Estimated Risk of Transmission of the Human Immunodeficiency Virus by Screened Blood in the United States
Eve M. Lackritz, M.D., Glen A. Satten, Ph.D., John Aberle-Grasse, M.P.H., Roger Y. Dodd, Ph.D., Vincent P. Raimondi, M.S., Robert S. Janssen, M.D., W. Frank Lewis, Ph.D., Edward P. Notari, M.P.H., and Lyle R. Petersen, M.D., M.P.H.
Background In the United States, transmission of the human immunodeficiencyvirus (HIV) by blood transfusion occurs almost exclusively whena recently infected blood donor is infectious but before antibodiesto HIV become detectable (during the "window period"). We estimatedthe risk of HIV transmission caused by transfusion on the basisof the window period associated with the use of current, sensitiveenzyme immunosorbent assays and recent data on HIV incidenceamong blood donors.
Methods We analyzed demographic and laboratory data on morethan 4.1 million blood donations obtained in 1992 and 1993 in19 regions served by the American National Red Cross, as wellas the results of HIV-antibody tests of 4.9 million donationsobtained in an additional 23 regions.
Results We estimated that, in the 19 study regions, 1 donationin every 360,000 (95 percent confidence interval, 210,000 to1,140,000) was made during the window period. In addition, itis estimated that 1 in 2,600,000 donations was HIV-seropositivebut was not identified as such because of an error in the laboratory.We estimated that 15 to 42 percent of window-period donationswere discarded because they were seropositive on laboratorytests other than the HIV-antibody test. When these results wereextrapolated to include the additional 23 Red Cross serviceregions, there was a risk of 1 case of HIV transmission forevery 450,000 to 660,000 donations of screened blood. If theRed Cross centers are assumed to be representative of all U.S.blood centers, among the 12 million donations collected nationallyeach year an estimated 18 to 27 infectious donations are availablefor transfusion.
Conclusions The estimated risk of transmitting HIV by the transfusionof screened blood is very small and nearly half that estimatedpreviously, primarily because the sensitivity of enzyme immunosorbentassays has been improved.
Source Information
From the HIV Seroepidemiology Branch (E.M.L., R.S.J., L.R.P.) and the Statistics and Data Management Branch (G.A.S.), Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta; the Orkand Corporation, Atlanta (V.P.R.); and the Jerome H. Holland Laboratory, American National Red Cross, Rockville, Md. (J.A.-G., R.Y.D., W.F.L., E.P.N.). The use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or the Department of Health and Human Services.
Address reprint requests to Dr. Lackritz at the Division of HIV/AIDS Prevention, Mailstop E-46, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333.
The Risk of HIV Transmission by Screened Blood
Vyas G. N., Rawal B. D., Busch M. P., Kinloch S., Perrin L., Hirschel B., Carlson B., Lackritz E. M., Janssen R. S., Epstein J. S.
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N Engl J Med 1996;
334:992-993, Apr 11, 1996.
Correspondence
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334: 1734-1735
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334: 992-993
[Full Text]
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334: 922-923
[Full Text]
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1996: 10-10
[Full Text]
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1996: 2-2
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