Safety of immunoglobulin preparation containing anti-HTLV-III [letter]

The use of screened and standardized plasma pools for the manufacture of blood products has raised the risk of virus transmission. In selecting donors on the basis of exposure to a certain virus donors exposed to other viruses can be unwittingly included. This letter provides an example of this risk relating to a commercial anti-hepatitis B immunoglobulin (HBIG) that was subsequently found to contain high levels of antibody to human T-lymphotropic virus type III (HTLV-III). In 1983 a patient in a UK renal unit who was undergoing hemodialysis was identified as having an acute hepatitis B virus infection. All patients attending the unit were given HBIG. In 1984 during experiments to confirm the specific activity of the anti-HBs contained in this product the preparation was assayed for anti-HTLV-III. It was found to be highly reactive. A total of 31 doses of this material had been administered to 19 patients. Levels of passively acquired anti-HTLV-III were detected shortly after injection but this reactivity did not persist. 16 of the 19 patients available for testing 6 months after their last injection were seronegative. This example demonstrates that the selection among commercial donors for HBV-immune persons will also select for HTLV-III-infected persons especially since hepatitis B is a marker for promiscuous homosexual behavior. Thus great care is recommended in the production of immunoglobulins. Ethanol fractionation and other virucidal procedures should be used to inactivate HTLV-III especially if the immunoglobulins are for hepatitis B or cytomegalovirus.