Risk of HIV from blood transfusion
- Steven Kleinman, MD
Steven Kleinman, MD
- Section Editor — Transfusion Medicine
- Clinical Professor of Pathology
- University of British Columbia, Vancouver
Since the early 1980s, tremendous progress has been made in understanding, as well as decreasing, the risk of human immunodeficiency virus (HIV) transmission from blood transfusion . The major interventions that are used to minimize this risk include questioning of donors concerning HIV risk behaviors and laboratory testing of each donated unit of blood for antibodies to HIV-1 and HIV-2 and for HIV-1 RNA. In the United States this is done by pooling of 6 to 16 specimens (minipool nucleic acid testing, or MP-NAT), whereas in some other countries this is done as individual donation testing. (See "Blood donor screening: Procedures and processes to enhance safety for the blood recipient and the blood donor" and "Blood donor screening: Medical history" and "Blood donor screening: Laboratory testing".)
The rate of HIV seropositivity in the blood donor population has been shown to be approximately 0.5 per 10,000 donations, a value much lower than the rate of 3.5 per 10,000 donations shortly after the introduction of routine HIV antibody screening . When analyzed in first time blood donors, the rate is 1 per 10,000 to 20,000 donors and has remained stable . Because of careful donor selection criteria, it has been calculated that HIV seroprevalence in blood donors is less than 2 percent of that expected in the adult American population.
Despite these procedures, HIV transmission may still occur for three theoretical reasons:
●Donations may be collected during the window period of infection, defined as the interval of time shortly after HIV infection, when the donor is infectious but has not yet developed positive HIV laboratory tests.
●Infection with variant strains of HIV that may escape detection by current screening assays.
- Kleinman SH, Lelie N, Busch MP. Infectivity of human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus and risk of transmission by transfusion. Transfusion 2009; 49:2454.
- Phelps R, Robbins K, Liberti T, et al. Window-period human immunodeficiency virus transmission to two recipients by an adolescent blood donor. Transfusion 2004; 44:929.
- Zou S, Dorsey KA, Notari EP, et al. Prevalence, incidence, and residual risk of human immunodeficiency virus and hepatitis C virus infections among United States blood donors since the introduction of nucleic acid testing. Transfusion 2010; 50:1495.
- Donegan E, Stuart M, Niland JC, et al. Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations. Ann Intern Med 1990; 113:733.
- Donegan E, Lenes BA, Tomasulo PA, Mosley JW. Transmission of HIV-1 by component type and duration of shelf storage before transfusion. Transfusion 1990; 30:851.
- Kalbfleisch JD, Lawless JF. Estimating the incubation time distribution and expected number of cases of transfusion-associated acquired immune deficiency syndrome. Transfusion 1989; 29:672.
- Operskalski EA, Stram DO, Lee H, et al. Human immunodeficiency virus type 1 infection: relationship of risk group and age to rate of progression to AIDS. Transfusion Safety Study Group. J Infect Dis 1995; 172:648.
- Selik RM, Ward JW, Buehler JW. Trends in transfusion-associated acquired immune deficiency syndrome in the United States, 1982 through 1991. Transfusion 1993; 33:890.
- Ward JW, Holmberg SD, Allen JR, et al. Transmission of human immunodeficiency virus (HIV) by blood transfusions screened as negative for HIV antibody. N Engl J Med 1988; 318:473.
- Nelson KE, Donahue JG, Muñoz A, et al. Transmission of retroviruses from seronegative donors by transfusion during cardiac surgery. A multicenter study of HIV-1 and HTLV-I/II infections. Ann Intern Med 1992; 117:554.
- Cumming PD, Wallace EL, Schorr JB, Dodd RY. Exposure of patients to human immunodeficiency virus through the transfusion of blood components that test antibody-negative. N Engl J Med 1989; 321:941.
- Lackritz EM, Satten GA, Aberle-Grasse J, et al. Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States. N Engl J Med 1995; 333:1721.
- Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 1996; 334:1685.
- Kleinman S, Busch MP, Korelitz JJ, Schreiber GB. The incidence/window period model and its use to assess the risk of transfusion-transmitted human immunodeficiency virus and hepatitis C virus infection. Transfus Med Rev 1997; 11:155.
- Stramer S, Salemi B, Brodsky JP, et al. Comparison of four seroconverting blood donors identified by HIV-1 p24 antigen screening. Transfusion 1998; 38(Suppl):2S.
- Schreiber GB, Glynn SA, Satten GA, et al. HIV seroconverting donors delay their return: screening test implications. Transfusion 2002; 42:414.
- Stramer SL, Caglioti S, Strong DM. NAT of the United States and Canadian blood supply. Transfusion 2000; 40:1165.
- Dodd RY, Notari EP 4th, Stramer SL. Current prevalence and incidence of infectious disease markers and estimated window-period risk in the American Red Cross blood donor population. Transfusion 2002; 42:975.
- Busch MP, Glynn SA, Stramer SL, et al. A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion 2005; 45:254.
- Stramer SL, Glynn SA, Kleinman SH, et al. Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. N Engl J Med 2004; 351:760.
- Marshall DA, Kleinman SH, Wong JB, et al. Cost-effectiveness of nucleic acid test screening of volunteer blood donations for hepatitis B, hepatitis C and human immunodeficiency virus in the United States. Vox Sang 2004; 86:28.
- Delwart EL, Kalmin ND, Jones TS, et al. First report of human immunodeficiency virus transmission via an RNA-screened blood donation. Vox Sang 2004; 86:171.
- Centers for Disease Control and Prevention (CDC). HIV transmission through transfusion --- Missouri and Colorado, 2008. MMWR Morb Mortal Wkly Rep 2010; 59:1335.
- Jackson BR, Busch MP, Stramer SL, AuBuchon JP. The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations. Transfusion 2003; 43:721.
- Shi L, Wang JX, Stevens L, et al. Blood safety and availability: continuing challenges in China's blood banking system. Transfusion 2014; 54:471.
- Glynn SA, Kleinman SH, Wright DJ, et al. International application of the incidence rate/window period model. Transfusion 2002; 42:966.
- Petersen LR, Satten GA, Dodd R, et al. Duration of time from onset of human immunodeficiency virus type 1 infectiousness to development of detectable antibody. The HIV Seroconversion Study Group. Transfusion 1994; 34:283.
- Busch MP, Lee LL, Satten GA, et al. Time course of detection of viral and serologic markers preceding human immunodeficiency virus type 1 seroconversion: implications for screening of blood and tissue donors. Transfusion 1995; 35:91.
- Niu MT, Stein DS, Schnittman SM. Primary human immunodeficiency virus type 1 infection: review of pathogenesis and early treatment intervention in humans and animal retrovirus infections. J Infect Dis 1993; 168:1490.
- Busch MP, Satten GA. Time course of viremia and antibody seroconversion following human immunodeficiency virus exposure. Am J Med 1997; 102:117.
- Korber BT, MacInnes K, Smith RF, Myers G. Mutational trends in V3 loop protein sequences observed in different genetic lineages of human immunodeficiency virus type 1. J Virol 1994; 68:6730.
- Taylor BS, Sobieszczyk ME, McCutchan FE, Hammer SM. The challenge of HIV-1 subtype diversity. N Engl J Med 2008; 358:1590.
- O'Brien TR, George JR, Holmberg SD. Human immunodeficiency virus type 2 infection in the United States. Epidemiology, diagnosis, and public health implications. JAMA 1992; 267:2775.
- Loussert-Ajaka I, Ly TD, Chaix ML, et al. HIV-1/HIV-2 seronegativity in HIV-1 subtype O infected patients. Lancet 1994; 343:1393.
- Soriano V, Gomes P, Heneine W, et al. Human immunodeficiency virus type 2 (HIV-2) in Portugal: clinical spectrum, circulating subtypes, virus isolation, and plasma viral load. J Med Virol 2000; 61:111.
- Sullivan MT, Guido EA, Metler RP, et al. Identification and characterization of an HIV-2 antibody-positive blood donor in the United States. Transfusion 1998; 38:189.
- Assal A, Barlet V, Deschaseaux M, et al. Sensitivity of two hepatitis B virus, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) nucleic acid test systems relative to hepatitis B surface antigen, anti-HCV, anti-HIV, and p24/anti-HIV combination assays in seroconversion panels. Transfusion 2009; 49:301.
- Centers for Disease Control and Prevention (CDC). Identification of HIV-1 group O infection--Los Angeles county, California, 1996. MMWR Morb Mortal Wkly Rep 1996; 45:561.
- Delwart EL, Orton S, Parekh B, et al. Two percent of HIV-positive U.S. blood donors are infected with non-subtype B strains. AIDS Res Hum Retroviruses 2003; 19:1065.
- Brennan CA, Stramer SL, Holzmayer V, et al. Identification of human immunodeficiency virus type 1 non-B subtypes and antiretroviral drug-resistant strains in United States blood donors. Transfusion 2009; 49:125.
- Brennan CA, Yamaguchi J, Devare SG, et al. Expanded evaluation of blood donors in the United States for human immunodeficiency virus type 1 non-B subtypes and antiretroviral drug-resistant strains: 2005 through 2007. Transfusion 2010; 50:2707.
- Busch MP, Watanabe KK, Smith JW, et al. False-negative testing errors in routine viral marker screening of blood donors. For the Retrovirus Epidemiology Donor Study. Transfusion 2000; 40:585.
- Kroner BL, Rosenberg PS, Aledort LM, et al. HIV-1 infection incidence among persons with hemophilia in the United States and western Europe, 1978-1990. Multicenter Hemophilia Cohort Study. J Acquir Immune Defic Syndr 1994; 7:279.
- Horowitz B, Prince AM, Hamman J, Watklevicz C. Viral safety of solvent/detergent-treated blood products. Blood Coagul Fibrinolysis 1994; 5 Suppl 3:S21.
- Stramer SL, Hollinger FB, Katz LM, et al. Emerging infectious disease agents and their potential threat to transfusion safety. Transfusion 2009; 49 Suppl 2:1S.
- Klein HG, Dodd RY, Dzik WH, et al. Current status of solvent/detergent-treated frozen plasma. Transfusion 1998; 38:102.
- RISK OF HIV INFECTION
- Before HIV antibody testing
- After HIV antibody testing
- After p24 antigen testing
- After nucleic acid testing
- Defining the HIV window period
- OTHER POTENTIAL REASONS FOR HIV TRANSMISSION
- HIV genetic variation
- Technical error
- VIRAL INACTIVATION OF BLOOD COMPONENTS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS