First transmission of human immunodeficiency virus Type 1 by a cellular blood product after mandatory nucleic acid screening in Germany.
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.
Schmidt
Michael
M
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
Korn
Klaus
K
Nübling
C Micha
CM
Chudy
Michael
M
Kress
Julia
J
Horst
Heinz A
HA
Geusendam
Geert
G
Hennig
Holger
H
Sireis
Walid
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Rabenau
Holger F
HF
Doerr
Hans Wilhelm
HW
Berger
Annemarie
A
Hourfar
Michael Kai
MK
Gubbe
Knut
K
Karl
Andreas
A
Fickenscher
Helmut
H
Tischer
B Karsten
BK
Babiel
Reiner
R
Seifried
Erhard
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Gürtler
Lutz
L
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
D054299:env Gene Products, Human Immunodeficiency Virus; D054301:gag Gene Products, Human Immunodeficiency Virus