van de Laar Thijs J, Bezemer Daniela, van Laethem Kristel, Vandewalle Giovani, de Smet Annie, van Wijngaerden Eric, Claas Eric C, van Sighem Ard I, Vandamme Anne-Mieke, Compernolle Veerle, Zaaijer Hans L
Department of Blood-borne Infections, Sanquin Research, Amsterdam, the Netherlands.
Stichting HIV Monitoring, Amsterdam, the Netherlands.
Transfusion. 2017 May;57(5):1235-1247. doi: 10.1111/trf.14097. Epub 2017 Apr 4.
Separate transmission networks for human immunodeficiency virus (HIV) coexist. Molecular typing of viral genomes can provide insight in HIV transmission routes in donors for whom risk behavior-based donor selection failed.
This study includes all HIV-infected Dutch and Flemish donors in the period 2005 to 2014 (n = 55). Part of the HIV polymerase (pol) gene was amplified, sequenced, and compared with more than 10,000 HIV strains obtained from HIV-infected Dutch and Flemish patients. The most likely transmission route was determined based on HIV phylogeny and the donor's self-reported risk behavior during the exit interview.
HIV-infected donors were predominantly male (69%), were repeat donors (73%), were born in the Netherlands or Belgium (95%), and harbored HIV Subtype B (68%). Seventy-five percent of HIV-infected male donors were part of robust phylogenetic clusters linked to male-to-male sex, while only 24% of HIV-infected male donors reported male-to-male sex during posttest counseling. Sex between men and women accounted for 13% of HIV infections in male donors and 93% of HIV infections in female donors based on phylogenetic analysis. Only 40% of HIV-infected female donors had HIV Subtype B; 65% of female donors reported a foreign partner and indeed HIV sequences interspersed with sequences from HIV-endemic areas abroad, in particular sub-Saharan Africa.
HIV typing helps to understand HIV transmission routes in donor populations. We found substantial underreporting of male-to-male sex among HIV-infected male donors. Donor education on HIV risk factors and the danger of window-period donations and a donor environment that encourages frank disclosure of sexual behavior will contribute to a decrease of HIV-infected donors.
人类免疫缺陷病毒（HIV）存在不同的传播网络。对病毒基因组进行分子分型有助于了解在基于风险行为的献血者筛选失败的献血者中HIV的传播途径。
本研究纳入了2005年至2014年期间所有感染HIV的荷兰和佛兰德献血者（n = 55）。对HIV聚合酶（pol）基因的部分片段进行扩增、测序，并与从荷兰和佛兰德HIV感染患者中获得的10000多个HIV毒株进行比较。根据HIV系统发育关系和献血者在离职面谈时自我报告的风险行为确定最可能的传播途径。
感染HIV的献血者以男性为主（69%），为重复献血者（73%），出生于荷兰或比利时（95%），携带HIV B亚型（68%）。75%感染HIV的男性献血者属于与男男性行为相关的紧密系统发育簇，而只有24%感染HIV的男性献血者在检测后咨询中报告有男男性行为。根据系统发育分析，男女之间的性行为导致男性献血者中13%的HIV感染，女性献血者中93%的HIV感染。只有40%感染HIV的女性献血者携带HIV B亚型；65%的女性献血者报告有外国伴侣，其HIV序列确实与国外HIV流行地区（特别是撒哈拉以南非洲）的序列交织在一起。
HIV分型有助于了解献血人群中的HIV传播途径。我们发现感染HIV的男性献血者对男男性行为的报告严重不足。对献血者进行HIV危险因素教育以及窗口期献血的危险性教育，营造鼓励坦诚披露性行为的献血环境，将有助于减少感染HIV的献血者。
