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A model to estimate the probability of human immunodeficiency virus and hepatitis C infection despite negative nucleic acid testing among increased-risk organ donors.

A model to estimate the probability of human immunodeficiency virus and hepatitis C infection despite negative nucleic acid testing among increased-risk organ donors.
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Annambhotla PD, Gurbaxani BM, Kuehnert MJ, Basavaraju SV,


Annambhotla PD, Gurbaxani BM, Kuehnert MJ, Basavaraju SV, (click to view)

Annambhotla PD, Gurbaxani BM, Kuehnert MJ, Basavaraju SV,

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Transplant infectious disease : an official journal of the Transplantation Society 2017 02 08() doi 10.1111/tid.12676

Abstract
BACKGROUND
In 2013, guidelines were released for reducing the risk of viral bloodborne pathogen transmission through organ transplantation. Eleven criteria were described that result in a donor being designated at increased infectious risk. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission risk from an increased-risk donor (IRD), despite negative nucleic acid testing (NAT), likely varies based on behavior type and timing.

METHODS
We developed a Monte Carlo risk model to quantify probability of HIV among IRDs. The model included NAT performance, viral load dynamics and per-act risk of acquiring HIV by each behavior. The model also quantifies the probability of HCV among IRDs by non-medical intravenous drug use (IVDU).

RESULTS
Highest risk is among donors with history of unprotected, receptive anal male-to-male intercourse with partner of unknown HIV status (MSM), followed by sex with HIV-infected partner, IVDU, and sex with a commercial sex worker.

CONCLUSION
With NAT screening, the estimated risk of undetected HIV remains small even at 1 day following a risk behavior. The estimated risk for HCV transmission through IVDU is likewise small and decreases quicker with time owing to the faster viral growth dynamics of HCV compared with HIV. These findings may allow for improved organ allocation, utilization, and recipient informed consent. This article is protected by copyright. All rights reserved.

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