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Individual at risk

Recipient

Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)

Acceptable

Guidance at CT/WORK-UP

Generally unacceptable. However, the donor may be accepted at the discretion of the requesting transplant centre, especially if the current sexual partner living with HIV is on antiretroviral therapy and has had an undetectable viral load for at least six months.

Justification for guidance

HIV infection is sexually transmitted and might be passed on to recipient by transplant of stem cells. Furthermore, patients undergoing stem cell transplantation are immunocompromised and are therefore at high risk of complications if infected with HIV.

Since peoples’ sexual practices change over time, and since the window period for HIV detection is less than three months, a sexual history is not necessary at the time of recruitment and need only be taken from potential donors at the time of confirmatory typing and workup assessment. Furthermore, individuals should not be deferred at time of recruitment due to behavioural risk factors for infectious disease.

Although HIV testing is performed at confirmatory typing and workup assessment, such testing will not capture window period infections that could result in transmission of HIV to the patient.

While pre-exposure prophylaxix (PrEP) or post-exposure prophylaxis (PEP) medications are highly effective at preventing HIV transmission when used as prescribed, these medications are not 100% effective, and it is possible for an individual to become infected with HIV while taking them. If PrEP/ PEP is not used as prescribed, there is a greater chance for becoming infected with HIV. This is called a “breakthrough” HIV infection. Additionally, PrEP/ PEP interfere with accurate HIV testing: if an individual is HIV-positive, these medications may cause the HIV viral load in the blood to temporarily drop to a level that cannot be detected but could still be transmitted to a patient. Therefore, individuals on PrEP/ PEP are deferred from donation (see PrEP/ PEP guidance: https://share.wmda.info/x/agDuHQ).