The efficacy of a malarial antibody enzyme immunoassay for establishing the reinstatement status of blood donors potentially exposed to malaria.

BACKGROUND AND OBJECTIVES: The two key objectives of the study were, first, to evaluate the sensitivity and specificity of a recombinant antigen-based malarial enzyme-linked immunoassay (EIA) and, second, to estimate the risk associated with implementing this test with a shortened cellular component restriction period (6 months rather than the standard 12-36 months) for blood donors with a malarial risk exposure. MATERIALS AND METHODS: Blood donors were recruited into four distinct groups [non-exposed (control), malarial area 'visitors', 'residents' and 'previous infection') and screened by using the Newmarket malarial antibody EIA. Assay specificity was evaluated in unexposed blood donors, and sensitivity was determined in acute clinical samples. RESULTS: No parasitaemic donors were detected amongst 337 malarial 'visitors' who had returned from a malaria-endemic area less than 6 months previously, or for 402 'visitors' or 'residents' who had returned from a malaria-endemic area more than 6 months previously. The incidence of malarial antibodies within the exposed blood donor groups was 1.33% (10/751). In acute clinical non-donor samples, the Newmarket EIA detected 106/108 (98.1; 93.5-99.5%) 'film' positive Plasmodium falciparum infections and 12/12 (100, 75.7-100.0%) P. vivax infections. The estimated additional risk exposure of the proposed new strategy was one infectious P. falciparum donation per 175 years or 1 per 4.2 years for P. vivax. CONCLUSIONS: The study findings support the efficacy and safety of a targeted screening strategy combining antibody screening with a 6-month cellular component restriction period for donors with a declared malarial risk.

Molecular evidence for transmission of human T-lymphotropic virus type II infection by a human bite.

Investigation of a human T-lymphotropic virus type II (HTLV-II) infection in a female Australian blood donor identified a human bite as the likely mode of transmission, confirmed by nucleotide sequencing of the proviral tax/rex from both donor and contact. We believe this to be the first report of the transmission of an HTLV by a human bite.

Subtype B isolates of human immunodeficiency virus type 1 detected in Australia.

The human immunodeficiency virus type 1 (HIV-1) can be subtyped on the basis of nucleotide sequence variability. Knowledge of circulating HIV-1 genotypes or subtypes allows understanding of the origin and spread of HIV-1 in different geographical regions, and is required for rational vaccine development. A study was undertaken to determine the predominant HIV-1 subtype in Australia. Part of the HIV-1 envelope gene (including the variable domain, V3) was sequenced directly from DNA extracted from peripheral blood mononuclear cells of 17 HIV-1 seropositive people in Sydney, Australia. Phylogenetic analysis based on nucleotide sequence suggested that all patients (including individual cases acquired in New Zealand, Papua New Guinea and Thailand) were infected with HIV-1 subtype B. Octapeptides from the HIV-1 envelope V3 loop tip indicated variation but included a predominance of the most common subtype B octapeptides HIGPGRAF (4 cases), NIGPGRAF (3 cases) and PIGPGRAF (1 case). These data suggest that subtype B is the major HIV-1 strain in Australia (and probably in New Zealand and Papua New Guinea), although the importation of HIV-1 acquired overseas is likely to lead to the detection and dissemination of other subtypes in Australia.

Apparent HIV-1 glycoprotein reactivity on western blot in uninfected blood donors.

OBJECTIVES: To investigate samples with 'false-positive' reactivity to HIV-1 glycoproteins on Western blot (WB). DESIGN: Samples from 13 blood donors with glycoprotein reactivity were examined for serological evidence of HIV infection and followed-up where possible. METHODS: Samples were tested for anti-HIV-1, HIV-1 p24 antigen, anti-HIV-2 and anti-HTLV-1. Reactivity to multimeric, monomeric, and deglycosylated gp41 was determined, as was the ability of recombinant gp160 (rgp160) to inhibit reactivity to multimeric gp41. RESULTS: Serology and follow-up failed to confirm HIV infection in any of the donors. All samples reacted to multimeric gp41, and eight out of the 13 reacted to deglycosylated gp41. Reactivity on a commercial WB was inhibited by rgp160. CONCLUSION: Apparent reactivity to HIV-1 glycoprotein may occur in individuals with no other serological evidence of HIV infection. Reactivity to different forms of gp41 and inhibition by rgp160 suggested that the observed WB reactivity may be due to cross-reactivity with gp41 rather than to a co-migrating contaminant.

Prevalence of hepatitis C virus antibodies in Sydney blood donors.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) antibodies in the Sydney blood donor population. DESIGN: All blood donations collected from Red Cross blood donors in Sydney from February 1990 until April 1991 were tested for HCV antibodies. For those samples found reactive in an anti-HCV screening test, a confirmatory test was carried out for the presence of HCV antibodies and the alanine aminotransferase level was measured. RESULTS: The prevalence of repeated reactivity to the screening test was 0.45% among blood donations overall, and 1.02% in donors giving blood for the first time in the study period. The confirmatory test result was positive for 30.8% of donations found to be repeatedly reactive in the screening test. There was little change over the study period in the HCV antibody prevalence of donors giving blood for the first time, but there was a clear decrease in the prevalence among all donations. Prevalence in males was nearly twice the prevalence in females--a difference which was consistent across age groups. The highest prevalence in both sexes was in the age group 30-34 years. Among samples for which the screening test results was positive, there was a strong correlation between the reactivity recorded for the screening test and both the proportion found positive by the confirmatory test and the proportion with an elevated alanine aminotransferase level. CONCLUSION: The small proportion of blood donations found to be repeatedly reactive by anti-HCV screening and the relatively good correlation with the confirmatory test and liver function assay indicate that a policy of discarding these donations will decrease the risk of transfusion-transmitted HCV infection without materially affecting the supply of blood.

Risk factors for hepatitis C virus infection in blood donors: a case-control study.

OBJECTIVE: To investigate risk factors for hepatitis C virus (HCV) infection in Sydney blood donors. DESIGN: Blood donors confirmed to be positive for HCV antibodies were compared with blood donors with a positive result of a screening assay, but whose HCV antibody status had not been confirmed. A questionnaire on sexual, parenteral and other potential risk factors was administered to both groups. SETTING: Blood Transfusion Service in Sydney. PARTICIPANTS: The study enrolled 220 donors who had confirmed HCV infection, and 210 donors who did not. RESULTS: The relative risk associated with injecting drug use was 63 (95% confidence interval, 19-260) when comparison was made with all other donors. Among donors who did not report injecting drug use, a significant, independent increase in risk was found in association with having had a tattoo. Among donors who did not give a history of parenteral exposure, there was a significantly greater risk in people with more than one life-time sexual partner than in those with at most one partner. CONCLUSION: A history of injecting drug use was elicited as the most important risk factor in Sydney blood donors with antibodies to hepatitis C. Having had a tattoo, and an increased number of lifetime sexual partners were also independently associated with HCV infection.

HIV-1 western blot: development and assessment of testing to resolve indeterminate reactivity.

OBJECTIVE: To reduce the number of HIV-1 Western blot (WB)-indeterminates requiring follow-up and the time taken to provide a clear positive or negative result. DESIGN: In the first of two stages, a testing and follow-up strategy was developed to resolve anti-HIV-1 status of WB-indeterminates. In the second stage, implementation of this strategy was assessed. METHODS: After dividing indeterminates into four groups according to WB profile, samples were tested for anti-HIV-1, anti-HIV-2, anti-HTLV-I antibodies, and HIV-1 antigen using the most sensitive assays available. When testing failed to clarify anti-HIV-1 status, follow-up samples were taken to monitor changes in antibody status. RESULTS: Samples in two out of the four indeterminate groups were negative for anti-HIV-1. The other two groups required additional testing and/or follow-up to distinguish reactivity caused by anti-HIV-1 from cross-reactivity. CONCLUSION: Grouping HIV-1 WB-indeterminates according to profile allows a significant percentage to be reported as anti-HIV-1-negative, while additional testing may allow others to be reported as anti-HIV-1-positive. The remainder require a maximum of 3 months' follow-up to resolve anti-HIV-1 status.