Will genome detection replace serology in blood screening for microbial agents?

The residual risk of transfusion-transmitted viral infection in developed c ountries is considered minimal or negligible. However, zero risk remains a strong political objective. Genomic screening for HCV, HIV and HBV represen ts a major advance, eliminating infectious blood donations collected during the pre-seroconversion window period, rare cases of immunosilent infection s and, possibly, a large spectrum of viral variants. In Western countries, HCV RNA genomic screening started on pools of 16-400 plasma samples from in dividual donations. Pooling may produce false-positive and false-negative r esults. Individual donation testing is more suitable to blood screening but requires multiplexing, automation, and affordable cost. Because donations from individuals who are HBV DNA-negative/serologically positive, or those apparently recovered from HCV infection, may remain infectious, it is unlik ely that HBsAg, anti-HCV, and anti-HIV will be discontinued when genomic sc reening is extended to all three viruses. HIV-I p24 antigen may prove redun dant with HIV RNA screening. Anti-HTLV-l and HTLV-II will remain more effec tive than genomic testing.