The Natural History of Transfusion-Associated Infection with Human Immunodeficiency Virus

Abstract

Patients infected by the human immunodeficiency virus (HIV) as a result of blood transfusions are unique in that their dates of infection are well defined and their medical conditions before infection are known. To characterize the natural history of transfusion-associated HIV infection, we studied 694 recipients of blood from 112 donors in whom AIDS later developed and from 31 donors later found to be positive for HIV antibody. Of the recipients tested, 85 were seronegative, 116 were seropositive, and 19 had AIDS. Of 101 HIV-seropositive recipients followed for a median of 55 months after infection, 54 had Centers for Disease Control Class IV disease, including 43 with AIDS. Life-table analysis suggested that AIDS will develop in 49 percent of infected recipients (95 percent confidence limits, 36 to 62 percent) within seven years after infection. As compared with recipients without AIDS, the 43 recipients with AIDS had received more transfusions at the time of infection (median, 21 vs. 7; P = 0.01). HIV-infected blood donors in whom AIDS developed were grouped according to whether AIDS developed within 29 months (the median) after donation (Group 1) or 29 or more months after donation (Group 2). As compared with the 31 recipients of blood from Group 2 blood donors, the 31 recipients of blood from Group 1 donors were more likely to have AIDS four years after infection (49 percent vs. 4 percent; P = 0.005) and illnesses resembling acute retroviral syndrome (14 of 24 vs. 5 of 22; P = 0.03). We conclude that most recipients of HIV-infected blood become seropositive, that AIDS develops in about half these recipients within seven years, and that the risk may be higher when AIDS develops in the blood donor soon after donation.

Pathogenesis of Human Immunodeficiency Virus Infection

“…In one study, the chance of infection was reported to rise substantially if the donor developed AIDS in 2 to 3 years after donation (913). Other studies have shown that individuals receiving blood from donors who subsequently develop AIDS within 29 months have a greater chance of progressing to disease than those recipients of infected blood from donors who become symptomatic after this period (1249). This latter finding could reflect the amount of virus present and/or the biologic properties of the virus in the donated blood (e.g., more virulent) (see Sections IV A and XVI D).…”

Lack of infection in HIV-exposed individuals is associated with a strong CD8+cell noncytotoxic anti-HIV response

“…The relative risk of infection by HIV correlates directly with the number of exposures to the virus (1,2). However, within any exposed uninfected (EU) population, some individuals remain uninfected despite multiple unprotected encounters with HIV-infected partners.…”

The UK Register of HIV Seroconverters: methods and analytical issues

“…It is likely that new advances in the management of individuals with HIV infection will influence these distributions. Further, changes in the incubation period distribution could occur even in the absence of changes in available treatments and treatment uptake, due to the evolving distributions of new viral strains in HIV-infected persons [3,4]. It is therefore important to monitor whether there are changes in the incubation period distribution and, if so, the extent of those changes and factors associated with them.…”