Use of Blood‐Donor and Transfusion‐Recipient Biospecimen Repositories to Address Emerging Blood‐Safety Concerns and Advance Infectious Disease Research: The National Heart, Lung, and Blood Institute Biologic Specimen Repository

Abstract

In this issue of the Journal a seminal article by Cannon et al. [1] addresses the long-standing debate over the transmissibility of human herpesvirus (HHV)–8, the etiological agent of Kaposi sarcoma (KS), via blood transfusion. Although concern over transmission via transfusion was raised shortly after the discovery of HHV-8 nearly 2 decades ago, this issue has been difficult to resolve because of problems with the sensitivity, reliability, and throughput capacity of HHV-8 screening assays, particularly for healthy donors with latent infections, in whom antibody titers are low and viremia is generally undetectable [2]. Identifying appropriate populations in which to conduct large-scale linked donor-recipient transmission studies has also been a challenge The issue of HHV-8 in the blood supply is important, because it guides decisions as to whether donor screening is warranted and because it may affect the heated debate over relaxing (to either 1 or 5 years) the current “since 1977” donor deferral of men who have sex with men (MSM) [3, 4]. For all practical purposes, this deferral policy is now tantamount to permanently deferring men who have had sex with men once in their lifetime. MSM are known to have relatively high rates of HHV-8 infection, and, if HHV-8 is transmitted via transfusion and the prevalence of HHV-8 (or other potential transfusion-transmissible agents for which screening is not currently performed) among prospective donors with remote MSM exposure is high, then relaxing the current MSM deferral criterion could facilitate transmission of those infections to transfusion recipients, many of whom are immunocompromised and, hence, at risk for serious sequelae. Criticism over retention of the current policy has been intense, with many colleges and even cities canceling blood drives because of what they consider to be a discriminatory policy. The putative transmissibility of HHV-8 has been a major question in need of resolution before the US Food and Drug Administration (FDA) gives serious consideration to relaxing this deferral criterion

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