Current Trends Surveillance for HIV-2 Infection in Blood Donors -- United States, 1987-1989

In collaboration with CDC, blood collection agencies are conducting ongoing surveillance for human immunodeficiency virus type 2 (HIV-2) infection among U.S. blood donors. Through December 1989, no blood donors with HIV-2 infection had been detected. This report summarizes findings of recent HIV-2 surveillance by the American Red Cross Blood Services (ARCBS) and the New York Blood Center (NYBC).

To examine the potential for HIV-2 infection in blood supplies, the ARCBS and the NYBC tested stored frozen serum (collected from January 1987 to December 1989) that had previously tested repeatedly reactive by the HIV-1 enzyme immunoassay (EIA) (serum from persons with HIV-2 infection often cross-reacts with HIV-1 EIA (1,2)). The ARCBS tested 24,826 samples (approximately 95% of all specimens at the ARCBS that tested repeatedly reactive by the HIV-1 EIA). Of these, 93% were identified from routine HIV-1 screening of approximately 18 million regular, directed (i.e., recipient specifies donor), and autologous blood donations from all ARCBS collection facilities; 7% were identified from testing of nondonor samples referred for HIV-1 confirmatory testing. The NYBC tested 3314 specimens that were repeatedly reactive by the HIV-1 EIA and indeterminate by HIV-1 Western blot. These samples were identified from approximately 2 million donations.

The ARCBS and the NYBC screened donors with the licensed Abbott* (North Chicago, Illinois) and Dupont/Biotech (Wilmington, Delaware) whole-virus lysate HIV-1 EIAs, respectively. Serum samples repeatedly reactive by HIV-1 EIA were tested with a whole-virus lysate HIV-2 EIA (Genetic Systems, Seattle, Washington) that was recently licensed by the Food and Drug Administration (FDA). Of the 24,826 ARCBS samples, 2426 (9.8%) were also repeatedly reactive by the HIV-2 EIA (Table 1). Of these, 86% were HIV-1 positive by Western blot at the time of initial donor screening. Of the 3314 NYBC samples, 48 (1.5%) had repeatedly reactive HIV-2 EIA results.

Twenty-six blinded HIV-2-positive control specimens**, 141 HIV-1 EIA-negative control specimens, and 2415 specimens from ARCBS and NYBC that tested repeatedly reactive by the HIV-2 EIA were sent to CDC for further testing with investigational HIV-1 and HIV-2 EIA peptide assays (Genetic Systems, Seattle, Washington). (An additional 59 specimens from ARCBS and NYBC had insufficient quantity of serum for further testing.) Specimens with positive HIV-2 peptide-assay results were also tested by an investigational whole-virus lysate HIV-2 Western blot (Genetic Systems, Seattle, Washington). Specimens with positive HIV-1 and HIV-2 peptide results were also tested with an HIV-1 Western blot (Dupont/Biotech, Wilmington, Delaware) at CDC.

A specimen was considered to have HIV-2 antibody if the HIV-2 Western blot result was reactive by World Health Organization criteria (3). No blood-donor specimens had HIV-2 antibody. Reported by: CT Fang, PhD, AE Williams, PhD, Jerome H Holland Laboratory, American National Red Cross, Rockville, Maryland. MCJ Rios, C Bianco, New York Blood Center, New York City. Div of HIV/AIDS, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: ARCBS accounts for greater than or equal to 50% of the blood donations in the United States (4). Sixty percent to 90% of serum samples from persons with HIV-2 infection are reactive by the Abbott whole-virus lysate HIV-1 EIA (1,2), which is used for donor screening by the ARCBS. Therefore, by testing blood donations that were repeatedly reactive by the HIV-1 EIA (approximately 0.13% of greater than 18 million), the ARCBS study would have detected greater than or equal to 60% of donations potentially containing HIV-2 antibody. However, among approximately 18 million ARCBS donations, no blood donors with HIV-2 infection were detected.

A previously reported study from San Francisco that used a similar methodology for 942 donor samples reactive by the HIV-1 EIA also failed to identify donors seropositive for HIV-2 antibody (5). Although the San Francisco study and the study reported here may have failed to detect persons with HIV-2 infection whose serum samples did not cross-react on the HIV-1 EIA, these findings suggest that from 1987 through 1989. HIV-2 infection in U.S. blood donors was extremely rare. In a previous study of 8503 blood donors randomly selected from three areas of the United States in 1988, no donors with HIV-2 infection were detected (6).

Eighteen persons with HIV-2 infection in the United States have been reported to CDC. All of the 15 for whom historical information is available had recently immigrated from West Africa, had sexual contact with West Africans, or had traveled to West Africa. One person was a volunteer blood donor (7) who was born in the United States and had traveled to West Africa; she donated blood in 1986 before the HIV-2 surveillance project began. Because she had a reactive HIV-1 EIA, her blood was not transfused.

Based on the low prevalence of HIV-2 in the United States and the failure to detect HIV-2 infections in large blood-donor surveys, routine HIV-2 donor screening with HIV-2-specific assays from 1987 through 1989 would have detected few, if any, additional donations from persons infected with HIV-2. For these reasons, the Blood Products Advisory Committee of the FDA has recommended and the FDA has determined that routine HIV-2 screening of blood and plasma donated for use in transfusion is not necessary (8). (Moreover, recent immigrants from West Africa or persons who are sexual contacts of West Africans have been requested to defer from donating blood (9).) FDA will reevaluate and update the recommendations for donor deferral and screening of blood donors for HIV-2 based on additional surveillance reports and new technologic developments, such as licensed combination tests for the detection of antibodies to both HIV-1 and HIV-2. CDC and collaborating blood collection agencies will continue surveillance for HIV-2 in U.S. blood donors and other selected populations.

References

1. George JR, Rayfield MA, Phillips S, et al. Efficacies of U.S. Food and Drug Administration-licensed HIV-1-screening enzyme immunoassays for detecting antibodies to HIV-2. AIDS 1990;4:321-6.

2. Schumacher RT, Howard J, Ayres L, Pista A, Avillez F, Garrett P. Cross-reactivity of anti-HIV-2 positive serum in U.S. FDA licensed screening tests for anti-HIV-1 (Abstract). VI International Conference on AIDS. Vol 3. San Francisco, June 20-24, 1990:245.

3. World Health Organization. Recommendations for the interpretation of HIV-2 Western blot results. Wkly Epidemiol Rec 1990;65:69-76.

4. Petersen LR, Dodd R, Dondero TJ. Methodologic approaches to surveillance of HIV infection among blood donors. Public Health Rep 1990;105:153-7.

5. Busch MP, Petersen LR, Schable C, Perkins HA. Monitoring blood donors for HIV-2 infection by testing anti-HIV-1 reactive sera. Transfusion 1990;30:184-7.

6. CDC. AIDS due to HIV-2 infection--New Jersey. MMWR 1988;37:33-5.

7. O'Brien TR, Schable CA, Polon C, et al. HIV-2 infections in the United States (Abstract). VI International Conference on AIDS. Vol 2. San Francisco, June 20-24, 1990:245.

8. Parkman PD. Use of Genetic Systems HIV-2 EIA (Memorandum to all registered blood establishments). Bethesda, Maryland: Food and Drug Administration, Center for Biologics Evaluation and Research, 1990.

9. Parkman PD. Recommendations for the prevention of human immunodeficiency virus (HIV) transmission by blood and blood products (Memorandum to all registered blood establishments). Bethesda, Maryland: Food and Drug Administration, Center for Biologics Evaluation and Research, 1990.

• Use of trade names is for identification only and does not imply endorsement by the Public Health Service, the U.S. Department of Health and Human Services, the American National Red Cross, or the New York Blood Center.

** As determined by all of the following: 1) either a nonreactive or weakly reactive HIV-1 peptide EIA, 2) a strongly reactive HIV-2 peptide EIA, 3) a reactive HIV-2 Western blot, and 4) an indeterminate HIV-1 Western blot.

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