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Value and cost‐effectiveness of screening blood donors for antibody to hepatitis B core antigen as a way of detecting window‐phase human immunodeficiency virus type 1 infections
Author(s) -
Busch M. P.,
Dodd R. Y.,
Lackritz E. M.,
AuBuchon J. P.,
Birkmeyer J. D.,
Petersen L. R.
Publication year - 1997
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.1537-2995.1997.371098016437.x
Subject(s) - medicine , seroconversion , window period , immunology , hepatitis b , hepatitis b virus , antibody , viral disease , antigen , virology , human immunodeficiency virus (hiv) , virus , serology
BACKGROUND: The value of screening donors for antibody to hepatitis B core antigen (anti‐HBc) for the prevention of posttransfusion hepatitis has declined markedly. However, anti‐HBc screening may still be useful as a surrogate marker for the window period (WP) of human immunodeficiency virus type 1 (HIV‐1) infection. STUDY DESIGN AND METHODS: First, the relationship between anti‐HBc reactivity and HIV‐1 WP infections was examined among 225 donors who had seroconverted to anti‐HIV‐1 positivity between 1987 and 1990. In addition, data from 1654 HIV‐1 seropositive donors were analyzed to characterize the relationship among anti‐HBc reactivity, donor demographics, and HIV‐1‐ related risk factors. The yield and cost‐effectiveness of anti‐HBc for HIV‐1 prevention were then projected on the basis of a published decision analysis model. RESULTS: Forty (18%) of 225 HIV‐1‐ seroconverting donors tested anti‐HBc‐reactive on the donation preceding anti‐HIV‐1 seroconversion; in contrast, 341 (34%) of 1014 HIV‐ 1‐seropositive donors interviewed tested anti‐HBc‐reactive (chi‐square test; p < 0.001). Anti‐HBc reactivity was more common among HIV‐1‐ seropositive donors reporting male‐to‐male sexual contact (169/360, 47%) and injection drug use (44/83, 53%) than among those with heterosexual contacts known to be HIV‐1‐positive (31/190, 16%) or transfusion exposure (3/21, 14%) or among females with no identified risk factors (21/124, 17%). The estimates of 18 to 34 percent sensitivity for anti‐HBc in detecting HIV‐1 WP donations and a current rate of 1 in 676,000 HIV‐1 WP donations (after p24 antigen screening) suggest that continued use of anti‐HBc screening could result in the transfusion of 5 to 12 fewer HIV‐1‐infected units per year in the United States, which would add 19 to 48 quality‐adjusted years of life for the 3.5 million annual transfusion recipients at a cost of $992,020 to $2,345,000 per quality‐adjusted life‐year saved. CONCLUSION: The low yield and very poor cost‐effectiveness of anti‐HBc screening indicate that this test is not an effective screening test for HIV‐1 WP donations.