title: Human immunodeficiency virus prevalence, incidence, and residual risk of transmission by transfusions at Retrovirus Epidemiology Donor Study-II blood centers in Brazil.
abstract: BACKGROUND
  In Brazil nationally representative donor data are limited on human immunodeficiency virus (HIV) prevalence, incidence, and residual transfusion risk. The objective of this study was to analyze HIV data obtained over 24 months by the Retrovirus Epidemiology Donor Study-II program in Brazil.
  
  
  METHODS
  Donations reactive to third- and fourth-generation immunoassays (IAs) were further confirmed by a less-sensitive (LS) IA algorithm and Western blot (WB). Incidence was calculated for first-time (FT) donors using the LS-EIA results and for repeat donors with a model developed to include all donors with a previous negative donation. Residual risk was projected by multiplying composite FT and repeat donor incidence rates by HIV marker-negative infectious window periods.
  
  
  RESULTS
  HIV prevalence among FT donors was 92.2/10(5)  donations. FT and repeat donor and composite incidences were 38.5 (95% confidence interval [CI], 25.6-51.4), 22.5 (95% CI, 17.6-28.0), and 27.5 (95% CI, 22.0-33.0) per 100,000 person-years, respectively. Male and community donors had higher prevalence and incidence rates than female and replacement donors. The estimated residual risk of HIV transfusion transmission was 11.3 per 10(6)  donations (95% CI, 8.4-14.2), which could be reduced to 4.2 per 10(6)  donations (95% CI, 3.2-5.2) by use of individual-donation nucleic acid testing (NAT).
  
  
  CONCLUSIONS
  The incidence and residual transfusion risk of HIV infection are relatively high in Brazil. Implementation of NAT will not be sufficient to decrease transmission rates to levels seen in the United States or Europe; therefore, other measures focused on decreasing donations by at-risk individuals are also necessary.
authors: Pró-Sangue Foundation, São Paulo, Brazil. sabinoec@usp.br
authors: Ester C
authors: EC
authors: Sabino
authors: Thelma T
authors: TT
authors: Gonçalez
authors: Anna Bárbara
authors: AB
authors: Carneiro-Proietti
authors: Moussa
authors: M
authors: Sarr
authors: João Eduardo
authors: JE
authors: Ferreira
authors: Divaldo A
authors: DA
authors: Sampaio
authors: Nanci A
authors: NA
authors: Salles
authors: David J
authors: DJ
authors: Wright
authors: Brian
authors: B
authors: Custer
authors: Michael
authors: M
authors: Busch
mesh_terms: D000328:Adult; D000368:Aged; D001782:Blood Donors; D001938:Brazil / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012306:Risk; D065227:Transfusion Reaction