Retrovirus Epidemiology Donor Study I (REDS I)

NCT ID: NCT00005278

Last Updated: 2016-04-15

Basic Information

• Recruitment Status: COMPLETED
• Study Classification: OBSERVATIONAL
• Study Start Date: 1989-07-31
• Study Completion Date: 2007-10-31

Brief Summary

To conduct a multicenter epidemiologic study of the human retroviruses HIV-1, HIV-2, HTLV-I, and HTLV-II in volunteer blood donors from areas of the United States that were reportedly at high and medium or low risk for HIV. Also, to determine the prevalence of retrovirus seropositivity in first time blood donors; and the rate of retrovirus seroconversion in repeat blood donors as a measure of incidence of infection; to ascertain risk factors for antibody-positive donors; to characterize the blood donor population by geographic location, age, sex, race/ethnicity, and donation history to permit analysis on prevalence, incidence, and risk factors; to identify recipients of retrovirus-positive blood units and conduct clinical and laboratory follow-up of these recipients; and to establish a blood specimen repository for long-term storage of specimens from study donors and recipients for future testing.

Detailed Description

BACKGROUND:

HIV is known to be transmissible by blood, blood components, or plasma derivatives. The risk of contracting HIV infection from blood transfusion has been greatly reduced in the United States by implementing stringent criteria for donor acceptance, HIV antibody screening, and new methods of virus inactivation in coagulation factor concentrates. There are additional human retroviruses, however, that may pose a threat to the safety of the nation's blood supply.

The human T-cell lymphotropic retroviruses share many properties, including a preferred tropism for certain lymphocytes and similar modes of transmission. They also differ significantly from each other and on this basis are divided into two distinct groups: the human T-cell lymphocytropic viruses (HTLVs) and the human immunodeficiency viruses (HIVs). HTLV-I, a transforming virus, is the prototype of the first group (HTLVs). It is associated with adult T-cell leukemia (ATL) and is thought to be involved in a central nervous system disorder referred to as tropical spastic paraparesis. This group also includes HTLV-II, which is associated with a T-cell malignancy different from ATL. A newly isolated human retrovirus, termed HTLV-V, may be the etiologic agent of cutaneous T-cell lymphoma/leukemia, and may also be added to this group. HIV, previously known as HTLV-III or lymphadenopathy virus (LAV), a nontransforming virus, causes acquired immunodeficiency syndrome (AIDS) and is the prototype of the second group (HIVs). New members of this group of nontransforming human retroviruses were isolated from individuals in different countries of Africa. LAV-2, also referred to as HIV-2, was isolated from two AIDS patients in Africa, and the first case of AIDS in the United States caused by HIV-2 was reported in January, 1988. A third member of this group, HIV-3, was detected in Africa.

Although the HTLV family of retroviruses is distinct from the HIV family, both groups of viruses infect human T4 (CD4) lymphocytes preferentially and alter the host's T-cell functions. Whereas HTLV-I or HTLV-II primarily induce transformation and proliferation of T Lymphocytes and cause T-cell lymphoma/leukemia in humans, HIV and HIV-2 induce T-cell cytopathology that leads to depletion of CD4 cells.

The spread of HIV by blood transfusion represents a highly efficient mode of transmission. Blood components from donors with antibody to HIV have been shown to transmit the virus with frequencies of greater than 90 percent. Packed red blood cells, platelets, or fresh frozen plasma are all equally effective in transmitting the virus to recipients. It is highly likely, therefore, that recipients who receive blood from donors with antibody to HIV will themselves become infected with the virus. Fortunately, the likelihood of such an occurrence in the United States is now rare due to the implementation of screening procedures and other safeguards. When the study was initiated in 1989, there was a growing concern, however, that human retroviruses other than HIV might threaten the safety of the United States blood supply.

DESIGN NARRATIVE:

Blood donors were asked to participate in this multicenter study. Seropositive donors were notified of test results, counseled, and invited to join the follow-up study. Data collected during the first interview included such items as possible exposures to persons with retroviral infection, sexual preferences and contacts, marital history, intravenous drug use, occupation, travel, knowledge of AIDS and routes of HIV transmission. At subsequent visits a blood specimen was collected for laboratory testing and an assessment made of changes in behavior to reduce the risk of virus transmission.

To calculate incidence and prevalence rates, each center identified the appropriate study population for analysis purposes in collaboration with the coordinating center. For prevalence calculations, the study population consisted of donors at all centers who indicated that they had never donated blood previously. To calculate incidence, the study population consisted of donors who had donated previously in the same center. The incidence of retroviral infections was assessed annually in years three through five. Clinical follow-up of all subjects concluded 48 months after the beginning of enrollment. A blood profile for each center was required to calculate denominator values for incidence and prevalence determinations. The blood profile, or donor demographic characterization consisted of information regarding total donor volume with respect to donation status; new or repeat donor, and if repeat, the time of last donation; age; sex; and race.

An adjunct to the study was the development of repositories of plasma and cell samples from infected donors and negative controls collected at the same time. A potential byproduct of these repositories will be the ability in future years to retrospectively search the REDS frozen repository file for new retroviruses which may appear in the United States population.

Conditions

Acquired Immunodeficiency Syndrome; Blood Donors; Blood Transfusion; HIV Infections; HIV-1; HIV-2; HTLV-I; HTLV-II; Retroviridae Infections

Eligibility Criteria

Inclusion Criteria

No eligibility criteria

• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role: lead

Principal Investigators

George Garratty

Role:

American Red Cross Blood Services

Martha Higgens

Role:

American Red Cross Blood Services

Edward Murphy

Role:

University of California at San Francisco

Catharie Nass

Role:

American Red Cross Blood Services

George Schreiber

Role:

Westat, Inc.

James Smith

Role:

Oklahoma Blood Institute

References

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Zuck TF, Thomson RA, Schreiber GB, Gilcher RO, Kleinman SH, Murphy EL, Ownby HE, Williams AE, Busch MP, Smith JW, et al. The Retrovirus Epidemiology Donor Study (REDS): rationale and methods. Transfusion. 1995 Nov-Dec;35(11):944-51. doi: 10.1046/j.1537-2995.1995.351196110900.x. No abstract available.

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Murphy EL, Glynn SA, Fridey J, Smith JW, Sacher RA, Nass CC, Ownby HE, Wright DJ, Nemo GJ. Increased incidence of infectious diseases during prospective follow-up of human T-lymphotropic virus type II- and I-infected blood donors. Retrovirus Epidemiology Donor Study. Arch Intern Med. 1999 Jul 12;159(13):1485-91. doi: 10.1001/archinte.159.13.1485.

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Glynn SA, Smith JW, Schreiber GB, Kleinman SH, Nass CC, Bethel J, Biswas B, Thomson RA, Williams AE; Retrovirus Epidemiology Donor Study. Repeat whole-blood and plateletpheresis donors:unreported deferrable risks, reactive screening tests, andresponse to incentive programs. Transfusion. 2001 Jun;41(6):736-43. doi: 10.1046/j.1537-2995.2001.41060736.x.

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Sanchez AM, Schreiber GB, Bethel J, McCurdy PR, Glynn SA, Williams AE, Gilcher R; Retrovirus Epidemiology Donor Study (REDS). Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis. JAMA. 2001 Sep 26;286(12):1475-81. doi: 10.1001/jama.286.12.1475.

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Glynn SA, Williams AE, Nass CC, Bethel J, Kessler D, Scott EP, Fridey J, Kleinman SH, Schreiber GB; Retrovirus Epidemiology Donor Study. Attitudes toward blood donation incentives in the United States: implications for donor recruitment. Transfusion. 2003 Jan;43(1):7-16. doi: 10.1046/j.1537-2995.2003.00252.x.

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Schreiber GB, Glynn SA, Damesyn MA, Wright DJ, Tu Y, Dodd RY, Murphy EL; Retrovirus Epidemiology Donor Study. Lapsed donors: an untapped resource. Transfusion. 2003 Jan;43(1):17-24. doi: 10.1046/j.1537-2995.2003.00290.x.

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Wang B, Schreiber GB, Glynn SA, Nass CC, Smith JW, Higgins MJ, Hutching ST, Wright DJ, McEntire RL, Murphy EL; Retrovirus Epidemiology Donor Study. Prevalence of transfusion-transmissible viral infections in first-time US blood donors by donation site. Transfusion. 2003 Jun;43(6):705-12. doi: 10.1046/j.1537-2995.2003.00399.x.

Reference Type: BACKGROUND

PMID: 12757520 (View on PubMed)

Glynn SA, Busch MP, Schreiber GB, Murphy EL, Wright DJ, Tu Y, Kleinman SH; NHLBI REDS Study Group. Effect of a national disaster on blood supply and safety: the September 11 experience. JAMA. 2003 May 7;289(17):2246-53. doi: 10.1001/jama.289.17.2246.

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Schreiber GB, Sanchez AM, Glynn SA, Wright DJ; Retrovirus Epidemiology Donor Study. Increasing blood availability by changing donation patterns. Transfusion. 2003 May;43(5):591-7. doi: 10.1046/j.1537-2995.2003.00388.x.

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Roback JD, Drew WL, Laycock ME, Todd D, Hillyer CD, Busch MP. CMV DNA is rarely detected in healthy blood donors using validated PCR assays. Transfusion. 2003 Mar;43(3):314-21. doi: 10.1046/j.1537-2995.2003.00312.x.

Reference Type: BACKGROUND

PMID: 12675715 (View on PubMed)

Sacher RA, Luban NL, Ameti DI, Friend S, Schreiber GB, Murphy EL. Low prevalence of flower cells in U.S.A. blood donors infected with human T-lymphotrophic virus types I and II. Br J Haematol. 1999 Jun;105(3):758-63. doi: 10.1046/j.1365-2141.1999.01408.x.

Reference Type: BACKGROUND

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Guiltinan AM, Murphy EL, Horton JA, Nass CC, McEntire RL, Watanabe K. Psychological distress in blood donors notified of HTLV-I/II infection. Retrovirus Epidemiology Donor Study. Transfusion. 1998 Nov-Dec;38(11-12):1056-62. doi: 10.1046/j.1537-2995.1998.38111299056317.x.

Reference Type: BACKGROUND

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Kleinman S, Busch MP, Hall L, Thomson R, Glynn S, Gallahan D, Ownby HE, Williams AE. False-positive HIV-1 test results in a low-risk screening setting of voluntary blood donation. Retrovirus Epidemiology Donor Study. JAMA. 1998 Sep 23-30;280(12):1080-5. doi: 10.1001/jama.280.12.1080.

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Murphy EL, Glynn S, Watanabe K, Fridey J, Smith J, Sacher R, Wright D, Schreiber G, Luban N. Laboratory test differences associated with HTLV-I and HTLV-II infection. Retrovirus Epidemiology Donor Study Investigators. J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Apr 1;17(4):332-8. doi: 10.1097/00042560-199804010-00007.

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Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE. Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study. Transfusion. 1998 Apr;38(4):359-67. doi: 10.1046/j.1537-2995.1998.38498257374.x.

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Damesyn MA, Glynn SA, Schreiber GB, Ownby HE, Bethel J, Fridey J, McMullen Q, Garratty G, Busch MP; NHLBI Retrovirus Epidemiology Donor Study. Behavioral and infectious disease risks in young blood donors: implications for recruitment. Transfusion. 2003 Nov;43(11):1596-603. doi: 10.1046/j.1537-2995.2003.00532.x.

Reference Type: BACKGROUND

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Pellett PE, Wright DJ, Engels EA, Ablashi DV, Dollard SC, Forghani B, Glynn SA, Goedert JJ, Jenkins FJ, Lee TH, Neipel F, Todd DS, Whitby D, Nemo GJ, Busch MP; Retrovirus Epidemiology Donor Study. Multicenter comparison of serologic assays and estimation of human herpesvirus 8 seroprevalence among US blood donors. Transfusion. 2003 Sep;43(9):1260-8. doi: 10.1046/j.1537-2995.2003.00490.x.

Reference Type: BACKGROUND

PMID: 12919429 (View on PubMed)

Rugege-Hakiza SE, Glynn SA, Hutching ST, Bethel J, Nass CC, McEntire RL, Hirschler NV, Campbell JG, Ladavac A, Schreiber GB; Retrovirus Epidemiology Donor Study. Do blood donors read and understand screening educational materials? Transfusion. 2003 Aug;43(8):1075-83. doi: 10.1046/j.1537-2995.2003.00473.x.

Reference Type: BACKGROUND

PMID: 12869113 (View on PubMed)

Kleinman SH, Kuhns MC, Todd DS, Glynn SA, McNamara A, DiMarco A, Busch MP; Retrovirus Epidemiology Donor Study. Frequency of HBV DNA detection in US blood donors testing positive for the presence of anti-HBc: implications for transfusion transmission and donor screening. Transfusion. 2003 Jun;43(6):696-704. doi: 10.1046/j.1537-2995.2003.00391.x.

Reference Type: BACKGROUND

PMID: 12757519 (View on PubMed)

Schreiber GB, Sanchez AM, Garratty G, Nass CC, Tu Y, Busch MP; Retrovirus Epidemiology Donor Study. Mammalian brain consumption by blood donors in the United States: brains today, deferred tomorrow? Transfusion. 2004 May;44(5):667-74. doi: 10.1111/j.1537-2995.2004.03114.x.

Reference Type: BACKGROUND

PMID: 15104646 (View on PubMed)

Busch MP, Glynn SA, Stramer SL, Strong DM, Caglioti S, Wright DJ, Pappalardo B, Kleinman SH; NHLBI-REDS NAT Study Group. A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion. 2005 Feb;45(2):254-64. doi: 10.1111/j.1537-2995.2004.04215.x.

Reference Type: BACKGROUND

PMID: 15660836 (View on PubMed)

Tobler LH, Bianco C, Glynn SA, Schreiber GB, Dille BJ, Prince HE, Lanciotti RS, Linnen JM, Gallarda J, Shyamala V, Smith D, Kleinman SH, Busch MP; NHLBI Retrovirus Epidemiology Study (REDS). Detection of West Nile virus RNA and antibody in frozen plasma components from a voluntary market withdrawal during the 2002 peak epidemic. Transfusion. 2005 Apr;45(4):480-6. doi: 10.1111/j.0041-1132.2005.04266.x.

Reference Type: BACKGROUND

PMID: 15819666 (View on PubMed)

Kleinman S, Glynn SA, Busch M, Todd D, Powell L, Pietrelli L, Nemo G, Schreiber G, Bianco C, Katz L; NHLBI Retrovirus Epidemiology Study (REDS). The 2003 West Nile virus United States epidemic: the America's Blood Centers experience. Transfusion. 2005 Apr;45(4):469-79. doi: 10.1111/j.0041-1132.2005.04315.x.

Reference Type: BACKGROUND

PMID: 15819665 (View on PubMed)

Kleinman SH, Glynn SA, Higgins MJ, Triulzi DJ, Smith JW, Nass CC, Garratty G, Murphy EL, LeParc GF, Schreiber GB, King MR, Chamberland ME, Nemo GJ. The RADAR repository: a resource for studies of infectious agents and their transmissibility by transfusion. Transfusion. 2005 Jul;45(7):1073-83. doi: 10.1111/j.1537-2995.2005.00171.x.

Reference Type: BACKGROUND

PMID: 15987350 (View on PubMed)

Study Documents

Document Type: Operations Manual

Samples and characterization data. NHLBI provides controlled access to samples through BioLINCC. Access requires registration, evidence of local IRB approval or certification of exemption from IRB review, and completion of a materials use agreement.

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Document Type: Individual Participant Data Set

NHLBI provides controlled access to IPD through BioLINCC. Access requires registration, evidence of local IRB approval or certification of exemption from IRB review, and completion of a data use agreement.

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Document Type: Study Forms

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Document Type: Operations Manual

Samples and characterization data. NHLBI provides controlled access to samples through BioLINCC. Access requires registration, evidence of local IRB approval or certification of exemption from IRB review, and completion of a materials use agreement.

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1501

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Identifier Source: org_study_id