Hepatitis B Virus Blood Screening: Need for Reappraisal of Blood Safety Measures?
- 1DATS, Institut National de la Transfusion Sanguine, France
Over the past decades, the risk of HBV transfusion-transmission has been steadily reduced through the recruitment of volunteer donors, the selection of donors based on risk-behavior evaluation, the development of increasingly more sensitive hepatitis B antigen (HBsAg) assays, the use of hepatitis B core antibody (anti-HBc) screening in some low-endemic countries, and the recent implementation of HBV nucleic acid testing (NAT). Despite this accumulation of blood safety measures, the desirable zero risk goal has yet to be achieved. The residual risk of HBV transfusion-transmission appears associated with the preseroconversion window period and occult HBV infection characterized by the absence of detectable HBsAg and extremely low levels of HBV DNA. Infected donations tested false-negative with serology and/or NAT still persist and derived blood components were shown to transmit the virus, although rarely. Questions regarding the apparent redundancy of some safety measures prompted debates on how to reduce the cost of HBV blood screening. In particular, accumulating data strongly suggests that HBsAg testing may add little, if any HBV risk reduction value when HBV NAT and anti-HBc screening also apply. Absence or minimal acceptable infectious risk needs to be assessed before considering discontinuing HBsAg. Nevertheless, HBsAg remains essential in high-endemic settings where anti-HBc testing cannot be implemented without compromising blood availability. HBV screening strategy should be decided according to local epidemiology, estimate of the infectious risk, and resources.
Keywords: Hepatitis B virus, transfusion, Blood Safety, Nucleic acid testing, HBsAg, Anti-HBc, Residual Risk
Received: 04 Dec 2017;
Accepted: 29 Jan 2018.
Edited by:Christoph Niederhauser, Transfusion Interrégionale CRS SA, Switzerland
Reviewed by:Thierry Burnouf, Taipei Medical University, Taiwan
Anton P. Andonov, National Microbiology Laboratory, Canada
Copyright: © 2018 Candotti and Laperche. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: PhD. Daniel Candotti, Institut National de la Transfusion Sanguine, DATS, 6 rue Alexandre Cabanel, Paris, 75015, France, email@example.com