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Infection with Human Immunodeficiency Virus Type 1 (HIV-1) among Recipients of Antibody-Positive Blood Donations

Elizabeth Donegan, MD; Maria Stuart, MPH; Joyce C. Niland, PhD; Henry S. Sacks, MD, PhD; Stanley P. Azen, PhD; Shelby L. Dietrich, MD; Cheryl Faucett, MS; Mary Ann Fletcher, PhD; Steven H. Kleinman, MD; Eva A. Operskalski, PhD; Herbert A. Perkins, MD; Johanna Pindyck, MD; Eugene R. Schiff, MD; Daniel P. Stites, MD; Peter A. Tomasulo, MD; James W. Mosley, MD, Transfusion Safety Group*
[+] Article, Author, and Disclosure Information

Grant Support: By contracts N01-HB-4-7002, N01-HB-4-7003, and N01-HB-9-7074 of the National Heart, Lung, and Blood Institute.

Requests for Reprints: James W. Mosley, MD, University of Southern California, 1840 North Soto Street (EDM 108), Los Angeles, CA 90032.

Current Author Addresses: Drs. Donegan and Stites: University of California, San Francisco, Department of Laboratory Medicine, P.O. Box 0100, Room M-523, San Francisco, CA 94143.

Ms. Stuart and Drs. Azen, Operskalski, and Mosley: University of Southern California, 1840 North Soto Street (EDM 108), Los Angeles, CA 90032.

Dr. Niland and Ms. Faucett: City of Hope National Medical Center, 1500 East Duarte Road, Department of Biostatistics, Duarte, CA 91010-0269.

Dr. Sacks: Mount Sinai Medical Center, 1 Gustave L. Levy Place, Box 1042, New York, NY 10029.

Dr. Dietrich: Southern California Hemostasis Medical Group, 10 Congress Street, Suite 340, Pasadena, CA 91105-3023.

Drs. Fletcher and Schiff: University of Miami, Department of Medicine, P.O. Box 016960, Miami, FL 33101.

Dr. Kleinman: American Red Cross, 1130 South Vermont Avenue, Los Angeles, CA 90006.

Dr. Perkins: Irwin Memorial Blood Bank, 270 Masonic Avenue, San Francisco, CA 94118-9990.

Dr. Pindyck: Interfaith Hospital, 555 Prospect Place, Brooklyn, NY 11238.

Dr. Tomasulo: American Red Cross, 1675 Northwest 9th Avenue, Miami, FL 33136.

The following persons are responsible for the conduct of the Transfusion Safety Study.

Los Angeles: University of Southern California: J. W. Mosley, S. P. Azen, D. J. Bregman, M. F. Dougherty, J. Gaiennie, C. S. Johnson, C. K. Kasper, J. C. Niland, E. A. Operskalski, J. W. Parker, D. R. Powars, M. Stuart, E. Taylor-Munoz; American Red Cross Blood Services: S. H. Kleinman; Cedars-Sinai Medical Center: C. Hyman; Huntington Memorial Hospital: S. L. Dietrich.

Detroit: Wayne State University: J. M. Lusher, J. Kaplan, S. Sarnaik.

Miami: University of Miami: E. R. Schiff, M. de Medina, M. A. Fletcher, E. C. Y. Lian, C. H. Pegelow, K. R. Reddy, J. D. Temple, S. Toledano; American Red Cross Blood Services: B. A. Lenes, P. A. Tomasulo.

New York: Mount Sinai Medical Center: L. M. Aledort, J. Hassett, H. Sacks, P. Wiesen; Cornell University Medical Center: M. W. Hilgartner; Greater New York Blood Program: C. E. Stevens, P. E. Taylor; Long Island Children's Hospital: M. F. Kaufman, Y. Kulpa; State University of New York Downstate Medical Center: A. R. Brown, S. T. Miller.

San Francisco: University of California at San Francisco: E. Donegan, M. A. Koerper, K. Miller, D. P. Stites, G. N. Vyas. Irwin Memorial Blood Bank: H. A. Perkins, M. P. Busch; Alta Bates Hospital: R. A. Johnson, B. H. Lewis.

Seattle: Puget Sound Blood Center: R. B. Counts, G. F. Gjerset. National Institutes of Health: National Heart, Lung, and Blood Institute: C. G. Hollingsworth, G. J. Nemo, J. Hoak.

Protocol and Data Monitoring Committee: H. J. Alter, G. J. Grady, P. V. Holland, J. Osborne, N. R. Rose, L. B. Seeff, J. Wittes.

From the University of California, San Francisco, California; University of Southern California, Los Angeles, California; Mount Sinai Medical Center, New York, New York; Huntington Memorial Hospital, Pasadena, California; the University of Miami, Miami, Florida; the American Red Cross Blood Services, Los Angeles-Orange Counties Region, Los Angeles, California, and South Florida Region, Miami, Florida; Irwin Memorial Blood Centers, San Francisco, California; and the New York Blood Center, New York, New York. For current author addresses, see end of text.*Members of the Transfusion Safety Study Group are listed in the Acknowledgments section at the end of text.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(10):733-739. doi:10.7326/0003-4819-113-10-733
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Objective: To assess the incidence of human immunodeficiency virus type 1 (HIV-1) transmission by antibody (anti-HIV-1)-positive blood components, and to determine the immunologic and clinical course in HIV-1-infected recipients.

Design and Subjects: We retrospectively tested approximately 200 000 donor blood component specimens stored in late 1984 and 1985 for anti-HIV-1, and we contacted recipients of positive specimens to determine their serologic status. They were compared with both recipients of HIV-1-negative transfusions and healthy (untransfused) controls. Subjects were seen at 3- to 6-month intervals for up to 4 years for clinical and immunologic evaluations.

Measurements and Main Results: Of 133 recipients, 9 had other possible exposures. Excluding these cases, 111 of 124 (89.5%) were anti-HIV-1-positive (95% CI, 84.1% to 94.5%). The recipient's sex, age, underlying condition, and type of component did not influence infection rates. The cumulative risk for developing the acquired immunodeficiency syndrome (AIDS) within 38 months after transfusion was 13% (CI, 7.5% to 21.6%). At 36 ± 3 months after the index transfusion, seropositive recipients had lower counts of CD2+CDw26+, CD4+, CD4+CD29+, and CD4+CD45RA+ subsets and more CD8+I2+ lymphocytes than did recipients of anti-HIV-1-negative transfusions. The CD4+ and CD2+CDw26+ subsets changed the most rapidly. The absolute CD8+ count remained normal.

Conclusions: Transfusion of anti-HIV-1-positive blood infected 90% of recipients. The rate of progression to AIDS within the first 38 months after infection was similar to that reported for homosexual men and hemophiliacs. Although most lymphocyte subset counts changed over time, CD8+ counts were constant.


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