Will genome detection replace serology in blood screening for microbial agents?
The residual risk of transfusion-transmitted viral infection in developed countries is considered minimal or negligible. However, zero risk remains a strong political objective. Genomic screening for HCV, HIV and HBV represents a major advance, eliminating infectious blood donations collected during the pre-seroconversion window period, rare cases of immunosilent infections and, possibly, a large spectrum of viral variants. In Western countries, HCV RNA genomic screening started on pools of 16-400 plasma samples from individual donations. Pooling may produce false-positive and false-negative results. Individual donation testing is more suitable to blood screening but requires multiplexing, automation, and affordable cost. Because donations from individuals who are HBV DNA-negative/serologically positive, or those apparently recovered from HCV infection, may remain infectious, it is unlikely that HBsAg, anti-HCV, and anti-HIV will be discontinued when genomic screening is extended to all three viruses. HIV-1 p24 antigen may prove redundant with HIV RNA screening. Anti-HTLV-I and HTLV-II will remain more effective than genomic testing.
Allain
J P
JP
Division of Transfusion Medicine, University of Cambridge, Cambridge, UK.
D000914:Antibodies, Viral / Q000097:blood; D001782:Blood Donors; D004279:DNA, Viral / Q000097:blood*; D006678:HIV / Q000235:genetics; D016174:Hepacivirus / Q000235:genetics; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D012367:RNA, Viral / Q000097:blood*; D014777:Virus Diseases / Q000175:diagnosis* / Q000276:immunology; D014780:Viruses / Q000235:genetics*
D000914:Antibodies, Viral; D004279:DNA, Viral; D012367:RNA, Viral