{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T09:14:30Z","timestamp":1764494070959},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T00:00:00Z","timestamp":1543536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Confidential unit exclusion (CUE) was introduced in the 1980's as an additional layer to blood safety, before highly specific and sensitive nucleic acid tests (NAT) for HIV were implemented. The utility of CUE\u2010use in settings that have implemented NAT should be evaluated over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>STUDY DESIGN, METHODS<\/jats:title><jats:p>Cross\u2010sectional retrospective study carried out from June 2010\u2013November 2015, at Manaus Hemocenter (HEMOAM), Amazonas, Brazil that implemented HIV\u2010NAT in 2012. The HIV, HCV, HBV, HTLV, Chagas disease, and syphilis rates were compared among CUE and non\u2010CUE blood donors, before and after HIV\u2010NAT implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Among 287,588 donations, 2,154 (0.75%) were associated with CUE, mainly voluntary donations (64.2%), by repeat donors (58.4%) from young (median age = 31 years), males (84.4%), unmarried (63.1%). CUE\u2010users compared to non\u2010CUE donors (n = 285,434) had higher seropositivity rates to HIV (OR = 6.09, 95% CI: 3.68\u201310.07, p &lt; 0.001), HBV (anti\u2010HBc OR = 1.81 95% CI: 1.24\u20132.64, p = 0.004; HBsAg OR = 5.68, 95% CI: 1.78\u201318.07, p = 0.017), and syphilis (OR = 1.78, 95% CI: 1.05\u20133.04, p = 0.030). Most (97.2%) discarded blood units associated to CUE was seronegative for all pathogens. Most donations (73.4%) were tested by HIV\u2010NAT and showed four window period donations, positive by HIV\u2010NAT only among non\u2010CUE donors.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>A high rate of transfusion transmissible infections\/TTIs was observed at HEMOAM especially in CUE\u2010users. CUE\u2010use offered an additional layer of blood safety by its association with anti\u2010HBc\/HBsAg and syphilis that are not covered by NAT. For blood banks in highly endemic areas for HIV and TTI, as HEMOAM, the identification of at risk donors, and the orientation to be tested at proper sites remain a great challenge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.15045","type":"journal-article","created":{"date-parts":[[2018,11,30]],"date-time":"2018-11-30T12:28:55Z","timestamp":1543580935000},"page":"629-638","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["High rate of seromarkers for HIV, HBV and syphilis among blood donors using confidential unit exclusion, before and after HIV\u2010NAT implementation at a major public blood bank in the Brazilian Amazon"],"prefix":"10.1111","volume":"59","author":[{"given":"Janaina C.","family":"Souza","sequence":"first","affiliation":[{"name":"Hematology and Hemotherapy Foundation, HEMOAM  Manaus Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myuki A. 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