Screening of blood donors for idiopathic CD4+ T‐lymphocytopenia

Publisher Website
Google Scholar
Abstract
Background: The recent recognition of idiopathic CD4+ T‐lymphocytopenia (ICL) had led to concern that an unknown immunodeficiency virus may be transmissible by transfusion. Study Design and Methods: To evaluate the prevalence and significance of low CD4+ values among blood donors, CD4+ data on 2030 blood donors who were negative for antibody to human immunodeficiency virus type 1 (HIV‐1) were compiled. Those with CD4+ values below ICL cutoffs (< 300 CD4+ T cells/μL, or < 20% CD4+ T cells) were recalled for follow‐up investigations. Serial CD4+ data on 55 homosexual men who seroconverted during prospective follow‐up and data on 139 anti‐HIV‐1‐positive blood donors initially evaluated in 1986 were reviewed as well. Results: Five seronegative donors (0.25%) had absolute CD4+ counts < 300 cells per μL and/or < 20 percent. On follow‐up, all five donors had immunologic findings within normal ranges, lacked HIV risk factors, and tested negative for HIV types 1 and 2 and human T‐lymphotropic virus type I and II infections by antibody and polymerase chain reaction assays. Four of five donors reported transient illness shortly after their low CD4+ count donations. The median interval from HIV‐1 seroconversion to an initial CD4+ value below ICL CD4+ cutoffs was 63 months for infected homosexual men. Of 139 HIV‐1‐infected blood donors studied 1 to 2 years after seropositive donations, 34 (24%) had CD4+ counts < 300 cells per μL and/or < 20 percent. Conclusion: Low CD4+ counts are rare among anti‐ HIV‐1‐negative volunteer blood donors and are generally associated with transient illnesses. If any unknown virus progresses similarly to HIV‐ 1, CD4+ count donor screening would be a poor surrogate for its detection.