Residual risk of HIV, HCV, and HBV transmission through blood transfusion in France between 1992 and 2002 and the impact of viral genomic testing

Changes in the residual viral risk associated with labile blood products are an important indicator for assessing the impact of measures aimed at improving viral safety in blood transfusions. Changes in various estimates of residual risk are analyzed over nine overlapping three-year periods, from 1992 to 2002. These estimates are also compared with the results of viral genomic screening (VGS) implemented for HIV-1 and HCV in July 2001. Methods: Since residual risk is primarily due to the existence of the immunologically silent window period—the time between infection and the appearance of detectable markers—it is estimated for each of the three major viruses (HIV, HBV, HCV) by multiplying the incidence rate (seroconversions observed in known donors during the study period) by the respective durations of the serological windows. The first seven study periods considered only data from the SFTS GATT working group (representing more than 50% of donations collected nationwide); finally, the last two periods encompassed all donations. Results: Over the 2000–2002 period, residual risks without DGV were estimated at 1 in 1,400,000 donations for HIV, 1 in 1,000,000 for HCV, and 1 in 400,000 for HBV. With the DGV, the residual risk for HIV is reduced by nearly half (1 in 2,500,000) and by nearly sevenfold for HCV (1 in 6,650,000). Of the 4.9 million donations tested using DGV between July 1, 2001, and June 30, 2003, two HIV-positive donations and one HCV-positive donation were screened out thanks to DGV. For HIV, the observed benefit is in line with projections; however, it falls short of projections for HCV (4 donations in the serological window period predicted). The overall residual risk (HIV, HCV, HBV) without DGV fell from 1 in 65,000 to 1 in 235,000 between 1992 and 2002. Since the introduction of DGV, this overall risk is estimated at 1 in 325,000, which is 28% lower than without DGV. Conclusion: The DGV results reinforce the validity of the model used to assess residual viral transfusion risk. However, the benefit attributable to DGV is limited because the residual risk at the time of its implementation was minimal.

Author(s): Pillonel J, Laperche S

Publishing year: 2004

Pages: 81-6

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