2023-12-20 22:00:00
From 1983 to 2016, men who had had at least one sexual encounter with another man during their life were not allowed to donate blood, due to this population’s increased risk of acquiring HIV. . Thanks to the improvement in the selection of blood donors and the performance of screening tests, a first evolution of the blood donation selection criteria took place in 2016, allowing men who have sex between men (MSM ) to donate blood on the condition of not having had sex between men during the 12 months preceding the donation. The evaluation of this measure, published in 2018, showed that this development had not had a negative impact on the residual risk of HIV transmission by transfusion, i.e. had not increased the probability that an infectious donation is not detected by the screening tests used to qualify blood donations.
It is in this context that in April 2020, the Ministry of Health once once more broadened the conditions of access to blood donation for men who have sex between men by reducing the deferral period from 12 to 4 months without sexual intercourse between men. The impact on epidemiological indicators of this new expansion was presented at the Congress of the French-speaking Society of Blood Transfusion, on December 1, 2023.
No negative impact noted following changes to the selection criteria for MSM in 2020, but sustained monitoring of syphilis cases
By comparing the two 30-month periods before (P1 – 01/10/17-01/04/20) and following (P2 – 02/04/20-30/09/22) April 2, 2020, Public Health France has showed that this second development had not had a negative impact on transfusion safety either: the rates of donations positive for HIV, HCV or HBV decreased between the two periods studied. Only the rate of donations positive for syphilis increased, from 1.10/10,000 donations in P1 to 1.29 in P2.
What factors can explain this increase in the rate of syphilis?
epidemiological: increase in the number of cases of syphilis in the general population between 2020 and 2022; technical: deployment by the EFS, from the end of 2021, of new, more sensitive tests; contextual: opening of blood donation to MSM, knowing that the majority of cases of syphilis in the general population concern MSM and that the screening tests used by the EFS do not make it possible to distinguish active syphilis from scarring syphilis (=old syphilis ).
This increase is subject to sustained monitoring to verify whether this increase continues. However, it has no impact on the quality of labile blood products because systematic screening of each blood donation makes it possible to exclude from the transfusion circuit any bag of blood which presents an anomaly.
No negative impact on HIV, HBV and HCV indicators
The assessment results also show that the residual risks of transmission of HIV, HCV and HBV remained at very low levels. Thus, the residual risk of HIV transmission was 1 potentially infected donation every 7,800,000 donations in P1 and 1/10,500,000 donations in P2; for HCV, it was 1/25,200,000 donations in P1 and 1/47,300,000 donations in P2 and for HBV it was 1/6,400,000 in P1 and 1/6,000,000 in P2.
In March 2022, the selection criteria were changed once more and the deferral for MSM went from 4 months without sexual intercourse between men to 4 months without more than one sexual partner regardless of gender, i.e. an identical criterion for all blood donors. This latest development is still too recent to be evaluated, but is subject to regular monitoring.
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