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Abstract Details
Effectiveness of the HCV blood screening strategy through eighteen years of surveillance of HCV infection in blood donors in France
Blood Transfus. 2021 May 12. doi: 10.2450/2021.0032-21. Online ahead of print.
Pierre Cappy1, Laure Boizeau1, Daniel Candotti1, Rémi Caparros1, Quentin Lucas1, Eliane Garrabe2, Christophe Martinaud2, Sophie Le Cam3, Pierre Gallian34, Pascal Morel35, Josiane Pillonel6, Syria Laperche1
Author information
1Institut National de la Transfusion Sanguine (INTS), Département des Agents Transmissibles par le Sang, Centre National de Référence Risques Infectieux Transfusionnels, Paris, France.
2Centre de Transfusion des Armées, Clamart, France.
3Etablissement Français du Sang, La Plaine St-Denis, France.
4Unité des Virus Émergents, (UVE: Aix-Marseille Univ-IRD 190-INSERM 1207-IHU Méditerranée Infection), Marseille, France.
5UMR 1098 RIGHT, Inserm, EFS, Université de Franche-Comté, Besançon, France.
6Santé Publique France, Saint Maurice, France.
Abstract
Background: The question of maintaining blood screening based on both Hepatitis C virus (HCV) infection antibodies (Ab) and Nucleic Acid Testing (NAT) has been raised in several countries. The French blood donor surveillance database was used to address this issue.
Materials and methods: In France, HCV-NAT was implemented in mini pools (MP) in 2001 and in individual testing (ID) in 2010. HCV-positive donations are further investigated including detection of RNA with an alternative polymerase chain reaction assay: Amplicor HCV v2.0 (Roche; LOD95 50 IU/mL) from 2001 to 2006 and CobasTaqMan (CTM) HCV 2.0 assay (Roche; LOD95 9.3 IU/mL) since 2007.
Results: From 2001 to 2018, 3,058/48.8 million donations were confirmed HCV positive: 64.4% were Ab+/NAT+, 35.1% Ab+/NAT- and 0.5% Ab-/NAT+. From 2001 to 2018, the NAT yield decreased from 0.65 per million donations to 0, and NAT+ donations dropped from 77% to 46% of the total of HCV donations. 2,491/3,058 were further tested for HCV-RNA: 1,032 (816 NAT+, 216 NAT-) with Amplicor and 1,459 (897 NAT+, 562 NAT-) with CTM. Four (3 MP and 1 ID-NAT, 0.5%) of the 778 NAT negative donations had low viral loads.
Discussion: The decline in HCV-NAT yield cases raises the question of the relevance of NAT. Conversely, the increase in Ab+/NAT- donors, suggesting a growing number of resolve infections, argue for Ab discontinuation. In our experience, at least 0.5% of Ab+/NAT- donations had low RNA level when retested. Although the risk of viral transmission by such donations is probably low, the uncertainty associated with their infectivity goes against the removal of Ab in blood screening in our country.