乙型肝炎病毒血液筛查：需要重新评估血液安全措施？

StephenW

Front Med (Lausanne). 2018 Feb 21;5:29. doi: 10.3389/fmed.2018.00029. eCollection 2018.
Hepatitis B Virus Blood Screening: Need for Reappraisal of Blood Safety Measures?
Candotti D1, Laperche S1.
Author information

1
    Department of Blood-Transmitted Pathogens, National Transfusion Infectious Risk Reference Laboratory, National Institute of Blood Transfusion, Paris, France.

Abstract

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:

HBsAg; anti-HBc; blood safety; hepatitis B virus; nucleic acid testing; residual risk; transfusion

PMID:
    29515997
PMCID:
    PMC5826332
DOI:
    10.3389/fmed.2018.00029

StephenW

Front Med（洛桑）。 2018年2月21日; 5：29。 doi：10.3389 / fmed.2018.00029。 eCollection 2018年。
乙型肝炎病毒血液筛查：需要重新评估血液安全措施？
Candotti D1，Laperche S1。
作者信息

1
    法国巴黎国立输血研究所国家输血感染风险参考实验室血液传播病原体司。

抽象

在过去的几十年中，通过招募志愿者捐献者，基于风险行为评估的捐赠者选择，越来越敏感的乙型肝炎抗原（HBsAg）检测的发展，使用HBV输血传播的风险逐渐降低乙型肝炎核心抗体（抗-HBc）筛查在一些低流行国家的应用，以及最近实施的HBV核酸检测（NAT）。尽管采取了血液安全措施，积累的理想零风险目标尚未实现。 HBV输血传播的剩余风险似乎与preseconversion窗口期和隐匿性HBV感染有关，其特征是缺乏可检测的HBsAg和极低水平的HBV DNA。被感染的捐献被血清学检测为假阴性和/或NAT仍然存在，并且衍生的血液成分显示出传播病毒，尽管很少。有关安全措施明显冗余的问题引发了关于如何降低HBV血液筛查成本的辩论。特别是，积累数据强烈表明，当HBV NAT和抗-HBc筛查也适用时，如果有任何HBV风险降低值，HBsAg检测可能会增加很少。在考虑停止使用HBsAg之前，需要评估是否存在可接受的传染性风险。尽管如此，HBsAg仍然是高危地区的必需环境，在不影响血液利用率的情况下抗HBc检测无法实施。 HBV筛查策略应根据当地流行病学，传染风险评估和资源情况确定。
关键词：

乙肝表面抗原;抗-HBc;血液安全;乙型肝炎病毒;核酸测试;剩余风险;输

结论：
    29515997
PMCID：
    PMC5826332
DOI：
    10.3389 / fmed.2018.00029

StephenW

https://www.frontiersin.org/articles/10.3389/fmed.2018.00029/full