Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations

Abstract

BACKGROUND To achieve the elimination of hepatitis B and C, there is an urgent need to develop alternative strategies to increase the access of diagnosis, particularly among key populations such as people living with human immunodeficiency virus (HIV), individuals with coagulopathies and chronic kidney disease (CKD) patients. AIM To evaluate the use of dried blood spot (DBS) in the detection of hepatitis B virus (HBV) and hepatitis C virus (HCV) markers. METHODS A total of 430 individuals comprised of people living with HIV, coagulopathies and CKD provided paired serum and DBS samples. HBsAg, anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence. Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity. RESULTS Using DBS, HBsAg prevalence varied from 3.9% to 22.1%, anti-HBc rates varied from 25.5% to 45.6% and anti-HCV positivity ranged from 15.9% to 41.2% in key populations. Specificities of HBV and HCV tests using DBS varied from 88.9% to 100%. The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100% in people living with HIV. Accuracy of HBV and HCV detection in DBS varied from 90.2% to 100%. In the CKD group, HBsAg positivity was associated with infrequent use of condoms, and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes. Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens. In people living with HIV, only the male gender was associated with anti-HBc positivity in serum and DBS. CONCLUSION DBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment.

The role of dried blood spot tests in the detection of hepatitis B infection: A systematic review

“…A recent study performed by Bunthen et al 11 in Cambodia showed a high diagnostic accuracy of DBS for hepatitis B markers in pregnant women and their babies. This was consistent with other studies that performed large‐scale screenings using DBS samples to detect other serological markers (HBsAg and anti‐HBc) from newborns, 12 illegal miners 13 and at‐risk populations 14 . However, no systematic review exists to synthesize the available literature on this topic.…”

“…Some studies solely examined newborns, infants, or children ( n = 5) without including their mothers, 12,73–76 while others focused on pregnant women ( n = 3) 77–79 . Three studies ( n = 3) were conducted on adults, 54,75,80 and two studies ( n = 2) each targeted students in high school or university, 78,81 as well as populations with complications such as coagulopathies, chronic kidney disease and syphilis 14,40 . Notably, one study ( n = 1) investigated individuals occupationally exposed to BBVs, specifically hairdressers 82 .…”

“…[77][78][79] Three studies (n = 3) were conducted on adults, 54,75,80 and two studies (n = 2) each targeted students in high school or university, 78,81 as well as populations with complications such as coagulopathies, chronic kidney disease and syphilis. 14,40 Notably, one study (n = 1) investigated individuals occupationally exposed to BBVs, specifically hairdressers. 82 It is important to mention that six studies did not specify the population from which the samples were taken.…”

“…This was consistent with other studies that performed large-scale screenings using DBS samples to detect other serological markers (HBsAg and anti-HBc) from newborns, 12 illegal miners 13 and at-risk populations. 14 However, no systematic review exists to synthesize the available literature on this topic. Hence, this systematic review evaluated the use of dried blood spot tests in detecting Hepatitis B infections.…”

Dried blood spot is the feasible matrix for detection of some but not all hepatitis B virus markers of infection

“…The potential use of DBS, as an alternative sample material, for the detection of HBV markers of infection has been explored [ 6 – 10 ]. The aim of this study was to further evaluate the feasibility of using DBS for detection of HBsAg, total anti-HBc, HBeAg, and HBV DNA.…”