Hepatitis B virus nucleic acid testing in Chinese blood donors with normal and elevated alanine aminotransferase

Fu Rong Ren, Jing Xing Wang, Yi Huang, Fu Zhu Yao, Yun Lai Lv, Ju Lin Li, Guo Xin Wen, Xiu Qiong Wen, Jiang Liu, Xiang Dong Dong, Hong Li Ma, Zhong Min Zhou, Xin Hong Bi, Lin Tu, Melissa King, Kenrad Nelson, Paul Ness, Hua Shan

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Nucleic acid testing (NAT) is currently not a routine donor test in China. The aim of this study was to evaluate the current residual risk of hepatitis B virus (HBV) transmission and the value of ALT testing in preventing HBV infection. STUDY DESIGN AND METHODS: From January 2008 to September 2009, a total of 5521 qualified donations by routine screening and 5034 deferred donations due to elevated ALT alone were collected from five blood centers. Samples were tested for HBV DNA by triplex individual-donation (ID)-NAT (ULTRIO assay, on the TIGRIS system, Novartis Diagnostics). HBV NAT-reactive samples were further analyzed by HBV serology, alternative NAT, and viral load and were diluted to simulate if they could be detected in a minipool-NAT. RESULTS: There was no significant difference in the HBV NAT-yield rate between the qualified donations group (5/5521) and the deferred donations group (4/5034). Of these nine potential HBV-yield cases, one donor (11%) was a possible HBV window-period donor, one (11%) was a chronic HBV carrier, and seven (78%) had probable or confirmed occult HBV infections. Of seven potential HBV-yield cases quantified, the viral loads were less than or equal to 70.0 IU/mL. Minipool testing (minipools of 4, 8, and 16 donations) would miss 43% to 79% of the nine HBV-yield donations. CONCLUSIONS: Based on our findings in qualified donations, we estimate that the nationwide implementation of ID-NAT testing for HBV DNA in China would detect an additional 9964 viremic donations per year. ALT testing seems to have no significant value in preventing transfusion-transmitted HBV infection. ID-NAT versus simulated minipool-NAT using the ULTRIO test demonstrates the benefit to implement a more sensitive NAT strategy in regions of high HBV endemicity.

Original languageEnglish (US)
Pages (from-to)2588-2595
Number of pages8
JournalTransfusion
Volume51
Issue number12
DOIs
StatePublished - Dec 1 2011

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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