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A model to estimate the probability of human immunodeficiency virus and hepatitis C infection despite negative nucleic acid testing among increased‐risk organ donors
Author(s) -
Annambhotla Pallavi D.,
Gurbaxani Brian M.,
Kuehnert Matthew J.,
Basavaraju Sridhar V.
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12676
Subject(s) - medicine , transmission (telecommunications) , nat , hepatitis c virus , viral load , virology , men who have sex with men , nucleic acid test , immunology , hepatitis c , hepatitis b virus , hepatitis b , viral disease , human immunodeficiency virus (hiv) , virus , infectious disease (medical specialty) , disease , syphilis , computer network , covid-19 , computer science , electrical engineering , engineering
Background In 2013, guidelines were released for reducing the risk of viral bloodborne pathogen transmission through organ transplantation. Eleven criteria were described that result in a donor being designated at increased infectious risk. Human immunodeficiency virus ( HIV ) and hepatitis C virus ( HCV ) transmission risk from an increased‐risk donor ( IRD ), despite negative nucleic acid testing ( NAT ), likely varies based on behavior type and timing. Methods We developed a Monte Carlo risk model to quantify probability of HIV among IRD s. The model included NAT performance, viral load dynamics, and per‐act risk of acquiring HIV by each behavior. The model also quantifies the probability of HCV among IRD s by non‐medical intravenous drug use ( IVDU ). Results Highest risk is among donors with history of unprotected, receptive anal male‐to‐male intercourse with partner of unknown HIV status ( MSM ), followed by sex with an HIV ‐infected partner, IVDU , and sex with a commercial sex worker. Conclusion With NAT screening, the estimated risk of undetected HIV remains small even at 1 day following a risk behavior. The estimated risk for HCV transmission through IVDU is likewise small and decreases quicker with time owing to the faster viral growth dynamics of HCV compared with HIV . These findings may allow for improved organ allocation, utilization, and recipient informed consent.