A colleague at a blood center in the Western USA wonders how other blood centers would manage a prospective blood donor who acknowledges having had sexual contact with a deferred individual whose reason for deferral was a reactive HIV 1/2 antibody screening test followed by a negative or indeterminate Western Blot plus a negative HIV-1 NAT. Such a scenario might occur when a prospective blood donor answers the following question from the Uniform Donor History Questionnaire in the affirmative: "Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?" The inquiring colleague acknowledges that her blood center would defer any individual who has a reactive HIV 1/2 EIA, even if a followup Western Blot is negative or indeterminate and a followup HIV-1 NAT is negative. However, they would counsel such a deferred donor as NOT having had a positive test for HIV/AIDS, and they would not consider sexual partners of such an individual to be subject to deferral merely because of the sexual contact. This is based on their belief that a positive test for HIV/AIDS consists of a reactive HIV 1/2 EIA followed by a positive confirmatory Western Blot (or IFA). Using the aforementioned logic, the inquiring blood center would NOT defer a sexual partner of an individual who had a reactive HIV 1/2 antibody screening test followed by a negative or indeterminate Western Blot and a negative HIV-1 NAT. Comments agreeing with or disagreeing with the inquiring donor center's approach would be appreciated.

The following comments have been received.

ADDENDA Feb. 14, 2006

1. Susan Stramer, Ph.D., executive scientific officer, American Red Cross (attribution used with permission) reports that she would not defer a prospective blood donor merely because they have a sexual contact who tested repeat reactive by HIV 1/2 EIA, provided that confirmatory testing of the sexual contact showed neither a positive HIV-1 Western blot nor a positive HIV-1 NAT. According to Dr. Stramer, the testing scenario described by the colleague in the Western USA is not considered to be a positive test for HIV/AIDS. Not only did the antibody confirmatory test not indicate HIV infection, but there was also a non-reactive HIV-1 NAT result. Dr. Stramer reports that no documented case of HIV infection has been reported in an HIV Western Blot negative/inderminate donor who also has a negative HIV-1 NAT result, even if the NAT result was in a pooled format.

2. Dr. Louis Katz, past president of America's Blood Centers (attribution used with permission) reports that he would not defer a prospective blood donor merely because s/he had sexual contact with an individual who tested repeat reactive by HIV 1/2 EIA, provided that confirmatory testing showed neither a positive HIV-1 Western blot nor a positive HIV-1 NAT. Dr. Katz's center has a variance to use a positive HIV-1 NAT as a confirmatory test for HIV-1, in the face of a repeat reactive HIV 1/2 EIA. He reports that if the prospective donor with the aforementioned sexual contact had no other reason for deferral, and if s/he passed all mandated donor testing, he would not hesitate to use the donated blood products.

ADDENDA Feb. 15, 2006

3. Debra Kessler RN, MS, who is the Chair of the AABB Donor History Task Force and the Director of Regional Services for the New York Blood Center (attribution used with permission) reports that the AABB Donor History Task Force, in developing the Uniform Donor History Questionaire (UDHQ), agreed that the question in the UDHQ asking if the donor has "Had sexual contact with anyone who has HIV/AIDS or has had a positive test for the HIV/AIDS virus?" is NOT directed at donors described by the colleague from the Western USA, but is attempting to identify donors whose sexual contacts have CONFIRMED positive results when they are tested for HIV by Western Blot or NAT.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator