Background Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi–infected persons. Methods and Results We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi–seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of São Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S3 heart sound. Conclusions There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi–seropositive blood donors, although disease was mild at diagnosis.

During a large epidemic of DENV-4 infection in Brazil, >0.5% of donations were RNA positive, and approximately one third of components resulted in TT. However, no significant clinical differences were evident between RNA-positive and RNA-negative recipients.

We did not detect a difference in the proportion of test seekers across different types of blood donors; however, we did detect an association between HSV-2 infection and test seeking, especially among community-recruited lapsed blood donors. Of note, questions on test-seeking behaviour detected donors with increased prevalence of HSV-2, but the self-reported sexual risk behaviours currently used for deferral criteria did not. Incentives to get tested at sites other than blood banks may decrease the residual risk of HIV in the blood supply.

Background In Brazil nationally representative donor data are limited on HIV prevalence, incidence and residual transfusion risk. The objective of this study was to analyze HIV data obtained over 24 months by the REDS-II program in Brazil. Methods Donations reactive to 3rd and 4th generation immunoassays (IAs) were further confirmed by a less-sensitive (LS) IA algorithm and Western blot (WB). Incidence was calculated for first-time (FT) donors using the LS-EIA results and for repeat donors with a model developed to include all donors with a previous negative donation. Residual risk was projected by multiplying composite FT/repeat donor incidence rates by HIV marker-negative infectious window periods. Results HIV prevalence among FT donors was 92.2/105 donations. FT, repeat donor and composite incidence were 38.5 (95%CI: 25.6–51.4), 22.5 (95%CI: 17.6–28.0) and 27.5 (95%CI: 22.0–33.0) per 100,000 person-years, respectively. Male and community donors had higher prevalence and incidence rates than female and replacement donors. Estimated residual risk of HIV transfusion-transmission was 11.3 per 106 donations (95%CI: 8.4–14.2), which could be reduced to 4.2 per 106 donations (95%CI: 3.2–5.2) by use of individual donation nucleic acid testing (NAT). Conclusion Incidence and residual transfusion risk of HIV infection are relatively high in Brazil. Implementation of NAT testing will not be sufficient to decrease transmission rates to levels seen in the US or Europe, therefore other measures focused on decreasing donations by at-risk individuals are also necessary.

HIV incidence and residual transfusion risk estimates are approximately 10 times higher in Brazil FT donors compared to US and European FT donors. Community FT donors had higher HIV prevalence than replacement FT donors. The yield of p24 antigen or RNA screening will be low in Brazilian donors, but substantially higher than in US donors.

BACKGROUND-The profile of blood donors changed dramatically in Brazil over the past 20 years, from remunerated to non-remunerated and then from replacement to community donors. Donor demographic data from three major blood centers establish current donation profiles in Brazil, serving as baseline for future analyses and tracking longitudinal changes in donor characteristics.

Recruiting safe, volunteer blood donors requires understanding motivations for donating and knowledge and attitudes about HIV. We surveyed 1,600 persons presenting for blood donation at a large blood bank in São Paulo, Brazil using a self-administered, structured questionnaire, and classified motivations into three domains as well as categorizing persons by HIV test-seeking behavior. Motivations, in descending order, and their significant associations were: "altruism": female gender, volunteer donor and repeat donor status; "direct appeal": female gender, repeat donor status and age 21-50 years; "self-interest": male gender, age under 20 years, first-time donor status and lower education. HIV test-seekers were more likely to give incorrect answers regarding HIV risk behavior and blood donation and the ability of antibody testing to detect recent HIV infections. Altruism is the main motivator for blood donation in Brazil; other motivators were associated with specific demographic subgroups. HIV test-seeking might be reduced by educational interventions.

Background-Persons with HIV risk behaviors are excluded from donation to reduce the risk of transfusion-transmitted infection. Persons donating in order to be tested for HIV may therefore deny risk behaviors.