Effectiveness of human T‐lymphotropic virus (HTLV) recipient tracing (lookback) and the current HTLV‐I and ‐II confirmatory algorithm, 1999 to 2004

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Abstract
BACKGROUND:  This study reports on the efficacy of an investigational human T‐lymphotropic virus (HTLV)‐I and ‐II lookback program in the context of differing confirmatory testing algorithms.STUDY DESIGN AND METHODS:  The results of testing approximately 35 million donations for anti‐HTLV‐I and ‐II were evaluated for two recent periods reflecting the use of two different confirmatory algorithms. The number of seroconverting donors was established for the entire period, and the results of lookback on their prior donations were investigated.RESULTS:  The dual enzyme immunoassay (EIA) strategy was used throughout both study periods and resulted in a 57 to 76 percent reduction in the number of samples requiring confirmatory testing. From May 2000 to February 2002, a total of 9138 samples were repeatedly reactive by the primary screening test; of the concordant EIA‐reactive samples, 461 (12%) were confirmed by Western blot, whereas 3083 (79%) were indeterminate. From March 2002 to December 2004, a total of 21,291 samples were repeatedly reactive; of the concordant EIA‐reactive samples, 1099 (22%) were confirmed by the State of California’s reference laboratory and only 273 (5%) were equivocal. Overall, 38 or 1 in 921,000 donations were from a seroconverting donor with 32 prior donations within the lookback period. Of those 32, components from only 11 were transfused to recipients who survived; of these, 4 were tested and all were nonreactive for HTLV‐I and ‐II antibodies.CONCLUSION:  Use of creative algorithms can increase the efficacy of anti‐HTLV‐I and ‐II confirmatory testing and reduce the number of indeterminate results. Currently, lookback for HTLV‐I and ‐II has a very low yield, and its public health benefit is questionable.

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