The Potential Impact of Undisclosed Use of HIV Treatment and Prevention Antiretrovirals on Blood Safety.

Authors

Renata Buccheri, Eduard Grebe, Brian Custer

Published in

Transfusion medicine reviews. Pages 151045. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

The use of antiretroviral (ARV) medications for HIV treatment and prevention is a potential blood safety concern. HIV screening algorithms rely on the predictable appearance of viral RNA, p24 antigen, and anti-HIV antibodies during acute and early infection. However, exposure to ARVs can alter these biomarker dynamics and potentially compromise HIV detection. Evidence indicates that early initiation of antiretroviral therapy (ART) can suppress viremia, leading to incomplete seroconversion, reduced serologic reactivity, and seroreversion. HIV acquisition may also occur in individuals receiving pre- or postexposure prophylaxis (PrEP/PEP), resulting in delayed or altered progression of virologic and serologic markers. Long-acting injectable PrEP formulations, particularly cabotegravir, have been associated with prolonged delays in HIV diagnosis, Undisclosed ART among donors who have HIV infection has been reported in studies from South Africa, Brazil, and the USA. Undisclosed PrEP use has been reported in Canada, the Netherlands, the UK, and the USA. This has the potential to lead to undetected HIV infections in blood donors. Broader availability of ARVs and implementation of HIV treatment and prevention programs increase the relevance of this issue for blood safety. A limitation for defining ARV-associated HIV transfusion transmission risk is the availability of high-quality evidence on the likelihood of donations with altered biomarkers of infection. A framework for risk assessment in the context of sparse data is described. Additional evidence and evaluation of known or potential undisclosed ART, PrEP or PEP use in donors is required before more precise risk estimates are possible.

PMID:
42810884
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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