title: Two human immunodeficiency virus Type 2 cases in US blood donors including serologic, molecular, and genomic characterization of an epidemiologically unusual case.
abstract: Blood donation screening for human immunodeficiency virus Type 2 (HIV-2) has been in place in the United States since 1992. However, only three HIV-2 antibody-positive donors have been reported to date, all detected via HIV-1 cross-reactivity.
  
  
  
  Here we identify two additional HIV-2-positive donors by routine anti-HIV-1 and anti-HIV-2 screening, including a first-time male donor living in Georgia having recently immigrated to the United States from West Africa (from a 1998 donation) and a Taiwanese female repeat donor (nurse) living in California with no travel outside of Taiwan or apparent connections to West Africa (from a 2015 donation). Neither donor acknowledged any risk factors, and both remained asymptomatic through follow-up. The second donor was further investigated by serologic, molecular, and genomic assays because of her unusual demographics. She was documented to harbor HIV-2 RNA, albeit sporadically by HIV-2-specific nucleic acid tests (35%-100% of replicates) and at very low levels (<9.6 IU/mL). Metagenomic next-generation sequencing (mNGS) confirmed the identification of a Group B HIV-2 strain, with recovered reads covering 46.9% of the predicted genome.
  
  
  
  The estimated frequency of an HIV-2-positive blood donor in the United States is one in 57 million donations. Due to the low frequency and low pathogenicity of HIV-2, public health and blood donation screening efforts must focus on HIV-1 detection and prevention. However, detection of HIV-2 infection in a donor with no apparent link to West Africa suggests that the United States must remain vigilant for HIV-2 virus infections. Ultradeep mNGS may be useful in the future for comprehensive identification of rare transfusion-transmissible agents.
authors.affiliation: Scientific Affairs, the American Red Cross, Gaithersburg, Maryland.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Stramer
authors.affiliation: University of California at San Francisco, San Francisco, California.
authors.forename: Guixia
authors.initials: G
authors.lastname: Yu
authors.affiliation: Southern California Blood Collection Region, American Red Cross, and.
authors.forename: Ross
authors.initials: R
authors.lastname: Herron
authors.affiliation: Donor and Client Support Center, American Red Cross, Pomona, California.
authors.forename: Norma
authors.initials: N
authors.lastname: Espinoza
authors.affiliation: Scientific Affairs, the American Red Cross, Gaithersburg, Maryland.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Foster
authors.affiliation: University of California at San Francisco, San Francisco, California.
authors.forename: Samia N
authors.initials: SN
authors.lastname: Naccache
authors.affiliation: Quality Analytics, Riverwoods, Illinois.
authors.forename: Jaye P
authors.initials: JP
authors.lastname: Brodsky
authors.affiliation: Hologic, Inc., San Diego, California.
authors.forename: Edgar
authors.initials: E
authors.lastname: Ong
authors.affiliation: Hologic, Inc., San Diego, California.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Linnen
authors.affiliation: Roche Molecular Diagnostics, Pleasanton, California.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dyer
authors.affiliation: Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Styer
authors.affiliation: Wadsworth Center, New York State Department of Health, Albany, New York.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Parker
authors.affiliation: University of California at San Francisco, San Francisco, California.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000354:Africa, Western / Q000208:ethnology; D001782:Blood Donors; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission; D015497:HIV-1 / Q000472:pathogenicity; D015498:HIV-2 / Q000235:genetics / Q000276:immunology* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000208:ethnology; D065227:Transfusion Reaction; D014481:United States / Q000453:epidemiology
chemical_list: D015483:HIV Antibodies