Residual risk of infection with blood‐borne viruses in potential organ donors at increased risk of infection: systematic review and meta‐analysis

Karen MJ Waller, Nicole L De La Mata, Patrick J Kelly, Vidiya Ramachandran, William D Rawlinson, Kate R Wyburn and Angela C Webster
Med J Aust 2019; 211 (9): . || doi: 10.5694/mja2.50315
Published online: 14 October 2019


Objective: To estimate the prevalence and incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) among people at increased risk of infection in Australia; to estimate the residual risk of infection among potential solid organ donors in these groups when their antibody and nucleic acid test results are negative.

Study design: Systematic review and meta‐analysis of reports of the incidence and prevalence of HIV, HCV, and HBV in groups at increased risk of infection in Australia.

Data sources: MEDLINE, government and agency reports, Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine conference abstracts, the Australian New Zealand Clinical Trial Registry, and National Health and Medical Research Council grants published 1 January 2000 – 14 February 2019; personal communications.

Data synthesis: Residual risk of HIV infection was highest among men who have sex with men (4.8 [95% CI, 2.7–6.9] per 10 000 antibody‐negative persons; 1.5 [95% CI, 0.9–2.2] per 10 000 persons who are both antibody‐ and nucleic acid‐negative). Residual risk of HCV infection was highest among injecting drug users (289 [95% CI, 191–385] per 10 000 antibody‐negative persons; 20.9 [95% CI, 13.8–28.0] per 10 000 antibody‐ and nucleic acid‐negative persons). Residual risk for HBV infection was highest among injecting drug users (98.6 [95% CI, 36.4–213] per 10 000 antibody‐negative people; 49.4 [95% CI, 18.2–107] per 10 000 persons who were also nucleic acid‐negative).

Conclusions: Absolute risks of window period viral infections are low in people from Australian groups at increased risk but with negative viral test results. Accepting organ donations by people at increased risk of infection but with negative viral test results could be considered as a strategy for expanding the donor pool.

Registration: International Prospective Register of Systematic Reviews (PROSPERO), CRD42017069820.

  • Karen MJ Waller1
  • Nicole L De La Mata1
  • Patrick J Kelly1
  • Vidiya Ramachandran2
  • William D Rawlinson2,3
  • Kate R Wyburn4,5
  • Angela C Webster1,6

  • 1 University of Sydney, Sydney, NSW
  • 2 NSW Health Pathology, Prince of Wales Hospital and Community Health Services, Sydney, NSW
  • 3 University of New South Wales, Sydney, NSW
  • 4 Royal Prince Alfred Hospital, Sydney, NSW
  • 5 Sydney Medical School, University of Sydney, Sydney, NSW
  • 6 Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW



We thank Jenny Iversen and Hamish McManus, who contributed by personal communication unpublished data that were included in our meta‐analysis. Karen Waller is funded by a National Health and Medical Research Council Postgraduate Scholarship (APP1168202).

Competing interests:

No relevant disclosures.


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