies have been performed to search for host determinants of the development of chronic HBV infection, clinical outcomes, therapeutic efficacy, and responses to hepatitis B vaccines, with a focus on human leukocyte antigens (HLA), cytokine genes, and toll-like receptors. In addition to SNPs, gene insertions/deletions and copy number variants are associated with infection. However, conflicting results have been obtained. In the present review, we summarize the current state of research on host genetic factors and chronic HBV infection, its clinical type, therapies, and hepatitis B vaccine responses and classify published results according to their reliability. The potential roles of host genetic determinants of chronic HBV infection identified in these studies and their clinical significance are discussed. In particular, HLAs were relevant for HBV infection and pathogenesis. Finally, we highlight the need for additional studies with large sample sizes, well-matched study designs, appropriate statistical methods, and validation in multiple populations to improve the treatment of HBV infection.
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Affiliation(s)
- Zhenhua Zhang
- Department of Infectious Diseases, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
- College of Pharmacy, Anhui Medical University, Hefei, China
| | - Changtai Wang
- Department of Infectious Diseases, the Affiliated Anqing Hospital of Anhui Medical University, Anqing, China
| | - Zhongping Liu
- Department of Infectious Diseases, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guizhou Zou
- Department of Infectious Diseases, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Li
- College of Pharmacy, Anhui Medical University, Hefei, China
| | - Mengji Lu
- Institute of Virology, University Hospital of Duisburg-Essen, Essen, Germany
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