High rate of seromarkers for HIV, HBV and syphilis among blood donors using confidential unit exclusion, before and after HIV‐NAT implementation at a major public blood bank in the Brazilian Amazon

Abstract

BACKGROUND: Confidential unit exclusion (CUE) was introduced in the 1980's as an additional layer to blood safety, before highly specific and sensitive nucleic acid tests (NAT) for HIV were implemented. The utility of CUE-use in settings that have implemented NAT should be evaluated over time. STUDY DESIGN, METHODS: Cross-sectionalretrospective study carried out from June 2010-November 2015, at Manaus Hemocenter (HEMOAM), Amazonas, Brazil that implemented HIV-NAT in 2012. The HIV, HCV, HBV, HTLV, Chagas disease, and syphilis rates were compared among CUE and non-CUE blood donors, before and after HIV-NAT implementation. RESULTS:Among 287,588 donations, 2,154 (0.75%) were associated with CUE, mainly voluntary donations (64.2%), by repeat donors (58.4%) from young (median age = 31 years), males (84.4%), unmarried (63.1%). CUE-users compared to non-CUE donors (n = 285,434) had higher seropositivity rates to HIV (OR = 6.09, 95% CI: 3.68-10.07, p < 0.001), HBV (anti-HBc OR = 1.81 95% CI: 1.24-2.64, p = 0.004; HBsAg OR = 5.68, 95% CI: 1.78-18.07, p = 0.017), and syphilis (OR = 1.78, 95% CI: 1.05-3.04, p = 0.030). Most (97.2%) discarded blood units associated to CUE was seronegative for all pathogens. Most donations (73.4%) were tested by HIV-NAT and showed four window period donations, positive by HIV-NAT only among non-CUE donors. CONCLUSION:A high rate of transfusion transmissible infections/TTIs was observed at HEMOAM especially in CUE-users. CUE-use offered an additional layer of blood safety by its association with anti-HBc/HBsAg and syphilis that are not covered by NAT. For blood banks in highly endemic areas for HIV and TTI, as HEMOAM, the identification of at risk donors, and the orientation to be tested at proper sites remain a great challenge. W orldwide safe blood transfusions have been continuously challenged by both emerging and known transfusion transmissible infections (TTIs). Brazil, the largest and most populous country in Latin America is also the most affected by HIV/AIDS. From 1980From -2017,810 AIDS cases were reported in the country. 1 In the recent decade, the Brazilian Amazon in the North region has shown an uncontrolled AIDS epidemic with growing prevalence and mortality rates. 1 This expansion sharply contrasts with a stable epidemic with decreased prevalence and mortality in its epicenter, located in Southeast Brazil. 1 A recent 21-year historical series from a major public blood bank from Amazonas State, the Hematology and Hemotherapy Foundation of Amazonas State (HEMOAM), described a significant rate of HIV infection in young male donors, suggesting high-risk, test-seeker behavior and potential risk of HIV transmission by blood transfusion. 2 In the isolated geographic context of Amazonas state where there is a high demand for blood transfusions, the control of an expanding AIDS epidemic and the implementation of safe transfusion procedures are both challenging and represent a critical component for the public health network.From the

Hepatitis C Virus among Female Sex Workers: A Cross-Sectional Study Conducted along Rivers and Highways in the Amazon Region

“…In the Amazon region, the estimated prevalence of HCV infection ranges from 1% to 3%, with higher rates being recorded in vulnerable groups, such as PWUDs (23.1%), patients undergoing hemodialysis (8.4%), and patients with hemophilia (48.4%) [5,[20][21][22][23][24]29,36,46]. The prevalence of HCV infection detected in this study was 10.7%, and most of these infections were classified as active (7.8%).…”

Detection of human immunodeficiency virus Type 1 phylogenetic clusters with multidrug resistance mutations among 2011 to 2017 blood donors from the highly endemic Northern Brazilian Amazon

“…Previous reports from HEMOAM, a reference public blood bank in Amazonas state, Northern Brazil, showed a significant number of HIV‐1 infections in blood donors and a remarkable prevalence of Subtype B (M.E. Crispim et al, submitted for publication) . In this study we describe TDR/DRM rate and transmission clusters of drug‐resistant viruses in these HIV‐positive ARV‐naive blood donors from Northern Brazil.…”

“…Crispim et al, submitted for publication). 18,19 In this study we describe TDR/DRM rate and transmission clusters of drug-resistant viruses in these HIV-positive ARV-naive blood donors from Northern Brazil.…”

Correlation between serology and nucleic acid amplification test in blood donors who are reactive for hepatitis B virus, hepatitis C and human immunodeficiency virus and evaluation of the epidemiological profile of infected people in blood centers in the State of Paraná

“…In relation to HIV, 20 cases were detected by NAT, and in relation to HCV, 61 cases detected by NAT were reported. In a public blood bank in the Brazilian Amazon (HEMOAM), Souza et al (2019) found that most donations (73.4%) were positive for HIV–NAT, with 4 donations in the diagnostic window period.…”