Abstract

Abstract 3341

Background:

GB virus type C (GBV-C) infection is common with 3–5% rates of viremia in blood donors and a much higher prevalence in HIV infected patients. GBV-C is transmitted by sexual or blood exposure. Although infection may persist, most immune competent individuals clear viremia within 2 years. Few data describe the clinical course of acute GBV-C infection following transfusion in HIV infected patients. We estimated risk of GBV-C RNA acquisition following transfusion.

Methods:

We used a limited access database from the National Heart Lung and Blood Institute from the Viral Activation Transfusion Study (VATS). A RCT of leukoreduced (LR) vs. non-LR transfusion, VATS collected blood samples from U.S. HIV infected transfusion naïve patients. GBV-C RNA in pre- and post transfusion samples was tested after completion of VATS. GBV-C RNA acquisition up to 120 days post-transfusion was examined in 294 patients who were GBV-C RNA and antibody negative before transfusion. Discrete hazard of GBV-C RNA acquisition as a function of cumulative units transfused was estimated using pooled logistic regression.

Results:

GBV-C RNA was detected in 22 (7.5%) of 294 subjects within 120 days following first transfusion. Viremia was detected within the first 30 days in 12 (4.1%) subjects and between 31 and 120 days in 10 (3.4%) subjects. Median (IQR) follow-up duration and total blood units transfused for subjects who acquired GBV-C RNA or stayed negative were: 88.5 (80-108) and 77.5 (32-100) days; and 4 (2-7) and 4 (2-6) units, respectively (Table 1). Discrete hazard of GBV-C RNA acquisition increased with each additional unit transfused (OR=1.09, 95% CI=1.06, 1.11) (Table 2). In pooled logistic regression models, lower baseline HIV viral load and use of antiretroviral therapy (ART) predicted subsequent GBV-C RNA acquisition after controlling for units of blood transfused. Leukoreduction status was not associated with GBV-C transmission.

Table 1.

Subject characteristics by GBV-C acquisition status, VATS (n=294)

CharacteristicGBV-C RNA acquisition n=22GBV-C RNA negative n=272p-value
Follow-up time in days    
    Mean (SD) 85.0 (28.9) 71.2 (34.4) 0.06 
    Median (IQR) 88.5 (80–108) 77.5 (32–100) 0.04 
Baseline HIV viral load per ml, log10    
    Mean (SD) 4.1 (1.4) 4.7 (1.1) 0.02 
Baseline CD4 cells per uL    
    Mean (SD) 70.5 (86.7) 55.5 (105.5) 0.54 
    Median (IQR) 30.5 (7.5–95.5) 14 (3–56) 0.20 
Baseline ART exposure, n (%) 6 (27.3) 58 (21.3) 0.51 
Units transfused, mean (SD)    
    Mean (SD) 7.2 (9.3) 5.2 (4.5) 0.08 
    Median (IQR) 4 (2–7) 4 (2–6) 0.59 
CharacteristicGBV-C RNA acquisition n=22GBV-C RNA negative n=272p-value
Follow-up time in days    
    Mean (SD) 85.0 (28.9) 71.2 (34.4) 0.06 
    Median (IQR) 88.5 (80–108) 77.5 (32–100) 0.04 
Baseline HIV viral load per ml, log10    
    Mean (SD) 4.1 (1.4) 4.7 (1.1) 0.02 
Baseline CD4 cells per uL    
    Mean (SD) 70.5 (86.7) 55.5 (105.5) 0.54 
    Median (IQR) 30.5 (7.5–95.5) 14 (3–56) 0.20 
Baseline ART exposure, n (%) 6 (27.3) 58 (21.3) 0.51 
Units transfused, mean (SD)    
    Mean (SD) 7.2 (9.3) 5.2 (4.5) 0.08 
    Median (IQR) 4 (2–7) 4 (2–6) 0.59 
Table 2.

Odds Ratio (OR) for GBV-C RNA acquisition in HIV infected patients estimated using pooled logistic regression models*, VATS (n=294)

VariableUnadjusted OR (95% CI)Adjusted for cumulative units transfused (95% CI)Adjusted for ART use (95% CI)Adjusted for HIV viral load (95% CI)
Cumulative units of blood transfused (per unit) 1.09 (1.06, 1.11) – 1.08 (1.05, 1.11) 1.08 (1.05, 1.11) 
Baseline HIV viral load (per log10copies/ml) 0.61 (0.40, 0.92) 0.62 (0.40, 0.96) – – 
Current use of ART 4.78 (2.01, 11.3) 4.03 (1.79, 9.11) – – 
VariableUnadjusted OR (95% CI)Adjusted for cumulative units transfused (95% CI)Adjusted for ART use (95% CI)Adjusted for HIV viral load (95% CI)
Cumulative units of blood transfused (per unit) 1.09 (1.06, 1.11) – 1.08 (1.05, 1.11) 1.08 (1.05, 1.11) 
Baseline HIV viral load (per log10copies/ml) 0.61 (0.40, 0.92) 0.62 (0.40, 0.96) – – 
Current use of ART 4.78 (2.01, 11.3) 4.03 (1.79, 9.11) – – 
*

OR estimates discrete hazard of GBV-C RNA acquisition.

Model is adjusted for time-varying ART use.

Model is adjusted for HIV viral load at baseline (pre-transfusion).

Conclusion:

Blood transfusion is associated with significant risk of GBV-C acquisition in HIV infected patients. Establishing evidence for transfusion transmission of GBV-C will allow additional studies on the impact of acute acquisition on the course of HIV infection in co-infected patients.

Disclosures:

No relevant conflicts of interest to declare.

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Author notes

*

Asterisk with author names denotes non-ASH members.