Farnaz Vahidnia

Acquisition of GB Virus Type C and Lower Mortality in Patients With Advanced HIV Disease

BACKGROUND GB virus type C (GBV-C) is transmitted by sexual or parenteral exposure and is prevalent among patients receiving blood products. GBV-C is associated with lower human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. Open questions are the presence and the direction of any causal relationship between GBV-C infection and HIV disease markers in the context of highly active antiretroviral therapy (HAART). METHODS We used a limited access database obtained from the National Heart, Lung, and Blood Institutes Viral Activation Transfusion Study (VATS), a randomized controlled trial of leukoreduced vs nonleukoreduced transfusions to HIV-infected transfusion-naive patients. Blood samples from 489 subjects were tested for GBV-C markers. Cox regression models and inverse probability of treatment weights were used to examine the association between GBV-C coinfection and mortality in the VATS cohort. RESULTS We found a significant reduction in mortality among GBV-C coinfected VATS subjects, after adjusting for HAART status, HIV RNA level, and CD4 cell count at baseline. Acquisition of GBV-C RNA (n = 39) was associated with lower mortality in 294 subjects who were GBV-C negative at baseline, adjusting for baseline covariates (hazard ratio = 0.22, 95% confidence interval [CI]: .08-.58) and in models in which weights were used to control for time-updated covariates (odds ratio = 0.21, 95% CI: .08-.60). CONCLUSIONS GBV-C viremia is associated with lower mortality, and GBV-C acquisition via transfusion is associated with a significant reduction in mortality in HIV-infected individuals, controlling for HIV disease markers. These findings provide the first evidence that incident GBV-C infection alters mortality in HIV-infected patients.

Risk factors for retrovirus and hepatitis virus infections in accepted blood donors.

Risk factor surveillance among infected blood donors provides information on the effectiveness of eligibility assessment and is critical for reducing risk of transfusion‐transmitted infection.

Erratum to “Cancer Incidence and Mortality in a Cohort of US Blood Donors: A 20-Year Study”.

In the original paper, there was an error in Figure 3. In the legend for Figure 3, donor and nondonor lines were reversed. Here, we provide Figure 3 with the correct legend.

Development of a multisystem surveillance database for transfusion-transmitted infections among blood donors in the United States

The frequency of positive test results for transfusion‐transmitted infections (TTIs) among blood donors is an important index of safety; thus, appropriate monitoring is critical, particularly when there are changes in policies affecting donor suitability.

Motivations for donating and attitudes toward screening policies in US blood donors with viral infection

Differences in motivating factors that contribute to the decision to donate blood between infected and uninfected donors may help to identify areas for improving donor education.

Cancer Incidence and Mortality in a Cohort of US Blood Donors: A 20-Year Study

Blood donors are considered one of the healthiest populations. This study describes the epidemiology of cancer in a cohort of blood donors up to 20 years after blood donation. Records from donors who participated in the Retroviral Epidemiology Donor Study (REDS, 1991–2002) at Blood Centers of the Pacific (BCP), San Francisco, were linked to the California Cancer Registry (CCR, 1991–2010). Standardized incidence ratios (SIR) were estimated using standard US 2000 population, and survival analysis used to compare all-cause mortality among donors and a random sample of nondonors with cancer from CCR. Of 55,158 eligible allogeneic blood donors followed-up for 863,902 person-years, 4,236 (7.7%) primary malignant cancers were diagnosed. SIR in donors was 1.59 (95% CI = 1.54,1.64). Donors had significantly lower mortality (adjusted HR = 0.70, 95% CI = 0.66–0.74) compared with nondonor cancer patients, except for respiratory system cancers (adjusted HR = 0.93, 95% CI = 0.82–1.05). Elevated cancer incidence among blood donors may reflect higher diagnosis rates due to health seeking behavior and cancer screening in donors. A “healthy donor effect” on mortality following cancer diagnosis was demonstrated. This population-based database and sample repository of blood donors with long-term monitoring of cancer incidence provides the opportunity for future analyses of genetic and other biomarkers of cancer.

Transmission of GB Virus Type C via Transfusion in a Cohort of HIV-Infected Patients

BACKGROUND GB virus C (GBV-C) infection is transmitted by blood exposure and associated with lower human immunodeficiency virus (HIV) load and slower HIV disease progression. Few studies describe predictors of acute GBV-C infection following transfusion in HIV-infected patients. METHODS We used a limited-access database from the National Heart Lung and Blood Institutes Viral Activation Transfusion Study, a randomized controlled trial of leukoreduced versus nonleukoreduced transfusions received by HIV-infected, transfusion-naive patients. Blood samples from 489 subjects were tested for GBV-C markers in pretransfusion and posttransfusion samples. We estimated the risk of acquiring GBV-C RNA and predictors of GBV-C acquisition, using pooled logistic regression. RESULTS GBV-C RNA was detected ≤120 days following the first transfusion in 22 (7.5%) of 294 subjects who were GBV-C negative before transfusion. The risk of GBV-C RNA acquisition increased with each unit transfused (odds ratio, 1.09; 95% confidence interval, 1.06-1.11). Lower baseline HIV load and use of antiretroviral therapy were associated with subsequent GBV-C RNA acquisition, after control for units of blood transfused. Leukoreduced status of transfused units was not associated with GBV-C transmission. CONCLUSIONS Blood transfusion is associated with a significant risk of GBV-C acquisition among HIV-infected patients. Transmission of GBV-C by blood transfusion was inversely related to HIV load.

Risk factors and epidemiology of human T-lymphotropic virus types 1 and 2 in US blood donors

Blood donations in the US are routinely screened for markers of human T-lymphotropic virus (HTLV). Seroprevalence and risk factors associated with HTLV-1 and -2 infection from the US Retrovirus Epidemiology Donor Study (REDS-II) Transfusion-Transmitted Viral Infection (TTVI) Rate and Risk Factor Study are reported. Among 14,809,334 blood donations screened during 2011-2012, 516 HTLV confirmed seropositive cases were identified, with an overall prevalence of 3.5 infections per 1,0 donations (95% CI: 3.2-3.8). A case-control study of risk factors from 90 donors with serology-confirmed HTLV-1 infection, 102 with HTLV-2 (cases), and 1,587 donors with false-positive results (controls) was conducted. Frequencies and adjusted odds ratios (AORs) from separate multivariable logistic regression analyses for HTLV-1 and -2 cases compared to controls are reported. Mean age was 48.0 (SD: 12.4), 52.3 (SD: 11.0) and 41.7 (SD: 15.7) years for HTLV-1, HTLV-2 cases and controls, respectively. Being a first-time donor, older, non-white, non-Hispanic female were significant demographic factors associated with both infections. HTLV-1 cases were more likely than controls to be Black (AOR: 13.3, 95% CI: 6.1-29.2), born outside of the US (AOR: 8.6, 95% CI: 4.0-18.4), have migrated (family or self) from an endemic area (AOR: 1.8, 95% CI: 1.2-2.7), report sex with an IDU (AOR: 10.9, 95% CI: 3.6-33.4) or have multiple partners (AOR: 3.1, 95% CI: 1.5-6.1). HTLV-2 cases were more likely to be Black (AOR: 15.4, 95% CI: 6.9-34.3), Native Americans (AOR: 10.7, 95% CI: 1.5-77.0), report sex with an IDU (AOR: 27.2, 95% CI: 9.7-75.8) or have multiple partners (AOR: 2.9, 95% CI: 1.5-5.7). US blood donors with HTLV-1 or -2 infection present with the known risk factors. Migration from endemic areas is mainly associated with HTLV-1 infection, while HTLV-2 is associated with Native American donors. Sexual risk behavior and IDU continue to be risk factors for both viruses.