Abstract:
BACKGROUND:In February 2007, a 63-year-old man underwent surgery. Retrospective testing with nucleic acid testing (NAT) showed that the patient was human immunodeficiency virus Type 1 (HIV-1) positive 10 days after transfusion. The transfusion-transmitted infection had been identified by a donor-related lookback started in April 2007 after anti-HIV seroconversion. METHODS:Sequence analysis was performed in the gag-pol region as well as in the V3 loop env region. Archived plasma from the transmitting donation was investigated for the individual-donation NAT with the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 test (Roche CAP/CTM HIV-1 test) and for HIV antigen/antibody combination testing (Abbott Architect). Additional testing was done on the donor's follow-up sample and on the recipient's sample. RESULTS:The Roche CAP/CTM HIV-1 test failed to detect viral RNA by minipool NAT in the index donation (April 2007) as well as in the donation that caused the infection (January 2007). Phylogenetic analysis showed a very high genetic similarity among viral sequences from both donor and recipient, proving the HIV-1 transmission by sequence data. CONCLUSION:This case represents the first documented HIV-1 transmission by transfusion of red blood cells after mandatory introduction of HIV-1 NAT for blood screening in Germany. Low viral load and mismatches in the primer/probe region might explain the detection failure of the NAT screening assay. A certain risk remains that new virus variants contain mutations at positions critical for amplification or detection of viral genomes. An option to reduce the risk of a detection failure by NAT is the simultaneous use of several conserved regions as amplification targets.
journal_name
Transfusionjournal_title
Transfusionauthors
Schmidt M,Korn K,Nübling CM,Chudy M,Kress J,Horst HA,Geusendam G,Hennig H,Sireis W,Rabenau HF,Doerr HW,Berger A,Hourfar MK,Gubbe K,Karl A,Fickenscher H,Tischer BK,Babiel R,Seifried E,Gürtler Ldoi
10.1111/j.1537-2995.2009.02203.xsubject
Has Abstractpub_date
2009-09-01 00:00:00pages
1836-44issue
9eissn
0041-1132issn
1537-2995pii
TRF02203journal_volume
49pub_type
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