Prevalence, incidence, and residual risks for transfusion‐transmitted human immunodeficiency virus Types 1 and 2 infection among Chinese blood donors

Abstract

Background There is little data on HIV prevalence, incidence or residual risks for transfusion transmitted HIV infection among Chinese blood donors. Methods Donations from five Chinese blood centers in 2008–2010 were screened using two rounds of ELISA testing for anti-HIV-1/2. A reactive result in either or both rounds led to Western Blot confirmatory testing. HIV prevalence and demographic correlates among first time donors, incidence rate and demographic correlates among repeat donors were examined. Weighted multivariable logistic regression analysis examined correlates of HIV confirmatory status among first time donors. Residual risks for transfusion transmitted HIV infection were evaluated based on incidence among repeat donors. Results Among 821,320 donations, 40% came from repeat donors.1,837 (0.34%) first time and 577 (0.17%) repeat donations screened reactive for anti-HIV-1/2, among which 1,310 and 419 were tested by Western Blot. 233 (17.7%) first time and 44 (10.5%) repeat donations were confirmed positive. Estimated prevalence was 66 infections per 100,000 (95% CI: 59–74) first time donors. Estimated incidence was 9/100,000 (95% CI: 7–12) person-years among repeat donors. Weighted multivariable logistic regression analysis indicate that first time donors 26–45 years old were 1.6–1.8 times likely to be HIV positive than those 25 years and younger. Donors with some college or above education were less likely to be HIV positive than those with middle school education, ORs ranging from 0.35 to 0.60. Minority were 1.6 times likely to be HIV positive than Han majority donors (OR: 1.6; CI: 1.2–2.1). No difference in prevalence was found between gender. Current HIV TTI residual risk was 5.4 (1.2–12.5) infections per million whole blood donations. Conclusion Despite the declining HIV epidemic China, estimated residual risks for transfusion transmitted HIV infection are still high, highlighting the potential blood safety yield of NAT implementation in donation screening.

The Estimation of Prevalence, Incidence, and Residual Risk of Transfusion-Transmitted Human Hepatitis B Infection from Blood Donated at the Anhui Blood Center, China, from 2009 to 2011

“…The medical history questionnaire comprises the screening fields mandated by the Chinese Ministry of Health [13]. Briefly, all donors must declare any history of sexually transmitted diseases or hepatitis, illegal drug use, or sex with multiple partners.…”

Blood safety and availability: continuing challenges in China's blood banking system

“…In areas with lower HIV prevalence such as Zhejiang and Gansu, HIV‐seropositive rates among voluntary unpaid donors are 0.002% to 0.003% . A recent study among 821,320 donations at five regional blood centers found HIV prevalence among voluntary donors to be 0.07% …”

“…The factors contributing to this high HCV RNA–positive rate among seronegative units could include false‐negative HCV antibody test results, false‐positive HCV RNA PCR results, and true window‐phase HCV infections. A study in five regional blood centers estimated the current HIV TTI residual risk to be 5.4 infections per million (0.00054%) whole blood donations . These findings suggest that there might be a relatively large number of TTI‐infected units that are not being detected by the current screening system at Chinese blood centers.…”

An analysis of risk factors for human immunodeficiency virus infection among Chinese blood donors

“…Ideally, the predonation health screening questionnaire should have deferred all donors who have had medical history, family history, or risk behaviors associated with infectious diseases including HIV infection. Yet, reports on the increasing serologic reactive rates for syphilis and HIV infections among Chinese blood donors have raised questions about the effectiveness of the current donor health screening questionnaire . Little is known about the major risk factors and the importance of such risk factors for HIV infection among Chinese blood donors.…”

“…We conducted a multi–blood center survey study in four HIV high‐prevalence regions to explore the primary risk factors for HIV infection in Chinese blood donors and the relative importance of these risk factors. Based on 821,320 donations collected in 2008 to 2010 and Western blot confirmatory test results of anti‐HIV‐1/2 enzyme‐linked immunosorbent assay (ELISA) screen–reactive samples, the estimated mean HIV prevalence among blood donors in these regions was 66 (range, 2‐100) per 100,000 first‐time donors and the incidence among repeat donors was 9 (range, 1‐13) per 100,000 person‐years . The specific risks we examined included illegal drug use; hetero‐ and/or homosexual behavior; transfusion history; history of previous whole blood or plasma donation; self‐ and family history of hepatitis, HIV, and other infectious diseases; and medical injections and acupuncture, as well as having tattoo or body piercing and so forth as routes of transmission for HIV.…”