Global Journal of Transfusion Medicine

SPECIAL COMMUNICATION
Year
: 2022  |  Volume : 7  |  Issue : 1  |  Page : 80--81

U is dissimilar to u for human immunodeficiency virus transmission through the infected whole blood unit


Manish Raturi1, Reshma Nambiyar2, Mansi Kala2, Naveen Bansal3,  
1 Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
2 Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
3 Department of Transfusion Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India

Correspondence Address:
Dr. Manish Raturi
Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun
India

Abstract

It is a known fact that antiretroviral treatment (ART) is highly efficacious in reducing the sexual transmission of human immunodeficiency virus (HIV). In addition, it is clear now that those infected and living with HIV and having an undetectable viral load below 200 copies per mL, measured 4 to 6 monthwise, do not transmit it sexually to their partners. Therefore, U = U (Undetectable = Untransmittable; where symbol = means similar to) campaign is the message of a new UNAIDS explainer. The authors herein report the blood donation made by an HIV-I positive Indian male under the existing policy of confidential unit exclusion at their blood center. It was alarming because he was driven by an incorrect belief that being in a state of sexual nontransmissibility, due to the regular intake of ART, his donated blood was safe and suitable for blood transfusion too. He firmly believed that the ART he was receiving was highly efficacious in reducing the transmission of HIV through sexual intercourse and misconstrued the same for blood transfusion. After a thorough consultation and discussion with the transfusion medicine specialist, the individual could understand that U = U certainly, does not ascribe to the blood transfusion-related transmission due to a bigger inoculum and the intravenous route of administration.



How to cite this article:
Raturi M, Nambiyar R, Kala M, Bansal N. U is dissimilar to u for human immunodeficiency virus transmission through the infected whole blood unit.Glob J Transfus Med 2022;7:80-81


How to cite this URL:
Raturi M, Nambiyar R, Kala M, Bansal N. U is dissimilar to u for human immunodeficiency virus transmission through the infected whole blood unit. Glob J Transfus Med [serial online] 2022 [cited 2022 Aug 10 ];7:80-81
Available from: https://www.gjtmonline.com/text.asp?2022/7/1/80/344325


Full Text



 Introduction



Undetectable (U) = (similar) to Untransmittable (U) campaign is the message of a new UNAIDS explainer.[1] With around 20 years of evidence suggesting that the antiretroviral treatment (ART) is highly efficacious in reducing the transmission of human immunodeficiency virus (HIV), it is now clear that those infected and living with HIV and having an undetectable viral load (that is below 200 copies per mL) measured 4 to 6 monthwise, do not transmit it sexually to their partners. U = U is now a global campaign endorsed by almost 760 organizations in nearly a hundred countries including, Australia.[2] Indian blood donation guidelines mandate that receiving safe blood is the universal right of all. It categorically states that at least all donated blood must be serologically screened using an enzyme-linked immunosorbent assay for infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV), HIV-I and II, syphilis, and malaria.[3] Although U = U relates to sexual transmission, news marketing this fails to acknowledge the aspect of blood transmission openly. There are doubts in the minds of donors regarding the potential risk of their HIV transmission that may negatively impact the blood safety issues. Therefore, a timely intervention to address these doubts is of paramount importance. With this background, the authors describe herein an interesting case of a known HIV-I infected Indian male who was convinced, albeit, mistakenly that being in a state of untransmissibility through sexual route (due to low viral load and being on suppressive ART), his donated blood would be safe for transfusion too.

A 48-year-old unmarried HIV-I infected Indian man who has had sex with men [MSM] approached our blood transfusion center (BTC) with this genuinely valid question whether his “whole blood (WB) unit (if donated) would be safe for use in the patients?” and also regarding his doubtful yet remote eligibility to donate his WB. In fact, with his education and awareness level about the U = U campaign, he thought, somehow, that being in a state of untransmissibility by sexual route, his donated WB unit would be safe for transfusion too.

Further, during his predonation counseling with our transfusion medicine specialist (TMS), he said that his uncle got admitted at our hospital while he was almost being coerced for a unit of WB donation by his cousin. He revealed that he had been diagnosed with HIV-I infection back in 2020. He also requested that his WB unit be collected while his infectious status was maintained confidentially. Having understood his situation, the TMS complied and asked for his WB unit to be collected, following the existing confidential unit exclusion (CUE) policy at our BTC. His WB donation was uneventful. During the postdonation discussions, he revealed that he had been taking a regular dose of ART for the past couple of years, under the guidance of a local physician. He added that he regularly keeps checking his viral load and the last report results (done nearly 3 months back) showed a plasma viral load of 177 copies per mL (ultrasensitive AMPLICOR HIV-1 MONITORTM Test, Roche Molecular Systems, Inc.[Somerville, New Jersey, USA]). In his words, the concluding remarks were 'I am on suppressive ART, as per literature available, since my viral load is below the threshold for U = U…I am sexually noninfectious. Therefore, I am assuming that my WB unit would be practically safe against HIV transmission by blood transfusion too. However, I would like to clarify if my WB unit could be, transfused to the patients?

This was alarming because he was driven by an incorrect belief that being in a state of sexual untransmissibility, due to the regular intake of ART, his donated blood was safe and suitable for blood transfusion as well. He firmly believed that the ART he was receiving was highly efficacious in reducing the transmission of HIV through sexual intercourse and misconstrued the same for blood transfusion. At this juncture, our TMS addressed the doubts prevalent in the donor's mind and added, “Even though there is strong evidence that U = U could be, used for sexual transmission, it does not ascribe to blood transfusion-related transmission simply due to the greater inoculum and the intravenous route of administration.[2]” Furthermore, his WB unit was confidentially excluded from the inventory and discarded (after infection testing following our department protocol) while ensuring his complete confidentiality. The serology results performed in his sample showed HIV marker reactivity with an optical density value of 2.36 (Meril Diagnostics Pvt Ltd, Mumbai, India); while other infection markers, namely HBV, HCV, syphilis, and malaria, were nonreactive.

 Discussion



We have observed that the donors tend to frame the donor questionnaire while being asked: “Is my blood safe for use?,”[4] so that, in their minds, within the context of U = U, they start feeling that their WB donation is now safe. Where universal HIV-antibody test applies, barring a test failure or false-negative results, it may not be a significant risk toward blood safety. It happens because the antibody levels in an established HIV-infected individual should easily make these people detectable. Consequently, their donated WB unit would be selectively removed from the blood inventory. Nevertheless, any increase in the number of known HIV-infected individuals attending the blood donation services for their WB donation is risky and could actually jeopardize the blood safety. It also includes a marginal increase in the residual risk associated with a possible erroneous issue of HIV-infected blood units from the BTC. In this context, a self-assessment tool with adequate donor information, education, and communication (IEC) materials provided to the blood donors before donation can help address the wrong perceptions prevalent in their minds regarding blood safety issues. Community-level awareness targeted IEC while adding knowledge about various serological tests[5] and preventive strategies for blood safety can all help address the myths and fallacies prevalent in the minds of the potential blood donors. To sum up, evidence-based donor selection criteria, appropriate communication regarding blood safety, and the use of measures such as CUE all contribute to safer blood transfusion practices.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1UNAIDS Explainer. Available from: https://www.unaids.org/sites/default/files/media_asset/undetectable-untransmittable_en.pdf. [Last accessed on 2021 Sep 27].
2Gosbell IB, Hoad VC, Styles CE, Lee J, Seed CR. Undetectable does not equal untransmittable for HIV and blood transfusion. Vox Sang 2019;114:628-30.
3Saran RK. Blood transfusion safety and regulatory requirements. In: Transfusion Medicine Technical Manual DGHS. 2nd ed. New Delhi: Ministry of Health and Family Welfare; 2003. p. 383-416.
4Willson S, Miller K, Seem D, Kuehnert MJ. Cognitive evaluation of the AABB Uniform Donor History Questionnaire. Transfusion 2016;56:1662-7.
5Raturi M, Kusum A. Utilizing SPIKES protocol for breaking bad news to sero-reactive blood donors. Transfus Clin Biol 2020;27:165-7.