Transfusion transmission of human T‐lymphotropic virus types I and II: serologic and polymerase chain reaction results in recipients identified through look‐back investigations

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Abstract
To determine the transmissibility of human T‐lymphotropic virus types I and II (HTLV‐I and HTLV‐II) via transfusion, persons who, from 1983 to 1989, received blood components donated by persons who subsequently tested anti‐HTLV‐I‐positive were evaluated. It was found that 16 (30%) of 54 evaluable recipients of transfused cellular components became infected with one of the HTLVs: 8 had HTLV‐I and 8 had HTLV‐II. Forty percent of platelet recipients and 28 percent of red cell recipients acquired infection. The rate of transmission of HTLV‐I and HTLV‐II was significantly correlated with storage age of red cell units prior to transfusion: 47 percent for red cells stored < or = 14 days and 0 for red cells stored > 14 days (p < 0.01). Multiple confirmatory serologic tests performed in 46 anti‐HTLV‐I enzyme immunoassay‐negative recipients revealed that HTLV infection could not be excluded in 3 recipients of blood components from HTLV‐II‐infected donors. Polymerase chain reaction established HTLV‐II infection in one recipient, and the other two recipients could not be classified with respect to HTLV infection status. It appears that some HTLV‐II‐infected transfusion recipients will not be detected by existing HTLV‐I antigen‐based reagents. If it is deemed necessary to initiate or continue look‐back programs to detect transfusion transmission of HTLV‐II infection, it is suggested that the current testing algorithm be modified in selected cases.