AEGiS-14IAC: Transmission of HIV by blood transfusion from a seronegative and p24 negative donor. Lessons for Nucleic Acid Testing (NAT).

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Transmission of HIV by blood transfusion from a seronegative and p24 negative donor. Lessons for Nucleic Acid Testing (NAT).

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. F11745)

Toro C, Rodes B, Colino F, Flores MV, Poveda E, de Mendoza C, Tellez MJ, Soriano V
Hospital Carlos III, Madrid, Spain

BACKGROUND: The risk of transmission of HIV-1 during the window period has been reduced significantly since the combination of p24 antigen to antibody screening assays. In an attempt to further reduce this risk, exclusion of HIV-RNA by NAT has been implemented. Herein, we describe a case of HIV-1 infection acquired by transfusion from a HIV-RNA+ recipient with both Ab and p24 negative. Case Report: Blood was collected from a 27-year-old woman in Sept 2000 who was a regular donor. She completed satisfactorily the self-questionnaire and denied any HIV-related risk factor. Serum from her donation was negative for HIV-1/2 antibodies. Red blood cells were transfused to one recipient, a 78-year-old man, with no risk factors for HIV infection. 5 months later, the same donor returned to give blood, and at this time, she was found to be HIV+. Samples collected in her previuos donation were re-tested using several EIA tests and were non-reactive. Likewise, specific p24 Ag assays gave negative results. However, the sample harbored low levels of HIV-RNA (2,538 cop/ml). At this time, the recipient was tested and found to be HIV+. Genetic characterization of the donor virus showed it belonged to subtype B and had no drug resistance mutations. Phylogenetic analyses in are in progress.

CONCLUSIONS: This case highlights the risk of transmission of HIV during the window period, even with the use of Ab-p24 combined assays. The donor we identified gave infectious blood carrying low levels of HIV-RNA, which was enough to transmit the infection. Although the performance of NAT could have identified the infectious donation, concern on the risk of false negative HIV-RNA results using pools needs to be highlighted. Since most samples at this very narrow period of positive HIV-RNA and negative p24 Ag will harbor low levels of HIV-RNA, which will be further diluted using large pools, individual HIV-RNA testing might be inevitable if zero risk likes to be achieved

Keywords: AEGIS, HIV, HIV Infections, Blood Transfusion, HIV Seropositivity, HIV-1, HIV Core Protein p24, HIV Antibodies, Blood Donors, RNA, Viral, Tissue Donors, HIV Seronegativity, Research Design, HIV Antigens, Nucleic Acids, Human, Female, Male, transmission, immunology

020707
F11745