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Transmission of Retroviruses from Seronegative Donors by Transfusion during Cardiac Surgery: A Multicenter Study of HIV-1 and HTLV-I/II Infections

Kenrad E. Nelson, MD; James G. Donahue, DVM; Alvaro Muñoz, PhD; Noah D. Cohen, VMD, PhD; Paul M. Ness, MD; Anita Teague, RN; Veronica A. Stambolis, MA; David H. Yawn, MD; Betty Callicott, MTACP; Hugh McAllister, MD; Bruce A. Reitz, MD; Helen Lee, PhD; Homayoon Farzadegan, PhD; and Charles G. Hollingsworth, DrPH
[+] Article, Author, and Disclosure Information

Grant Support: In part by contract No 1-HB-6-7025 with the National Heart, Lung, and Blood Institute and by a National Institutes of Health Outpatient Clinical Research Centers Grant (5M01RR00722).

Requests for Reprints: Kenrad E. Nelson, MD, The Johns Hopkins University School of Hygiene and Public Health, 624 North Broadway, Room 886, Baltimore, MD 21205.

Current Author Addresses: Drs. Nelson, Donahue, Muñoz, and Farzadegan and Ms. Stambolis: Department of Epidemiology, The Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205.

Drs. Reitz and Ness: the Johns Hopkins Hospital, Baltimore, MD.

Dr. Cohen: College of Veterinary Medicine, Texas A&M.University, College Station, TX.

Dr. McAllister and Ms. Teague: Department of Pathology, St. Lukes Episcopal Hospital, Houston, TX.

Dr. Yawn and Ms. Callicott: Department of Pathology, Baylor College of Medicine, Methodist Hospital, Houston, TX. Dr. Lee: Abbott Laboratories, North Chicago, IL.

Dr. Hollingsworth: National Heart, Lung, and Blood Institute, Bethesda, MD.

Ann Intern Med. 1992;117(7):554-559. doi:10.7326/0003-4819-117-7-554
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Objective: To evaluate the effectiveness of serologic testing of blood donors for human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus types I and Il (HTLV-I/II) infections and to estimate the risk for transmission of HIV-1 and HTLV-I/II by transfusion of seronegative blood from screened donors.

Design: A prospective multicenter cohort study of cardiac surgery patients who received multiple transfusions between 1985 and 1991.

Setting: Cardiac surgery services of three large tertiary care hospitals.

Patients: The study included 11 532 patients in three hospitals who had cardiovascular surgery.

Measurements: Incident HIV-1 and HTLV-I or HTLV-II infection.

Results: We detected two new HIV-1 infections among patients transfused with 120 312 units of blood components from seronegative donors. In each case a donor was detected on follow-up who had seroconverted since the donation. The HIV-1 infection rate was 0.0017% with an upper limit of the 95% Cl of 0.0053%. Before donor screening for HTLV-I, transfusion of 51 026 units resulted in two HTLV-I infections (0.0039%) and four HTLV-II infections (0.0078%). After HTLV-I screening was instituted, one recipient was infected with HTLV-II among participants exposed to 69 272 units, a rate of 0.0014%. A corresponding HTLV-l/ll-infecteddonor was found for this patient.

Conclusion: Serologic screening of donors for antibodies to HIV-1 and HTLV-I coupled with exclusion of donors from groups having a relatively high risk for infection has led to a low incidence of transfusion-transmittedHIV-1 and HTLV-I/II infection in the United States. A small risk remains, however, despite these measures. We estimate the residual risk for HIV-1 and HTLV-II infection from transfusion of screened blood during the time of this study to be about 1 in 60 000 units.





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