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Failure To Develop HIV Infection after Receipt of HIV-Contaminated Blood and Postexposure Prophylaxis
- Terese L. Katzenstein, MD, PhD;
- Ebbe Dickmeiss, MD, DrMedSci;
- Hassan Aladdin, MSc;
- Adam Hede, MD;
- Claus Nielsen, MSc, PhD;
- Helle Nielsen, BA;
- Louise B. Jørgensen, MSc, PhD; and
- Jan Gerstoft, MD, DrMedSci
- From National University Hospital Rigshospitalet and State Serum Institute, Copenhagen, Denmark.
- Human immunodeficiency virus seropositivity
- Human immunodeficiency virus seronegativity
- Anti-HIV agents
- Blood transfusion
Use of HIV-antibody screening of blood donated for transfusions has reduced the risk for HIV transmission. However, because of the lag time between acquisition of HIV infection and development of antibodies (the window period), some HIV-infected blood donors escape detection (1, 2). Currently, the window period is estimated to be 3 weeks (3). We report a case in which transfusion of HIV RNA–positive, HIV-seronegative blood did not lead to infection in the recipient, most likely because potent postexposure antiretroviral therapy was initiated promptly and followed thoroughly.
Case Report
Patient D-1 developed fever and a follicular confluent rash. No exposure to HIV could be identified; the patient had had no extramarital contacts or intravenous drug use. He had, however, been involved in a bloody altercation at a gay bar 25 days earlier. During the altercation, the patient head-butted another guest. Substantial bleeding occurred, but the patient did not recall blood exchange. The patient was transferred to care in the Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark, with a diagnosis of primary HIV infection. He had a high HIV RNA load (2 × 106 copies/mL). Antiretroviral therapy with zidovudine, lamivudine, and ritonavir was initiated (Table).
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On admission to the ward, the patient disclosed that he had donated blood 1 week earlier. As is routine, the whole-blood donation had been divided into red blood cells in additive solutions (buffy coat removed), buffy coat, and fresh frozen plasma (4). The red blood cells were used for transfusion and the buffy coat was discarded. The fresh frozen plasma was still in stock and was immediately tested for HIV RNA and HIV p24 antigen. …
