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HIV Seroconversion Resulting from Insensitive Blood Screening Measures

It is estimated that 1 in 450,000 to 1 in 660,000 blood donations in the U.S. are made by donors who are infected with HIV but have not yet seroconverted to HIV-positive status as measured by current viral screening techniques. Currently used techniques include HIV-1 and HIV-2 antibody enzyme immunoassays (EIA), p24 antigen EIA, and nucleic acid amplification testing (NAT); these become positive at approximately 25 days, 14 to 21 days, and 4 to 16 days after infection, respectively. For logistic reasons and cost conservation, NAT is performed on mini-pools of 16 to 24 whole blood donations.

This case study demonstrated direct and unequivocal linkage between the donor's platelets and the recipient's seroconversion. Using stored samples, researchers retrospectively analyzed blood and platelets from a screened donor whose blood products had been linked to recipients' seroconversions to HIV positivity; by single-donor NAT screening, they found that the donor's plasma contained HIV DNA at 5 to 39 copies/mL at the time of donation. This low viral level was not detected by NAT mini-pool testing.

Comment: Existing safeguards are inadequate to detect very low levels of HIV in donor blood. Implementation of single-donation NAT testing would narrow, but not close, the window of transfusion infection potential. Emergency physicians should continue to administer blood products appropriately but with wariness of this remote, although catastrophic, potential problem.

— JA Marx

Published in Journal Watch Emergency Medicine September 8, 2000

Citation(s):

Ling AE et al. Failure of routine HIV-1 tests in a case involving transmission with preseroconversion blood components during the infectious window period. JAMA 2000 Jul 12 284 210 -214.

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Klein HG. Will blood transfusion ever be safe enough? JAMA 2000 Jul 12 284 238 -240.

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• Medline abstract (Free)