How sensitive are the commercial assays for anti- HTLV III/LAV?

The sensitivity of nine commercial assays, Western blot, and a newly developed monoclonal antibody-based assay for antibody to human T lymphotropic virus type III/lymphadenopathy associated virus (anti-HTLV III/LAV) were evaluated using a panel of mainly weak-positive sera. In tests on 20 sera three commercial assays and a monoclonal-based assay, representing two different solid-phase methodologies, were found to be more sensitive than Western blot. Our findings suggest that Western blot cannot be depended upon as the sole confirmatory test for anti-HTLV III/LAV. The continued use of the more sensitive enzyme-linked immunosorbent assays (ELISAs), particularly those of dissimilar methodology, would be a more valid approach to confirmatory testing.     

Radioimmunoassay and enzyme-linked immunoassay of antibodies to the core protein (P24) of human T-lymphotropic virus (HTLV III)

Human T-cell lymphotropic viruses designated HTLV III or LAV are considered to represent the causative agent(s) of the acquired immunodeficiency syndrome (AIDS). Individuals who have been infected with these viruses may generally be identified on the basis of a positive serological test for antibodies against the protein components of these viruses. Purified viruses or viral proteins have been utilized for developing such tests. Since AIDS may be transmitted by blood transfusion and by blood products, screening of donors for antibodies to HTLV III/LAV has become a necessity. Such screening may be facilitated by the application of assays based on the use of crude virus-infected tissue culture media avoiding elaborate, expensive and potentially hazardous virus purification steps. Serum specimens were mixed with an appropriate dilution of an HTLV III-infected tissue culture-derived fraction, obtained by precipitation with polyethylene glycol 6000 and treatment with Tween 80 and tri-n-butylphosphate (to disrupt virus particles), and incubated with polystyrene beads coated with antibodies to HTLV III/LAV (anti-HTLV III). Subsequently, washed beads were incubated with either 125I- or beta-lactamase-labeled anti-HTLV III. The radioactivity or enzymatic activity associated with the beads was proportionate to the quantity of HTLV III antigen originally added to the beads. The presence of anti-HTLV III in serum specimens resulted in decreased antigen binding and thus in decreased radioactivity or diminished beta-lactamase activity associated with the beads. The test was specific for antibodies to the approximately equal to 24 kDa core protein of HTLV III. The prevalence of these antibodies (given in parentheses) in distinct populations was as follows: random blood donors (0.33%); hemophiliacs (36.4%); random homosexual males (25.1%); homosexual males preselected on the basis of positive markers for infection with hepatitis B virus (50%); and those with persistent lymphadenopathy (70%).     

Evaluation of a new assay for antibodies to LAV/HTLV III

The sensitivity, specificity and reproducibility of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to LAV/HTLV III produced by Genetic Systems was assessed with the identical panel of sera used in previous evaluations of anti-HTLV III ELISAs. The results from this study show that the Genetic Systems anti-LAV/HTLV III ELISA proved to be of equivalent sensitivity and to have higher specificity than assays currently used in Australia for screening purposes while maintaining high levels of intra- and inter-laboratory reproducibility.     

Detection of antiphospholipid antibodies by automated chemiluminescence assay

The laboratory diagnosis of antiphospholipid antibody syndrome (APS) requires the demonstration of antiphospholipid antibodies (aPL) by lupus anticoagulant (LAC) measured through coagulation assays, anticardiolipin IgG or IgM antibodies (aCL) and/or anti-β2-glycoprotein I IgG or IgM antibodies (anti-β2-GPI), usually detected by ELISA. In this study we tested aCL by a new automated system using the chemiluminescence principle. Our results showed that, while almost all the sera from APS patients, positive for IgG aCL and anti-β2-GPI by ELISA, were also positive for IgG aCl by chemiluminescence, only 30.13% of patients without clinical manifestations of APS, but positive for aCL and persistently negative for anti-β2-GPI (by ELISA) and LA, confirmed the positive test by chemiluminescence. This difference was highly significant (p<0.0001). Interestingly, this test also prompted to identify 20% of patients positive for LA, but persistently negative for both aCL and anti-β2-GPI IgG (ELISA). Thus, the new technology of automated chemiluminescence assay for measuring aPL may represent an useful tool to identify "true" APS patients.     

Comparison of the western blot assay with the neutralizing-antibody and enzyme-linked immunosorbent assays for measuring antibody to verocytotoxin 1.

A Western blot (immunoblot) assay (WBA) was developed to detect immunoglobulin G (IgG) antibodies against Escherichia coli Verocytotoxin 1 (VT1) by using a chemiluminescence detection system. The assay was compared with a VT1-neutralizing-antibody (VT1-NAb) assay and an anti-VT1 IgG enzyme-linked immunosorbent assay (ELISA). When four human serum samples that were known to be positive by VT1-NAb assay and ELISA were titrated to the endpoint by the three assays, the WBA gave endpoint titers that were up to 8-fold higher than those by ELISA and up to 256-fold higher than those by the VT1-NAb assay. Of 32 serum samples that were known to be positive by VT1-NAb assay and ELISA, 31 (97%) were positive by WBA; the one sample with a discrepant result gave borderline results by the VT1-NAb assay and ELISA. Of 52 serum samples that were known to be negative by the VT1-NAb assay and ELISA, 50 (96%) were negative and 2 (4%) were positive by WBA. Of 44 serum samples that gave discrepant results by the VT1-NAb assay and ELISA, neither of the latter correlated with the results of WBA. In an investigation of 19 pairs of acute- and convalescent-phase serum samples from patients with hemolytic-uremic syndrome, 10 pairs that were positive by the VT1-NAb assay were also WBA positive, while 9 pairs that were NAb negative were also WBA negative. The WBA is inherently more specific and sensitive than either the NAb assay or the ELISA and may be used as a "gold standard" to detect IgG antibodies to VT1. Like the NAb assay and the ELISA for detecting antibodies to VT1, the WBA has little to offer in the diagnostic setting but is expected to play an important role in seroepidemiological studies.     

Enzyme-linked immunosorbent assay detection of immunoglobulins G and M to Venezuelan equine encephalomyelitis virus in vaccinated and naturally infected humans.

Enzyme-linked immunosorbent assays (ELISAs) were developed for detection of immunoglobulin G (IgG) and IgM antibodies to Venezuelan equine encephalomyelitis (VEE) virus in vaccinated and naturally infected humans. A total of 441 sera found negative for VEE antibodies by plaque reduction neutralization were examined by IgG ELISA and gave a 1.0% false-positive rate; no false-positives were found in the IgM ELISA. Sera with neutralizing antibody to western or eastern equine encephalomyelitis virus did not react with VEE antigen in the IgG ELISA. Sensitivity of the IgG ELISA was determined by testing 100 coded pre- and postvaccination human sera. Sixty-two were positive by ELISA; 58 of these 62 were also positive by neutralization tests, and 38 were negative by both tests. No neutralization-positive, ELISA-negative sera were found. Comparison of titers obtained by ELISA and neutralization tests indicated that 88% varied randomly by a fourfold dilution factor or less, while 61% were identical or varied only twofold. In sera obtained sequentially from 10 vaccinees and 5 naturally infected patients, both IgG and IgM antibodies appeared between 2 and 3 weeks after vaccination or onset of symptoms. The IgG and IgM antibody ELISAs described are rapid, specific, and sensitive indicators of VEE antibody status in vaccinated and naturally infected individuals.     

The accuracy of an alternative confirmatory strategy for detection of antibodies to HIV-1: experience from a regional laboratory in Kagera, Tanzania.

BACKGROUND: Constant improvement of HIV tests often results in withdrawal of poorer quality tests by the manufacturing companies. It is thus often necessary to evaluate new HIV testing kits and modify the existing testing strategies. OBJECTIVES: To evaluate an alternative HIV antibody testing strategy which involves consecutive testing of sera by two enzyme-linked immunosorbent assays (ELISA), which both are recombinant antigen-based but utilise different test principles, followed by re-testing of sera giving discordant results. STUDY DESIGN: Sera (n = 1558) from a cross-sectional study of the HIV-1 seroprevalence in the Kagera region of Tanzania were tested using two ELISAs in parallel: Enzygnost anti-HIV-1/2 plus and Wellcozyme HIV-1 recombinant. Western blot analysis was done on all concordantly reactive and repeatedly discordant reactive samples as well as on 10% of concordantly ELISA negative sera. RESULTS: Two hundred and four sera (13.1%) were confirmed HIV-1-antibody positive. Both ELISAs had a sensitivity of 100%. The specificities of the ELISAs at initial and repeated testing were 99.8 and 99.9%, respectively, for Enzygnost and 97.7 and 99.5%, respectively, for Wellcozyme. None of the sera was concordantly false positive in both ELISAs. The mean ratio of the optical density of a sample to the cut off value of the test run (OD/CO ratio) was lower for samples giving false positive reactions than for confirmed HIV-1-antibody-positive samples. It is therefore important to interpret with caution HIV antibody ELISA test results on samples giving low OD/CO ratios. None of 10% of randomly selected concordantly ELISA negative sera gave a positive Western blot reaction. CONCLUSIONS: This field evaluation of an HIV antibody testing strategy involving the use of a recombinant antigen-based sandwich ELISA (Enzygnost) followed by a recombinant antigen-based competitive ELISA (Wellcozyme) showed that it had a sensitivity and specificity of 100%.     

化学发光法测抗SS-A抗体、抗SS-B抗体的应用评价

目的 评价化学发光法(CLIA)检测抗SS-A抗体IgG和抗SS-B抗体IgG的临床应用价值.方法 收集276例自身免疫性疾病患者血清,采用双盲法分别用线性免疫印迹法(LIA)和CLIA法进行测试抗SS-A抗体IgG和抗SS-B抗体IgG,以LIA法为参照,计算CLIA的阴阳性符合率.两种方法阴阳性不符的样本用酶联免疫吸附法(ELISA)复测.并收集202例系统系红斑狼疮患者和140例干燥综合征患者血清用CLIA法进行测试,统计疾病阳性检出率.结果 以LIA法为参照,抗SS-A抗体IgG CLIA法阳性符合率为98.4％,阴性符合率为97.3％,Kappa为0.956,两种方法一致性较好.两种方法不一致的6例样本用ELISA确认均与CLIA结果一致;抗SS-B抗体IgG CLIA阳性符合率为95.7％,阴性符合率为98.1％,Kappa为0.933,两种方法一致性较好.两种方法不一致的7例样本用ELISA确认4例与CLIA结果一致.202例系统性红斑狼疮血清样本,用CLIA法测抗SS-A抗体IgG阳性检出率为58.9％,抗SS-B抗体IgG阳性检出率为17.3％.140例干燥综合征血清样本,用CLIA法测抗SS-A抗体IgG阳性检出率为88.6％,抗SS-B抗体IgG阳性检出率为85.7％,均与文献报道一致.结论 CLIA法和LIA法,ELISA法具有较好的一致性和符合率,并且疾病的阳性检出率符合要求.与其他两种方法相比,CLIA实现了真正的定量,真正的全自动,且随机上样、灵活组合,更加满足临床应用的要求.     

Clinical evaluation of Abbott and Wellcome enzyme linked immunosorbent assays for detection of serum antibodies to human immunodeficiency virus (HIV).

Abbott and Wellcome enzyme linked immunosorbent assays (ELISAs) for detection of antibodies to human immunodeficiency virus (HIV) were compared in tests on 932 sera collected predominantly from male homosexuals attending a sexually transmitted disease (STD) clinic in central London. Two hundred and twenty three sera had HIV antibodies detected by both types of assay, with confirmation of the results by further tests carried out at the Virus Reference Laboratory (VRL) in Colindale. There was a 97.3% correlation between the results obtained by the two commercial ELISA assays on the tests carried out on unheated sera. The Abbott ELISA gave significantly more false positive results than the Wellcome test when the manufacturer's instructions for cut off values were followed. There was one false negative Abbott results: it failed to react to repeated Abbott ELISA but was positive by Wellcome and confirmatory assays. Of 283 heat treated sera 14.8% gave falsely reactive results with the Abbott assay whereas there were no differences between heated and unheated sera with the Wellcome assay. VRL or Western blot confirmatory assays, or both, confirmed all the 235 positive results obtained with the Wellcome assay.     

Seroimmunology of AIDS retrovirus infection. I. Use of immunofluorescence assay to confirm sera with ELISA reactivity

One thousand sera shown to be reactive by one of two commercial enzyme linked immunosorbent assays (ELISA) for antibodies to the AIDS virus were referred to the NSW State Reference Laboratory for confirmatory assays. Each serum was retested by two commercial ELISA systems (Abbott and ENI), the ENI exclusionary H9 ELISA and an immunofluorescence assay. Three hundred and twenty four sera were reactive by all 3 tests whereas 244 demonstrated concordant non-reactivity. Three hundred and seventy seven sera were reactive by Abbott EIA only and could not be confirmed positive by the ENI ELISA incorporating exclusionary testing, immunofluorescence or Western immunoblot of representative sera. Sera obtained from teaching hospital laboratories were more likely to be positive and less likely to be negative by all 3 tests, and were also less likely to be Abbott EIA reactive only compared with sera obtained from the blood transfusion service. Of the remaining 55 sera, 52 demonstrated a negative immunofluorescent reaction or a pattern of equal fluorescence on AIDS virus infected and control cells. Representative sera were shown to be negative on Western immunoblot analysis. Of the 3 sera which demonstrated immunofluorescence reactivity, one was positive and one was negative by Western immunoblot, and one could not be determined. We conclude that a combination of two ELISAs, one with an exclusionary ELISA test and an immunofluorescence assay is a reliable and simple means of confirming reactive sera for AIDS virus antibodies.     

Use of recombinant human parvovirus B19 antigens in serological assays.

AIMS--To compare the sensitivity, specificity, and practicality of recombinant proteins in serological tests for the detection of human parvovirus B19 IgG and IgM. METHODS--Indirect enzyme linked immunosorbent assays using B19 structural proteins expressed in Escherichia coli were developed for the detection of B19 specific IgG and IgM (rELISA-G and rELISA-M). Cells infected with baculovirus expressing B19 structural proteins were also used in an indirect immunofluorescence assay for IgG and IgM antibodies (IFA-G and IFA-M). Antibody capture radioimmunoassays for IgG and IgM (GACRIA and MACRIA) were used as comparative assays. RESULTS--Twenty nine pools of intravenous immunoglobulin were clearly positive for B19 IgG by rELISA-G and contained low IgG titres by GACRIA. From 113 samples tested by all methods, sensitivities of 92% (77/84) and 97% (68/70) were obtained for ELISA and immunofluorescence, respectively, when compared with GACRIA. One hundred and sixteen samples from patients presenting with rash or arthralgia were compared by MACRIA, rELISA-M, and IFA-M. Sensitivities of both recombinant tests were more than 95%. Despite pretreatment to remove IgG or rheumatoid factor, false positive results were a problem in the rELISA-M but were not seen with the IFA-M. CONCLUSIONS--The limited supply of native antigen has severely restricted the wide application of serology for parvovirus B19. The use of recombinant antigens permitted the introduction of local screening tests which had many advantages, including quicker results and relief of the burden on the Reference Laboratory. The use of rELISA-M for sensitivity and IFA-M for specificity and confirmation proved a useful and practical combination for diagnosis of recent infection with B19, and rELISA-G allowed the immune response to be determined in selected populations.     

IgG1, IgG4, and IgE antibody responses in human strongyloidiasis by ELISA using <Emphasis Type="Italic">Strongyloides ratti</Emphasis> saline extract as heterologous antigen

The aim of this study was to evaluate total IgG, IgG1, IgG4, and IgE antibody responses in human strongyloidiasis by enzyme-linked immunosorbent assay (ELISA) using Strongyloides ratti saline extract as heterologous antigen for a possible clinical utility of the assay. A total of 40 serum samples of patients who were shedding Strongyloides stercoralis larvae in feces (group I), 30 sera from patients with other intestinal parasites (group II), and 30 sera from subjects with negative results in three parasitological assays (group III) were analyzed to detect total IgG, IgG1, IgG4, and IgE to Strongyloides spp. by ELISA and expressed in ELISA index. Levels of total IgG anti-Strongyloides spp. were significantly higher in patients of group I than in groups II (p=0.0005) and III (p<0.0001). Levels of specific IgG1, IgG4, and IgE of group I were also significantly higher than in groups II and III, respectively. There was a significant positive correlation between specific IgE and IgG4 (r=0.6524; p=0.0084) and IgG1 and IgG4 (r=0.5398; p=0.0171). It can be concluded that the detection of specific IgE, IgG1, and IgG4 subclasses rather than total IgG antibodies to Strongyloides spp. using the S. ratti antigen showed to be an additional tool for improving the serodiagnosis of human strongyloidiasis.     

Evaluation of an alternative confirmatory strategy for the diagnosis of HIV infection in Dar Es Salaam, Tanzania, based on simple rapid assays

Alternative confirmatory strategies for detection of antibodies to HIV using enzyme-linked immunosorbent assays (ELISAs) have been shown to be useful in laboratories with limited resources. Three simple and rapid HIV antibody detection assays (Capillus, Serocard and Determine) were evaluated using 1412 fresh serum samples in order to formulate an alternative confirmatory strategy for the diagnosis of HIV infection. All sera were also tested by an anti-HIV ELISA and all sera reactive by any of the assays were tested by a second ELISA as well as by Western blot. Three hundred and eighty-three sera were found to be HIV-1 antibody positive, while 1017 sera were HIV antibody negative; 12 sera which were reactive by one or more of the simple assays had indeterminate Western blot results and these were considered HIV seronegative during the analysis. All assays had a sensitivity of 100%. The initial specificity of the assays were 98.7, 98.2 and 97.9% for Capillus, Serocard and Determine, respectively. In an alternative confirmatory strategy the use of Capillus followed by Serocard or Determine gave a specificity of 99.9 and 99.8%, respectively. Serocard followed by Determine gave a specificity of 99.3%. A testing strategy with 100% specificity (95% CI; 99.6–100%) could be achieved by the sequential use of all three simple/rapid assays or by repeat testing by Capillus followed by Serocard.     

Measurement of IgG blocking antibody in human serum: comparison of ELISA with monoclonal antibody and fluorogenic substrate and Staphylococcus protein A solid-phase RIA

We compared ELISA with mouse monoclonal antihuman gamma-chain antibody and a fluorogenic substrate with the Staphylococcus protein A solid-phase radioimmunoassay (SPRIA) in the measurement of specific IgG antibody to short ragweed pollen. Sera from 51 ragweed-allergic patients undergoing allergen immunotherapy were evaluated for ragweed-specific IgG antibodies with the same ragweed extract in the two assay systems. With optimal conditions, the ELISA and SPRIA displayed comparable positive thresholds (approximately 1 ng/ml of ragweed-specific IgG). Both assays also demonstrated consistently parallel dilution curves with 51 sera (mean interdilutional coefficient of variation [CV] less than 8.8% for ELISA and less than 8.6% for SPRIA). Reproducibility was determined by constructing precision profiles for intra- and interassay variations over the working ranges of each assay (ELISA, 0.8 to 100 ng/ml; SPRIA, 1 to 250 ng/ml). ELISA intra-assay CVs ranged from 13% near threshold to less than 5% at higher antibody concentrations; SPRIA intra-assay CVs ranged from 4.3% to 2.8%. Interassay reproducibility was somewhat better for SPRIA (4.6% to 9.6%) than for ELISA (10% to 18%). In direct comparison, 41 (80%) of the 51 sera were concordant in the two assays (r = 0.91; p less than 0.001). Although each assay result was reproducible, 10 (20%) of the sera elicited consistently discrepant results in the two assays. In eight of the 10 discordant sera, the SPRIA results were higher than ELISA, suggesting the possibility that some ragweed allergen may be better represented on the short ragweed-pollen extract agarose than on ELISA plate wells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hepatitis C virus antibody prevalence among human immunodeficiency virus-1-infected individuals: Analysis with different test systems

Sera of 383 human immunodeficiency virus (HIV)-l-infected individuals from Frankfurt (Main)/Germany were assayed by two hepatitis C virus (HCV) screening tests (Abbott second generation, Ortho second generation). This population showed a prevalence for reactivity with both tests of 20.8% (80/383). Examination of all reactive sera (91/383) by a supplemental assay (Chiron RIBA 2) gave for 46 sera a positive, for 33 sera an indeterminate, and for 12 sera a negative result. Further analysis focussed on these RIBA 2-indeterminate and -negative samples. Analysis of the sera using an in-house Western blot with three different Escherichia coli-expressed HCV proteins revealed that none of the RIBA 2-nega-tive, but 24 of the 33 RIBA 2-indeterminate sera, including 3 of 4 c33c (NSS)-reactive samples, were reactive with a recombinant core protein. Twenty-one of 22 c22-3 (core) indeterminates stained the core antigen in the in-house Western blot and 3 of them in addition a NS5 moiety. HCV-polymerase chain reaction (PCR) was positive for 14 of the 24 RIBA 2 -indeterminate sera, but for none of the RIBA 2-negative or Western blot nonreactive samples. Discrepant results between the two screening tests could not be explained by differences in the antigen compositions (i.e., a NS3-NS4 moiety of 111 amino acids present in the Ortho enzyme-linked immunosor-bent assay (ELISA), not present in the Abbott or RIBA 2 assays). © 1994 Wiley-Liss, Inc.     

Evaluation of commercial enzyme immunoassays for detection of hepatitis delta antigen and anti-hepatitis delta virus (HDV) and immunoglobulin M anti-HDV antibodies.

Panels of hepatitis B virus surface antigen-positive sera from drug abusers were used to evaluate 14 commercial enzyme immunoassays from six companies for detecting hepatitis delta virus (HDV) markers. For detecting hepatitis delta virus antigen (HDAg), the Wellcome, Pasteur and Noctech assays had 100% sensitivity for all 42 HDAg-positive serum specimens that were confirmed in-house; the Organon reagents gave 59.5% sensitivity without detergent and 64.3% sensitivity with detergent, but there were 14 discrepant results with and without detergent. The Sorin assay detected HDAg in only 10 of the positive samples (23.8% sensitivity). For the detection of antibody to HDV (anti-HDV) all six commercial enzyme immunoassays were reactive with all 36 anti-HDV-positive specimens that were confirmed in-house. There were no false-positive results with the Wellcome, Noctech, or Sorin assay, but one specimen was false positive by the Organon assay. One HDAg-positive specimen gave a false anti-HDV-positive result in the Abbott assay and an equivocal result in the Pasteur assay (97.8% specificity). For the detection of immunoglobulin M anti-HDV, the Wellcome, Noctech, and Sorin assays agreed for the 38 positives confirmed in-house, except for one false negative with the Sorin test. We conclude that there has been a substantial improvement over previously evaluated assays in sensitivity and specificity of commercial assays for anti-HDV detection, and the sensitivities of immunoglobulin M anti-HDV assays are also comparable. However, there are still major differences in sensitivity among some assays for HDAg detection.     

Enzyme-linked immunosorbent assay for mumps IgM antibody: comparison of IgM capture and indirect IgM assay

We have established two enzyme-linked immunosorbent assays (ELISAs) for detection of mumps IgM antibody, i.e., indirect IgM ELISA and IgM capture ELISA, for serodiagnosis of recent mumps infection. In the latter method, peroxidase-conjugated monoclonal antibody to mumps virus was employed. Both methods detected mumps antibody of IgM class only in serum fractions separated by centrifugation through a sucrose density gradient. Optical density values given by both ELISAs were correlated for most sera examined. Indirect IgM ELISA, however, gave a false positive reaction for sera containing both rheumatoid factor and mumps IgG antibody, while giving a false negative reaction for sera containing high titers of mumps IgG antibody. This technique was, therefore, less reliable than IgM capture ELISA. IgM antibody detectable by IgM capture ELISA was present in all patients with mumps by the fifth day of illness and persisted for up to 3 mth in most and up to 5 mth in same cases.     

Evaluation of the clinical performance of the Beckman Coulter Access AbHBsII immunoassay for the detection of hepatitis B surface antibodies.

BACKGROUND: Hepatitis B virus (HBV) surface antibodies (anti-HBs) testing is useful in various clinical circumstances, including identification of HBV susceptible individuals in pre- and post-vaccination programs. OBJECTIVES: To assess the clinical performance of Beckman Coulter's anti-HBs chemiluminescence immunoassay (Access AbHBsII). STUDY DESIGN: Laboratory performances were evaluated on 1207 routine samples pre-screened with Abbott Axsym anti-HBs assay and divided into three different panels: vaccinated subjects (n=232), subjects with resolved HBV infection (n=150) and negative subjects for anti-HBs (n=825). Sera with discrepant results were resolved by an alternative method and further chart review. RESULTS: The overall concordance between Access and Axsym assays was 95.8%. The relative sensitivity, relative specificity, positive predictive value and negative predictive value were 97.8%, 98.1%, 96%, and 99%, respectively. Of the 51 discrepant results, eight were false negative by Access, fifteen were false positive by Access, including sera from seven pregnant women, two patients with acute leukemia, and four with inflammatory syndromes. CONCLUSIONS: The Beckman Coulter's Access AbHBsII assay displays satisfactory relative sensitivity and specificity performances. The assay has good precision and reliability and is technically simple and fast.     

Enzyme immunoassay for anti-hepatitis B core (HBc) immunoglobulin G1 and significance of low-level results in competitive assays for anti-HBc

An enzyme immunoassay (EIA) for anti-hepatitis B core (HBc) immunoglobulin G1 (IgG1) was compared with a commercial radioimmunoassay (RIA) for anti-HBc antibody (Corab: Abbott Laboratories, North Chicago, Ill.). In parallel tests of 445 consecutive samples, discrepant results were obtained with 2 samples, 1 of which was positive only by the RIA and the other of which was positive only by the EIA for anti-HBc IgG1. In tests of another 192 samples with low blocking activity in the RIA (inhibition range, 90 to 30%), 10 samples gave discrepant results, 5 of which were positive only by the RIA and the other 5 of which were positive only by the EIA for anti-HBc IgG1. Of 12 samples with discrepant results, 11 samples were tested further for anti-HBc IgG3, IgM, and IgA1 by the EIA. Of these, seven samples were positive for anti-HBc IgG1, anti-HBc IgG3, or both. All seven samples were also positive for anti-hepatitis B surface (HBs) antigen. Three samples were negative for anti-HBc IgG1, anti-HBc IgG3, or both but were positive for anti-HBc IgM, anti-HBc IgA1, or both; and one sample was reactive only in the RIA. These four samples were all negative for anti-HBs. Thus, low-level results in the RIA caused by anti-HBc IgM, anti-HBc IgA, or both reflect the unspecific activation of immature B lymphocytes that is not related to previous exposure to hepatitis B virus (HBV). In contrast, the presence of anti-HBc IgG1, anti-HBc IgG3, or both indicates differentiated anti-HBc IgG-producing plasma cells and previous exposure to HBV, as was also shown by the presence of anti-HBs. On class and subclass determination for confirmation of positivity for anti-HBc in 19 serum samples, which was identified by screening of blood from 1,343 donors by a competitive EIA (Hepanostika; Organon), 9 samples with positive results, all low level, did not indicate previous exposure to HBV. It was concluded that determination of classes and subclasses of anti-HBc provides a tool for discriminating positive anti-HBc results not caused by HBV exposure.