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Italian blood donors with anti-HBc and occult hepatitis B virus infection

From the Banca del Sangue e del Plasma, A.O. S. Giovanni Battista di Torino, Italy (PMan, FD, AP, CV, FCa, FCu); Immunoematologia e Medicina Trasfusionale, Ospedale di Ivrea, Italy (MG); S.O.C. di Medicina Trasfusionale, ASL 14, Presidio Ospedaliero di Domodossola (RB); Immunoematologia, A.S. Torino 4, Italy (OG); Medicina Trasfusionale ed Immunoematologia, Casale Monferrato, Italy (RG); Servizio di Immunoematologia e Trasfusionale, Osp. di Verbania, Italy (ML); Servizio di Immunoematologia e Trasfusionale, Ospedale SS. Annunziata-ASL 17, Savigliano, Italy (DT); Centro Trasfusionale, OIRM S. Anna di Torino, Italy (PG); Servizio di Immuno-ematologia e Trasfusione, A.O. Ospedale Maggiore della Carità di Novara, Italy (MV); SCDU Immunologia dei Trapianti, Università di Torino, Italy (PMag); SCDU Gastroenterologia ed Epatologia, Università di Torino, Italy (MLA, AS, MR)

Correspondence: Paola Manzini, Banca del Sangue e del Plasma, A.O. S. Giovanni Battista di Torino, Corso Bramante 88, 10126 Torino, Italy. E-mail: pmanzini{at}molinette.piemonte.it

Background and Objectives: Occult hepatitis B virus (HBV) infection might allow the release of viremic units into the blood supply network if blood is tested only for hepatitis B surface antigen (HBsAg). The aim of our study was to evaluate the actual prevalence, viral load and genotype of occult HBV infections among first-time blood donors in north-western Italy and to suggest a way to minimize risks of transmission of this infection.

Design and Methods: We assayed 6313 consecutive blood donors for antibodies to HBV core antigen (anti-HBc) in addition to mandatory screening. HBsAg-negative/anti-HBc-positive donors were assayed for antibodies to HBsAg (anti-HBs) and for HBV-DNA using COBAS Ampliscreen HBV (Roche^TM) on individual donations. All HBV-DNA-positive samples underwent confirmatory testing with additional polymerase chain reaction-based assays.

Results: The prevalence of anti-HBc positive subjects was 4.85%. Fourteen out of 288 blood donors (4.86%) were confirmed to have circulating HBV-DNA at a low level (range 8–108 IU/mL). All viremic donors were also anti-HBs-positive.

Interpretation and Conclusions: We estimate that in north-western Italy up to 2298 units per million donated units from first-time donors may contain HBV-DNA. The risk of an HBV-DNA positive unit from an occult carrier being released into the blood supply is more than 100 times higher than the estimated residual risk related to the window phase of HBV infection in our country. The potential infectivity of these units is debated, but their use cannot be considered safe at least in immunocompromised patients.

Key words: hepatitis B virus, HBV, anti-HBc, occult HBV infection, HBV-DNA⁺ blood units, blood donors.

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