High prevalence of cytomegalovirus DNA in plasma samples of blood donors in connection with seroconversion

BACKGROUND: Human cytomegalovirus (CMV) is considered to latently infect blood cells. Transfusion-transmitted infection (TT-CMV) of immunocompromised patients occurs despite the use of CMV-seronegative or leukoreduced units. STUDY DESIGN AND METHODS: The prevalence of CMV DNA in plasma was investigated in 82 blood donors who had previously been seronegative for CMV and showed anti-CMV immunoglobulin G for the first time, 598 blood donors who were seropositive for at least 1 year, and 150 seronegative blood donors. In a second part of the study, the overall prevalence of CMV DNA in blood donations was assessed based on 31,745 donations. RESULTS: CMV DNA was repeatedly detected in plasma samples of 44 percent of newly seropositive donors (12%-62%, depending on the interval to the last seronegative donation). All steadily seropositive or seronegative donors were negative for the presence of CMV DNA. Detection of CMV DNA in connection with seroconversion was accompanied by significantly increased neopterin, increased alanine aminotransferase, and reduced white blood cell counts, but the sensitivity of these surrogate markers was only 71 percent. The overall prevalence of CMV DNA in blood products due to primary CMV infection of donors was at least 0.13 percent. CONCLUSION: Viremia of newly seropositive donors may be an important reason for the residual risk of TT-CMV despite leukoreduction. Furthermore, transfusion of WBC-reduced blood components from seronegative donors could imply a greater risk of TT-CMV than transfusion of WBC-reduced blood from donors who have been seropositive for at least 1 year, because window-phase donations but no reactivation could be detected in this study.