Serologic test for syphilis as a surrogate marker for human immunodeficiency virus infection among United States blood donors.
BACKGROUND
This study evaluated the usefulness of the serologic test for syphilis (STS) in preventing the transmission of human immunodeficiency virus (HIV), hepatitis B and C viruses, and human T-lymphotropic virus via the transfusion of seronegative, infectious window-period blood.


METHODS
Demographic and laboratory information on blood donations made between January 1992 and June 1994 in 18 American Red Cross regions was analyzed. It was assumed that the same proportion of HIV-positive and HIV-infectious window-period donations reacted on STS and were negative on other screening tests (hepatitis B and C viruses and human T-lymphotropic virus). This proportion multiplied by the estimated number of HIV-infectious window-period donations is the number of post-screening HIV-infectious donations removed by STS.


RESULTS
Of 4,468,570 donations, 12,145 (0.27%) were STS positive and 377 (0.008%) were HIV positive. Among donations that were negative on other screening tests, STS-reactive donations were 12 times more likely to be HIV positive (odds ratio = 11.9; 95% CI = 5,26). However, of an estimated 13 infectious window-period donations, 0.2 would have been removed because of a reactive STS, at a cost of over $16 million.


CONCLUSIONS
STS is a poor marker and a costly strategy for preventing post-screening HIV infections and other blood-borne diseases.
Herrera
G A
GA
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Lackritz
E M
EM
Janssen
R S
RS
Raimondi
V P
VP
Dodd
R Y
RY
Aberle-Grasse
J
J
Petersen
L R
LR
D015415:Biomarkers / Q000097:blood; D001782:Blood Donors; D003365:Costs and Cost Analysis; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D015490:HTLV-I Infections / Q000635:transmission; D006509:Hepatitis B / Q000635:transmission; D006526:Hepatitis C / Q000635:transmission; D006801:Humans; D008403:Mass Screening / Q000191:economics; D012680:Sensitivity and Specificity; D013588:Syphilis Serodiagnosis / Q000191:economics; D013997:Time Factors
D015415:Biomarkers