Screening of blood donors for idiopathic CD4+ T-lymphocytopenia.
BACKGROUND
The recent recognition of idiopathic CD4+ T-lymphocytopenia (ICL) had led to concern that an unknown immunodeficiency virus may be transmissible by transfusion.


METHODS
To evaluate the prevalence and significance of low CD4+ values among blood donors, CD4+ data on 2030 blood donors who were negative for antibody to human immunodeficiency virus type 1 (HIV-1) were compiled. Those with CD4+ values below ICL cutoffs (< 300 CD4+ T cells/microL, or < 20% CD4+ T cells) were recalled for follow-up investigations. Serial CD4+ data on 55 homosexual men who seroconverted during prospective follow-up and data on 139 anti-HIV-1-positive blood donors initially evaluated in 1986 were reviewed as well.


RESULTS
Five seronegative donors (0.25%) had absolute CD4+ counts < 300 cells per microL and/or < 20 percent. On follow-up, all five donors had immunologic findings within normal ranges, lacked HIV risk factors, and tested negative for HIV types 1 and 2 and human T-lymphotropic virus type I and II infections by antibody and polymerase chain reaction assays. Four of five donors reported transient illness shortly after their low CD4+ count donations. The median interval from HIV-1 seroconversion to an initial CD4+ value below ICL CD4+ cutoffs was 63 months for infected homosexual men. Of 139 HIV-1-infected blood donors studied 1 to 2 years after seropositive donations, 34 (24%) had CD4+ counts < 300 cells per microL and/or < 20 percent.


CONCLUSIONS
Low CD4+ counts are rare among anti-HIV-1-negative volunteer blood donors and are generally associated with transient illnesses. If any unknown virus progresses similarly to HIV-1, CD4+ count donor screening would be a poor surrogate for its detection.
Busch
M P
MP
Irwin Memorial Blood Centers, San Francisco, California.
Valinsky
J E
JE
Paglieroni
T
T
Prince
H E
HE
Crutcher
G J
GJ
Gjerset
G F
GF
Operskalski
E A
EA
Charlebois
E
E
Bianco
C
C
Holland
P V
PV
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood; D001782:Blood Donors; D015496:CD4-Positive T-Lymphocytes; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D015497:HIV-1; D015498:HIV-2; D006716:Homosexuality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000175:diagnosis*