ABSTRACT: Background: Basically all patients transfused with HIV-infected blood have been reported to acquire HIV infection. Post-exposure prophylaxis (PEP) has proven efficacious after needlestick exposure to HIV and has reduced the rate of vertical HIV transmission. Successful PEP to a recipient of HIV-infected blood has not been previously reported.
Objective: To eradicate HIV infection from a recipient of HIV-infected seronegative blood. Therapy was initiated only 2 days after the recipient, a 13-year-old girl undergoing orthopedic surgery, was transfused with HIV-infected blood. We aimed at maintaining the patient on HAART (one PI plus two NRTIs) for 1 year and if no signs of HIV infection could be detected, to stop therapy under close monitoring.
Methods: Due to severe side effects we stopped therapy after 10 months. The patient, however, rigorously received triple therapy for this period in spite of the adverse effects. The recipient was monitored with HIV RNA (ultra-sensitive method) HIV DNA, HIV culture (both with and without phytohemagglutinin stimulation) and HIV antibody analyses during and 6 months after stopping therapy. As we could not isolate HIV RNA from the recipient, HIV RNA from the donor was analyzed for resistance mutation using sequence analysis.
Results: Our blood bank makes exhaustive use of bar coding and electronic data processing to ensure the ability to unequivocally trace the blood. We have revised all the documented steps in the procedure, and it ahs been ascertained that the recipient did receive HIV-infected blood. The plasma HIV RNA load in the transfused blood was 11,000 copies/mL. Plasma HIV RNA from the donor contained two secondary PI mutations (L63P and A71T); no primary PI mutations were detected. No RTI resistance-conferring mutations were detected. No signs of HIV infection could be detected in the recipient, even with very sensitive methods.
Conclusions: A case of transfusion of HIV-infected blood not leading to infection of the recipient is reported. The non-infected outcome is most likely due to the prompt initiation of, and thorough adherence to, potent PEP.
