Performance of a new-generation chemiluminescent assay for hepatitis B surface antigen.
BACKGROUND
The usual criteria for analysis of hepatitis B surface antigen (HBsAg) are detection of HBsAg and result confirmation by antibody neutralization. We observed that with the Immulite 2000 HBsAg assay [Diagnostics Product Corporation (DPC)] a relatively high percentage of weakly reactive (WR) samples did not pass the neutralization step.


METHODS
For each of 3 lots of Immulite 2000 HBsAg reagent (DPC), we collected and analyzed HBsAg data from approximately 3000 to 4000 patient blood samples and compared these data with HBsAg data from 3393 samples tested with the Abbott Auszyme assay. For 127 samples with initially WR detection signals (relative signal/cutoff index of 1.00-2.5) on the Immulite 2000 HBsAg assay, we then measured hepatitis B (HB) viral load and/or other HB serologic markers.


RESULTS
The Immulite 2000 HBsAg assay produced more initially reactive results than the Abbott Auszyme method. Many of these reactive samples, however, were WR and did not meet the confirmation criteria in the neutralization test. Moreover, DNA PCR testing indicated that 22 of the 38 WR samples (58%) that did meet the confirmation criteria had no detectable HB viral DNA.


CONCLUSIONS
Immulite 2000 HBsAg assay results include a unique group of WR samples that are associated with both false-positive and false-negative results, regardless of neutralization status, and require careful interpretation. WR HBsAg samples should be reported as confirmed HBsAg reactive only if the samples not only meet the neutralization criteria but also are positive for other HB serologic markers such as anti-HB core total and anti-HB core IgM.
Chen
Dan
D
Department of Pathology, New York University, School of Medicine, Clinical Chemistry Laboratory of Bellevue Hospital, New York, NY 10016, USA. chend09@med.nyu.edu
Kaplan
Lawrence A
LA
D015415:Biomarkers / Q000097:blood; D019963:Clinical Chemistry Tests; D004279:DNA, Viral / Q000032:analysis; D005188:False Negative Reactions; D005189:False Positive Reactions; D006509:Hepatitis B / Q000175:diagnosis* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000235:genetics; D006801:Humans; D007118:Immunoassay; D008163:Luminescent Measurements; D009500:Neutralization Tests; D019562:Viral Load
D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens