Evaluation of point-of-care testing (POCT) for blood-borne infections in forensic autopsy specimens

ABSTRACT Lateral flow immunoassay (LFIA)-based point-of-care testing (POCT) for viral antigen and antibody detection enables rapid screening for blood-borne viral infections and may be particularly valuable in forensic autopsy settings, where incomplete antemortem medical histories and invasive procedures increase the risk of occupational exposure. However, its performance in postmortem specimens remains unclear. We evaluated the applicability of LFIA-based POCT for detecting human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) in autopsy specimens, focusing on postmortem decomposition and the use of solid organ tissues as alternatives to blood. A total of 309 cases were analyzed using LFIA and quantitative polymerase chain reaction (qPCR) across blood, liver, and spleen specimens. Agreement was assessed using overall, positive, and negative percent agreement and Cohen’s kappa coefficient ( κ ). Positivity rates were compared by specimen type and decomposition status. LFIA agreement with qPCR varied by marker and specimen type, with substantial agreement for HIV and HCV antibody detection in blood and lower agreement in liver and spleen. Fresh specimens generally demonstrated higher LFIA positivity rates than decomposed specimens. Among specimens meeting predefined qPCR positivity criteria, LFIA-positive specimens tended to exhibit higher viral loads than LFIA-negative specimens, reaching statistical significance for HBV in liver, with similar but non-significant trends for blood HBV and liver HCV. LFIA-based POCT may serve as a preliminary screening tool in postmortem settings, particularly when blood is available. Nevertheless, negative results do not exclude infection—especially with low viral loads or advanced decomposition—and should be confirmed by molecular testing. IMPORTANCE Forensic personnel performing autopsies face significant occupational risks from exposure to blood-borne viruses, including human immunodeficiency virus, hepatitis B virus, and hepatitis C virus. Unlike clinical settings, forensic autopsies frequently involve bodies with unknown infection histories, making rapid infection screening essential for personnel safety. Lateral flow immunoassay (LFIA)-based point-of-care testing (POCT) for viral antigen and antibody detection offers a rapid, infrastructure-free screening option; however, its performance in postmortem specimens has not been systematically evaluated. This study suggests that rapid immunochromatographic POCT may serve as a preliminary screening tool in forensic autopsy settings, particularly when blood specimens are available. However, a negative result does not exclude infection, especially in cases with low viral load or advanced decomposition, and confirmatory molecular testing remains necessary. These findings provide practical guidance for forensic professionals on appropriate specimen selection and interpretation of LFIA results, ultimately supporting safer autopsy practices.