title: Transmission of human immunodeficiency virus Type-1 by fresh-frozen plasma treated with methylene blue and light.
abstract: BACKGROUND
  The risk of transfusion-transmitted infection (TTI) has been minimized by introduction of nucleic acid testing (NAT) and pathogen inactivation (PI). This case report describes transmission of human immunodeficiency virus Type 1 (HIV-1) to two recipients despite these measures.
  
  
  METHODS
  In March 2009 a possible TTI of HIV-1 was identified in a patient that had received pooled buffy coat platelet concentrate (BC-PLT) in November 2005. The subsequent lookback study found two more patients who had received methylene blue (MB)-treated fresh-frozen plasma (FFP) and red blood cells (RBCs) from the same donation. In November 2005 the donor had tested negative for both HIV antibodies and HIV-1 RNA by 44 minipool (44 MP) NAT. Repository samples of this donation and samples from the recipients were used for viral load (VL) and sequence analysis.
  
  
  RESULTS
  HIV-1 RNA was detectable by individual donation (ID)-NAT in the repository sample from the 2005 window period donation and a VL of 135 copies/mL was measured. HIV-1 infection was confirmed in both recipients of both BC-PLT (65 mL of plasma) and MB-FFP (261 mL of plasma), but not in the patient that had received 4-week-old RBCs (20 mL of plasma). The sequence analysis revealed a close phylogenetic relationship between the virus strains isolated from the donor and recipients, compatible with TTI.
  
  
  CONCLUSIONS
  Approximately 17,600 and 4400 virions in the MB-FFP and BC-PLT were infectious, but 1350 virions in the RBCs were not. ID-NAT would have prevented this transmission, but the combination of MP-NAT and MB-PI did not.
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Álvarez
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Luis-Hidalgo
authors.affiliation: Joint Research Unit "Infection and Health" FISABIO-Universitat de València and CIBER in Epidemiology and Public Health (CIBERESP), Valencia, Spain.
authors.forename: María Alma
authors.initials: MA
authors.lastname: Bracho
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Amando
authors.initials: A
authors.lastname: Blanquer
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Larrea
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Villalba
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Puig
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Planelles
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Montoro
authors.affiliation: Joint Research Unit "Infection and Health" FISABIO-Universitat de València and CIBER in Epidemiology and Public Health (CIBERESP), Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: González-Candelas
authors.affiliation: Valencian Regional Blood Transfusion Center, Valencia, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Roig
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001782:Blood Donors; D015658:HIV Infections / Q000097:blood / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification / Q000528:radiation effects; D006801:Humans; D008027:Light; D008297:Male; D008751:Methylene Blue / Q000494:pharmacology*; D010949:Plasma / Q000187:drug effects / Q000528:radiation effects / Q000821:virology*; D012367:RNA, Viral / Q000097:blood; D017211:Treatment Failure; D038301:Virus Inactivation / Q000187:drug effects / Q000528:radiation effects; D055815:Young Adult
chemical_list: D012367:RNA, Viral; D008751:Methylene Blue