Making every question count: the impact of temporary donor deferral for suspected acute retroviral syndrome

Abstract

Background: Blood donor history questionnaires are used world-wide to detect blood supply and donor safety risks. Donors are less likely to return to donate blood following deferral, therefore removing questions with limited impact on safety would likely improve donor satisfaction and donation rates. Early human immunodeficiency virus (HIV) infection can manifest as acute retroviral syndrome (ARS). This study aimed to evaluate the impact of questioning and deferring blood donors for self-reported symptoms of ARS on Australian blood transfusion safety. Methods: A retrospective analysis of Australian Red Cross Lifeblood databases for the 17-year period, 2000–2016, was undertaken. Voluntary Australian blood donors who reported rash and lymphadenopathy on the donor questionnaire (DQ) were determined at risk of ARS and thus HIV. The proportion of donors deferred for possible ARS, the proportion who later returned, and donor return time for ARS and other 12-month deferrals was assessed. HIV status on subsequent donation in ARS declaring donors and proportion of HIV-positive donors with ARS-like symptoms was also reviewed. Results: Of donors who declared possible ARS, 65.56% [95% confidence interval (CI): 55.74–75.37%] were deferred and only 22.34% (95% CI: 17.40–27.29%) of deferred donors later returned. Compared to other 12-month deferral categories, donors deferred for possible ARS were less likely to return. No donor who declared possible ARS and subsequently donated tested HIV-positive. Moreover, no donors who tested HIV-positive reported both rash and lymphadenopathy in combination. Conclusions: The ARS question does not effectively differentiate HIV-positive from HIV-negative donors. The continued questioning of donors about ARS, through a self-reported combination of rash and lymphadenopathy, resulted in loss of donors who were unlikely to pose a threat to transfusion safety.