title: 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. The HIV Blood Donor Study Group.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Laboratory Medicine, University of California, San Francisco, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Busch
authors.forename: R Y
authors.initials: RY
authors.lastname: Dodd
authors.forename: E M
authors.initials: EM
authors.lastname: Lackritz
authors.forename: J P
authors.initials: JP
authors.lastname: AuBuchon
authors.forename: J D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: L R
authors.initials: LR
authors.lastname: Petersen
mesh_terms: D001782:Blood Donors; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006679:HIV Seropositivity / Q000175:diagnosis; D015497:HIV-1; D006508:Hepatitis Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000592:standards*; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors
chemical_list: D006508:Hepatitis Antibodies; D006512:Hepatitis B Core Antigens