Concerns Arise Over Blood Donated by People on Antiretrovirals

[Jim Allen]

  I had to read this three times...

https://www.poz.com/article/concerns-arise-blood-donated-people-antiretrovirals

Given that a small number of people donating blood in the United States are taking antiretrovirals (ARVs), researchers have expressed concern that such medication use, whether as HIV treatment or pre-exposure prophylaxis (PrEP), could mask the presence of HIV and allow the virus into the blood supply, Healio reports.

Publishing their findings in the journal Blood, Custer and his colleagues conducted blind testing for ARVs in blood donation samples drawn from a group of individuals identified as having HIV through routine blood-donation screening and another group of donors who tested negative for the virus through screening. The researchers also screened samples from the blood donations of HIV-negative men 18 to 45 years old who gave blood at six U.S. locations, testing for the presence of the two components of Truvada (tenofovir disoproxil fumarate/emtricitabine), the first drug approved for use as PrEP.

Among the 300 samples from HIV-negative people that were tested for the presence of ARVs, no such medications were detected. However, 46 (15%) of the samples from the HIV-positive individuals showed evidence of ARVs. Of those samples, 94% came from people who were donating blood for the first time, and 74% were from men.

Custer and his colleagues are concerned that if blood donations come from people with HIV who are taking ARVs or people who have recently taken PrEP and yet contracted the virus, the ARVs in their bloodstream could suppress the virus such that the HIV testing used to screen the blood supply could fail to detect the virus’s presence. Furthermore, it remains at least theoretically possible that such a blood donation could transmit the virus to its recipient.

“Persons who are HIV positive and taking [ARV treatment] and persons taking PrEP to prevent HIV infection are donating blood,” the study authors concluded. “Both situations could lead to increased risk of HIV transfusion transmission if blood screening assays are unable to detect HIV in donations from infected donors.”

https://ashpublications.org/blood/article-abstract/doi/10.1182/blood.2020006890/461293/HIV-antiretroviral-therapy-and-prevention-use-in

Objectives: Three different ART/PrEP prevalence analyses in blood donors were conducted.

Methods: First, blood samples from HIV-positive and a comparison group of infection-nonreactive donors were tested under blind using liquid chromatography-tandem mass spectrometry for ART.

Second, blood donor samples from infection-nonreactive, 18-45 year-old, male, first-time blood donors in six US locations were tested for emtricitabine and tenofovir.

Third, in men who have sex with men (MSM) participating in the 2017 CDC National HIV Behavioral Surveillance (NHBS) from five US cities self-reported PrEP use proximate to donation was assessed.

Findings: In blind testing, no ART was detected in 300 infection-nonreactive donor samples, but in 299 HIV-confirmed infected donor samples, 46 (15.4%, 95% CI 11.5 - 20.0%) had evidence of ART. Of the 1,494 samples tested from first-time, male donors, 9 (0.6%, 95% CI 0.03 - 1.1%) had tenofovir and emtricitabine.

In the NHBS MSM survey, 27 of 591 respondents (4.8%, 95% CI 3.2 - 6.9%) reported donating blood in 2016 or 2017 and PrEP use within the same time frame as blood donation.

Conclusions: Persons who are HIV-positive and taking ART and persons taking PrEP to prevent HIV infection are donating blood.