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# Direct HIV testing of donated blood is inevitable

BMJ 1997; 314 (Published 17 May 1997) Cite this as: BMJ 1997;314:1433
1. Newcastle

The introduction of a polymerase chain reaction (PCR) test for HIV in donated blood products is inevitable, according to scientists at the National Blood Authority. They say, however, that such a move would result in a “quantum leap” in cost for doubtful benefit.

Testing directly for HIV, rather than the current antibody testing, would reduce the window of opportunity for missing infected blood from around three weeks to a matter of days. Three patients in northwest England recently contracted HIV infection from blood transfusions from a donor positive for HIV (26 April, p 1222). Retrospective testing of the donated blood confirmed it to be negative for HIV antibodies but positive for HIV with PCR testing. The donor probably became infected only days before donating blood.

Dr John Barbara, microbiology consultant at the National Blood Authority, said that PCR testing for hepatitis C virus in pooled plasma products will be introduced next year as part of European legislation and that testing for HIV will almost certainly follow.

Various working groups are currently looking at using PCR to test for HIV. “The implications are enormous–it's a quantum leap not just in terms of cost but of organisation,” said Dr Barbara. “It could be a huge amount of money for something that is going to produce a minimal reduction in risk.”

He estimates that there is a residual risk with the current system of 1 in 2.5 million. The recent cases are the first time the virus has been passed on through donated blood since 1986, since when there have been an estimated 30 million blood donations. “Looking at cost effectiveness, we have a very safe system,” said Dr Barbara.

Professor Ian Franklin, national medical and scientific director at the Scottish National Blood Transfusion Service, said the introduction of PCR testing for HIV in the United States would cost an estimated $96m (£60m) and prevent 24 cases of infection, although he points out that the incidence of HIV is greater there. “That works out at$2m for each quality of life year gained, compared to \$3600 for antibody testing. I do not think that PCR detection of HIV is something we should rush into.”

Both Dr Barbara and Dr Franklin believe that it is time for a radical rethink about how blood transfusion services are organised in Britain. One option might be autologous blood transfusion, whereby patients would be asked to donate their own blood before elective surgery. Professor Franklin said: “It has always been seen as too expensive, but it may now become cost effective.” He added: “We must also look at ways of avoiding large transfusions, perhaps by using erythropoietin.”

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