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

Nucleic acid testing has been routinely performed in all blood donations in France since July 1st 2001. This is the story of a controversial decision. "The unacceptable HIV risk" in the context of the early 2000s influenced the decision. The results achieved over these past 10 years are analyzed given the expected progress of this new screening tool for infectious agents in transfusion. They confirm the relevance of models used by experts in 2000. Out of 22.3 million donations over the period (2001-2009), 22 donations have been rejected because of nucleic acid testing positive for hepatitis C virus (n=11) and human immunodeficiency virus (n=11). Nucleic acid testing has contributed to improve the functioning of the transfusion chain activities in order to ensure the availability of blood products. In terms of reactivity against emerging infectious agents, its role in the West Nile virus (WNV) outbreak is exemplary, but it did not play a similar role in crises of the same order. ALT determination has been stopped thanks to nucleic acid testing. The risk of contamination of the method by amplification products has been confirmed and caution is still required. Nucleic acid testing is being maintained and reached a new milestone in 2010 with the implementation of a full automated system, meanwhile pool screening was given up and hepatitis B virus screening became widespread. Nucleic acid tests will probably be revised when all blood products are pathogen-inactivated.