Trends in donor infection profiles and residual risks of transfusion‐transmitted human immunodeficiency virus, hepatitis C virus and hepatitis B virus after the implementation of universal mini‐pool nucleic acid testing in Taiwan

Abstract Background and Objectives Universal mini‐pool nucleic acid testing (NAT) for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) in blood donations has been introduced in Taiwan since 2013. This study aimed to evaluate changes in donors' infection profiles and residual risks of transfusion‐transmitted infections (TTIs) for these viruses after NAT implementation. Materials and Methods Donations from 15 January 2013 to December 2023 were included in this study. Residual risks associated with the window period (WP) and occult HBV infection (OBI) were both estimated. Results Among 19,756,973 donations, 465, 5592 and 23,534 were confirmed positive for HIV, HCV and HBV, respectively. A high proportion of HBV‐positive donations was NAT‐yield donations (19.5%), particularly among repeat donors (61.3%). Donor prevalences for these viruses declined regardless of first‐time or repeat donors. The residual risks of WP per million donations in 2022–2023 were estimated at 0.08 (95% confidence interval [CI]: 0.02–0.17) for HIV‐TTI, 0.31 (95% CI: 0.24–0.55) for HCV‐TTI and 26.38 (95% CI: 12.81–50.06) for HBV‐TTI, with significant declining trends for HIV‐TTI and HBV‐TTI since universal NAT implementation. The residual risk of OBI was relatively high yet decreasing, accounting for more than half of the total residual risk for HBV‐TTI in 2022–2023. Conclusion After NAT implementation in Taiwan, prevalences and residual risks of TTI for HIV, HCV and HBV have declined. Although the residual risk of HBV‐TTI remains relatively high, it is comparable to that in other endemic areas, and no cases of TTI from these viruses have been reported since NAT implementation.