Absence of prolonged immunosilent infection with human immunodeficiency virus in individuals with high-risk behaviors

The risks and benefits of accepting men who have had sex with men as blood donors

BACKGROUND

It has been suggested that men who have had sex with men (MSM) should become eligible to donate blood if they recently abstained from male-to-male sex.

STUDY DESIGN AND METHODS

The impact of a 12-month deferral policy for MSM on the risk of introducing contaminated units in the blood supply and the benefit of obtaining additional donations were estimated. Considered were the prevalence of HIV among MSM, the window period of infection, the rate of laboratory testing errors, and the occurrence of other system failures. This was compared with the risk and benefit that currently results from accepting female donors who have had sex with MSM.

RESULTS

The revised policy for MSM would potentially result in one HIV-contaminated unit for every 136,000 additional donations (95% CI, 1 in 69,000 to 1 in 268,000), for an overall increase in HIV risk estimated at 8 percent. The number of donations would increase by 1.3 percent (95% CI, 0.9%-1.7%). The risk-benefit ratio of currently accepting female partners of MSM is approximately five times lower.

CONCLUSION

The risk increment of accepting 12-month abstinent MSM would be very small but not zero. From a risk-benefit perspective, the current deferral policy for MSM is more efficient compared to an analogous hypothetical criterion for female partners of MSM.

Feline immunodeficiency virus clade C mucosal transmission and disease courses

The transmissibility and pathogenicity of a clade C feline immunodeficiency virus (FIV-C) was examined via the oral-nasal, vaginal, or rectal mucosa. FIV-C was transmissible by all three mucosal routes. Vaginal transmission was most efficient (100%), oral exposure resulted in a 80% infection rate, and rectal transmission was least effective (44%). In contrast to previous intravenous passage studies, a broader range of host-virus relationships was observed after mucosal exposure. Three categories of FIV-C infection were defined: (1) rapidly progressive infection marked by high virus burdens and rapid CD4+ cell depletion (43% of vaginally exposed animals); (2) conventional (typical) infection featuring slowly progressive CD4+ cell decline (61% of all exposed animals); and (3) regressive (transient) infection marked by low and then barely detectable virus burdens and no CD4+ cell alterations (22% of rectally inoculated cats). These disease courses appear to have parallels in mucosal HIV and SIV infections, emphasizing the importance of the virus-mucosa interface in lentiviral pathogenesis.

Persistently negative HIV-1 antibody enzyme immunoassay screening results for patients with HIV-1 infection and AIDS: serologic, clinical, and virologic results. Seronegative AIDS Clinical Study Group

OBJECTIVE

To describe persons with HIV infection and AIDS but with persistently negative HIV antibody enzyme immunoassay (EIA) results.

DESIGN

Surveillance for persons meeting a case definition for HIV-1-seronegative AIDS.

SETTING

United States and Canada.

PATIENTS

A total of eight patients with seronegative AIDS identified from July 1995 through September 1997.

MAIN OUTCOME MEASURES

Clinical history of HIV disease, history of HIV test results, and CD4 cell counts from medical record review; results of testing with a panel of EIA for antibodies to HIV-1, and HIV-1 p24 antigen; and viral subtype.

RESULTS

Negative HIV EIA results occurred at CD4 cell counts of 0-230 x 10(6)/l, and at HIV RNA concentrations of 105,000-7,943,000 copies/ml. Using a panel of HIV EIA on sera from three patients, none of the HIV EIA detected infection with HIV-1, and signal-to-cut-off ratios were < or = 0.8 or all test kits evaluated. Sera from five patients showed weak reactivity in some HIV EIA, but were non-reactive in other HIV EIA. All patients were infected with HIV-1 subtype B.

CONCLUSIONS

Rarely, results of EIA tests for antibodies to HIV-1 may be persistently negative in some HIV-1 subtype B-infected persons with AIDS. Physicians treating patients with illnesses or CD4 cell counts suggestive of HIV infection, but for whom results of HIV EIA are negative, should consider p24 antigen, nucleic acid amplification, or viral culture testing to document the presence of HIV.

Coamplification of HIV type 1 and beta-globin gene DNA sequences in a nonisotopic polymerase chain reaction assay to control for amplification efficiency

The polymerase chain reaction (PCR) fails to detect HIV-1 sequences in 5% of infected individuals. To screen for false-negative PCR tests, we developed a nonisotopic PCR assay in which sequences from the beta-globin gene and from the HIV-1 vpu-env region were coamplified with biotinylated and fluorescein-labeled primers, respectively. Coamplified products were reacted with specific internal digoxigenin-labeled RNA probes. Hybrids were detected in a microtiter plate coated with streptavidin or anti-fluorescein antibody, with enzyme-labeled anti-digoxigenin antibody. After the optimization of the coamplification conditions, the assay could detect 5 proviral DNA copies in a lysate from 100,000 peripheral blood mononuclear cells. Fifty-seven samples from 55 HIV-1-seropositive patients and 25 samples from 25 seronegative individuals were evaluated. Fifty-two samples from HIV-infected individuals were positive for HIV-1 vpu-env sequences. Three of the 5 PBMC lysates falsely negative for HIV-1 sequences had reactivities for beta-globin (3-23 fu) below that of 100,000 cells (304 fu). Nonisotopic coamplification allowed for the evaluation of the quality of specimens for PCR concurrently with the detection of the presence of viral template sequences.

Existing problems in the testing for infectious diseases

Current methods for testing donated blood for presence of infectious viral agents in the USA differ from those used in other countries because of the USA Food and Drug Administration's (FDA) control which inhibits rapid introduction of testing methods or improvements. Delays in FDA approval may occur because of concerns about methodology or the state of knowledge about the disease it is intended to detect as well as due to variability between manufacturers. Despite strict FDA control, testing problems continue to occur in the USA. No approved method detects infectious agents during the "window period," and variations in detection, i.e., false positives and false negatives (even with confirmatory testing), continue to occur. The effect of physical and chemical changes (e.g., various anticoagulants) on samples has not been thoroughly evaluated. Test performance problems include lapses in sample identification, failure to use routine laboratory controls, improper calculation and reporting of results, improper acceptance of test runs and failure to properly detect and retest samples when carryover from very reactive samples occurs. For these reasons, transfusion-related disease transmission continues to occur. The current USA emphasis on good manufacturing practices should provide continuous improvements.