title: Prevalence of human immunodeficiency virus RNA and antibody in first-time, lapsed, and repeat blood donations across five international regions and relative efficacy of alternative screening scenarios.
abstract: BACKGROUND
  Twenty-one blood organizations from five geographical regions provided HIV individual donation (ID)-NAT and serology data on 11,787,610 donations. Infections were classified as anti-HIV-/RNA+ window period (WP), anti-HIV+/RNA+ concordant positive (CP) or anti-HIV+/RNA- elite controller (EC). Residual risk and efficacy of several screening scenarios were estimated for first time, lapsed and repeat donations.
  
  
  METHODS
  WP residual risk estimates assumed a 50% infectious dose of 3.16 virions and a 50% detection limit of 2.7 HIV RNA copies/mL for ID-NAT and 10,000 copies/mL for p24Ag. Infectivity for CP (100%) and EC (2.2%) donations was estimated based on viral load distributions and 100-fold reduced infectivity by antibody neutralization as reported elsewhere. Efficacy was calculated as proportion of transmission risk removed from baseline (i.e. in absence of any screening).
  
  
  RESULTS
  There was no significant difference in transmission risk between lapsed and repeat donations in any region. Risk was 3.8-fold higher in first time than combined lapsed/repeat donations in South Africa but not in other regions. Screening strategies were most efficacious at interdicting infectious transfusions in first time (98.7-99.8%) followed by lapsed (97.6-99.7%) and repeat (86.8-97.7%) donations in all regions combined. In each donor category the efficacy of ID-NAT alone (97.7-99.8%) was superior to that of minipool (MP)-NAT/anti-HIV (95.0-99.6%) and p24 Ag/anti-HIV (89.8-99.1%).
  
  
  CONCLUSIONS
  Efficacy patterns were similar by donor/donation status in each region despite large differences in HIV prevalence and transmission risk. As similar data become available for HBV and HCV, this modeling may be useful in cost effectiveness analyses of alternative testing scenarios.
authors.affiliation: Blood Systems Research Institute, Lelie Research, San Francisco, California, Paris, France; University of British Columbia, Canada.
authors.forename: Roberta
authors.initials: R
authors.lastname: Bruhn
authors.forename: Nico
authors.initials: N
authors.lastname: Lelie
authors.forename: Brian
authors.initials: B
authors.lastname: Custer
authors.forename: Michael
authors.initials: M
authors.lastname: Busch
authors.forename: Steven
authors.initials: S
authors.lastname: Kleinman
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001208:Asia / Q000453:epidemiology; D001782:Blood Donors / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005843:Geography; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D015528:HIV Seroprevalence; D015497:HIV-1 / Q000235:genetics* / Q000276:immunology*; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D044349:Oceania / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood*; D012698:Serologic Tests / Q000379:methods; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral