title: Transmission of retroviruses from seronegative donors by transfusion during cardiac surgery. A multicenter study of HIV-1 and HTLV-I/II infections.
abstract: 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 II (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.
  
  
  METHODS
  A prospective multicenter cohort study of cardiac surgery patients who received multiple transfusions between 1985 and 1991.
  
  
  METHODS
  Cardiac surgery services of three large tertiary care hospitals.
  
  
  METHODS
  The study included 11,532 patients in three hospitals who had cardiovascular surgery.
  
  
  METHODS
  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% CI 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-I/II-infected donor was found for this patient.
  
  
  CONCLUSIONS
  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-transmitted HIV-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.
authors.affiliation: Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland.
authors.forename: K E
authors.initials: KE
authors.lastname: Nelson
authors.forename: J G
authors.initials: JG
authors.lastname: Donahue
authors.forename: A
authors.initials: A
authors.lastname: Muñoz
authors.forename: N D
authors.initials: ND
authors.lastname: Cohen
authors.forename: P M
authors.initials: PM
authors.lastname: Ness
authors.forename: A
authors.initials: A
authors.lastname: Teague
authors.forename: V A
authors.initials: VA
authors.lastname: Stambolis
authors.forename: D H
authors.initials: DH
authors.lastname: Yawn
authors.forename: B
authors.initials: B
authors.lastname: Callicott
authors.forename: H
authors.initials: H
authors.lastname: McAllister
mesh_terms: D000368:Aged; D001782:Blood Donors; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000635:transmission*; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006679:HIV Seropositivity / Q000175:diagnosis; D015497:HIV-1; D015490:HTLV-I Infections / Q000175:diagnosis / Q000635:transmission*; D015491:HTLV-II Infections / Q000175:diagnosis / Q000635:transmission*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012698:Serologic Tests; D065227:Transfusion Reaction; D014481:United States