Prevalence, incidence, and residual risk of human immunodeficiency virus among community and replacement first-time blood donors in São Paulo, Brazil.
ABSTRACT 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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ABSTRACT: Reducing risk of HIV window period transmission requires understanding of donor knowledge and attitudes related to HIV and risk factors. We conducted a survey of 7635 presenting blood donors at three Brazilian blood centres from 15 October through 20 November 2009. Participants completed a questionnaire on HIV knowledge and attitudes about blood donation. Six questions about blood testing and HIV were evaluated using maximum likelihood chi-square and logistic regression. Test seeking was classified in non-overlapping categories according to answers to one direct and two indirect questions. Overall, respondents were male (64%) repeat donors (67%) between 18 and 49 years old (91%). Nearly 60% believed blood centres use better HIV tests than other places; however, 42% were unaware of the HIV window period. Approximately 50% believed it was appropriate to donate to be tested for HIV, but 67% said it was not acceptable to donate with risk factors even if blood is tested. Logistic regression found that less education, Hemope-Recife blood centre, replacement, potential and self-disclosed test-seeking were associated with less HIV knowledge. HIV knowledge related to blood safety remains low among Brazilian blood donors. A subset finds it appropriate to be tested at blood centres and may be unaware of the HIV window period. These donations may impose a significant risk to the safety of the blood supply. Decreasing test-seeking and changing beliefs about the appropriateness of individuals with behavioural risk factors donating blood could reduce the risk of transfusing an infectious unit.Vox Sanguinis 12/2013; · 3.30 Impact Factor
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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.
- Asian Journal of Transfusion Science 07/2013; 7(2):107-8.