Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7604
Peer-review started: May 5, 2016
First decision: May 30, 2016
Revised: June 27, 2016
Accepted: July 31, 2016
Article in press: July 31, 2016
Published online: September 7, 2016
To detect chronic hepatitis B (CHB), chronic hepatitis C (CHC) and human immunodeficiency virus (HIV) infections in dried blood spot (DBS) and compare these samples to venous blood sampling in real-life.
We included prospective patients with known viral infections from drug treatment centers, a prison and outpatient clinics and included blood donors as negative controls. Five drops of finger capillary blood were spotted on filter paper, and a venous blood sample was obtained. The samples were analyzed for HBsAg, anti-HBc, anti-HBs, anti-HCV, and anti-HIV levels as well as subjected to a combined nucleic acid test (NAT) for HBV DNA, HCV RNA and HIV RNA.
Samples from 404 subjects were screened (85 CHB, 116 CHC, 114 HIV and 99 blood donors). DBS had a sensitivity of > 96% and a specificity of > 98% for the detection of all three infections. NAT testing did not improve sensitivity, but correctly classified 95% of the anti-HCV-positive patients with chronic and past infections. Anti-HBc and anti-HBS showed low sensitivity in DBS (68% and 42%).
DBS sampling, combined with an automated analysis system, is a feasible screening method to diagnose chronic viral hepatitis and HIV infections outside of the health care system.
Core tip: This study shows that it is feasible to combine serology and nucleic acid screening for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections in one dried blood sample (DBS) collected in real life and analyzed using a modern laboratory platform. We observed a sensitivity and specificity of > 96% for HBV, HCV, and HIV and correctly classified 95% of all HCV patients into past vs chronic infections compared to simultaneously collected venous blood samples. The study confirms that DBSs are feasible samples in outreach clinics and confirms the high sensitivity and specificity of previous laboratory-based studies.