HIV Transmission Through Transfusion --- Missouri and Colorado, 2008

HIV Transmission Through Transfusion --- Missouri and Colorado, 2008
Weekly
October 22, 2010 / 59(41);1335-1339

Transmission of human immunodeficiency virus (HIV) through transfusion of contaminated blood components was documented in the United States in 1982 (1). Since then, the risk for transfusion-transmitted HIV infection has been almost eliminated by the use of questionnaires to exclude donors at higher risk for HIV infection and the use of highly sensitive laboratory screening tests to identify infected blood donations. The risk for acquiring HIV infection through blood transfusion today is estimated conservatively to be one in 1.5 million, based on 2007--2008 data (2). This report describes the first U.S. case of transfusion-transmitted HIV infection reported to CDC since 2002 (3). A blood center in Missouri discovered that blood components from a donation in November 2008 tested positive for HIV infection. A lookback investigation determined that this donor had last donated in June 2008, at which time he incorrectly reported no HIV risk factors and his donation tested negative for the presence of HIV. One of the two recipients of blood components from this donation, a patient undergoing kidney transplantation, was found to be HIV infected, and an investigation determined that the patient's infection was acquired from the donor's blood products. Even though such transmissions are rare, health-care providers should consider the possibility of transfusion-transmitted HIV in HIV-infected transfusion recipients with no other risk factors.

Case Reports

Donor. In June 2008, a man in his forties donated whole blood at a blood center in Missouri (Figure 1). He was a repeat blood donor who reported no HIV risk factors on the routine eligibility screening questionnaire. He was not compensated for his blood donation. His whole blood donation was screened at a reference laboratory for HIV by enzyme immunoassay (EIA) (Genetic Systems HIV-1/HIV-2 Plus O EIA, Bio-Rad Laboratories, Redmond, Washington) and by nucleic acid amplification testing of minipools of plasma specimens (MP-NAT) from 16 donations (Procleix HIV-1 Nucleic Acid Test, Gen Probe, San Diego, California); both tests were negative. Components from this donation later were transfused into two recipients. No specimens from this donation were stored. In November 2008, the man donated blood again at the same blood center and again reported no risk factors on the routine eligibility screening questionnaire. At that time, his blood tested positive for HIV by EIA, MP-NAT, and indirect immunofluorescence assay (Fluorognost HIV-1 IFA, Sanochemia Corporation, Vienna, Austria). The man was placed on the list of donors who are indefinitely ineligible for future donation, all products from this donation were destroyed, and the man was notified by the blood center of his probable HIV infection. The Missouri Department of Health and Senior Services (MDHSS) was notified of this case on December 4, 2008. Because of the rare possibility that the donor might have been infected shortly before his June 2008 donation and donated blood that contained HIV at a concentration too low to be detected, an investigation was initiated to determine whether recipients of the June donation had been infected with HIV, consistent with regulatory requirements to investigate such events.

Initially, the donor declined repeated contacts by MDHSS to be interviewed. In April 2009, he agreed to a brief interview with MDHSS, and an OraQuick rapid HIV test (OraSure Technologies, Bethlehem, Pennsylvania) was performed. This test was reactive and confirmed by a positive Western blot at MDHSS. During his interview, the donor reported he was married but had sex with both men and women outside of his marriage, including just before his June 2008 donation. He indicated that the sex often was anonymous and occurred while he was intoxicated.

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HIV Transmission Through Transfusion --- Missouri and Colorado, 2008