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A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors.

Abstract

BACKGROUND

Estimates for human immunodeficiency virus (HIV)-1 and hepatitis C virus (HCV) transfusion-transmitted risks have relied on incidence derived from repeat donor histories and imprecise estimates for infectious, preseroconversion window periods (WPs).

STUDY DESIGN AND METHODS

By use of novel approaches, WPs were estimated by back-extrapolation of acute viral replication dynamics. Incidence was derived from the yield of viremic, antibody-negative donations detected by routine minipool nucleic acid testing (MP-NAT) of 37 million US donations (1999-2002) or from sensitive/less-sensitive HIV-1 enzyme immunoassay (S/LS-EIA) results for seropositive samples from 6.5 million donations (1999). Incidences and WPs were combined to calculate risks and project yield of individual donation (ID)-NAT.

RESULTS

The HIV-1 WP from presumed infectivity (1 copy/20 mL) to ID-NAT detection was estimated at 5.6 days, and the periods from ID to MP-NAT detection and from MP-NAT to p24 detection at 3.4 and 6.0 days, respectively; corresponding estimates for HCV were 4.9, 2.5, and 50.9 days (the latter represents period from MP-NAT to HCV antibody detection). The HIV-1 incidence projected from MP-NAT yield or from S/LS-EIA data was 1.8 per 100,000 person-years, resulting in a corresponding HIV-1 transfusion-transmitted risk of 1 in 2.3 million. The HCV incidence from MP-NAT yield was 2.70 per 100,000 person-years with a corresponding risk of 1 in 1.8 million donations. Conversion from MP-NAT to ID-NAT was projected to detect two to three additional HIV-1 and HCV infectious units annually.

CONCLUSIONS

MP-NAT yield and S/LS-EIA rates can accurately project transfusion risks. HCV and HIV-1 risks, currently estimated at 1 per 2 million units, could be reduced to 1 in 3 to 4 million units by ID-NAT screening.

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  • Authors+Show Affiliations

    ,

    Blood Systems Research Institute, San Francisco, California 94118, USA. mpbusch@itsa.ucsf.edu

    , , , , , , ,

    Source

    Transfusion 45:2 2005 Feb pg 254-64

    MeSH

    Acute Disease
    Blood Donors
    Blood Transfusion
    HIV Infections
    HIV-1
    Humans
    Incidence
    Predictive Value of Tests
    Risk Factors
    Transfusion Reaction

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15660836

    Citation

    Busch, Michael P., et al. "A New Strategy for Estimating Risks of Transfusion-transmitted Viral Infections Based On Rates of Detection of Recently Infected Donors." Transfusion, vol. 45, no. 2, 2005, pp. 254-64.
    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(2):254-64.
    Busch, M. P., Glynn, S. A., Stramer, S. L., Strong, D. M., Caglioti, S., Wright, D. J., ... Kleinman, S. H. (2005). A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion, 45(2), pp. 254-64.
    Busch MP, 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(2):254-64. PubMed PMID: 15660836.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. AU - Busch,Michael P, AU - Glynn,Simone A, AU - Stramer,Susan L, AU - Strong,D Michael, AU - Caglioti,Sally, AU - Wright,David J, AU - Pappalardo,Brandee, AU - Kleinman,Steven H, AU - ,, PY - 2005/1/22/pubmed PY - 2005/3/8/medline PY - 2005/1/22/entrez SP - 254 EP - 64 JF - Transfusion JO - Transfusion VL - 45 IS - 2 N2 - BACKGROUND: Estimates for human immunodeficiency virus (HIV)-1 and hepatitis C virus (HCV) transfusion-transmitted risks have relied on incidence derived from repeat donor histories and imprecise estimates for infectious, preseroconversion window periods (WPs). STUDY DESIGN AND METHODS: By use of novel approaches, WPs were estimated by back-extrapolation of acute viral replication dynamics. Incidence was derived from the yield of viremic, antibody-negative donations detected by routine minipool nucleic acid testing (MP-NAT) of 37 million US donations (1999-2002) or from sensitive/less-sensitive HIV-1 enzyme immunoassay (S/LS-EIA) results for seropositive samples from 6.5 million donations (1999). Incidences and WPs were combined to calculate risks and project yield of individual donation (ID)-NAT. RESULTS: The HIV-1 WP from presumed infectivity (1 copy/20 mL) to ID-NAT detection was estimated at 5.6 days, and the periods from ID to MP-NAT detection and from MP-NAT to p24 detection at 3.4 and 6.0 days, respectively; corresponding estimates for HCV were 4.9, 2.5, and 50.9 days (the latter represents period from MP-NAT to HCV antibody detection). The HIV-1 incidence projected from MP-NAT yield or from S/LS-EIA data was 1.8 per 100,000 person-years, resulting in a corresponding HIV-1 transfusion-transmitted risk of 1 in 2.3 million. The HCV incidence from MP-NAT yield was 2.70 per 100,000 person-years with a corresponding risk of 1 in 1.8 million donations. Conversion from MP-NAT to ID-NAT was projected to detect two to three additional HIV-1 and HCV infectious units annually. CONCLUSIONS: MP-NAT yield and S/LS-EIA rates can accurately project transfusion risks. HCV and HIV-1 risks, currently estimated at 1 per 2 million units, could be reduced to 1 in 3 to 4 million units by ID-NAT screening. SN - 0041-1132 UR - https://www.unboundmedicine.com/medline/citation/15660836/full_citation L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2005&volume=45&issue=2&spage=254 DB - PRIME DP - Unbound Medicine ER -