HIV Subtypes and Drug-resistance-associated Mutations in US Blood Donors, 2015-2020

Brian Custer; Eda Altan; Leilani Montalvo; Alison Coyne; Eduard Grebe; Xutao Deng; Mars Stone; Eric Delwart; Sonia Bakkour; Benyam Hailu; Rita Reik; Debra Kessler; Susan L Stramer; Michael P Busch; Transfusion Transmissible Infections Monitoring System (TTIMS) Program

doi:10.1093/ofid/ofae343

HIV Subtypes and Drug-resistance-associated Mutations in US Blood Donors, 2015-2020

Open Forum Infect Dis. 2024 Jun 17;11(7):ofae343. doi: 10.1093/ofid/ofae343. eCollection 2024 Jul.

Authors

Brian Custer^{1

2}, Eda Altan¹, Leilani Montalvo¹, Alison Coyne¹, Eduard Grebe¹, Xutao Deng^{1

2}, Mars Stone^{1

2}, Eric Delwart^{1

2}, Sonia Bakkour³, Benyam Hailu⁴, Rita Reik⁵, Debra Kessler⁶, Susan L Stramer⁷, Michael P Busch^{1

2}; Transfusion Transmissible Infections Monitoring System (TTIMS) Program

Collaborators

Transfusion Transmissible Infections Monitoring System (TTIMS) Program:
E Notari, S Stramer, R Dodd, G Conti, R Fayed, D Nelson, R Townsend, G Foster, J Haynes, E Crawford, E Huseynova, D Krysztof, D Burke, M Lanteri, V Green, S Cyrus, P Williamson, D Kessler, J Gorlin, L Milan-Benson, C DelValle, P Chien, T Brown, R Reik, C Shea, M Lopez, K Richards, T Foster, J Brodsky, M Barr, T Rains, B Custer, R Bruhn, E Grebe, M Busch, M Stone, C Di Germanio, D Hindes, Z Kaidarova, K Zurita, A Tadena, L Montalvo, A Dayana, S Hughes, M Townsend, M Bravo, J Vannoy, S Fallon, S Anderson, B Whitaker, H Yang, A Belov, A Eder, B Hailu, S Zou, J Berger, Brian Custer, Susan Stramer, Debra Kessler, Rita Reik, Phillip Williamson, Steven A Anderson, Benyam Hailu

Affiliations

¹ Vitalant Research Institute, San Francisco, California, USA.
² Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA.
³ Global Medical Affairs Donor Screening, Grifols Diagnostic Solutions, Emeryville, California, USA.
⁴ Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland, USA.
⁵ Scientific, Medical, Technical and Research, OneBlood, St. Petersburg, Florida, USA.
⁶ Medical Programs and Services, New York Blood Center, New York, New York, USA.
⁷ Infectious Disease Consultant, North Potomac, Maryland, USA.

Abstract

Background: Monitoring genotypes of HIV infections in blood donors may provide insights into infection trends in the general population.

Methods: HIV RNA was extracted from plasma samples of blood donors confirmed as HIV positive by blood screening nucleic acid and antibody tests. HIV genome target regions were amplified using nested real time-polymerase chain reaction followed by next-generation sequencing. Sequences were compared to those in the Los Alamos National Laboratory (LANL) database. Sequences were also assessed for drug resistance mutations (DRM) using the Stanford HIV DRM Database.

Results: From available HIV-positive donations collected between 1 September 2015 and 31 December 2020, 563 of 743 (75.8%) were successfully sequenced; 4 were subtype A, 543 subtype B, 5 subtype C, 1 subtype G, 5 circulating recombinant forms (CRF), and 2 were subtype B and D recombinants. Overall, no significant differences between blood donor and available LANL genotypes were found, and the genotypes of newly acquired versus prevalent HIV infections in donors were similar. The proportion of non-B subtypes and CRF remained a small fraction, with no other subtype or CRF representing more than 1% of the total. DRM were identified in 122 (21.6%) samples with protease inhibitor, nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor DRMs identified in 4.9%, 4.6% and 14.0% of samples, respectively.

Conclusions: HIV genetic diversity and DRM in blood donors appear representative of circulating HIV infections in the US general population and may provide more information on infection diversity than sequences reported to LANL, particularly for recently transmitted infections.

Keywords: HIV; blood donors; blood screening; genetic sequence analysis; phylogenetics.