Comprehensive analysis of hepatitis B virus infections in blood donors in southern China that are surface antigen positive but nucleic acid testing negative
Bibliographic record
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is one of the major concerns for the safety of blood transfusion in high‐prevalent countries such as in China. Prior studies outside of China have shown hepatitis B surface antigen (HBsAg) false‐reactive rate of 0.02% to 0.04%. Similarly, false‐negative HBsAg and HBV DNA results may occur in infected donors. Our study analyzed HBsAg enzyme‐linked immunosorbent assay (ELISA)‐reactive but NAT‐negative donations in Shenzhen Blood Center, China. STUDY DESIGN AND METHODS HBsAg ELISA‐positive/NAT‐negative plasma samples identified from screening 101,025 donations during 2017‐2018 were analyzed by molecular and serologic tests including neutralization, chemiluminescence immunoassays, and various HBV DNA amplification assays. Molecular characterizations of HBsAg‐positive/NAT‐negative samples were determined by quantitative polymerase chain reaction (qPCR) and nested PCR amplification of the basic core and precore promotor regions (295 base pairs) and HBsAg (S) region (496 base pairs). RESULTS Screening of 101,025 eligible blood donations identified 157 (0.16%, 95% confidence interval, 0.13%‐0.18%) HBsAg ELISA‐positive/NAT‐negative plasma samples; of those, 71 (45.2%) were HBsAg confirmed positive by further HBsAg testing and DNA positive by molecular tests with increased sensitivity. Of the 71, all but one was antibody to hepatitis B core antigen reactive without antibody to hepatitis B surface antigen, yielding one recent (window‐period) HBV infection. Of the remaining donations, 80 (51%) were not considered as HBV‐infected donors, and 6 (3.8%) were interpreted as indeterminate since HBsAg results were discordant with unconfirmed HBV DNA results. In the 71 confirmed positives, HBsAg levels ranged from 0.05 to 400 IU/mL and HBV DNA from 6 to 2654 IU/mL; however, the correlation between the two was weak (R 2 = 0.24). CONCLUSION Fewer than half of HBsAg ELISA‐positive/NAT‐negative samples were confirmed as HBsAg positive. Our study demonstrates that in highly HBV‐endemic countries, assays with high sensitivity and specificity may be required.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".