Case of HIV-1 Transmission by Antigen-Positive, Antibody-Negative Blood

Abstract

Transmission of human immunodeficiency virus type 1 (HIV-1) is one of the most serious infectious complications of transfusion or transplantation. Soon after this virus was identified as the agent in the acquired immunodeficiency syndrome,¹ the American Association of Blood Banks recommended that all donated blood be tested for antibodies to human T-cell lymphotropic virus Type III, as it was then called. Seroconversion after infection was found to occur in most cases within a month or two of infection, although it sometimes took six months. However, because there were few reported instances of the transmission of HIV-1 by blood negative on screening for antibody,² identifying infected donors before seroconversion by testing for viral antigen was considered. To address this problem, two multicenter studies were carried out by Alter et al.³ and Busch et al.⁴ (Nov. 8, 1990, issue) to see whether antigen testing could prevent any of the donors from transmitting HIV-1 infection when the antibody test was negative. Over half a million donors were tested nationwide for the p24 antigen of the virus, and not one who was negative for the antibody was positive for the antigen. On the basis of this study and other data, the Food and Drug Administration recommended against routine screening of the blood supply for p24 antigen, in a memorandum issued to all registered establishments handling blood (Oct. 4, 1989).