[Ten years of nucleic acid testing: lessons and prospects]

Area of Science:

• Transfusion Medicine
• Virology
• Public Health

Background:

• Routine nucleic acid testing (NAT) for blood donations began in France in 2001, driven by concerns over human immunodeficiency virus (HIV) transmission.
• The decision to implement NAT was controversial, necessitating an evaluation of its impact on transfusion safety and infectious agent screening.

Purpose of the Study:

• To analyze the results of nucleic acid testing in French blood donations over a 10-year period (2001-2009).
• To assess the effectiveness of NAT in screening for infectious agents and improving the transfusion chain.
• To evaluate the relevance of predictive models used for NAT implementation.

Main Methods:

• Analysis of 22.3 million blood donations screened using nucleic acid testing between 2001 and 2009.
• Review of infectious agent detection rates, including hepatitis C virus (HCV) and HIV.
• Evaluation of NAT's role in managing emerging infectious agent outbreaks, such as West Nile virus (WNV).

Main Results:

• NAT identified 22 donations positive for HCV (n=11) and HIV (n=11) out of 22.3 million donations.
• NAT contributed to improved transfusion chain operations and blood product availability.
• ALT determination was discontinued due to NAT's efficacy; however, contamination risks were noted. NAT's role in WNV outbreak response was exemplary, though less impactful in other crises.

Conclusions:

• Nucleic acid testing has been a valuable tool in enhancing blood safety in France, confirming the accuracy of initial risk assessments.
• NAT has improved transfusion safety and efficiency, with ongoing advancements like automation and expanded screening.
• Future revisions of NAT protocols are anticipated with the advent of pathogen-inactivated blood products.