Absence of HIV Infection in Blood Donors with Indeterminate Western Blot Tests for Antibody to HIV-1

J. Brooks Jackson, Kristine L. Macdonald, Jane Cadwell, Carolyn Sullivan, William E. Kline, Margaret Hanson, Kim J. Sannerud, Susan L. Stramer, Nicola J. Fildes, Shirley Y. Kwok, John J. Sninsky, Robert J. Bowman, Herbert F. Polesky, Henry H. Balfour, Michael T. Osterholm

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121 Scopus citations


To determine whether apparently healthy persons who have had repeatedly reactive enzyme immunoassays and an indeterminate Western blot assay for antibody to the human immunodeficiency virus type 1 (HIV-1) are infected with HIV-1 or HIV-2, we studied 99 such volunteer blood donors in a low-risk area of the country. The subjects were interviewed about HIV risk factors. Coded blood specimens were tested again for HIV-1 antibody (by two different enzyme immunoassays, a Western blot assay and a radioimmunoprecipitation assay) and for HIV-2 antibody by enzyme immunoassay, for HIV-1 by the serum antigen test, for HIV-1 by culture, for human T-cell leukemia virus Type I or II antibody by enzyme immunoassay, and for sequences of HIV DNA by the polymerase chain reaction. Of the 99 blood donors, 98 reported no risk factors for HIV-1 infection; 1 donor had used intravenous drugs. After a median of 14 months (range, 1 to 30) from the time of the initial test, 65 subjects (66 percent) were still repeatedly reactive for HIV-1 antibody on at least one immunoassay. In 91 subjects (92 percent) the Western blot results were still indeterminate, whereas in 8 they were negative. No donor met the criteria for a positive Western blot assay for HIV-1, and none had evidence of HIV-1 or HIV-2 infection on culture or by any other test. We conclude that persons at low risk for HIV infection who have persistent indeterminate HIV-1 Western blots are rarely if ever infected with HIV-1 or HIV-2. LICENSED enzyme immunoassay kits for screening the blood of volunteer blood donors for antibody to the human immunodeficiency virus type 1 (HIV-1) have been available since March 1985.1 The blood from donors who have been found to be repeatedly reactive on an enzyme immunoassay for HIV-1 antibody has not been used in transfusion or manufactured into other products capable of transmitting infectious agents.2 To verify the presence of HIV-1 antibody in a repeatedly reactive sample, the Western blot assay3 has most often been used as a confirmatory test in the United States.4 This assay typically reveals six to nine characteristic…

Original languageEnglish (US)
Pages (from-to)217-222
Number of pages6
JournalNew England Journal of Medicine
Issue number4
StatePublished - Jan 25 1990


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