Transfusion of HIV-infected blood products despite highly sensitive nucleic acid testing

Publié le 19 Février 2019
Mis à jour le 18 janvier 2020

Background: in France, the risk of HIVtransmission by transfusion was reduced byimplementing pooled nucleic acid testing (NAT) in2001 and individual NAT in 2010. We report here thefirst case in France of transfusion of humanimmunodeficiency virus (HIV)-infected blood donatedduring HIV pre-ramp-up phase that tested individualNAT negative. Methods: blood donations are screened for HIVantibodies and HIV RNA (ProcleixUltrio, Grifols; limitof detection at 95%, 23 copies/mL). When a repeatdonor tests positive for HIV, a repository sample fromthe previous donation is tested with the CobasTaqman HIV-1 test (CTM, Roche; limit of detection at95%, 17 copies/mL). Results: in August 2017, a 57-year-old malerepeat donor was screened positive for HIVantibodies and RNA (plasma viral load, 11,599copies/mL). The previous donation had testednegative with Ultrio in March 2017 but was positivewith an unquantifiable plasma viral load when testedwith CTM. Sequencing showed no mismatch betweenUltrio primers/probes and the target sequence. HIVtransmission was excluded by lookback studies in therecipient of platelets, which had been pathogenreduced, but not in the recipient of RBCs due topremature death. Conclusion: this case demonstrates that the riskof contaminated donations due to the early HIVinfection phase going undetected by highly sensitiveNAT is real but exceptional. The absence oftransmission to the platelets recipient could be due tothe very low viral inoculum and/or to the efficacy ofthe viral inactivation. This case also highlights theadditional value of a systematic donation archivingand the importance of donor education andpredonation selection.

Auteur : Cappy Pierre, Barlet Valérie, Lucas Quentin, Tinard Xavier, Pillonel Josiane, Gross Sylvie, Tiberghien Pierre, Laperche Syria
Transfusion, 2019, vol. 59, n°. 6, p. 2046-2053