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Interesting problem we're dealing with: Truvada potentially makes it harder to identify HIV+ blood donors (as their antibody titers fall naturally over time) an

Interesting problem we're dealing with: Truvada potentially makes it harder to identify HIV+ blood donors (as their antibody titers fall naturally over time) and raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". It is a well-known fact in their community that men having sex with men are deferred from being blood donors for 12 months from last male intercourse, and there is at least a vocal minority in the community which feels this is unjust. Presently, there is no approved question for the donor questionnairre along the lines of "Are you using Truvada?" but it is a hotly debated topic among blood bankers.

dmix 8y ago
Is there any centralized ruling for this in the US (and other countries) or is this up to the blood banks. I'd imagine they'd face liability issues if they were taking blood from high risk individuals. This also applies to intravenous drug users as well (which has nothing to do with sexual orientation).
- killjoywashere 8y ago
  Each donor center medical director is responsible for their own checklist, however, The American Association of Blood Banks (AABB) inspects blood donor centers and publishes their questionnairre. Not asking these questions will constitute a hit agaisnt your program and may jeopardize your institution's ability to seek reimbursement for services from, say, CMS. http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%20v2.0.pdf http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%2...
esf 8y ago
Truvada does nothing to change identification of HIV+ donors. Truvada does not change response to HIV tests, an HIV+ person taking Truvada as part of treatment does not stop testing positive for HIV antibodies. Nothing changes from the existing blood donation situation due to Truvada.
- killjoywashere 8y ago
  Like most things in science, be suspicious of pure logical arguments. The question for any test, even a true-false, is first a matter of "how much". Antibodies fade over time, ergo various vaccine boosters, such as tetanus. At some point, we can't detect it.
  - dogma1138 8y ago
    I don’t know why is this being downvoted. Anti bodies are produced to combat a pathogen if the levels of the pathogen are below of what would trigger the immune system you will not produce anti bodies and the ones that you have had produced will fade of over time you don’t have anti bodies for every pathogen you encounter flowing through your blood that would likely kill you. If the pill can reduce the virus to trace levels and prevent HIV from developing into AIDS it’s not unreasonable to question if it can affect current HIV detection protocols. Heck it wouldn’t surprise me if they measured the levels of anti bodies dropping while the levels of immune cells remaining normal to test the efficiency of the new drug. That said I know some HIV tests check for the levels of virions in the blood these are often used for AIDS prognosis I don’t know how sensitive these are and if they’ll be able to detect trace levels of the virus if anti bodies response tests will become unreliable. Also like with everything it’s not binary if this new treatment regiment can reduce the effectiveness of HIV testing by any meaningful margin it will be a problem. I have very hard time believing that current HIV testing is 100% false negative proof.
    - esf 8y ago
      The pill was already part of HIV trratment, it does nothing to change the effectiveness of HIV tests. The only unknown would be whether if you are one of the very, very few people that manages to contract HIV while taking prep, your antibody response is different during that initial window. But: Anyone in that situation is already covered by the questions about recent partners and already is not donating if answering the existing questions in good faith. If they are donating in this situation at all they are already just ignoring the questions.
sigmar 8y ago
>raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". What? This sounds like completely made up scaremongering. Why wouldn't they just get their viral load tested?
- killjoywashere 8y ago
  Thinking of remote possibilities and assuming your patients could be lying to you (corollary: trust but verify) is pretty standard practice in medicine.
  - sigmar 8y ago
    and your solution to these adversarial patients that are willing to lie is to... ask a second question?
    - killjoywashere 8y ago
      Whether Bayesian or Frequentist, surely you can agree the result of different tests are unlikely to have 100% concordance.
flashman 8y ago
> there is no approved question for the donor questionnairre Do they not already ask if someone's ever been diagnosed with asthma, hepatitis, HIV, leukemia, lymphoma, myeloma, etc? All of which are permanent disqualifications.
canekong 8y ago
As a gay man on prep, I find this comment quite offensive. Within my circle of friends (some of whom are quite adventurous) none of them says “let’s donate blood and see what happens”. Furthermore being on PrEP requires strict complete STD testing (Chlamydia, Syphillis, HIV, included) testing every 3 months before allowed to be prescribed again. The same time interval as any recommended STD testing. I had a discussion with my Dr last week about Truvada on similar topic. Her reply was that Truvada is not enough to suppress viral load and thus they can be detected if a person is infected still and is not on treatment. Also Truvada is not magic pill and can take time to take effect (about 1-2 weeks) and there have been cases of people getting infected while on PrEP because their drugs haven’t taken effect yet.

dmix 8y ago

Is there any centralized ruling for this in the US (and other countries) or is this up to the blood banks. I'd imagine they'd face liability issues if they were taking blood from high risk individuals. This also applies to intravenous drug users as well (which has nothing to do with sexual orientation).

killjoywashere 8y ago
Each donor center medical director is responsible for their own checklist, however, The American Association of Blood Banks (AABB) inspects blood donor centers and publishes their questionnairre. Not asking these questions will constitute a hit agaisnt your program and may jeopardize your institution's ability to seek reimbursement for services from, say, CMS. http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%20v2.0.pdf http://www.aabb.org/tm/questionnaires/Documents/dhq/v2/DHQ%2...

esf 8y ago

Truvada does nothing to change identification of HIV+ donors. Truvada does not change response to HIV tests, an HIV+ person taking Truvada as part of treatment does not stop testing positive for HIV antibodies. Nothing changes from the existing blood donation situation due to Truvada.

killjoywashere 8y ago
Like most things in science, be suspicious of pure logical arguments. The question for any test, even a true-false, is first a matter of "how much". Antibodies fade over time, ergo various vaccine boosters, such as tetanus. At some point, we can't detect it.
- dogma1138 8y ago
  I don’t know why is this being downvoted. Anti bodies are produced to combat a pathogen if the levels of the pathogen are below of what would trigger the immune system you will not produce anti bodies and the ones that you have had produced will fade of over time you don’t have anti bodies for every pathogen you encounter flowing through your blood that would likely kill you. If the pill can reduce the virus to trace levels and prevent HIV from developing into AIDS it’s not unreasonable to question if it can affect current HIV detection protocols. Heck it wouldn’t surprise me if they measured the levels of anti bodies dropping while the levels of immune cells remaining normal to test the efficiency of the new drug. That said I know some HIV tests check for the levels of virions in the blood these are often used for AIDS prognosis I don’t know how sensitive these are and if they’ll be able to detect trace levels of the virus if anti bodies response tests will become unreliable. Also like with everything it’s not binary if this new treatment regiment can reduce the effectiveness of HIV testing by any meaningful margin it will be a problem. I have very hard time believing that current HIV testing is 100% false negative proof.
  - esf 8y ago
    The pill was already part of HIV trratment, it does nothing to change the effectiveness of HIV tests. The only unknown would be whether if you are one of the very, very few people that manages to contract HIV while taking prep, your antibody response is different during that initial window. But: Anyone in that situation is already covered by the questions about recent partners and already is not donating if answering the existing questions in good faith. If they are donating in this situation at all they are already just ignoring the questions.

sigmar 8y ago

>raises the question of whether HIV+ individuals will be more likely to attempt to donate in order to "prove they're safe". What? This sounds like completely made up scaremongering. Why wouldn't they just get their viral load tested?

killjoywashere 8y ago
Thinking of remote possibilities and assuming your patients could be lying to you (corollary: trust but verify) is pretty standard practice in medicine.
- sigmar 8y ago
  and your solution to these adversarial patients that are willing to lie is to... ask a second question?
  - killjoywashere 8y ago
    Whether Bayesian or Frequentist, surely you can agree the result of different tests are unlikely to have 100% concordance.

flashman 8y ago

> there is no approved question for the donor questionnairre Do they not already ask if someone's ever been diagnosed with asthma, hepatitis, HIV, leukemia, lymphoma, myeloma, etc? All of which are permanent disqualifications.

canekong 8y ago

As a gay man on prep, I find this comment quite offensive. Within my circle of friends (some of whom are quite adventurous) none of them says “let’s donate blood and see what happens”. Furthermore being on PrEP requires strict complete STD testing (Chlamydia, Syphillis, HIV, included) testing every 3 months before allowed to be prescribed again. The same time interval as any recommended STD testing. I had a discussion with my Dr last week about Truvada on similar topic. Her reply was that Truvada is not enough to suppress viral load and thus they can be detected if a person is infected still and is not on treatment. Also Truvada is not magic pill and can take time to take effect (about 1-2 weeks) and there have been cases of people getting infected while on PrEP because their drugs haven’t taken effect yet.