Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States
Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States
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DOI：
10.1056/nejm199512283332601
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发表时间：
1995-12-28
影响因子：
158.5
通讯作者：
Petersen, LR
中科院分区：
文献类型：
--
作者：
Lackritz, EM;Satten, GA;Petersen, LR
背景。在美国，人类免疫缺陷病毒 (HIV) 通过输血传播几乎完全发生在最近感染的献血者具有传染性但在 HIV 抗体可检测到之前（在“窗口期”期间）。我们根据与使用当前灵敏的酶免疫吸附测定相关的窗口期以及献血者中艾滋病毒发病率的最新数据，估计了输血引起的艾滋病毒传播风险。方法。我们分析了 1992 年和 1993 年在美国国家红十字会服务的 19 个地区获得的超过 410 万份献血的人口和实验室数据，以及在另外 23 个地区获得的 490 万份献血的 HIV 抗体检测结果。我们估计，在 19 个研究地区，每 360,000 人中有 1 人在窗口期内进行了捐赠（95% 置信区间，210,000 至 1,140,000）。此外，据估计，每 2,600,000 份捐赠中有 1 份呈 HIV 血清阳性，但由于实验室错误而未被识别。我们估计，15% 至 42% 的窗口期捐赠被丢弃，因为它们在 HIV 抗体检测以外的实验室检测中呈血清阳性。当将这些结果推算到另外 23 个红十字会服务区域时，每 450,000 至 660,000 次筛查血液献血就有 1 例 HIV 传播风险。如果假设红十字中心代表美国所有血液中心，那么在每年全国收集的 1200 万份献血中，估计有 18 至 27 份感染性献血可用于输血。 结论 通过输注经过筛查的血液传播 HIV 的估计风险非常小，几乎是之前估计的一半，这主要是因为酶免疫吸附测定的灵敏度得到了提高。
Background. In the United States, transmission of the human immunodeficiency virus (HIV) by blood transfusion occurs almost exclusively when a recently infected blood donor is infectious but before antibodies to HIV become detectable (during the ''window period''). We estimated the risk of HIV transmission caused by transfusion on the basis of the window period associated with the use of current, sensitive enzyme immunosorbent assays and recent data on HIV incidence among blood donors.Methods. We analyzed demographic and laboratory data on more than 4.1 million blood donations obtained in 1992 and 1993 in 19 regions served by the American National Red Cross, as well as the results of HIV-antibody tests of 4.9 million donations obtained in an additional 23 regions.Results. We estimated that, in the 19 study regions, 1 donation in every 360,000 (95 percent confidence interval, 210,000 to 1,140,000) was made during the window period. In addition, it is estimated that 1 in 2,600,000 donations was HIV-seropositive but was not identified as such because of an error in the laboratory. We estimated that 15 to 42 percent of window-period donations were discarded because they were seropositive on laboratory tests other than the HIV-antibody test. When these results were extrapolated to include the additional 23 Red Cross service regions, there was a risk of 1 case of HIV transmission for every 450,000 to 660,000 donations of screened blood. If the Red Cross centers are assumed to be representative of all U.S. blood centers, among the 12 million donations collected nationally each year an estimated 18 to 27 infectious donations are available for transfusion.Conclusions The estimated risk of transmitting HIV by the transfusion of screened blood is very small and nearly half that estimated previously, primarily because the sensitivity of enzyme immunosorbent assays has been improved.