Candotti D, Boizeau L, Laperche S
Département d'études des agents transmissibles par le sang, institut national de la transfusion sanguine, centre national de référence risques infectieux transfusionnels, 6, rue Alexandre-Cabanel, 75015 Paris, France.
Département d'études des agents transmissibles par le sang, institut national de la transfusion sanguine, centre national de référence risques infectieux transfusionnels, 6, rue Alexandre-Cabanel, 75015 Paris, France.
Transfus Clin Biol. 2017 Sep;24(3):189-195. doi: 10.1016/j.tracli.2017.06.014. Epub 2017 Jun 30.
Advances in serology and viral nucleic acid testing (NAT) over the last decades significantly reduced the risk of transfusion-transmitted hepatitis B virus (HBV). The combination of HBsAg testing and NAT efficiently prevents the majority of HBV transmission. However, a specific residual risk remains associated with extremely low viral DNA levels in blood donors with occult HBV infection (OBI) that are intermittently or not detectable even by highly sensitive individual donation (ID) NAT. Studies have reported HBV transfusion-transmission with blood components from donors with OBI that contained low amount of viruses (<200 virions). HBV transfusion-transmission seems to depend on a combination of several factors including the volume of plasma associated with the infected blood components transfused, the anti-HBV immune status of both recipient and donor, and possibly the viral fitness of the infecting HBV strain. Models based on clinical and experimental evidences estimate a residual transmission risk of 3-14% associated with OBI donations testing HBsAg and ID-NAT non-reactive. Anti-HBc testing has the potential to improve further blood safety but it may also compromise blood availability in settings with medium/high HBV prevalence. Pathogen reduction procedures might be considered.
在过去几十年中，血清学和病毒核酸检测（NAT）技术的进步显著降低了输血传播乙型肝炎病毒（HBV）的风险。乙肝表面抗原（HBsAg）检测与NAT相结合可有效预防大多数HBV传播。然而，对于隐匿性HBV感染（OBI）的献血者，即使采用高灵敏度的单份献血（ID）NAT检测，其血液中极低水平的病毒DNA仍会间歇性或无法检测到，从而存在特定的残余风险。研究报告称，接受含有少量病毒（<200个病毒颗粒）的OBI献血者的血液成分后会发生HBV输血传播。HBV输血传播似乎取决于多种因素的综合作用，包括与所输注的受感染血液成分相关的血浆量、受血者和献血者的抗HBV免疫状态，以及可能还与感染性HBV毒株的病毒适应性有关。基于临床和实验证据的模型估计，对于HBsAg和ID-NAT检测均呈阴性的OBI献血，其残余传播风险为3%-14%。抗-HBc检测有可能进一步提高血液安全性，但在HBV流行率中/高的地区，这也可能会影响血液供应。可能需要考虑采用病原体灭活程序。
