First report of human immunodeficiency virus transmission via an RNA-screened blood donation

Background and Objectives Blood banks in the USA have recently introduced minipool nucleic acid amplification testing (MP‐NAT) of blood products to reduce the transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) by transfusions. However, MP‐NAT is limited in its ability to detect preseroconversion samples with very low viral RNA loads. Materials and Methods To determine whether a red blood cell unit, from an MP‐NAT‐negative donation, transmitted HIV when transfused to a patient, we compared the viral sequences from the blood donor and recipient. The implicated donation was also tested by commercially available NAT assays at a range of dilution factors to determine whether the infectious unit could have been detected using individual‐donation NAT (ID‐NAT). Results Phylogenetic linkage of HIV sequences in the blood donor and recipient confirmed the transmission of HIV by blood transfusion, the first such case identified since introduction of MP‐NAT screening in 1999. Viral RNA was reliably detected by ID‐NAT, but only inconsistently detected by MP‐NAT. Conclusions Even following the introduction of MP‐NAT, a preseroconversion donation with a viral load of ≤ 150 copies of RNA/ml went undetected and resulted in an HIV transmission. Implementation of ID‐NAT will further reduce such rare transmissions, but at a considerable cost per infectious unit interdicted.