Transfusion of the HIV-seropositive patient

TRANSFUSION MEDICINE

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TRANSFUSION OF THE HIV-SEROPOSITIVE PATIENT To the Editor:

In their review article, Hillyer et al I identify many important issues with respect to transfusion of the HIV-seropositive patient. As they point out, retrospective analyses of HIV-seropositive patients have identified decreased survival times and increased rates of opportunistic infections in those who had received transfusions. 2,3 Although Busch, Lee, and Heitman4 have presented evidence of reactivation of latent virus from HIV-infected individuals by allogeneic leukocytes,4 whether this effect is responsible for those clinical observations has not been determined. Although there is a substantial amount of evidence linking detrimental clinical and laboratory effects with allogeneic white blood cells from transfusions, whether leukocyte reduction to the levels possible by current filtration methods would obviate them in HIV-l-infected individuals is also not known. Having pointed out these concerns, we find it regrettable that the authors made recommendations regarding the transfusion therapy of HIV patients without providing their readers with the critically important information that a current NHLBI study will, in the near future, provide the basis for evidence-based transfusion management of HIV-infected persons. The Viral Activation Transfusion Study,5 a multicenter, prospective, randomized trial that began enrolling patients in 1995, was designed to specifically address the question of whether blood transfuSion leads to immune activation and consequent induction of HIV-1. Endpoints will examine whether leukocyte reduction of blood components by prestorage filtration results in any significant difference in immune activation, xiral burden, and clinical outcome versus non-leukocyte-reduced transfusions. We agree with the authors that there is a striking lack of data on the effects of transfusion of HIV-seropositive individuals, but we believe that current data are insufficient to make a recommenda-

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tion for leukocyte reduction of all blood components transfused to HIV-seropositive individuals. T.A. Lane T.B. Gernsheimer M.R Busch R Holland

the Steering Committee of the ViralActivation Transfusion Study (VATS) REFERENCES 1. Hillyer CD, Lankford KV, Roback JD, et al: Transfusion of the HIV-seropositive patient: Immunomodulation, viral reactivation, and limiting exposure to EBV, CMV and HHV-6, 7 and 8. Transfus Med Rev 13:1-17, 1999 2. Varnvakas E, Kaplan HS: Early transfusion and length of survival in acquired immune deficiency syndrome: Experience with a population receiving medical care at a public hospital. Transfusion 33:111-118, 1993 3. Sloand E, Kumar E Klein HG, et al: Transfusion of blood components to persons infected with human immunodeficiency virus type 1: Relationship to opportunistic infection. Transfusion 34:48453, 1994 4. Busch MP, Lee T-H, Heitman J: Allogeneic leukocytes but not therapeutic blood elements induce reactivation and dissemination of latent human immunodeficiency virus type I infection: Implications for transfusion support of infected patients. Blood 80:2128-2135, 1992 5. Busch MP, Collier A, Gernsheimer T, et al: The Viral Activation Transfusion Study (VATS): Rationale, objectives and design overview. Transfusion 36:854-859, 1996

Response to the Letter to the Editor In Reply: We appreciate the comments of Dr Lane and his colleagues and are also awaiting the results of the Viral Activation Transfusion Study. Christopher D. Hillyer, MD Krista V. Lankford, MD John D. Roback, MD, PhD Theresa W. Gillespie, PhD Leslie E. Silberstein, MD

Atlanta, GA

Transfusion Medicine Reviews, Vo113, No 4 (October), 1999: p 334