Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
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The Wall Street Journal - December 28 1995
Jerry E. Bishop, Staff Reporter of The Wall Street Journal
The probability of AIDS being transmitted by blood transfusions is dropping so low that public health officials may have to consider whether the benefit of adding new tests for the virus is worth the cost, the researchers said.
The estimates, specifically, are that one out of every 450,000 to 660,000 blood donations may be HIV-contaminated and may get through the blood-screening tests undetected.
These odds are markedly lower than previous estimates that one out of every 153,000 to 225,000 blood donations is contaminated with the AIDS-causing virus and manages to slip past screening tests into the blood supply for transfusions.
Since a patient who receives a blood transfusion gets blood or blood components from an average of 5.4 donors, the chances of getting infected blood are one in 83,000 to one in 122,000, the researchers calculated. However, 25% to 50% of people receiving blood transfusions die within a year of their underlying medical conditions and before they could develop AIDS.
The new estimates, published in this week's New England Journal of Medicine, are based on records of more than four million donations made at American Red Cross centers during 1992 and 1993. The centers in the study accounted for 43% of the donations made to the Red Cross. The Red Cross, in turn, accounts for about half of the 12 million blood donations made annually in the U.S.
The difference between the old and new estimates stems, in large part, from new views on how long an HIV infection is undetectable in the blood stream after the initial infection. Previously, researchers had believed people may not produce detectable antibodies for an average of 45 to 56 days after first being infected. Improved tests for HIV infections indicate this "window" of undetectable infection has been reduced to an average of 25 days.
As a result, only one of every 360,000 donations comes from an infected donor who is in the "window" of undetectable infection, reported Eve M. Lackritz of the federal Centers for Disease Control and Prevention in Atlanta, and her colleagues at the center and at the American National Red Cross laboratories in Rockville, Md.
In addition, the number of HIV-infected people making blood donations appears to be declining as blood banks question donors more carefully and exclude blood that tests positive in the laboratory. Chances that a contaminated unit of blood might slip by because of a laboratory error are only one in 2.6 million, the researchers calculated.
Blood from many HIV-infected patients who still may be in the undetectable stage also is being excluded from the banks because it tests positive for other diseases, such as hepatitis, they noted.
In total, they estimated, of the 12 million units of blood donated each year only 18 to 27 are infectious for HIV. A test for the virus, called the p24 antigen test, might pick up four to six of these infected units, Dr. Lackritz and her colleagues calculated, a benefit so small it raises cost-benefit questions.
"Implementing new techniques [of blood screening] will require consideration of the cost of testing 12 million donations a year, will raise the issue of counseling and excluding donors who have false positive test results, and may attract high-risk donors who seek testing by a more sensitive test than is routinely offered," the researchers cautioned.
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