Improvements in detection of antibody to hepatitis B core antigen by treating specimens with reducing agent in an automated microparticle enzyme immunoassay.

A fully automated microparticle enzyme immunoassay (EIA), IMx Core, was developed for the detection of antibody against hepatitis B core antigen (anti-HBc). IMx Core sensitivity was less than 0.5 Paul Ehrlich Institut units per ml and was greater than that of the commercial radioimmunoassay (RIA) or EIA, Corab and Corzyme, respectively. Specimens from blood donors and diagnostic and hospital patients, which included individuals with a variety of infectious and immune diseases, were tested in parallel by the IMx Core and EIA. Overall agreement of 99.1% (4,797 of 4,841) was obtained. Prevalence of anti-HBc tested by IMx Core ranged from 1.2% in volunteer blood donors to 9.1% in hospital laboratories. Discordant specimens reactive by IMx Core but negative by Corzyme or Corab resulted from the increased sensitivity of the IMx Core assay, since other hepatitis B markers were usually present. However, most discordant specimens were positive by the EIA or RIA but negative by IMx Core. No other hepatitis B markers could be detected in these discordants, and after addition of reducing agent, these specimens also became negative by EIA or RIA. In clinical trials, 30% (14 of 47) of volunteer blood donors and 8% (9 of 119) of hospital patients testing repeatedly reactive by the EIA had reduction-sensitive (unspecific) anti-HBc reactivity. The reducing agent, dithiothreitol, was added to each specimen automatically in the IMx assay to eliminate these unspecific reactions without significantly affecting anti-HBc reactivity resulting from hepatitis B virus infection as judged by the correlation with other hepatitis B markers.