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Adverse Occurrence type:
The report does not provide any information about the recipient outcomes of other blood components of the same blood donation, such as platelets and plasma. The platelet component was transfused to a patient who died two days later. The plasma component was used for lab studies related to this report. Thus, we cannot estimate the efficiency of the RBC and other components to carry and transmit HIV.
Time to detection:
The report does not disclose any signs or symptoms due to the new HIV infection. The patient’s positive testing took place approximately 69 days after the implicated RBC transfusion. No testing earlier. Thus the days to seroconversion were not calculatable.
Alerting signals, symptoms, evidence of occurrence:
In 2012, a leukemic patient received transfusions from 47 donors and seroconverted to anti-HIV positive, Western Blot non-reactive. No clinical signs or symptoms were reported in this laboratory study. The 47 blood donors had not been tested for HIV RNA by nucleic acid testing (NAT). Frozen archived blood samples from each of these 47 past donations were retested and found negative for HIV RNA by NAT. Newly collected samples from 37 of the 47 donors were tested for anti-HIV and one implicated donor was found repeat reactive. This more recent sero-positive donor sample tested positive for HIV RNA by NAT at 39,658 copies per mL. Special dilutional studies of the original HIV RNA-negative implicated donation showed, using two platforms, positive results for HIV RNA at 3.7 and 7.7 IU per mL, below the detectable limits for the standard screening donor test.
Demonstration of imputability or root cause:
A red cell transfusion from a donor who was later shown to be infected by HIV was transfused to a leukemic patient who later developed HIV infection. Nucleic acid sequencing and HIV-1 protease and reverse transcriptase phylogenetic analysis of the virus from donor and infected recipient showed 100% sequence identity and clustering with 100% bootstrap within the same B subtype glade.
Suggest new keywords:
NAT, lookback, test sensitivity, seronegative window, leukemia, RBC
HIV, human immunodeficiency virus, red cells, transfusion,
blood donor, donor screening, blood testing, donor infections,
HIV RNA, nucleic acid testing
Human immunodeficiency virus transfusion transmission despite nucleic acid testing. Salles NA et al. Transfusion. 53(10 Pt 2):2593-5, 2013 Oct.
See also existing records 1435 and 1673 (EP)
Expert comments for publication:
This report is a case of transfusion-transmitted HIV via RBC despite acceptable donor medical and social history screening along with negative donor testing for HIV RNA by NAT. Although other cases of transmitting HIV despite negative donor testing for HIV RNA by NAT have been previously reported in the published literature by Kleinman (2009), the current case demonstrates infectivity at an extremely low viral load, the lowest reported to date. The donor must have been exposed to HIV only a few days before donation but he still denied any risky behaviors. This case demonstrates not only the failure of donor testing sensitivity but also the failure of careful screening of the donor medical and social history for risky behaviors and reliance on donor truth-telling. These limitations of current blood donation and collection programs raise the question of a possible need for blood component viral inactivation, disinfection or sterilization steps. Brief reports of transmission of infectious diseases such as this one could be of more value to other patients’ physicians in the future for early recognition of infected recipients and for surveillance systems if details of the earliest patient’s signs and symptoms and clinical course were reported. Documenting initial alerting signs and symptoms are important to surveillance programs. 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;49:2454-89