Genetic diversity of recently acquired and prevalent HIV, hepatitis B virus, and hepatitis C virus infections in US blood donors

Abstract

Background: Genetic variations of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) can affect diagnostic assays and therapeutic interventions. Recent changes in prevalence of subtypes/genotypes and drug/immune-escape variants were characterized by comparing recently infected vs more remotely infected blood donors.

Methods: Infected donors were identified among approximately 34 million US blood donations, 2006-2009; incident infections were defined as having no or low antiviral antibody titers. Viral genomes were partially sequenced.

Results: Of 321 HIV strains (50% incident), 2.5% were non-B HIV subtypes. Protease and reverse transcriptase (RT) inhibitor resistance mutations were found in 2% and 11% of infected donors, respectively. Subtypes in 278 HCV strains (31% incident) yielded 1a>1b>3a>2b>2a>4a>6d, 6e: higher frequencies of 3a in incident cases vs higher frequencies of 1b in prevalent cases were found (P = .04). Twenty subgenotypes among 193 HBV strains (26% incident) yielded higher frequencies of A2 in incident cases and higher frequencies of A1, B2, and B4 in prevalent cases (P = .007). No HBV drug resistance mutations were detected. Six percent of incident vs 26% of prevalent HBV contained antibody neutralization escape mutations (P = .01).

Conclusions: Viral genetic variant distribution in blood donors was similar to that seen in high-risk US populations. Blood-borne viruses detected through large-scale routine screening of blood donors can complement molecular surveillance studies of highly exposed populations.

Figures

Figure 1.

A, Algorithm for classification of human immunodeficiency virus (HIV)–positive donations as incident or prevalent infections for selection of cases for sequencing. Boxes in gray indicate the donations from which samples were selected for sequencing for this study. B, Histograms showing success of polymerase chain reaction (PCR) relative to viral loads; frequencies of donations from incident and prevalent cases are shown separately. C, HIV subtypes of sequenced samples by incident and prevalent case status. Abbreviations: IFA, immunofluorescence assay; NAT, nucleic acid testing; WB, Western blot.

Figure 2.

A, Algorithm for classification of hepatitis C virus (HCV)–positive donations as incident or prevalent infections for selection of cases for sequencing. Boxes in gray indicate the donations from which samples were selected for sequencing for this study. B, Histograms showing success of polymerase chain reaction (PCR) relative to viral loads; frequencies of donations from incident and prevalent cases are shown separately. C, HCV subtypes of sequenced samples by incident and prevalent case status. Abbreviations: NAT, nucleic acid testing; RIBA, recombinant immunoblot assay.

Figure 3.

A, Algorithm for classification of hepatitis B virus (HBV)–positive donations as incident or prevalent infections for selection of cases for sequencing. Boxes in gray indicate the donations from which samples were selected for sequencing for this study. B, Histograms showing success of polymerase chain reaction (PCR) relative to viral loads; frequencies of donations from incident and prevalent cases are shown separately. C, HBV subgenotypes of sequenced samples by incident and prevalent case status. Abbreviations: HBc, anti-HBV core antibody; HBsAg, HBV surface antigen.