Individual donation nucleic acid technology testing to minimize human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus transfusion transmitted infections.

Sir,

We read with interest the letter submitted by Mathur et al. in the January-June 2012 issue of the Asian Journal of Transfusion Science.[1] While we agree with our colleagues that the use of nucleic acid technology (NAT) testing, in combination with serology, to detect human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) is the best method for improving blood safety, we disagree with their conclusion that using minipools (MPs) is the best choice for India.

India has reported prevalence of HIV, HCV, and HBV: 0.36%, 0.9%, and 2.5-4.0%, respectively, among the general population and 0.3%, 0.4%, and 1.1%, respectively, among blood donors.[2] In our response to this paper, the deficiencies of MP NAT must be reviewed with specific reference to HBV, the predominant transfusion transmitted infection (TTI) in India. It has been established that Individual donation (ID) NAT provides increased safety by significantly decreasing the window period (WP) of HBV.[3] In areas of high prevalence of disease, MP testing results in a high number of reactive tests that will require additional time and cost for repeat testing of deconvolution of donor pools. MP NAT testing also lengthens the WP, increasing the risk of missed infections in the blood supply.[4]

India with HBV prevalence among the first-time blood donors of ~3% for hepatitis B surface antigen (HBsAg) and 25% for occult hepatitis B infections (OBIs), can learn from the experience of South Africa, a country with a 0.8% donor prevalence of HBV.[56] Four years screening of 2,921,561 blood donations in South Africa identified 336 ID NAT yields that were negative for HBsAg, and determined that 237 (71%) of the yields would have been missed if a MP of 16 had been used. Among first-time donors in the South African study, 30% were acute-phase HBsAg only negative WP infections and the majority 70% were OBIs. This report underlines the importance of detecting OBIs, chronic low viremia HBV infections that are HBsAg negative, especially in high prevalence areas.

Finally, the costs of missed TTIs may be substantial. In India, which requires over 10-12 million transfusions/year, the costs of disease resulting from missed TTIs must be considered as social burden and stigma for patients who acquire a lifelong diagnosis of HIV, HCV or HBV. Although the argument of affordability of ID-NAT has been the premise for promotion of pool testing, the residual risk of TTI place a serious burden on the health-care, finances, society, and human life.