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

• Published in: Transplant infectious disease 2017-04, Vol.19 (2), p.n/a
• Main Authors: Annambhotla, Pallavi D., Gurbaxani, Brian M., Kuehnert, Matthew J., Basavaraju, Sridhar V.
• Format: Article
• Language: English
• Subjects: Allografts - virology; Blood-Borne Pathogens; Disease Transmission, Infectious - statistics & numerical data; Hepacivirus - isolation & purification; Hepatitis; Hepatitis C - epidemiology; hepatitis C virus; HIV - isolation & purification; HIV Infections - epidemiology; human immunodeficiency virus; Humans; increased infectious risk; increased‐risk donor; Models, Theoretical; Monte Carlo simulation; Nucleic Acid Amplification Techniques; nucleic acid testing; Nucleic acids; Practice Guidelines as Topic; Risk; Risk taking; RNA, Viral - isolation & purification; Serologic Tests; Sex Work; Sexually transmitted diseases; STD; Time Factors; Tissue and Organ Harvesting - standards; Tissue Donors - psychology; Tissue Donors - statistics & numerical data; Viral Load
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12676

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 an 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.