Prevalence, incidence and residual risk of HIV among community and replacement first-time blood donors in São Paulo Brazil

Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States
Transfusion (Impact Factor: 3.23). 11/2005; 45(11):1709-14. DOI: 10.1111/j.1537-2995.2005.00575.x
Source: PubMed


Concerted efforts have been directed toward recruitment of community rather than replacement donors in Brazil. Time trends and demographic correlates of human immunodeficiency (HIV) prevalence and incidence among first-time (FT) donors in Brazil were examined by donation type. HIV residual risk from FT-donor transfusions, and projected yield of p24 antigen and nucleic acid test (NAT) screening were estimated.
HIV prevalence data and seroreactive specimens were obtained at Fundação Pró-Sangue/Hemocentro-de-São Paulo from 1995 to 2001. To estimate incidence, confirmed-positive samples from July 1998 through December 2001 were tested with a less-sensitive (detuned) enzyme immunoassay to detect recent seroconversions. Incidence data were used to estimate residual risk and p24 and NAT yield based on published window periods (WPs).
HIV prevalence was 22 percent higher among the FT community donors than replacement donors (19.6 vs. 16.1 per 10,000; p < 0.01) and 48 percent higher among men than women (19.1 vs. 12.9; p < 0.01). In the multivariable logistic regression, both variables remained significant predictors of HIV prevalence. HIV prevalence decreased from 20.4 (1995) to 13.1 per 10,000 FT donations (2001). HIV incidence was 2.7 per 10,000 person-years. The estimated rate of infected antibody-negative donations was 14.9 per 1,000,000 units (95% confidence interval, 9.8-20.0). It was estimated that addition of p24 antigen, minipool NAT, and individual-donation NAT assays would detect 3.9 (2.0-5.8), 8.3 (5.3-11.3), and 10.8 (7.1-14.5) WP units per 1,000,000 FT donations, respectively.
HIV incidence and residual transfusion risk estimates are approximately 10 times higher in Brazil FT donors compared to US and European FT donors. Community FT donors had higher HIV prevalence than replacement FT donors. The yield of p24 antigen or RNA screening will be low in Brazilian donors, but substantially higher than in US donors.

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Available from: Michael P Busch, May 22, 2015
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    • "There are few studies in literature that have directly compared the performance of NAT assay and fourth generation HIV ELISA assay. In a retrospective study on first time blood donors by Barreto et al., from Brazil from 1995-2001,[20] it was estimated that addition of p24 antigen, minipool NAT, and individual donation NAT assays would detect 3.9, 8.3 and 10.8 window period units per 10,00,000 first-time donations, respectively. In contrast, Nantachit et al., did not find any additional yield for HIV 1 with NAT assay compared to 4th generation ELISA.[21] "
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    ABSTRACT: The percentage of HIV cases attributable to blood transfusion has decreased significantly in the last decade. The newer 4(th) generation Enzyme linked immunosorbent assay (ELISA) has been shown to have increased sensitivity compared to 3(rd) generation ELISA. To estimate the seroprevalence of HIV among blood donors using 4(th) generation ELISA assay and to compare it with the 3(rd) generation ELISA. This prospective study involved 10,200 blood donors- 6,800 were voluntary donors (3400-students and 3400-non students) and 3400 were replacement donors. All blood units were tested with 3(rd) as well as 4(th) generation ELISA. All samples found reactive or in grey zone with either 3(rd) or 4(th) generation ELISA were retested by Western blot (WB). The seroprevalence of HIV was estimated to be 1.37/1000 donations (0.14%) with 3(rd) generation ELISA compared to 3.62/1000 donations (0.36%) with 4(th) generation ELISA (p>0.05). The seroprevalence of HIV among voluntary donors was estimated to be 1.32/1000 donations (0.13%) with 3(rd) generation ELISA and 3.67/1000 donations (0.36%) with 4(th) generation ELISA. The prevalence of HIV among replacement donors was 1.47/1000 donations (0.15%) with 3(rd) generation ELISA and 3.52/1000 donations (0.35%) with 4(th) generation ELISA. 4(th) generation HIV ELISA detects a higher number of seroreactive donors compared to 3(rd) generation ELISA. However, larger studies are required with confirmatory tests for both 3(rd) and 4(th) generation ELISA for making any policy changes.
    Asian Journal of Transfusion Science 07/2013; 7(2):125-9. DOI:10.4103/0973-6247.115570
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    • "In a survey by Andrade Neto et al.(6) for the 1992-1999 period, a much lower prevalence was found (0.149%). Similarly, Barreto et al.(7) reported a rate falling from 0.204% in 1995 to 0.131% in 2001. "
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    ABSTRACT: To determine factors associated with HIV infection in blood donor candidates in Recife, Brazil. A transversal study was performed of 106,203 blood donor candidates found eligible by the routine clinical screening process in the blood bank in Recife of the Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE) in the period from January 1998 to November 2003. Additional indirect immune and western blot confirmation tests for HIV infection were performed and the candidates were classified as HIV positive or negative. The Chi-squared test and stepwise multiple logistic regression were conducted to examine any association between HIV infection and age, gender, place of residence, schooling, number of donations and serological tests for core hepatitis B antigen virus (anti-HBc), the hepatitis C antivirus (anti-HCV), human T-type antivirus lymph cells (anti-HTLV 1 and 2), serological tests for syphilis (VDRL) and the hepatitis B virus surface antigen (HBsAg). In the observed sample, 0.204% of blood donor candidates were found to be HIV positive. Among the studied variables, the age, education level, residency, donation type, and serologic status for anti-HBc and VDRL tests were found to be associated with HIV infection. The younger, spontaneous donor candidates living in the Recife metropolitan area with a low level of education and positive for anti-HBc and VDRL have an higher risk of HIV infection than the other candidates. Data such as these are useful to understand the dynamics of infection and to guide healthcare policies.
    03/2012; 34(3):217-21. DOI:10.5581/1516-8484.20120053
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    • "In the past 3 years the proportion of donations from volunteer donors has stabilized at approximately 60% and the proportion of donations by repeat donors has increased from 22 to 48% (Goncalez et al. 2003). Contrary to expectation, first-time donor HIV prevalence has been consistently higher among volunteer than among replacement donors (Barreto et al. 2005). The finding raises the question of why volunteer donors at risk for HIV choose to donate blood. "
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    ABSTRACT: Recruiting safe, volunteer blood donors requires understanding motivations for donating and knowledge and attitudes about HIV. We surveyed 1,600 persons presenting for blood donation at a large blood bank in São Paulo, Brazil using a self-administered, structured questionnaire, and classified motivations into three domains as well as categorizing persons by HIV test-seeking behavior. Motivations, in descending order, and their significant associations were: "altruism": female gender, volunteer donor and repeat donor status; "direct appeal": female gender, repeat donor status and age 21-50 years; "self-interest": male gender, age under 20 years, first-time donor status and lower education. HIV test-seekers were more likely to give incorrect answers regarding HIV risk behavior and blood donation and the ability of antibody testing to detect recent HIV infections. Altruism is the main motivator for blood donation in Brazil; other motivators were associated with specific demographic subgroups. HIV test-seeking might be reduced by educational interventions.
    AIDS and Behavior 07/2008; 12(4 Suppl):S39-47. DOI:10.1007/s10461-008-9391-3 · 3.49 Impact Factor
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