HIV antibody screening remains indispensable for ensuring viral safety of blood components despite NAT implementation

The main objective of the implementation of NAT for the screening of blood-borne viruses was to compensate for the failure of serologic assays during the window period. Because this new screening procedure theoretically covers the entire period of infectivity, the necessity for maintaining serologic assays in blood screening strategy could become questionable.

To investigate this issue, a panel of 35 samples has been studied by NAT. These samples had been collected from HIV-1 antibody-positive individuals presenting a persistently low viral RNA load (<400 copies/mL) in the absence of antiviral therapy. All samples were analyzed with the minipool (x8) NAT routinely used in blood bank setting (HIV-1 and HCV assay based on transcription-mediated amplification) and with single-donation testing.

The minipool NAT failed to detect the presence of HIV RNA in 15 of the 35 samples (11 remained negative when retested). Single-donation testing gave negative results in 4 samples (3 remained negative when retested). Fourteen of the 18 samples with a viral load greater than 50 copies per mL were positive by minipool NAT versus 6 of the 17 samples with fewer than 50 copies per mL (p = 0.02).

The results clearly demonstrate that anti-HIV screening should not be withdrawn from biologic qualification procedures of blood donations, even when single NAT is performed.