Transfusion Medicine | ORIGINAL ARTICLE Case report of a haemovigilance investigation using phylogenetic analysis of HIV-1 in Brazil A. R. Pinto, 1 A. Petry, 2 T. Gr¨ af, 1 R. Vandresen 2 & E. Kupek 3 1 Department of Microbiology, Immunology and Parasitology, Federal University of Santa Catarina (UFSC), Florian´ opolis, Brazil, 2 Centre for Haematology and Haemotherapy of the State of Santa Catarina (HEMOSC), Florian´ opolis, Brazil, and 3 Department of Public Health, Federal University of Santa Catarina (UFSC), Florian´ opolis, Brazil Received 26 July 2011; accepted for publication 08 November 2011 SUMMARY Objectives: The aim of this work is to provide the first report of a transfusion-acquired HIV-1 infection and to verify transmission from the donor to the recipients using phylogenetic analysis of HIV-1 DNA sequences in a Brazilian blood bank. Background: Although haemovigilance procedures based on phylogenetic analysis of HIV have been reported in several countries, this type of study has yet to be conducted in Latin America. Materials and Methods: Upon identifying a HIV-1-positive repeat blood donor by enzyme immunoassay (EIA) blood screening, all recipients of the donor’s previous donation were identified and tested for HIV-1 by EIA, nucleic acid amplification test and HIV-1 DNA sequencing and phylogenetic analysis. Results: One of the recipients tested positive for HIV-1. The phylogenetic analysis showed a high genetic similarity among the viruses, thus supporting the hypothesis of transmission from the donor to the recipient. Conclusions: Phylogenetic analysis of HIV-1 DNA sequences has been a decisive tool in verifying suspected transmission of the virus from blood donor to recipient in Brazil. Key words: blood donation, HIV, phylogenetic analysis, transfusion. Haemovigilance is a set of procedures aimed at improving blood transfusion safety by reducing transfusion complications, among which TRALI (transfusion-related acute lung injury) has received particular attention (Flesland, 2007). In the 21st century, significant advances have been made to better co- ordinate haemovigilance systems in place, both within and between the countries (Faber, 2009). Despite these efforts, Correspondence: Emil Kupek, Department of Public Health/CCS, Universidade Federal de Santa Catarina, 88040-900 Florianopolis-SC, Brazil. Tel.: +55 48 30256232; fax: +55 48 37219542; e-mail: kupek@ccs.ufsc.br under-reporting of transfusion complications is still a major problem even in developed countries. In Brazil, the notification of serious transfusion complications is mandatory. When a health authority receives such notification, the Brazilian Ministry of Health guidelines instruct the officials to contact the state blood bank association which then initiates a haemovigilance investigation (Minist´ erio de Sa ´ ude, 2003). First, blood bank computerised donor records are searched to identify the donors who donated the blood components involved in the transfusion suspected to have caused the complications. Second, the donors are verified for subsequent donations and possible positive test results by serology screening. If no subsequent donation took place, the donors are invited for serology testing at a blood bank. For all investigations, suspected donors’ plasma, which had been frozen at −20 ◦ C following their last donation, is submitted for serological testing. In the case of suspected HIV transmission, these tests involve enzyme immunoassay (EIA), Western blot and polymerase chain reaction (PCR) for HIV. In the last decade, Brazilian Ministry of Health has created two computerised national databases for haemovigilance known as SINEPS and HEMOVIGI, as well as an electronic publication of the main results (Minist´ erio de Sa ´ ude, 2010). However, under- reporting of transfusion complications was estimated to be 80% in 2007 (Minist´ erio de Sa ´ ude, 2010). This may explain why only three cases of transfusion-transmitted infectious diseases have been reported in this source, despite high residual risk estimates that suggest much higher figures (Kupek, 2001, 2004). Despite significant technological advances in blood safety in Brazil, such as recent introduction of nucleic acid amplification test (NAT) techniques for blood screening in some blood banks, a paucity of published research on haemovigilance exists. Even well-established epidemiological studies based on lookback methodology have been lacking in Brazil. The aim of this work is to diminish the gap between recently established technological advances in blood safety and their application to haemovigilance in the country. To this end, we describe an application of phylogenetic analysis of HIV-1 as means of © 2011 The Authors First published online 2 December 2011 Transfusion Medicine © 2011 British Blood Transfusion Society doi: 10.1111/j.1365-3148.2011.01120.x