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Risk of HIV from blood transfusion

Steven Kleinman, MD
Section Editor
Arthur J Silvergleid, MD
Deputy Editor
Jennifer S Tirnauer, MD


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 [1]. 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 [2]. When analyzed in first time blood donors, the rate is 1 per 10,000 to 20,000 donors and has remained stable [3]. 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.


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Literature review current through: Sep 2016. | This topic last updated: Jun 16, 2016.
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