title: First report of human immunodeficiency virus transmission via an RNA-screened blood donation.
abstract: OBJECTIVE
  Blood banks in the USA have recently introduced minipool nucleic acid amplification testing (MP-NAT) of blood products to reduce the transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) by transfusions. However, MP-NAT is limited in its ability to detect preseroconversion samples with very low viral RNA loads.
  
  
  METHODS
  To determine whether a red blood cell unit, from an MP-NAT-negative donation, transmitted HIV when transfused to a patient, we compared the viral sequences from the blood donor and recipient. The implicated donation was also tested by commercially available NAT assays at a range of dilution factors to determine whether the infectious unit could have been detected using individual-donation NAT (ID-NAT).
  
  
  RESULTS
  Phylogenetic linkage of HIV sequences in the blood donor and recipient confirmed the transmission of HIV by blood transfusion, the first such case identified since introduction of MP-NAT screening in 1999. Viral RNA was reliably detected by ID-NAT, but only inconsistently detected by MP-NAT.
  
  
  CONCLUSIONS
  Even following the introduction of MP-NAT, a preseroconversion donation with a viral load of <or= 150 copies of RNA/ml went undetected and resulted in an HIV transmission. Implementation of ID-NAT will further reduce such rare transmissions, but at a considerable cost per infectious unit interdicted.
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Delwart
authors.forename: N D
authors.initials: ND
authors.lastname: Kalmin
authors.forename: T S
authors.initials: TS
authors.lastname: Jones
authors.forename: D J
authors.initials: DJ
authors.lastname: Ladd
authors.forename: B
authors.initials: B
authors.lastname: Foley
authors.forename: L H
authors.initials: LH
authors.lastname: Tobler
authors.forename: R C P
authors.initials: RC
authors.lastname: Tsui
authors.forename: M P
authors.initials: MP
authors.lastname: Busch
mesh_terms: D000328:Adult; D001782:Blood Donors; D018562:Disease Transmission, Infectious; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005188:False Negative Reactions; D008040:Genetic Linkage; D015483:HIV Antibodies / Q000097:blood; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000635:transmission*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008403:Mass Screening; D021141:Nucleic Acid Amplification Techniques; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood*; D012689:Sequence Homology, Nucleic Acid; D019562:Viral Load; D014766:Viremia / Q000635:transmission* / Q000821:virology
chemical_list: D015483:HIV Antibodies; D016655:HIV Core Protein p24; D012367:RNA, Viral