Epidemiologic Notes and Reports Transfusion-Associated Human T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus Infection From a Seronegative Donor -- Colorado

In November 1985, a blood donor at a Colorado blood-collection center was found to be seropositive for human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV)* antibody by both the enzyme-linked immunosorbent assay (ELISA) and Western blot methods. He had previously donated at the center in April and August 1985, when he had been seronegative by ELISA. Both recipients from the August donation, one of whom had no other risk factors for acquisition of HTLV-III/LAV, were subsequently found to be seropositive. Both recipients of the April donation were seronegative. The donor had probably been infected through sexual contact 12 weeks or less before the August donation. This is the first reported transmission of infection from a blood donor that has occurred despite routine screening for HTLV-III/LAV antibody in blood banks and plasma centers.

Details of the donor and recipient investigation are as follows: Donor. The donor was a 31-year-old man who had donated blood at the same center in April, August, and November 1985. He was seronegative in April (optical densities of Abbott ELISA on sample/control = 0.052/0.160) and August (0.034/0.142), but seropositive by ELISA (0.926/0.173) and Western blot in November. His blood from the November donation was discarded, and physicians of the recipients from the August donation were notified by the blood center of the possible transmission of HTLV-III/LAV from these blood products.

When interviewed in April 1986, the donor stated that he had had sexual contact with one male partner, with the first exposure taking place on May 15, 1985. No condoms were used. His only other sexual partner was a man in 1974. He denied intravenous (IV) drug use or history of blood transfusion. He had no history of acute viral illnesses or symptoms of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) in 1985 or 1986. Physical examination in December 1985 was normal. Repeat ELISA testing in April 1986 revealed a high absorbency value (

2.000/0.125), and Western blot was once again positive. Attempts at locating previous sera for antibody testing were unsuccessful.

Donor's Partner. The donor's sexual partner was a 22-year-old man who corroborated the donor's history of their initial sexual contact on May 15, 1985. He had been homosexually active since 18 years of age. He denied IV drug abuse or history of blood transfusion. After notification by the donor of his positive antibody status, the partner was tested for HTLV-III/LAV in November 1985 and was seropositive by ELISA and Western blot; these findings were reconfirmed on a separate specimen in April 1986. He had not previously been tested for HTLV-III/LAV antibody.

Recipient 1. Recipient 1 was a 60-year-old man who underwent surgery in August 1985. He received from 15 different donors six units of packed red blood cells, four units of fresh frozen plasma, and six units of platelets (including one unit from the previously described donor). He had been married for 30 years and denied extramarital sexual contact, either heterosexual or homosexual, or any previous blood transfusions or IV drug abuse. In February 1986, he had no symptoms of AIDS or ARC and had a normal physical examination. The HTLV-III/LAV antibody test was positive by ELISA and Western blot and reconfirmed on a separate specimen in March 1986. His wife was seronegative for HTLV-III/LAV antibody in April 1986.

Recipient 2. Recipient 2 was a 57-year-old man who underwent surgery in August 1985. He received two units of platelet-poor whole blood (including one unit from the previously described donor) and one unit of packed red blood cells. During the postoperative period, he had unexplained fever and diarrhea that persisted for 6 weeks and was associated with a 20-pound weight loss. Stool specimens were negative for bacterial pathogens and ova and parasites, including cryptosporidia. In October 1985, he was tested for HTLV-III/LAV antibody for reasons unrelated to the blood transfusion and was positive by ELISA and Western blot, which was confirmed on a separate specimen in April 1986. He had been divorced for 12 years and was strictly homosexual since that time, with multiple partners.

Other investigative findings. The blood donated in April 1985 was given to two recipients, and both were seronegative by ELISA when tested in May 1986.

One other person was a common donor to recipients 1 and 2 in August 1985. This person was retested in April 1986 and was negative by ELISA for HTLV-III/LAV antibody. Of the 13 remaining donors to recipient 1, 11 were seronegative when retested 5 months or more after the August donations. Two donors reside outside Colorado and have not been retested. Of the two remaining donors to recipient 2, both were seronegative when retested 6 months or more after the August donations. Reported by CA Raevsky, DL Cohn, MD, FC Wolf, MPA, FN Judson, MD, Colorado Dept of Health, Denver Disease Control Svc, SW Ferguson PhD, State Epidemiologist, TM Vernon, MD, Executive Director, Colorado Dept of Health; AIDS Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: This is the first report of HTLV-III/LAV transmission from a person whose blood tested negative for HTLV-III/LAV antibody at the time of blood donation. As with previous reports that have documented the presence of the virus in a small number of persons who have no detectable antibody, this donor appears to have had a recent infection (1,2). Most infected people develop antibody within 2-3 months of infection (2-6).

The current risk of transfusion-associated infection is small. The prevalence of positive Western blot tests among units screened by the American Red Cross in early 1985 suggests that 0.04% of all donated units may have been potentially infectious (7). This prevalence declined to 0.02% in early 1986 (8). Currently available screening tests detect HTLV-III/LAV antibody in the great majority of infected persons. Since antibody may not be detectable in blood from donors with very recent infections, the safety of the blood supply also requires deferral of donation by persons at increased risk for HTLV-III/LAV infection.

Donor-deferral programs, initially implemented in blood banks in March 1983 and subsequently refined, provide all prospective donors with educational information on the practices associated with an increased risk of HTLV-III/LAV infection. Evidence suggests that most persons at increased risk have stopped donating blood (9-11), but a few such individuals continue to donate. The donor described in this report said that he felt he was not at risk for infection because he had only one sexual partner. Although a steady sexual relationship with a single partner is generally safer with regard to HTLV-III/LAV infection than relationships with multiple sexual partners, men who have had sexual contact with another man since 1977 must not donate blood (12).

Efforts are continuing to assure maximum effectiveness of donor-deferral programs (13,14). As an example, blood collection agencies have agreed to implement procedures in which prospective donors are asked to sign an expanded consent statement. The statement indicates that the prospective donor has reviewed and understands the informational material provided and that donors who are at increased risk for transmission of HTLV-III/LAV or other infectious agents will not donate blood or plasma for transfusion to another person.

References

1. Salahuddin SZ, Groopman JE, Markham PD, et al. HTLV-III in symptom-free seronegative persons. Lancet 1984;II:1418-20.

2. Ho DD, Sarngadharan MG, Resnick L, Dimarzo-Veronese F, Rota TR, Hirsch MS. Primary human T-lymphotropic virus type III infection. Ann Intern Med 1985;103:880-3.

3. Anonymous. Needlestick transmission of HTLV-III from a patient infected in Africa. Lancet 1984;II:1376-7.

4. Tucker J, Ludlam CA, Craig A, et al. HTLV-III infection associated with glandular-fever-like illness in a haemophiliac. Lancet 1985;I:585.

5. Cooper DA, Gold J, Maclean P, et al. Acute AIDS retrovirus infection. Lancet 1985;I:537-40.

6. Esteban JI, Shih J W-K, Tai C-C, Bodner AJ, Kay JWD, Alter HJ. Importance of Western blot analysis in predicting infectivity of anti-HTLV-III/LAV positive blood. Lancet 1985;II:1083-6.

7. Schorr JB, Berkowitz A, Cummings PD, Katz AJ, Sandler SG. Prevalence of HTLV-III antibody in American blood donors (Letter). N Engl J Med 1985;313:384-5.

8. Sandler SG, American Red Cross. Personal communication.

9. Dahlke MB. Designated blood donations (Letter). N Engl J Med 1984;310:1194.

10. Grindon A. Efficacy of voluntary self-deferral of donors at high risk of AIDS (Abstract). Transfusion 1984;24:434.

11. Pindyck J, Waldman A, Zang E, Oleszko W, Lowy M, Bianco C. Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Transfusion 1985;25:3-9.

12. CDC. Update: revised Public Health Service definition of persons who should refrain from donating blood and plasma--United States. MMWR 1985;34:547-8.

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