A model to estimate the probability of human immunodeficiency virus and hepatitis C infection despite negative nucleic acid testing among increased-risk organ donors.
BACKGROUND
In 2013, guidelines were released for reducing the risk of viral bloodborne pathogen transmission through organ transplantation. Eleven criteria were described that result in a donor being designated at increased infectious risk. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission risk from an increased-risk donor (IRD), despite negative nucleic acid testing (NAT), likely varies based on behavior type and timing.


METHODS
We developed a Monte Carlo risk model to quantify probability of HIV among IRDs. The model included NAT performance, viral load dynamics, and per-act risk of acquiring HIV by each behavior. The model also quantifies the probability of HCV among IRDs by non-medical intravenous drug use (IVDU).


RESULTS
Highest risk is among donors with history of unprotected, receptive anal male-to-male intercourse with partner of unknown HIV status (MSM), followed by sex with an HIV-infected partner, IVDU, and sex with a commercial sex worker.


CONCLUSIONS
With NAT screening, the estimated risk of undetected HIV remains small even at 1 day following a risk behavior. The estimated risk for HCV transmission through IVDU is likewise small and decreases quicker with time owing to the faster viral growth dynamics of HCV compared with HIV. These findings may allow for improved organ allocation, utilization, and recipient informed consent.
Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.|Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
Pallavi D
PD
Annambhotla
Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, GA, USA.|H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Brian M
BM
Gurbaxani
Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Matthew J
MJ
Kuehnert
Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Sridhar V
SV
Basavaraju
D064591:Allografts / Q000821:virology*; D017848:Blood-Borne Pathogens; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology*; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008962:Models, Theoretical; D021141:Nucleic Acid Amplification Techniques; D017410:Practice Guidelines as Topic; D012367:RNA, Viral / Q000302:isolation & purification; D012306:Risk; D012309:Risk-Taking; D012698:Serologic Tests; D011477:Sex Work; D013997:Time Factors; D014019:Tissue Donors / Q000523:psychology / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000592:standards; D019562:Viral Load
D012367:RNA, Viral
hepatitis C virus; human immunodeficiency virus; increased infectious risk; increased-risk donor; nucleic acid testing