846 GBV (HGV) Is Frequently Transmitted to HIV-infected Patients by Blood Transfusions M. Busch*1, D. Zdunek2, M. Laycock3, J. Mosley4, G. Hess5 1Blood Systems, Inc, Phoenix, AZ; 2Roche Diagnostics, Penzburg, Germany; 3Blood Ctrs of the Pacific, San Francisco, CA; 4Univ of Southern California, Los Angeles; and 5Roche Diagnostics, Mannheim, Germany
Background: Recent studies have demonstrated that HIV-infected persons co-infected with GBV (HGV) have slower progression to HIV disease, a finding supported by in vitro data indicating that GBV inhibits HIV replication kinetics. These findings suggest that GBV co-infection may be clinically beneficial, with possible therapeutic implications. It would be of great interest to monitor acute and long-term changes in viral load and immunologic/clinical parameters in HIV-infected persons following GBV infection. However, absent definitive data on clinical benefit and/or risk, ethical concerns preclude intentional GBV inoculation into immunosuppressed HIV-infected patients.
Methods: The Viral Activation Transfusion Study (VATS) enrolled and followed 531 HIV-infected persons requiring blood transfusions to study the impact of transfusions (median 2 RBC units) on HIV, immunological parameters, and clinical HIV disease progression. Samples analyzed were collected pre-transfusion, weekly for 4 wks post-transfusion, and quarterly for up to 3 yrs. Pre-transfusion and last follow-up samples from 490 VATS subjects with available specimens were tested for GBV RNA and antibody (quantitative GBV-RNA RT-PCR, anti-GBenv uplate EIA; Roche Diagnostics).
Results: A total 294 (60%) subjects were GBV RNA- and antibody-negative pre-transfusion; 39 (13.3%) tested GBV RNA+ and 26 (8.8%) anti-GBenv+ at end of follow-up (mean 306 days), with no overlap; 162 (33%) tested anti-GBenv+/RNA- and 34 (7%) RNA+/anti-GBenv- pre-transfusion, with no overlap; and GBV antibody/RNA loss was observed in 15%/18% at end of follow-up, respectively. No GBV re-infections (e.g., RNA) were observed in those anti-GBenv+ pre-transfusion.
Conclusions: These results demonstrate a high (22%) GBV transmission rate for HIV-infected persons after transfusion, with 2/3 of acutely infected persons evidencing persistent viremia. In contrast, prior GBV infection/seroconversion was protective against re-infection, despite anti-GBenv loss. Serial samples are being characterized to define GBV viral load and antibody kinetics, and VATS data analyzed to determine impact of acute GBV infection on HIV viral load, immunological, and clinical parameters.
