Premium
Relationship between antibody to hepatitis B core antigen and retroviral infections in blood from volunteer donors
Author(s) -
Korelitz J.J.,
Busch M.P.,
Kleinman S.H.,
Williams A.E.,
Zuck T.F.,
Gilcher R.O.,
Ownby H.E.,
Chien H. Co,
Nemo G.J.
Publication year - 1996
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1996.36396182141.x
Subject(s) - medicine , retrovirus , antibody , immunology , virology , hepatitis b virus , volunteer , antigen , hepatitis b , viral disease , hepatitis c virus , virus , biology , agronomy
Background: The value of the test for antibody to hepatitis B core antigen (anti‐HBc) as a surrogate screening assay in the time before sensitive, virus‐specific screening tests were available has been well established. There is significant debate, however about the residual value of anti‐HBc screening after the implementation of human immunodeficiency virus (HIV)‐, human T‐lymphotrophic virus (HTLV)‐, and hepatitis C virus (HCV)‐specific assays and, in particular, about its utility as a lifestyle marker to identify persons at risk for retrovirus infections. Study Design and Methods: Screening tests for antibodies to HIV, HTLV, and HBc, as well as confirmatory or supplemental test results for anti‐HIV and anti‐HTLV, were obtained from approximately 2.8 million donations collected from 1991 through 1993 by five blood centers within the United States. The sensitivity, positive predictive value, and relative prevalence of anti‐HBc for each retrovirus were calculated and compared among demographic subgroups. Results: The overall relationship between anti‐HBc and anti‐HIV was similar to that between anti‐HBc and anti‐HTLV. When calculated from the measured endpoint of the prevalence of anti‐HIV‐positive and anti‐ HTLV‐positive donations, the sensitivities were 31.1 and 26.2 percent, the positive predictive values were 0.18 and 0.21 percent, and the relative prevalences were 30.1 and 23.8, respectively. Among 27 anti‐ HIV‐seroconverting donors and 9 anti‐HTLV‐seroconverting donors, the sensitivities were 7.4 percent (95% CI: 0.9–24.3%) and 0 percent (95% CI: 0.0–28.3%), respectively. It was estimated that for each HIV‐ infected window‐period donation detected by anti‐HBc, from 19,000 to 81,000 HIV‐noninfected donations are discarded. Similarly, more than 33,000 HTLV‐noninfected donations are likely to be discarded for each HTLV‐infected donation detected by anti‐HBc. Conclusion: Although anti‐ HBc‐reactive donations are more likely to be seropositive for a retrovirus than are anti‐HBc‐nonreactive donations, the low positive predictive value limits the test's effectiveness. If the anti‐HBc test is retained in the blood donor setting, efforts should be focused on reducing the number of false‐positive results.