National AIDS Unit, National Institute of Health, Rome, Italy.
Blood Transfus. 2013 Jul;11(3):441-8. doi: 10.2450/2013.0162-12. Epub 2013 Jun 14.
In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy.
We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year.
In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009-2010 than in 1999 (2009-2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18).
When comparing the period before (1999) and after (2009-2010), the implementation of the individual risk assessment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.
2001 年，意大利通过部长级法令修改了献血者资格标准，将“男男性行为者”的永久延期改为对性行为的个体风险评估。本研究旨在评估献血者筛查标准的这一变化对意大利献血人群中人类免疫缺陷病毒流行的影响。
我们使用了从意大利献血者流行病学监测系统获得的数据。我们比较了 2009 年和 2010 年（实施个体风险评估政策时）与 1999 年（男男性行为者根据性取向声明被永久延期时）的数据。我们评估了随着时间的推移，从男男性行为者感染和异性性暴露感染获得 HIV 抗体阳性的献血者的相对比例的变化；使用 1999 年作为参考年计算相对风险。
在所有 3 年中，大多数 HIV 抗体阳性的献血者报告的性接触为 HIV 感染的风险因素；尽管没有统计学意义，但这一比例随着时间的推移而增加。异性恋者始终至少占所有 HIV 抗体阳性病例的 40%。男男性行为者和异性恋者的 HIV 抗体阳性献血者的比例都相似地增加；具体而言，2009-2010 年男男性行为者的 HIV 抗体阳性病例每 10 万献血者中的比例比 1999 年高出两倍多（2009-2010 年比 1999 年，RR=2.8；P=0.06），而异性恋者的比例高出 1.5 倍（P=0.18）。
在比较 2001 年实施个体风险评估政策之前（1999 年）和之后（2009-2010 年）的时期，HIV 抗体阳性献血者中男男性行为者与异性恋者的比例没有明显增加，这表明献血者延期政策的改变并没有导致 HIV 阳性的男男性行为者不成比例地增加。
