HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 ACTIVATION AFTER BLOOD-TRANSFUSION

Background: Anemia and transfusion are predictors of disease progressi on in AIDS patients. This study was designed to examine the effects of blood transfusion on human immunodeficiency virus type 1 (HIV-1) expr ession. Study Design and Methods: Assays of plasma viral load were per formed before and after transfusion in nine HIV-1-infected patients wh o required blood transfusion for refractory anemia. Results: There was a modest rise in plasma HIV-1 p24 antigen and plasma HIV-1 RNA beginn ing 1 to 2 weeks after the blood transfusion. The mean change in plasm a p24 antigen for all patients was 9.3 +/- 5.1 (mean +/- SE) pg per mL at Week 2 after transfusion and 18 +/- 11.1 pg per mL at Week 4. Plas ma HIV-1 RNA levels were unchanged immediately after transfusion and e xceeded pretransfusion levels with a mean rise of 84 +/- 40 percent (S E) at Week 1, 70 +/- 27 percent at Week 2, and 67 +/- 38 percent at We ek 4 (p = 0.006, exact permutation test). There was no increase in spo ntaneous or interleukin 2-induced lymphocyte proliferation or p24 anti gen production by patients' lymphocytes that were examined immediately after blood transfusion. Conclusion: The transfusion of blood to pers ons with advanced HIV-1 infection modestly increases plasma levels of HIV-1. The activation of HIV-1 expression by transfusion may help to e xplain the accelerated course of HIV-1 disease in recipients of blood transfusion.