Since the advent of AIDS, men who have sex with men (MSM) have often been permanently deferred from blood donation in France and elsewhere.1 Such a ban, which is more stringent than deferrals for other risk exposures, can be considered to be discriminatory and often is misunderstood.2
In France, the theoretical risk of transfusion-transmitted human immunodeficiency virus (HIV) infection is 1 in 3.0 million donations3 (i.e., one infection per year). However, the last known case of transfusion-transmitted HIV infection in France occurred in 2002.
According to the French national surveillance system for blood donors, between 2011 and 2015, a total of 108 of the 142 donors (76%) who were found to be HIV-positive were men. Among these 108 donors, 82 had data that could be evaluated (see the Supplementary Appendix, available with the full text of this letter at NEJM.org), and of these men, 49 (60%) reported having had sex with men. Furthermore, among the 22 HIV nucleic acid–positive, antibody-negative donors identified between 2001 and 2015, a total of 20 were men (91%), and 65% of the men who had data that could be evaluated were MSM. Therefore, during a period in which a policy of permanent deferral was in place, some MSM donated blood very soon after they had been infected with HIV. A more evidence-based deferral policy may result not only in an unchanged rate of donations from persons with HIV infection4 but also in enhanced donor adherence and ultimately in increased recipient safety.
In 2015, the French Health Ministry held extensive meetings with stakeholders, including health regulatory authorities, the French national blood service (Établissement Français du Sang), patients, blood donors, and lesbian, gay, bisexual, and transgender (LGBT) associations (see the Supplementary Appendix). Almost all stakeholders agreed that the permanent deferral could be lifted. Although a 1-year deferral was recognized as being substantially longer than the current 12-day window (i.e., the duration of time when a person is infected with HIV before a test can detect it), health authorities thought that data to provide support for a shorter deferral were lacking, particularly with respect to donor adherence as well as to the incidence of HIV among MSM with no more than one sexual partner. Nevertheless, several LGBT associations preferred that the deferral policies be more aligned with individual risk assessments.
To detect HIV in blood donated during the window period, part of apheresis plasma in France is quarantined until a new donation is made and testing is repeated at least 2 months later. Thus, several stakeholders reasoned that such a blood donation could be made by MSM under the same conditions as other donors (i.e., donors who had no more than one partner over the previous 4 months). Furthermore, such a donation offers a unique opportunity to safely assess the epidemiologic features of HIV among MSM donors who are subjected to identical deferral rules as other donors. However, with this policy, a large number of MSM donors would need to be screened before sufficient data could be generated.
Effective nationwide in France since July 2016, the deferral period with respect to donations by MSM has been reduced to 1 year. The notable exception to this policy is apheresis-quarantined plasma, for which identical deferral rules now apply to all donors. Results of ongoing studies of epidemiologic features of HIV and overall donor adherence will be essential to verify the safety of transfusions and pave the way to further changes regarding deferral policies that apply to MSM.
Pierre Tiberghien, M.D., Ph.D. Etablissement Français du Sang, La Plaine Saint-Denis, France
Josiane Pillonel, M.Sc. Santé Publique France, Saint-Maurice, France
François Toujas, M.A. Etablissement Français du Sang, La Plaine Saint-Denis, France
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