Current testing strategies for hepatitis C virus infection in blood donors and the way forward

Abstract

Screening tests for blood donations are based upon sensitivity, cost-effectiveness and their suitability for high-throughput testing. Enzyme immunoassay (EIAs) for hepatitis C virus (HCV) antibodies were the initial screening tests introduced. The "first generation" antibody EIAs detected seroconversion after unduly long infectious window period. Improved HCV antibody assays still had an infectious window period around 66 d. HCV core antigen EIAs shortened the window period considerably, but high costs did not lead to widespread acceptance. A fourth-generation HCV antigen and antibody assay (combination EIA) is more convenient as two infectious markers of HCV are detected in the same assay. Molecular testing for HCV-RNA utilizing nucleic acid amplification technology (NAT) is the most sensitive assay and shortens the window period to only 4 d. Implementation of NAT in many developed countries around the world has resulted in dramatic reductions in transfusion transmissible HCV and relative risk is now < 1 per million donations. However, HCV serology still continues to be retained as some donations are serology positive but NAT negative. In resource constrained countries HCV screening is highly variable, depending upon infrastructure, trained manpower and financial resource. Rapid tests which do not require instrumentation and are simple to perform are used in many small and remotely located blood centres. The sensitivity as compared to EIAs is less and wherever feasible HCV antibody EIAs are most frequently used screening assays. Efforts have been made to implement combined antigen-antibody assays and even NAT in some of these countries.

Epidemiology of Chronic Hepatitis C Infections at a Tertiary Care Centre in Oman

“…This may be potentially due to the use of serological testing instead of advanced screening techniques such as nucleic acid amplification. 30 A history of surgery is another risk factor for HCV infection due to the role that contaminated surgical equipment can play in the transmission of blood-borne diseases. The incidence of surgery-associated HCV infections caused by breaches in infection control practices have been previously reported in the USA.…”

KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease

“…135 HCV is easily transmitted parenterally, primarily through percutaneous exposure to blood. Dramatic reductions were noted in the incidence following introduction of screening for HCV in blood donors and reduction in blood transfusion requirements following introduction of ESAs, 136 leaving nosocomial transmission as the main method of spread of HCV in dialysis units. Several studies have confirmed nosocomial transmission in dialysis units using epidemiologic and phylogenetic data obtained by viral sequencing.…”

Скринінг На Вірусні Гепатити: Актуальність Проблеми Та Шляхи Вдосконалення (Огляд Літератури)

“…Они обладают высокой чувствительностью и специфичностью, а большинство клиник располага-ет оборудованием для проведения этих исследований. В странах с низким уровнем экономического развития, а также в тех случаях, когда необходимо быстро устано-вить, инфицирован больной или нет, с успехом исполь-зуются ИХА-тесты, проведение которых не требует спе-циальной подготовки и какого-либо оборудования [5].…”