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Avelino-Silva VI, Stone M, Bakkour S, Di Germanio C, Schmidt M, Conway AL, Wright D, Grebe E, Custer B, Kleinman SH, Deng X, Lingappa JR, Defechereux P, Mehrotra M, Grant RM, Vasan S, Facente S, Phanuphak N, Sacdalan C, Akapirat S, de Souza M, Busch MP, Norris PJ. Suppressed HIV antibody responses following exposure to antiretrovirals-evidence from PrEP randomized trials and early antiretroviral treatment initiation studies. Int J Infect Dis 2024; 148:107222. [PMID: 39186969 DOI: 10.1016/j.ijid.2024.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Exposure to antiretrovirals at or early after HIV acquisition can suppress viral replication and blunt antibody (Ab) responses; a reduced HIV detectability could impact diagnosis and blood donation screening. METHODS We used three antigen (Ag)/Ab assays and one nucleic acid test (NAT) to analyze samples collected in pre-exposure prophylaxis (PrEP) trials (iPrEx; Partners PrEP) before infection detection by Ab-only rapid diagnostic tests (RDTs), and in early antiretroviral treatment (ART) initiation studies (RV254; SIPP). RESULTS Reactivity using NAT and Ag/Ab assays in samples collected up to 8 weeks prior to the first reactive RDT from 251 PrEP trials participants varied between 49-61% for active PrEP users and between 27-37% for placebo users. Among RV254 participants, reactivity in Ag/Ab assays was <100% at all timepoints, and lower among those initiating ART earlier. Seroreversions occurred for 29% (16/55), and blood donation screening with NAT and Ag/Ab assays could have missed up to 36% (20/55) of RV254 participants. For SIPP participants, who started ART at later timepoints, Ag/Ab assays identified infections with no evidence of reactivity waning. CONCLUSION PrEP and early ART initiation can delay or reduce HIV detectability. Considerations for the implementation of NAT and Ag/Ab tests in PrEP/PEP programs relying on Ab-only RDTs should be balanced according to feasibility and public health impact. While blood transfusion services using Ab-only RDTs for HIV screening should adopt higher sensitivity tests, surveillance and further research are needed to determine the need for novel HIV testing algorithms for those already using NAT and Ag/Ab screening assays.
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Affiliation(s)
- Vivian I Avelino-Silva
- Vitalant Research Institute, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sonia Bakkour
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Xutao Deng
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jairam R Lingappa
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Megha Mehrotra
- Gladstone Institute of Virology, San Francisco, California, USA
| | - Robert M Grant
- Gladstone Institute of Virology, San Francisco, California, USA
| | - Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Shelley Facente
- Vitalant Research Institute, San Francisco, California, USA; School of Public Health, University of California, Berkeley, California, USA
| | | | - Carlo Sacdalan
- SEARCH Research Foundation, Bangkok, Thailand; Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siriwat Akapirat
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Mark de Souza
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand; SEARCH Research Foundation, Bangkok, Thailand
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, California, USA; Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA; Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Quee FA, Slot E, van Leeuwen I, Brands R, Franssen EJF, Hogema BM, Zaaijer HL, van de Laar TJW. Blood safety markers in Dutch donors after relaxation of deferral for men who have sex with men: re-emergence of syphilis and HIV pre-exposure prophylaxis use. Transfusion 2024. [PMID: 38963400 DOI: 10.1111/trf.17941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/31/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Less discriminatory donor selection policies for men who have sex with men (MSM) may impact transfusion safety in terms of higher residual risks for known transfusion-transmitted infections (TTIs), increased vulnerability toward new TTIs that are also transmitted via sex, and HIV infections masked by pre-exposure prophylaxis (PrEP). STUDY DESIGN AND METHODS TTI trends in Dutch donors were studied over a 13-year period (2011-2023), characterized by successive relaxations of MSM deferral criteria. Structured posttest counseling was performed to determine risk factors in TTI-positive donors. PrEP drug levels were measured in 9977 donations from male donors living in urban areas and in 67 donors with active or resolved syphilis. RESULTS HIV incidence (from 5.8 to 1.5 per 1,000,000 donor years (DY)) and HBV incidence (from 12.4 to 4.5 per 1,000,000 DY) in Dutch donors decreased with less stringent MSM deferral criteria, while syphilis prevalence (from 26.4 to 44.1 per 100,000 new donors) and syphilis incidence (from 18.3 to 46.3 per 1,000,000 DY) increased over time. The proportion of MSM-related syphilis rose from 2% to 32% in new donors and from 12% to 27% in repeat donors. PrEP was detected in 2 of 9977 (0.02%) donations from male donors living in urban areas, and in 1 of 39 (2.6%) male donors with syphilis. DISCUSSION To date, phasing out donor deferral for MSM had no significant impact on transfusion safety in the Netherlands. However, rising syphilis rates and (recent) PrEP use in the blood donor population, albeit rare, suggest an influx of donors with higher sexual risk profiles and requires intensified TTI surveillance in donors.
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Affiliation(s)
- Franke A Quee
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health (APH) Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ed Slot
- Department of Medical Affairs, Sanquin Corporate Staff, Amsterdam, The Netherlands
| | - Ingeborg van Leeuwen
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ralph Brands
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Eric J F Franssen
- Department of Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Boris M Hogema
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Thijs J W van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Department of Virology, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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3
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Goldman M, Jacquot C, Land K. Medication Deferrals in Blood Donors. Transfus Med Rev 2024; 38:150777. [PMID: 37919209 DOI: 10.1016/j.tmrv.2023.150777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023]
Abstract
Medication use is extremely common in blood donors. Blood centers use various methods to obtain a history of medication use, all of which have strengths and weaknesses. Some data are available to develop policies for medications that impact product quality, transmissible disease testing, and infectious risks. Many blood centers defer donors for use of a small number of highly teratogenic medications, as a precautionary measure. Others also defer for possible harms related to the pharmacologic effects of medications. However, a single exposure to a blood component containing medication, with immediate dilution in the recipient's blood stream, is a very different situation from ongoing use of medication in a patient, with steady state concentrations achieved over time. It is therefore highly unlikely that these effects are relevant for recipient safety.
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Affiliation(s)
| | - Cyril Jacquot
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Kevin Land
- Department of Pathology, UT Health, San Antonio, TX, USA
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4
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Custer B, Whitaker B, Pollack L, Buccheri R, Bruhn R, Crowder L, Stramer SL, Reik R, Pandey S, Stone M, Di Germanio C, Buchacz K, Eder A, Lu Y, Forshee R, Anderson S, Marks P. HIV risk behavior profiles among men who have sex with men interested in donating blood: Findings from the Assessing Donor Variability and New Concepts in Eligibility study. Transfusion 2023; 63:1872-1884. [PMID: 37642154 PMCID: PMC11284767 DOI: 10.1111/trf.17515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individual risk assessment allows donors to be evaluated based on their own behaviors. Study objectives were to assess human immunodeficiency virus (HIV) risk behaviors in men who have sex with men (MSM) and estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors. STUDY DESIGN AND METHODS Cross-sectional survey and biomarker assessment were conducted in eight U.S. cities. Participants were sexually active MSM interested in blood donation aged 18-39 years, assigned male sex at birth. Participants completed surveys during two study visits to define eligibility, and self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, one of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Associations were assessed between HIV infection status or HIV PrEP use and behaviors, including sex partners, new partners, and anal sex. RESULTS A total of 1566 MSM completed the visit 1 questionnaire and blood draw and 1197 completed the visit 2 questionnaire. Among 1562 persons without HIV, 789 (50.4%) were not taking PrEP. Of those not taking PrEP, 66.2% reported one sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. CONCLUSION The study found that questions were able to identify sexually active, HIV-negative MSM who report lower risk sexual behaviors. About a quarter of enrolled study participants would be potentially eligible blood donors using individual risk assessment questions.
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Affiliation(s)
- Brian Custer
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Barbee Whitaker
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Lance Pollack
- University of California San Francisco, San Francisco, CA
| | - Renata Buccheri
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Lauren Crowder
- American Red Cross, Scientific Affairs, Rockville & Gaithersburg, MD
| | - Susan L. Stramer
- American Red Cross, Scientific Affairs, Rockville & Gaithersburg, MD
| | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, CA
- University of California San Francisco, San Francisco, CA
| | - Kate Buchacz
- U.S. Centers for Disease Control and Prevention, HIV Research Branch, Division of HIV Prevention, Atlanta, GA
| | - Anne Eder
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Yun Lu
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Richard Forshee
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Steven Anderson
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
| | - Peter Marks
- U.S. Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD
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Li X, Su B, Yang L, Kou Z, Wu H, Zhang T, Liu L, Han Y, Niu M, Sun Y, Li H, Jiang T. Highly sensitive and rapid point-of-care testing for HIV-1 infection based on CRISPR-Cas13a system. BMC Infect Dis 2023; 23:627. [PMID: 37749486 PMCID: PMC10518925 DOI: 10.1186/s12879-023-08492-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus type one (HIV-1) is the leading cause of acquired immunodeficiency syndrome (AIDS). AIDS remains a global public health concern but can be effectively suppressed by life-long administration of combination antiretroviral therapy. Early detection and diagnosis are two key strategies for the prevention and control of HIV/AIDS. Rapid and accurate point-of-care testing (POCT) provides critical tools for managing HIV-1 epidemic in high-risk areas and populations. METHODS In this study, a POCT for HIV-1 RNA was developed by CRISPR-Cas13a lateral flow strip combined with reverse transcriptase recombinase-aided amplification (RT-RAA) technology, the results can be directly observed by naked eyes. RESULTS Moreover, with the degenerate base-binding CRISPR-Cas13a system was introduced into the RT-RAA primer designing, the technology developed in this study can be used to test majority of HIV-1 RNA with limit of detection (LOD) 1 copy/μL, while no obvious cross-reaction with other pathogens. We evaluated this method for detecting HIV-1 RNA of clinical samples, the results showed that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 91.81% (85.03- 96.19%), 100% (92.60-100%), 100% (96.41-100%), 39.14% (25.59-54.60%) and 92.22% (86.89-95.88%), respectively. The lowest viral load detectable by this method was 112copies/mL. CONCLUSION Above all, this method provides a point-of-care detection of HIV-1 RNA, which is stable, simple and with good sensitivity and specificity. This method has potential to be developed for promoting early diagnosis and treatment effect monitoring of HIV patients in clinical.
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Affiliation(s)
- Xiaohui Li
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Bin Su
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Lan Yang
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Zhihua Kou
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Hao Wu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Tong Zhang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Lifeng Liu
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Yao Han
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Mengwei Niu
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China
| | - Yansong Sun
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China.
| | - Hao Li
- State Key Laboratory of Pathogens and Biosafety, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, China.
| | - Taiyi Jiang
- Beijing Key Laboratory for HIV/AIDS Research, Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.
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Schroyens N, Borra V, Compernolle V, Vandekerckhove P, De Buck E. Men who have sex with men and risk for transfusion-transmissible infections in blood donors in Western countries: A systematic review update. Vox Sang 2023; 118:709-720. [PMID: 37322809 DOI: 10.1111/vox.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/21/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES This systematic review update summarizes evidence concerning transfusion-transmissible infections (TTIs) in male blood donors reporting sex with another man (MSM) or after easing the MSM deferral period. MATERIALS AND METHODS We searched five databases, including studies comparing MSM versus non-MSM donors (Type I), MSM deferral periods (Type II) or infected versus non-infected donors (Type III) in Western countries, and used GRADE to determine evidence certainty. RESULTS Twenty-five observational studies were included. Four Type I studies suggest that there may be an increased risk for overall TTIs, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis in MSM donors, but the evidence is very uncertain. There was insufficient evidence of MSM with low-risk sexual behaviour. A Type II study indicates that easing the MSM deferral period to 1 year may have little to no effect on TTI risk. TTI prevalence in blood donors under 5-year, 1-year, 3-month or risk-based deferral in eight other Type II studies was too low to provide clear conclusions on the effect of easing the deferral. Three Type III studies reported that MSM may be a risk factor for HIV. Increased risk of HBV, hepatitis C virus and HTLV-I/II could not be shown. The evidence from Type III studies is very uncertain. CONCLUSION There may be an increased risk of HIV in MSM blood donors. Shortening the deferral from permanent to 1 year may have little to no effect on TTI risk. However, there is limited, unclear evidence from observational studies concerning the impact of introducing 3-month or risk-based deferrals.
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Affiliation(s)
- Natalie Schroyens
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Vere Borra
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Belgian Red Cross, Blood Services, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
- Belgian Red Cross, Mechelen, Belgium
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
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7
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Gahan L, Seed CR, Hammoud MA, Prestage G, Hoad VC, Kaldor JM. Perceived risk of HIV transmission by blood transfusion among gay, bisexual, and other men who have sex with men (gbMSM) in Australia. Transfusion 2023; 63:1528-1537. [PMID: 37300281 PMCID: PMC10953370 DOI: 10.1111/trf.17456] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Australia, men who have sex with men (MSM) are deferred from blood donation for 3 months from last sexual contact. Internationally, deferral policies for MSM are evolving in the direction of expanded inclusivity in response to community expectations. To inform future policy options, we assessed perceptions of the risk of HIV transmission from blood transfusion among Australian MSM. STUDY DESIGN AND METHODS Flux is an online prospective cohort of Australian gay and bisexual men (cis or trans, regardless of their sexual history) and other men who have had sex with men (gbMSM). We included questions on blood donation rules, window period (WP) duration, infectivity of blood from people with HIV on treatment and attitudes to more detailed questioning of sexual practices in the regular survey of Flux participants and conducted a descriptive analysis of responses. RESULTS Of 716 Flux participants in 2019, 703 responded to the blood donation questions. The mean age was 43.7 years (SD 13.6 years). Overall, 74% were willing to confidentially respond to specific sexual behavior questions, such as the last time they had sex and the type of sex they had, in order to be considered eligible to donate blood. The majority (92%) of participants correctly assessed the duration of the WP as less than 1 month. When asked whether transfusion of blood from a donor with HIV and an undetectable viral load could transmit HIV, just under half (48%) correctly said yes. CONCLUSION Our study suggests Australian gbMSM are generally comfortable with answering more detailed questions regarding sexual activity during the assessment to donate, indicating they would do so honestly. gbMSM are knowledgeable about the WP duration, important for their ability to correctly self-assess their HIV risk. However, half of participants incorrectly assessed the transmissibility by blood transfusion from an HIV positive person with an undetectable viral load, suggesting the need for a targeted education campaign.
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Affiliation(s)
- Luke Gahan
- School of Humanities and Social Sciences, La Trobe UniversityMelbourneVictoriaAustralia
| | - Clive R. Seed
- Australian Red Cross LifebloodMelbourneVictoriaAustralia
| | - Mohamed A. Hammoud
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | | | - John M. Kaldor
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
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8
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Leblanc JF, Custer B, Van de Laar T, Drews SJ, Germain M, Lewin A. HIV Pre-Exposure Prophylaxis, Blood Donor Deferral, Occult Infection, and Risk of HIV Transmission by Transfusion: A Fine Balance Between Evidence-Based Donor Selection Criteria and Transfusion Safety. Transfus Med Rev 2023; 37:150754. [PMID: 37741792 DOI: 10.1016/j.tmrv.2023.150754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/25/2023]
Abstract
Pre- and postexposure prophylaxis for human immunodeficiency virus (HIV) are key to reducing the transmission of this virus. Furthermore, low-toxicity, long-acting formulations provide additional clinical benefits, in particular easier adherence to treatment and prevention. However, breakthrough HIV infections can occur despite the use of pre-exposure prophylaxis (PrEP), mainly due to suboptimal adherence or multi-drug resistant HIV strains. Albeit rare, PrEP breakthrough infections have also been reported in fully adherent patients. Should such breakthrough infection occur in an eligible blood donor, PrEP might suppress viremia and delay antibody seroconversion, thereby masking the infection and increasing the risk of transfusion transmission. This possibility has raised concerns in the blood transfusion community but remains little documented. Therefore, a literature search was performed to assess the state of knowledge on the risk of PrEP breakthrough infection, with a particular focus on the risk of HIV entering the blood supply. Evidently, PrEP breakthrough infections are rare, although the risk is not zero. Moreover, a fraction of individuals - including blood donors - do not disclose PrEP use according to various surveys and measurements of HIV PrEP analytes. Additionally, viremia and seroconversion may remain undetectable or close to the limit of detection for a long time after cessation of PrEP, particularly with long-acting antiretrovirals. Therefore, current recommendations to defer donors for at least 3 months after the last dose of oral PrEP or 2 years for long-acting PrEP appear justified, as they safeguard the blood supply and public trust toward the system. These recommendations help to safeguard blood safety and public trust in the blood supply.
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Affiliation(s)
| | - Brian Custer
- Vitalant Research Institute, San Francisco, CA, USA; Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Thijs Van de Laar
- Sanquin Research, Department of Donor Medicine Research, Amsterdam, The Netherlands; Onze Lieve Vrouwe Gasthuis, Laboratory of Medical Microbiology, Amsterdam, The Netherlands
| | - Steven J Drews
- Microbiology, Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada; Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Marc Germain
- Hema-Québec, Medical Affairs and Innovation, Montréal and Québec, Québec, Canada
| | - Antoine Lewin
- Hema-Québec, Medical Affairs and Innovation, Montréal and Québec, Québec, Canada; Université de Sherbrooke, Faculty of Medicine and Health Sciences, Sherbrooke, Québec, Canada.
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9
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Fonner VA, Ridgeway K, van der Straten A, Lorenzetti L, Dinh N, Rodolph M, Schaefer R, Schmidt HMA, Nguyen VTT, Radebe M, Peralta H, Baggaley R. Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition. AIDS 2023; 37:957-966. [PMID: 36723489 PMCID: PMC10090368 DOI: 10.1097/qad.0000000000003494] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE HIV remains a significant burden, despite expanding HIV prevention tools. Long-acting injectable cabotegravir (CAB-LA) is a new preexposure prophylaxis (PrEP) product. We reviewed existing evidence to determine the efficacy and safety of CAB-LA as PrEP to inform global guidelines. DESIGN Systematic review and meta-analysis. METHODS We systematically reviewed electronic databases and conference abstracts for citations on CAB-LA from January 2010 to September 2021. Outcomes included HIV infection, adverse events, drug resistance, pregnancy-related adverse events, and sexual behavior. We calculated pooled effect estimates using random-effects meta-analysis and summarized other results narratively. RESULTS We identified 12 articles/abstracts representing four multisite randomized controlled trials. Study populations included cisgender men, cisgender women, and transgender women. The pooled relative risk of HIV acquisition comparing CAB-LA to oral PrEP within efficacy studies was 0.21 (95% confidence interval: 0.07-0.61), resulting in a 79% reduction in HIV risk. Rates of adverse events were similar across study groups. Of 19 HIV infections among those randomized to CAB-LA with results available, seven had integrase strand transfer inhibitor (INSTI) resistance. Data on pregnancy-related adverse events were sparse. No studies reported on sexual behavior. CONCLUSIONS CAB-LA is highly efficacious for HIV prevention with few safety concerns. CAB-LA may lead to an increased risk of INSTI resistance among those who have acute HIV infection at initiation or become infected while taking CAB-LA. However, results are limited to controlled studies; more research is needed on real-world implementation. Additional data are needed on the safety of CAB-LA during pregnancy (for mothers and infants) and among populations not included in the trials.
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Affiliation(s)
| | - Kathleen Ridgeway
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Ariane van der Straten
- ASTRA Consulting and Center for AIDS prevention Studies (CAPS), Department of Medicine, San Francisco, California, USA
| | - Lara Lorenzetti
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Nhi Dinh
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Michelle Rodolph
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Robin Schaefer
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Heather-Marie A. Schmidt
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | - Mopo Radebe
- World Health Organization, Country Office, Pretoria, South Africa
| | | | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
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10
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Yost CC, Peedin AR. LGBTQ+ inclusivity in blood donation: Sexual behavior-based screening is the first step to getting it right. Transfusion 2023; 63:441-444. [PMID: 36810773 DOI: 10.1111/trf.17290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Colin C Yost
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Alexis R Peedin
- Pathology, Anatomy, & Cell Biology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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11
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Lambert G, Cox J, Fourmigue A, Dvorakova M, Apelian H, Moodie EEM, Grace D, Skakoon-Sparling S, Moore DM, Lachowsky N, Jollimore J, Lal A, Parlette A, Hart TA. HIV incidence and related risks among gay, bisexual, and other men who have sex with men in Montreal, Toronto, and Vancouver: Informing blood donor selection criteria in Canada. Transfusion 2022; 62:2555-2567. [PMID: 36197064 PMCID: PMC10092181 DOI: 10.1111/trf.17127] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND An individualized behavior-based selection approach has potential to allow for a more equitable blood donor eligibility process. We collected biological and behavioral data from urban gay, bisexual, and other men who have sex with men (GBM) to inform the use of this approach in Canada. STUDY DESIGN AND METHODS Engage is a closed prospective cohort of sexually active GBM, aged 16+ years, recruited via respondent-driven-sampling (RDS) in Montreal, Toronto, and Vancouver, Canada. Participants completed a questionnaire on behaviors (past 6 months) and tested for HIV and sexually transmitted and blood-borne infections at each visit. Rate ratios for HIV infection and predictive values for blood donation eligibility criteria were estimated by RDS-adjusted Poisson regression. RESULTS Data on 2008 (study visits 2017-02 to 2021-08) HIV-negative participants were used. The HIV incidence rate for the three cities was 0.4|100 person-years [95%CI:0.3, 0.6]. HIV seroconversion was associated with age <30 years: adjusted rate ratio (aRR) 9.1 [95%CI:3.2, 26.2], 6-10 and >10 anal sex partners versus 1-6 aRR: 5.3 [2.1,13.5] and 8.4 [3.4, 20.9], and use of crystal methamphetamine during sex: 4.2 [1.5, 11.6]. Applying the combined selection criteria: drug injection, ≥2 anal sex partners, and a new anal sex partner, detected all participants who seroconverted (100% sensitivity, 100% negative predictive value), and would defer 63% of study participants from donating. CONCLUSION Using three screening questions regarding drug injection and sexual behaviors in the past 6 months would correctly identify potential GBM donors at high risk of having recently contracted HIV. Doing so would reduce the proportion of deferred sexually active GBM by one-third.
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Affiliation(s)
- Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Joseph Cox
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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12
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Caffrey N, Goldman M, Osmond L, Yi QL, Fan W, O'Brien SF. HIV incidence and compliance with deferral criteria over three progressively shorter time deferrals for men who have sex with men in Canada. Transfusion 2021; 62:125-134. [PMID: 34854092 DOI: 10.1111/trf.16753] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Canada, the deferral for men who have sex with men (MSM) has been progressively reduced from a permanent deferral for MSM since 1977, to 5 years, 1 year, and, most recently, 3 months. We estimated human immunodeficiency virus (HIV) residual risk and compliance with the MSM time deferral after each change. METHODS Four anonymous online compliance surveys were carried out before and after each change. HIV incidence and prevalence were monitored from 2010 to 2021. Residual risk was estimated using the incidence-window period model. RESULTS Human immunodeficiency virus prevalence, incidence, and residual risk did not change with incrementally shorter MSM deferrals. The residual risk per million donations post 3-month deferral was 0.05 (0.001-0.371). Men with temporally remote MSM history became eligible and, therefore, compliant as the deferral periods decreased (Cochran-Armitage p value = <.0001). However, the percentage of men with MSM history in the last 3 months with the indefinite deferral in place was similar to the percentage noncompliant, while the 3-month deferral was in place. MSM donors did not report high-risk behaviors for which they would otherwise be deferred in any survey. Following the change, an estimated 4467 MSM per year were eligible to donate, an increase from 2501 estimated eligible MSM donors following the change to the 1-year deferral. CONCLUSION With progressively shorter MSM deferral periods, HIV residual risk was unchanged. The proportion of male donors with deferrable MSM history remained low, while those with temporally remote MSM history became eligible, increasing the number of eligible MSM donors.
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Affiliation(s)
- Niamh Caffrey
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Mindy Goldman
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Osmond
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Qi-Long Yi
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Wenli Fan
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada
| | - Sheila F O'Brien
- Donation Policy & Studies, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, K1G 4J5, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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13
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Flössner C, Avetisyan M, Frese T. Basic knowledge among GP trainees regarding HIV pre- and post-exposition-prophylaxis. J Family Med Prim Care 2021; 10:3283-3287. [PMID: 34760745 PMCID: PMC8565146 DOI: 10.4103/jfmpc.jfmpc_414_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Preventing human immunodeficiency virus (HIV) infection is central to containing the HIV pandemic. For pre- and post-exposure prophylaxis (PrEP and PEP), drugs approved in Germany are available. Basic information on this should be obtained from physicians in further training to become specialists in General Practice (GP) since they may have to deal with this topic of high relevance for the health of patients at risk and also the physicians' health after a possible exposure in the professional context. Methodology A multiple-choice questionnaire was handed out to doctors in further training in General Practice on seminar days of the Competence Centre for General Practice Saxony-Anhalt for an immediate answer. Results Of the 109 doctors, 73 completed the questionnaire. A general high relevance of the topic HIV was stated by 95%. In contrast, 71% said it was relevant for family doctor activities. The knowledge questions on the prevalence were answered correctly for all questions with less than 40%; 21% stated that they knew the indication prerequisite for a PEP; 49% answered the question about the period of the highest efficacy of PEP correctly. PrEP as a drug option for prophylaxis is known to a part of the respondents, 79% would prescribe PrEP, 69% were in favour of a health insurance benefit. Discussion The results show that the necessary basic knowledge about HIV is partly available. Basic knowledge on structured action in the fields of HIV testing, PEP and PrEP should be taught in a manner appropriate to the relevance of the topic in the context of the German general practice setting. Even a basic knowledge about PEP may help to ensure that the general practice teams receive proper measures after a possible exposition.
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Affiliation(s)
- Christian Flössner
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
| | - Meri Avetisyan
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
| | - Thomas Frese
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
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14
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Nishiya AS, Salles NA, de Almeida-Neto C, Witkin SS, Ferreira SC, Nogueira FAH, Facincani T, Rocha V, Mendrone-Jr A. Influence of unreported HIV prophylaxis on the kinetics of post-blood donation HIV seroconversion. Transfusion 2021; 61:3488-3492. [PMID: 34617611 DOI: 10.1111/trf.16698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2020, of 110,000 blood donors screened for HIV exposure two individuals were identified who were viral RNA-positive but seronegative. One of the donors, borderline negative in a pooled screening test for HIV RNA, utilized antiretroviral drugs as post-exposure, pre-donation prophylaxis. The kinetics of subsequent HIV seropositivity in both donors are described. STUDY DESIGN AND METHODS Both donors were recalled and interviewed, and blood was obtained at intervals for HIV antibodies and RNA testing. RESULTS One donor used antiretroviral prophylaxis for 30 days due to a relationship with an HIV-positive partner. In follow-up samples, seroconversion was noted at 70 days, and viral RNA was detected at 105 days, after blood donation. In contrast, the other donor seroconverted in <25 days and the appearance and titer of HIV RNA was in accordance with the typical pre-seroconversion window. CONCLUSION The use of anti-viral prophylaxis by blood donors in the acute phase of HIV infection delays seroconversion. A 6-month deferral in blood donation after HIV prophylaxis, as currently recommended in Brazil, would have been sufficient in this case to mitigate the risk of transfusion-transmitted HIV. Ultimately, improvement in donor compliance with selection procedures for blood donation is needed to optimize blood safety.
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Affiliation(s)
- Anna S Nishiya
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Nanci A Salles
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Steven S Witkin
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Suzete C Ferreira
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Tila Facincani
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Churchill Hospital, Oxford University, Oxford, UK
| | - Alfredo Mendrone-Jr
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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15
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Harvala H, Reynolds C, Ijaz S, Maddox V, Penchala SD, Amara A, Else L, Brailsford S, Khoo S. Evidence of HIV pre-exposure or post-exposure prophylaxis (PrEP/PEP) among blood donors: a pilot study, England June 2018 to July 2019. Sex Transm Infect 2021; 98:132-135. [PMID: 33782147 PMCID: PMC8862030 DOI: 10.1136/sextrans-2021-054981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Due to increased use of pre-exposure prohylaxis (PrEP) and its potential to affect HIV screening of blood donors, we undertook antiretroviral residual testing among HIV-negative male donors in England. Methods Residual plasma samples were obtainnd from 46 male donors confirmed positive for syphilis and 96 donors who were repeat reactive for HIV antibodies in screening but confirmed as HIV-negative by reference testing. These were tested for concentrations of tenofovir and emtricitabine by high-performance liquid chromatograhpy coupled with mass spectrometry. Results We found evidence of pre-exposure or post-exposure prophylaxis (PrEP/PEP) use in three male blood donors confirmed positive for syphilis (3 out of 46 screened, 6.5%). Two were estimated to have taken PrEP/PEP within a day of donating, and the third within 2 days. Two were new donors, whereas one had donated previously but acquired syphilis infection after his last donation. Conclusions Our findings indicate that a small proportion of blood donors have not been disclosing PrEP/PEP use and therefore donating in non-compliance to donor eligibility criteria.
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Affiliation(s)
- Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK .,Infection and Immunity, University College London, London, UK
| | - Claire Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Samreen Ijaz
- National Infection Service, Public Health England, London, UK
| | - Vicki Maddox
- Microbiology Services, NHS Blood and Transplant, London, UK
| | | | - Alieu Amara
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura Else
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - Susan Brailsford
- Microbiology Services, NHS Blood and Transplant, London, UK.,NHS Blood and Transplant/Public Health England Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Saye Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
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16
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Saeed S, Goldman M, Uzicanin S, O'Brien SF. Evaluation of a pre-exposure prophylaxis (PrEP)/post-exposure prophylaxis (PEP) deferral policy among blood donors. Transfusion 2021; 61:1684-1689. [PMID: 33724472 DOI: 10.1111/trf.16349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The use of pre-/post-exposure prophylaxis (PrEP/PEP) may interfere with routine HIV screening. As a result, blood services worldwide have adopted a variety of deferral policies to mitigate increased residual risk. In this study, we evaluated the operational impact of modifying the donor health questionnaire (DHQ) to include explicit questions to assess PrEP/PEP exposure. STUDY DESIGN AND METHODS We conducted a retrospective study between June 2019 and October 2020 of all blood donors attempting to donate at Canadian Blood Services. Sixteen-months post-implementation, we summarized self-reported PrEP/PEP rates and their indications for use. We also assessed deferral rates and the sensitivity of using existing risk questions to defer people exposed to PrEP/PEP. RESULTS Of 1,122,075 donations, 89 people (eight per 100,000 donations) reported PrEP (64%)/PEP (34%) use in the last 4 months. People exposed to PrEP were more likely to be men (94%) and taking PrEP for lifestyle reasons (87%). In contrast, indications for PEP use included occupational exposure (50%) and sexual assault (27%). Most donors who answered affirmatively to PrEP/PEP exposure were deferred (96%). If potential donors were not directly asked about their PrEP/PEP use, the majority would not have been deferred for any other reasons (PrEP 32/57 (56%) and PEP 15/30 (50%)). CONCLUSION Not all blood services have adopted direct questions to identify PrEP/PEP exposure; some rely on existing DHQ questions. In Canada, despite DHQ questions such as medication use in the last 3-days, more than half of people exposed to PrEP/PEP would not have been identified and deferred.
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Affiliation(s)
- Sahar Saeed
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Samra Uzicanin
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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