title: First transmission of human immunodeficiency virus Type 1 by a cellular blood product after mandatory nucleic acid screening in Germany.
abstract: BACKGROUND
  In February 2007, a 63-year-old man underwent surgery. Retrospective testing with nucleic acid testing (NAT) showed that the patient was human immunodeficiency virus Type 1 (HIV-1) positive 10 days after transfusion. The transfusion-transmitted infection had been identified by a donor-related lookback started in April 2007 after anti-HIV seroconversion.
  
  
  METHODS
  Sequence analysis was performed in the gag-pol region as well as in the V3 loop env region. Archived plasma from the transmitting donation was investigated for the individual-donation NAT with the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 test (Roche CAP/CTM HIV-1 test) and for HIV antigen/antibody combination testing (Abbott Architect). Additional testing was done on the donor's follow-up sample and on the recipient's sample.
  
  
  RESULTS
  The Roche CAP/CTM HIV-1 test failed to detect viral RNA by minipool NAT in the index donation (April 2007) as well as in the donation that caused the infection (January 2007). Phylogenetic analysis showed a very high genetic similarity among viral sequences from both donor and recipient, proving the HIV-1 transmission by sequence data.
  
  
  CONCLUSIONS
  This case represents the first documented HIV-1 transmission by transfusion of red blood cells after mandatory introduction of HIV-1 NAT for blood screening in Germany. Low viral load and mismatches in the primer/probe region might explain the detection failure of the NAT screening assay. A certain risk remains that new virus variants contain mutations at positions critical for amplification or detection of viral genomes. An option to reduce the risk of a detection failure by NAT is the simultaneous use of several conserved regions as amplification targets.
authors.affiliation: Institute of Transfusion Medicine and Immunohematology, German Red Cross, and the Institute for Medical Virology, Johann Wolfgang Goethe University, Frankfurt, Germany. m.schmidt@blutspende.de
authors.forename: Michael
authors.initials: M
authors.lastname: Schmidt
authors.forename: Klaus
authors.initials: K
authors.lastname: Korn
authors.forename: C Micha
authors.initials: CM
authors.lastname: Nübling
authors.forename: Michael
authors.initials: M
authors.lastname: Chudy
authors.forename: Julia
authors.initials: J
authors.lastname: Kress
authors.forename: Heinz A
authors.initials: HA
authors.lastname: Horst
authors.forename: Geert
authors.initials: G
authors.lastname: Geusendam
authors.forename: Holger
authors.initials: H
authors.lastname: Hennig
authors.forename: Walid
authors.initials: W
authors.lastname: Sireis
authors.forename: Holger F
authors.initials: HF
authors.lastname: Rabenau
authors.forename: Hans Wilhelm
authors.initials: HW
authors.lastname: Doerr
authors.forename: Annemarie
authors.initials: A
authors.lastname: Berger
authors.forename: Michael Kai
authors.initials: MK
authors.lastname: Hourfar
authors.forename: Knut
authors.initials: K
authors.lastname: Gubbe
authors.forename: Andreas
authors.initials: A
authors.lastname: Karl
authors.forename: Helmut
authors.initials: H
authors.lastname: Fickenscher
authors.forename: B Karsten
authors.initials: BK
authors.lastname: Tischer
authors.forename: Reiner
authors.initials: R
authors.lastname: Babiel
authors.forename: Erhard
authors.initials: E
authors.lastname: Seifried
authors.forename: Lutz
authors.initials: L
authors.lastname: Gürtler
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D016679:Genome, Viral / Q000235:genetics; D005858:Germany; D015658:HIV Infections / Q000175:diagnosis* / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008297:Male; D018580:Mandatory Testing / Q000379:methods*; D008875:Middle Aged; D010802:Phylogeny; D054299:env Gene Products, Human Immunodeficiency Virus / Q000235:genetics; D054301:gag Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054299:env Gene Products, Human Immunodeficiency Virus; D054301:gag Gene Products, Human Immunodeficiency Virus