Transmission via Blood Transfusions or Transplantation

“In June 2006, a 77-year-old Japanese man with an acute asthma attack was admitted to our hospital in Yokohama, Japan. A pre-admission HIV screening test by enzyme immunoassay unexpectedly detected his HIV seropositivity…strong seroreactivity to HIV-2, but not to HIV-1 [and further tests confirmed this]…He had no history of engaging in high risk sexual contact and substance abuse in the past. Both his spouse (72 years old) and their son (34 years old) were HIV-negative. He, however, had a near-fetal[sic] motor accident in Senegal in June 1971…he received a large unit of blood from a number of volunteer Senegalian donors. He has never been transfused with blood products except on that occasion…After 8 days, he was discharged from hospital…His CD4 cell count was 827 cells/µL…He continues to be [a] long-term nonprogressor”

“41 adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. 13 additional adults developed AIDS after receiving tissue, organs, or artificial insemination from HIV-infected donors. Four of the 13 received tissue, organs, or artificial insemination from a donor who was negative for HIV antibody at the time of donation.”

“In June 1997, whole blood was collected from a repeat blood donor at the Singapore Blood Transfusion Service, Singapore, after the donor denied having any HIV-related risk factors. At that time, serum from the donor tested negative for both HIV antibodies and p24 antigen. When returning in October 1997, the donor was found to be HIV antibody positive. Two recipients of platelets and red blood cells derived from the June 1997 donation also tested positive for HIV…The 2 commercial quantitative RNA assays failed to detect HIV RNA during the window period [the time after infection in which antibodies are already believed not to be present]”

“The softening additive [DEHP, used in blood bags] is a cancer-causing agent linked to heart, lung, liver, testicle and kidney damage”

“…newly updated filters…virtually eliminate those white cells from donated blood will help end side-effects that tend to suppress the immune system. They include severe fever and chills, serious post-surgery infections, recurrence of cancer and unsuccessful bone marrow transplants [indicating that ill effects can occur from blood transfusions, whether HIV-infected or not]”

“66 recipients [of HIV-positive blood] were traced of whom 40 have developed AIDS. In 1988 a campaign to find transfusion-related AIDS cases was initiated and 7000 recipients were tested of whom 10 have developed AIDS…[However] The 66 traced recipients received a total of 1435 units (half of which was received by 5 people) [an average of 144 units for 5 people and 12 units for the other 61]…using a published estimate of 5.4 units per transfusion [we can see that the people who developed AIDS had more blood transfused on average than people who remained HIV-negative]…The statistically significant link between the HIV antibody-positive status of the donor and the development of AIDS in transfusion recipients who received HIV-positive blood product, therefore, supports the contention that HIV causes AIDS [but it also supports the contention that it is the quantity of blood transfused that is the problem, not the HIV antibody status of the donor]”

“we identified a group of 6 subjects who had been infected [with HIV] through a single common [blood] donor...Throughout follow-up (range 6.8-10.1 years after infection), 5 of the recipients and the donor...remained clinically free of symptoms, with normal CD4 cell counts and no p24 antigenaemia. HIV-1 was isolated [via culture, which is not really isolation] from only 1 recipient...1 infected recipient (who had received extensive immunosuppressive treatment for systemic lupus erythematosus) developed Pneumocystis carinii pneumonia and died [i.e. of an AIDS-like disease, but probably not caused by HIV]”

“During follow-up of subjects with transfusion-acquired HIV-1 infection in New South Wales, Australia, we identified a group of 6 subjects who had been infected through a single common donor…Throughout follow-up (range 6.8-10.1 years after infection, 5 of the recipients and the donor (last follow-up 10.2 years after infection of the first recipient) remained clinically free of symptoms, with normal CD4 cell counts and no p24 antigenaemia [i.e. undetectable p24 antigen]…1 infected recipient (who had received extensive immunsuppressive treatment for systemic lupus erthematosus) developed Pneumocystis carinii pneumonia and died…The donor…has never received antiretroviral therapy, nor any prophylactic treatment for Pneumocystis carinii pneumonia…Recipients A-E had no signs or symptoms of HIV-1 disease during follow-up of 6.8 to 10.1 years…No recipient has been given antiretroviral therapy or prophylaxis against P carinii pneumonia.”

“158 patients with AIDS…had purportedly acquired their infections from blood that was negative on screening for HIV [in the US after March, 1985]…Of the 97 patients with completed follow-up…9 had received blood from donors later found to be negative for HIV antibody [but had no other risk factor for HIV infection]…7 of the 15 patients [who received HIV-positive blood and had no other risk factors or pre-March 1985 transfusions]…received their infecting transfusion in (usually small) cities with a low incidence of AIDS…the risk of HIV infection from screened blood may not be directly proportional to the prevalence of AIDS in a geographic area.”

“We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies [this is just an assumption, as antibodies were never detected in this man]. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative…HIV-1 was detected in cultured lymphocytes from the donor”

“Of the 35 (7%) seropositive donors who initially reported receiving a blood transfusion in the US after 1977 [out of almost four million donations tested], 14 did not report another HIV-1 risk. Of these…5 had never actually received a transfusion according to medical record review, 2 had received transfusions only from donors who are [as of 1991] currently seronegative, 1 was unlikely to have been infected via transfusion because he tested seronegative more than 3 years after the transfusion and subsequently seroconverted (the serologic status of the transfusion donor is unknown) [and 3 others could not be investigated]”

“The survival pattern of case [transfused with HIV+ blood] and control [transfused with HIV- blood] was significantly different. Cumulative mortality was higher among case patients than controls from the first month after transfusion (24% versus 11%) and reached 47% and 16%, respectively, at month 12 [but, of the 39 transfused with HIV+ blood who died within a year, 27 died of the initial illness, 6 from unknown causes, 2 from septicemia, 1 from measles, 1 from malaria and only 2 from AIDS!”]

“Of the 694 recipients [of blood suspected of being HIV infected] 331 (48%) had died within one year of transfusion...Of the 233 recipients [with stronger evidence that the blood was HIV+] 95 (41 percent) had died within the first year after transfusion. By comparison 73 of 146 recipients of components from a random selection of donors not known to be infected with HIV (50%) died in the year after transfusion...the recipients with AIDS had received significantly more units of blood at the time of infection than the recipients without AIDS (median, 21 vs. 7 components; P=0.01). In addition, the recipients with AIDS appeared to be more severely ill when analyzed according to the total days of hospitalization (median, 19 vs 13) or according to admission to an intensive care unit (64 percent vs. 46 percent), although these differences were not statistically significant...In our study...HIV infection had no apparent effect on the one-year mortality rate after transfusion”

“We note that many cases of TA-AIDS [Transfusion Associated AIDS] are unconfirmed in that less than 5% of the patients have been determined to have received blood from a donor who was later found to be HIV positive or in a high-risk category [which still would not prove that they were actually HIV-infected at the time of donation]”

“We thus obtain a point estimate for…the eventual number of TA[Tranfusion Associated]-AIDS cases due to infections up to June 1985, of about 15,000…That figure is broadly in line with point estimates obtained…by Medley et al, who gave figures of 6,371 and 13,796…Peterman et al, using a different approach based on estimates of the prevalence of HIV-infected blood in blood donations up to 1984, estimated the number of TA-HIV infections between 1978 and 1984 in surviving persons aged 13 to 65 to be 12,000 [The actual number, according to the CDC, for all US cases to the end of 2001, was 9,125]”

“We describe a patient with acute leukemia in whom both antibodies against HLA-DR4 and a false-positive HIV ELISA transiently occurred while he was receiving red-cell and platelet transfusions.”

“The person who seroconverted to HIV-1 was a 63-year-old man who reported no potential exposures to the virus other than the receipt of screened [HIV-negative] blood…He had no previous or interim transfusions…His postoperative blood sample was repeatedly positive for antibody to HIV-1 on ELISA and was confirmed as positive by Western blotting and RIPA [pre-operative sample was negative]…A male donor was identified whose seropositivity was confiirmed by Western blotting more than 16 months after his donation [one of 32 donors]…Attempts to isolate the virus from his serum were unsuccessful, precluding comparison of viral isolates from the donor and the recipient.”

“4 patients [recipients of transplants or transfusions that may have been HIV-positive] had illnesses that fulfilled the CDC criteria for AIDS. In 2 cases the only AIDS-like illness was pneumocystis pneumonia [PCP], a not-infrequent complication in organ transplant recipients without HIV-1 infection. Another patient developed pneumocystis pneumonia and miliary tuberculosis, but both illnesses occurred before seroconversion to HIV-1. Conversely, several patients in this series had invasive candidiasis or severe bacterial infections but were not judged to have an AIDS-like illness, as these infections are common in transplant recipients [because of immune suppression due to drugs (e.g. cyclosporin) and blood transfusions]. Notably absent in the series are cases of Kaposi’s sarcoma, cryptosporidiosis, and disseminated Mycobacterium-avium-intracellulare infection, which are rare in transplant recipients but common in patients with AIDS [in other words, transplant recipients exposed to HIV had diseases more similar to other transplant recipients than to standard ‘AIDS’]”

“A review of the HLA-compatible cases [of bone-marrow grafts] in 1984 showed that of 93 multiply transfused patients, 46% were still alive, whereas of 43 patients who had not had transfusions, 81% were still alive...[by contrast] of the 93 [kidney transplant] patients who had never received a transfusion or who had only received frozen blood, 28% had a one-year survival. Of the 197 transfused patients, the survival rate was 53% [indicating that the immune suppressive impacts of blood transfusions help avoid organ rejection]...natural killer activity was markedly depressed in patients who had received multiple transfusions...in chronically transfused recipients of plasma products, abnormalities in white blood cells and platelets were apparent regardless of the presence of the HIV antibody”

“As of December 7, 1987, 1171 transfusion-associated cases of AIDS had been reported to the Centers for Disease Control; reportedly, 12 persons had received only blood screened as negative for HIV antibody…7 of these recipients were found to have other risk factors for HIV infection [although no evidence was given that the potential source of infection was actually HIV-positive]…The remaining 5 recipients reported no risk factors for HIV infection other than transfusion, but the donors to 4 of these were retested and found to be negative for HIV antibody 10 months or more after donation.”

“As of December 7, 1987, 1171 transfusion-associated cases of AIDS had been reported to the [CDC]; reportedly, 12 persons had received only blood screened as negative for HIV antibody. On subsequent investigation, 7 of these recipients were found to have other risk factors for HIV infection…The remaining 5 recipients reported no risk factors for HIV infection other than transfusion, but the donors to four of these were retested and found to be negative for HIV antibody 10 months or more after donation.”

“Of the 4911 consecutive patients [attending a Baltimore city clinic for sexually transmitted diseases] from whom serum was obtained, 256 (5.2%) were seropositive for HIV…[among men] No significant association was found between HIV-antibody status and a history of blood transfusions since 1978, sex with a prostitute, or the number of sexual partners in the previous month…Among the 1310 female patients studied, no significant associations were found with blood transfusion since 1978 or with a history of syphilis, gonorrheam, hepatitis or genital herpes.”

“post-transfusion hepatitis was diagnosed in 7.7% of all blood recipients and that 87% of the hepatitis was classified as non-A, non-B [Hepatitis C]. However, hepatitis B was the etiologic agent in 10% of cases, although only HBsAg-negative blood had been transfused. Other studies have documented a similar incidence of both non-A, non-B hepatitis and of hepatitis B after transfusion with HBsAg-negative blood...Hepatitis was diagnosed when, between 2 and 26 weeks after transfusion, the alanine aminotransferase level exceeded 2-1/2 times the upper limit of normal and when a repeat sample one week later had a level at least twice normal. In that study, as in almost all others, the diagnosis of hepatitis was based only on the finding of biochemical abnormalities... “hepatitis” developed in 2.4% to 5.1% of control patients who had not received a transfusion but were followed in the same way...Note the striking different between the proportion of cases actually reported (0.07%) and the 100-fold higher incidence when, as in the transfusion-transmitted viruses study, recipients with abnormal results on liver-function tests were sought in an epidemiologic investigation”

“blood down to a volume of 1 microliter was a potent immunogen [causing an immune response] and that heating the blood to 45¡C did not affect the immunogenicity…The antibody response to lymph node cells fell away between 0.1 and 0.05 million cells. The smallest volume of blood used, 1 microliter…would not be expected to be immunogenic…a likely possibility is that the red cells in both the 45¡C heated blood and spleen cell preparations were the immunogenic component.”

“Our description of 18 adults without other risk factors in whom AIDS developed after transfusion indicates that other blood components may transmit AIDS. Furthermore, the seven completed donor investigations provide circumstantial evidence that exposure to as little as one unit may result in transmission. The failure to identify definite cases of AIDS or even severe symptoms among the affected donors examined suggests that affected donors with only mild or inapparent illness account for the majority of cases of transfusion-associated AIDS”