HIV antiretroviral therapy and prevention use in US blood donors: a new blood safety concern.

Abstract

Antiretroviral therapy (ART) to treat and pre-exposure prophylaxis (PrEP) to prevent HIV infection are effective tools to help end the HIV epidemic. However, their use could affect HIV transfusion-transmission risk. Three different ART/PrEP prevalence analyses in blood donors were conducted. First, blood samples from HIV-positive and a comparison group of infection-nonreactive donors were tested under blind using liquid chromatography-tandem mass spectrometry for ART. Second, blood donor samples from infection-nonreactive, 18- to 45-year-old, male, first-time blood donors in 6 US locations were tested for emtricitabine and tenofovir. Third, in men who have sex with men (MSM) participating in the 2017 Centers for Disease Control and Prevention National HIV Behavioral Surveillance (NHBS) from 5 US cities, self-reported PrEP use proximate to donation was assessed. In blind testing, no ART was detected in 300 infection-nonreactive donor samples, but in 299 HIV confirmed-infected donor samples, 46 (15.4%; 95% confidence interval [CI], 11.5% to 20.0%) had evidence of ART. Of the 1494 samples tested from first-time male donors, 9 (0.6%; 95% CI, 0.03% to 1.1%) had tenofovir and emtricitabine. In the NHBS MSM survey, 27 of 591 respondents (4.8%; 95% CI, 3.2% to 6.9%) reported donating blood in 2016 or 2017 and PrEP use within the same time frame as blood donation. Persons who are HIV positive and taking ART and persons taking PrEP to prevent HIV infection are donating blood. Both situations could lead to increased risk of HIV transfusion transmission if blood screening assays are unable to detect HIV in donations from infected donors.

• Authors: Brian Custer, Claire Quiner, Richard Haaland, Amy Martin, Mars Stone, Rita Reik, Whitney R Steele, Debra Kessler, Phillip C Williamson, Steven A Anderson, Alan E Williams, Henry F Raymond, Willi McFarland, William T Robinson, Sara Glick, Kwa Sey, C David Melton, Simone A Glynn, Susan L Stramer, Michael P Busch
• Journal: Blood (Blood) Vol. 136 Issue 11 Pg. 1351-1358 (09 10 2020) ISSN: 1528-0020 [Electronic] United States
• PMID: 32645148 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents
• Tenofovir
• Emtricitabine

Topics

• Adolescent
• Adult
• Anti-HIV Agents (blood, therapeutic use)
• Blood Donors
• Blood Safety
• Chromatography, Liquid
• Emtricitabine (blood)
• Female
• HIV Infections (blood, drug therapy, prevention & control, transmission)
• Humans
• Male
• Middle Aged
• Post-Exposure Prophylaxis
• Pre-Exposure Prophylaxis
• Risk
• Single-Blind Method
• Tandem Mass Spectrometry
• Tenofovir (blood)
• Truth Disclosure
• United States
• Viremia (blood, transmission)
• Young Adult