The Risk of HIV, HBV, HCV and HTLV Infection Among Musculoskeletal Tissue Donors in Australia

In Australia, there are no current national estimates of the risks of transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) or human T-lymphotrophic virus (HTLV) by musculoskeletal tissue transplantation. We determined the prevalence rates of antibodies against HIV (anti-HIV), HCV (anti-HCV) and HTLV (anti-HTLV) and Hepatitis B surface antigen (HBsAg) for 12 415 musculoskeletal tissue donors from three major bone tissue banks across Australia for the period 1993-2004. The prevalence (per 100 000 persons) was 64.44 for anti-HIV, 407.13 for HBsAg, 534.63 for anti-HCV and 121.88 for anti-HTLV. The estimated probability of viremia at the time of donation was 1 in 128 000, 1 in 189 000, 1 in 55 000 and 1 in 118 000, respectively. With the addition of nucleic acid amplification testing (NAT), the probability of donor viremia would be reduced to 1 in 315 000 for HIV, 1 in 385 000 for HBV and 1 in 500 000 for HCV. The prevalence of HIV, HBV, HCV and HTLV although low, are higher among musculoskeletal tissue donors than among first-time blood donors. The risks associated with musculoskeletal donation will be reduced with NAT, though further cost analysis is required prior to its implementation. Copyright (C) 2007 Blackwell Publishing Ltd.; References: 1. Transplantation Society of Australia and New Zealand. Bank Activities (2002-2204). Available from: http://www.atbf.org.au, accessed August 2006. 2. Zou S, Dodd RY, Stramer SL, Strong DM. Probability of viremia with HBV, HCV, HIV, and HTLV among tissue donors in the United States. N Engl J Med 2004; 351: 751-759. 3. Seed CR, Kiely P, Keller AJ. Residual risk of transfusion transmitted human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T lymphotrophic virus. Intern Med J 2005; 35: 592-598. 4. Seed CR, Cheng A, Ismay SL et al. Assessing the accuracy of three viral risk models in predicting the outcome of implementing HIV and HCV NAT donor screening in Australia and the implications for future HBV NAT. Transfusion 2002; 42: 1365-1372. 5. Dodd RY, Notari EP, 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: 975-979. 6. 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: 283-289. 7. Tugwell B, Patel P, Williams I. Transmission of hepatitis C virus to several organ and tissue recipients from an antibody-negative donor. Ann Intern Med 2005; 143: 648-654. 8. Glynn SA, Kleinman SH, Wright DJ, Busch MP. International application of the incidence rate/window period model. Transfusion 2002; 42: 966-972. 9. Coste J, Reesink HW, Engelfriet CP et al. Implementation of donor screening for infectious agents transmitted by blood by nucleic acid technology: Update to 2003. Vox Sang 2005; 88: 289-303. 10. Galea G, Dow BC. Comparison of prevalence rates of microbiological markers Between bone/tissue donations and new blood donors in Scotland. Vox Sang 2006; 91: 28-33. 11. Australian Therapeutic Goods Administration. Code of Good Manufacturing Practice - Human Blood and Tissues. Australian Therapeutic Goods Administration, Wooden ACT Australia 2000. 12. 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: 155-172. 13. 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: 1685-1690. 14. 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: 721-729. 15. 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: 254-264. 16. 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: 91-97. 17. Kleinman SH, Busch MP. Assessing the impact of HBVNAT on window period reduction and residual risk. J Clin Virol 2006; 36(Suppl 1) S23-S29. 18. Pillonel J, Saura C, Courouce AM. Prevalence of HIV, HTLV, and hepatitis B and C viruses in blood donors in France, 1992-1996. Transfus Clin Biol 1998; 5: 305-312. 19. Manns A, Wilks RJ, Murphy EL et al. A prospective study of transmission by transfusion of HTLV-I and risk factors associated with seroconversion. Int J Cancer 1992; 51: 886-891. 20. Challine D, Pellegrin B, Bouvier-Alias M, Rigot P, Laperche L, Pawlotsky JM. HIV and hepatitis C virus RNA in seronegative organ and tissue donors. Lancet 2004; 364: 1611-1612. 21. Kleinman S, Stramer S, Mimms L et al. Comparison of preliminary observed yield of HCV and HIV minipool (MP) nucleic acid testing (NAT) with predictions from the Incidence/Window Period (INC/WP) Model. Transfusion 2000; 40: S6-S30.