Blood system changes since recognition of transfusion‐associated AIDS

T he year 2013 brought us to the close of the third decade since the discovery of human immunodeficiency virus (HIV), originally called lymphadenopathy-associated virus or human T-lymphotropic virus Type 3 (HTLV-III), as the cause of AIDS. This landmark occasions a time for reflection on the transformations of the blood system that were set in motion by recognition of transfusion-associated AIDS (TAA). While the decade of the 1980s was characterized by rapid introduction of novel strategies to address an unprecedented challenge, changes made in the 1990s, though independently significant, were also reactive, as the system tried to define and incorporate the lessons of TAA. In the latter decade, criticisms of prior decision making, coupled with new technology options, led to a broad-based initiative to enhance blood safety. In the new millennium, ongoing efforts to address blood safety have focused repeatedly on threats from known and emerging infectious diseases. However, concerns have arisen about a trend of increasing safety costs with progressively decreasing added benefits. This commentary summarizes key changes to the blood system during this 30-year period and discusses the evolving framework for blood safety decision making that is taking form.