Hepatitis B virus infection in low and middle – income Countries: combined serological markers for efficient diagnosis

Abstract

Hepatitis B virus (HBV) infection is a global problem with Asia and sub-Saharan Africa mostly affected. Unfortunately, residual risk of transfusion associated HBV (TAHBV) is greater in low- and middle-income countries where virus prevalence is higher and implementation of Nucleic Acid Testing (NAT) and/or anti-HBc testing remain high-priced due to cost and loss of donors/blood products. There is therefore the need for cheaper and practical alternatives to reducing TAHBV. For this study, blood samples were collected from 273 consenting blood donors, aged 18-60 years. Five HBV serological markers: HBV surface and envelope antigens (HBsAg, HBeAg), and HBV core, surface and envelope antibodies (anti-HBc,anti-HBs, HBeAb) were detected using Enzyme Linked Immunosorbent Assays. A high anti-HBs prevalence of 37.7% was detected among the donors while HBsAg prevalence was 5.1%, a rate lower than 8% value for high endemic regions to which Nigeria is classified. Among the donors HBcIgM prevalence was 4.8% (13/273), with twelve donors (4.4%; 12/13) having anti-HBc IgM as the only detectable marker of HBV infection. Anti-HBs presence of 200 mIU/mL or more has been reported safe as a transfusion component in anti-HBc-positive blood. A high anti-HBs observed among blood donors in this study could be explored in routine HBV screening of anti-HBc-positive blood donors. Including anti-HBs screening and anti-HBc IgM found as the only HBV infection marker in 12 (4.4%) donors could reduce TAHBV in Nigeria where HBV NAT screening is not affordable and discarding anti-HBc IgG-positive blood not feasible because blood transfusion is critical to treatment of diverse pathologies.