Is Having Sex with Other Men a Risk Factor for Transfusion-Transmissible Infections in Male Blood Donors in Western Countries? A Systematic Review

Abstract

BackgroundAlthough increased prevalence of transfusion transmissible infections (TTI) among “men who have sex with men” (MSM) has been well documented, the exclusion of MSM as blood donors is contested. The aim of this systematic review is to find studies that describe the risk of TTI in MSM blood donors.MethodsWe searched MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, Cinahl, and Web of Science, and used GRADE for determining evidence quality. We included studies comparing MSM and non-MSM blood donors (or people eligible to give blood), living in areas most relevant for our Blood Service.ResultsOut of 18 987 articles, 14 observational studies were included. Two studies directly compared MSM with non-MSM donors showing that MSM donors have a statistically significant higher risk of HIV-1 infections. In one of these studies it was shown that this was related to recent (< 12 months) MSM contact. In two additional studies no evidence was shown in favour of a certain deferral period for MSM. Ten studies, applying permanent deferral for MSM, compared infected versus non-infected donors. One study found that MSM is a statistically significant risk factor for HIV-1 infection in blood donors. For other TTI such as HBV or HCV, an increased risk of infection could not be demonstrated, because the precision of the results was affected by the low numbers of donors with MSM as risk factor, or because of risk of bias in the included studies. All studies included low level evidence, because of risk of bias and imprecision of the results.ConclusionsHigh-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.

Motivations for donating and attitudes toward screening policies in US blood donors with viral infection

“…It is noteworthy that donors' opinion about screening policies might have been influenced by the level of public awareness and advocacy around the MSM deferral policy. The MSM donor deferral policy in many countries has been debated for years . Previous studies found that donors may not find DHQ questions acceptable due to misunderstanding of the risk of sexual behavior on blood safety and perception of unfair screening .…”

Blood donor deferral: time for change? An evidence-based analysis

“…Fifteen low-quality observational studies suggested a link between blood donors who were MSM and HIV-1 infection, but the evidence is too limited to recommend a precise deferral period. 31 Recently, a systematic review was performed on the risk of TTIs in blood donors who recently had an endoscopic examination, since the invasive procedure and the reusable character of an endoscope could threaten a safe blood supply. Twenty-eight observational studies (of very low quality) were included, and several meta-analyses showed an association between endoscopic examinations and hepatitis B and C infection.…”

Blood donation and/or donated blood acceptance: The different stakeholders’ ethical considerations

“…Because of this tragic history, decision makers may decide that a potential--though sometimes theoretical--risk must not be taken and that actions are determined accordingly [17]. It is sometimes difficult to decipher between an actual and a theoretical epidemiological risk where expected occurrence is extremely low: this has typically been the case for the ban from donating blood of males having or having had sexual intercourse with other men [18]. The societal dispute between blood transfusion professionals and nonprofessionals often focuses on the issues of theory (principle of precaution) vs epidemiology (actual data).…”