Trends of HIV infection in the blood donors of Delhi

Screening of HIV Infection was made mandatory for every unit of blood collected for transfusion in Delhi, India since 1989. Ten Zonal Blood Testing Centres have been identified which test all the blood collected for HIV by 29 blood blanks for the city. Reports from these testing centres have been analysed yearwise to find out the magnitude and trends of HIV infection in different groups of blood donors. Although initially there was no difference in HIV Sero-reactivity in different blood donors categories (between 1 & 2 per 1000 blood donors samples tested) but subsequently there is significant increase (5.24/1000 in 1992 & 7.48/1000 in 1993) in the HIV sero-reactivity in replacement donor category possibly because professional donors donate blood in the guise of being replacement donors. The fact which comes out clearly is that HIV infection is present in all sections of the population in Delhi and mandatory HIV Screening of all blood collected for transfusion is justified.

Papua New Guinea Red Cross Blood Transfusion Service: present status and future considerations

About 28,000 units of blood are collected per annum. This is adequate for present needs. 11 donors have been found positive for human immunodeficiency virus (HIV) since testing started in 1987, 8 of these in the last year and a half. No case of transmission of HIV by transfusion in Papua New Guinea has been established. Although the prevalence varies in different areas, on average 15% of donors are positive for hepatitis B. The impact of these figures, future requirements for quantity of blood and the need for additional testing of donations for hepatitis C (HCV) and cytomegalovirus (CMV) will require clear evaluation of the choices and firm decisions.

Donation deferral criteria for human immunodeficiency virus positivity among blood donors in northern Thailand

BACKGROUND

The purpose of this study was to develop human immunodeficiency virus (HIV) infection donation deferral criteria for blood donors in an HIV-epidemic area of northern Thailand, where the predominant means of transmission of HIV is through heterosexual contact.

STUDY DESIGN AND METHODS

In a preliminary study, 2242 blood donors were interviewed, and their blood was tested for HIV antibodies between September 1993 and April 1994. The risk factors associated with HIV positivity were identified. Criteria to identify HIV-positive persons on the basis of a logistic equation were developed and applied to another group of 5769 prospective blood donors.

RESULTS

A multivariate analysis showed the following odds ratios (OR) for traits that were independently associated with HIV positivity: younger age (OR = 0.93 for each additional year of age), male gender (OR = 2.41), having no more than a primary school education (OR = 2.00), being in the military (OR = 1.78), being unsure of one's own blood safety (OR = 2.00), history of injecting drug use (OR = 5.36), diagnosis of syphilis or positive syphilis serologic test in the past 12 months (OR = 2.67), and genital ulcer in the past 12 months (OR = 4.56). On the basis of the model, with a limit of <10 percent loss of uninfected donors, predicted probabilities of HIV positivity alone or of markers of infection with HIV, hepatitis B virus, or Treponema pallidum were calculated. With a cutoff of 6.5-percent estimated probability of HIV infection, derived from the logistic equation, the donor deferral criteria have 33.6-percent sensitivity and 8.3-percent positive predictive value for HIV positivity and 15.5-percent sensitivity and 18.4-percent positive predictive value for markers of infection with one of the three pathogens.

CONCLUSION

The proposed donor deferral system provides a more flexible, sensitive, and predictive tool for averting donation by those who, though HIV antibody-negative, are at a higher risk of being infected with HIV.

A study on the epidemiology of hepatitis C infection among blood donors in Singapore

BACKGROUND

Hepatitis C viral (HCV) infection has been identified as the main cause of post-transfusion hepatitis (PTH) since 1989. Despite this, little is known regarding the prevalence and mode of transmission of the disease. The purpose of this study was therefore to study the demographic factors associated with HCV infection among Singaporean blood donors.

METHODS

In this study, the screening questionnaire records of HCV-positive donors were analysed. A total of 241 donors, tested positive for HCV between 7 December 1992 and 31 August 1994, were included. Demographic details studied included the age, sex, race, citizenship, occupation and number of previous donations. In additions, the associations of HCV infection with other screened diseases were analysed.

RESULTS

The prevalence of HCV infection was found to be 0.370 per cent (241/65208) among the donors. Of these, 200 (0.389 per cent prevalence) were male and 41 (0.298 per cent prevalence) were female. The mean age was 34.2, SD = 9.4. The prevalence of the disease was found to increase with age. Significant differences were seen among the races (chinese versus Malay, 0.329 percent versus 0.513 percent, p < 0.05). There was also a significant association of HCV with Human Immunodeficiency Virus (HIV) infection among the donors (0.4 percent co-infection versus 0.004 percent in the general donor population, p < 0.01).

CONCLUSION

The incidence of HCV infections is relatively low among blood donors in Singapore. The differences in prevalence seen among the different groups studied suggest that the disease is community acquired and may be due to the lifestyle of the donors.

Benefits of HIV screening of blood transfusions in Zambia

Blood transfusion continues to be an important route of transmission of HIV in developing countries, especially for young children following the perinatal period. Testing for HIV is costly and reliable donor support for the purchase of test kits is often essential, yet difficult to secure. The costs of screening transfusions for HIV and the financial benefits in terms of savings on treatment costs averted were calculated for a district hospital in Zambia where seroprevalence among donors was 15.9%. Financial benefits exceed costs by a factor of 2.7-3.5. In 1991, 1073 transfusions were given and an estimated 150 cases of transfusion-related AIDS were prevented by screening, of which 59% were in children aged 5 years or under and 31% were in women. The total cost of HIV screening was 3061 pounds ($4745), and the cost per case of HIV infection prevented was 20.40 pounds ($31.62); the cost of this protection for the population served by the hospital was 0.02 pounds ($0.03) per person. An estimated 3625 undiscounted healthy years of life were saved, of which nearly 69% were in children under 6, at a cost of 0.85 pounds ($1.32) per year of life saved. It is essential that financial and political support for HIV screening of blood for transfusion is maintained.

HIV seroprevalence in healthy blood donors in northeastern Zaire

Despite high seroprevalence rates in some parts of Africa, there is notable variation in prevalence between population subgroups. To document changes and trends in HIV seroprevalence in northeastern Zaire, 1989 to 1992 blood donor data were reviewed. Overall, 2453 donors were tested with seropositivity varying from 2.8% in 1989 to 6.9% in 1992. The increase in seropositivity was significant for men (2.5 to 5.8%, P = 0.017) and for people residing in rural areas (2.0 to 6.1%, P = 0.0008) but not for women (5.4 to 8.6%, P = 0.15) nor for urban individuals (10.5 to 8.6%, P = 0.55). These findings suggest that: 1) HIV infection is spreading in previously less-affected population subgroups rather than increasing widely in the entire population, 2) the HIV epidemic could be reaching a plateau or endemic phase in northeastern Zaire, and, 3) continued blood donor screening and wise transfusion practices are needed.

Attitudes and beliefs about blood donation among adults in Mwanza Region, Tanzania

A study was carried out to assess the attitudes and beliefs about blood donation among the population of Mwanza Region, Tanzania, in order to target better the voluntary blood donor recruitment and retention. A random sample of 1141 adults, 743 residents of Mwanza town and 398 from Mwanza rural areas were interviewed on aspects related to blood donation. A high proportion (26.4%) of interviewees had already given blood but only 3.8% had donated voluntarily within the last 10 years. Voluntary blood donation was correlated with secondary school attendance. We noted a positive attitude towards voluntary blood donation although the majority of people would do so only for an incentive in the form of remuneration. Respondents frequently thought that blood donation would infect them with HIV or damage their health. No correlation was found between fear to donate and self perceived risk for HIV infection. We found that a substantial number of men would accept pre-test counselling on HIV in order to "infect others" if found positive. Thus we recommend that HIV counselling should be done with extreme care and defer individuals with wrong intentions from blood donation. Donor recruitment campaigns should also focus on clearing wrong conceptions about blood donation through providing information on all aspects related to blood donation. Based on these findings, a scheme for blood donor recruitment and retention in Mwanza Region is proposed.

Effectiveness of mandatory transmissible diseases screening in Indian blood donors

This study was undertaken to determine the prevalence of transfusion transmitted diseases (TTDs) among local blood donors, the safety offered by the four mandatory tests (for HIV, HBsAg, syphilis and malaria) and to assess alanine aminotransferase (ALT) as a surrogate test. A total of 313 blood donors were tested for HBsAg, hepatitis B core (HBc) antibody, hepatitis C (HCV) antibody, HIV antibody, and IgM antibody to cytomegalovirus (CMV-IgM). The serum alanine aminotransferase levels were also done on each unit of blood. The prevalence of various markers was 7(2.2%) for HBsAg, 57 (18.2%) for anti HBc (total), 1 (0.3%) for anti HCV, 16 (5.1%) for anti CMV. None of the donors were positive for HIV, VDRL or malaria. ALT level was raised in 16.5 per cent of donors and showed no correlation with hepatitis markers. ALT was not found to be useful as a surrogate marker for routine screening of donors. Sensitive tests like ELISA and immunofluoresence for malaria antigen should be applied for screening for malaria. VDRL test may be used to detect high risk donors rather than detection of syphilis when stored blood is used. HBsAg and HIV tests should be routinely done on every unit of blood and anti HCV tests should be done regularly, if possible.

Infectious disease markers in blood donors in northern Thailand

BACKGROUND

A major epidemic of human immunodeficiency virus type 1 (HIV-1) infections that are primarily due to heterosexual transmission has developed in Thailand since 1988. The epidemic has been most severe in northern Thailand. The blood banks in Chiang Mai began screening donors for HIV-1 antibodies in February 1988 and for p24 antigen in April 1992.

STUDY DESIGN AND METHODS

The trends of HIV-1 antibody prevalence were analyzed by type of donor (i.e., paid, replacement, and voluntary) for the period of 1988 through 1993. In addition, the prevalence of HIV-1 p24 antigen and of antibodies to syphilis, hepatitis B surface antigen, and hepatitis C virus was evaluated among blood donors at Chiang Mai University Hospital and the Thai Red Cross blood banks in Chiang Mai.

RESULTS

The prevalence of HIV-1 antibodies increased from 0.84 percent in 1988 to 4.04 percent in 1991. Seropositivity was highest in paid professional donors. After discontinuation of the use of paid donors in 1993, HIV-1 antibody prevalence decreased to 3.34 percent. Antibody prevalence in replacement donors increased from 0.56 percent in 1988 to 5.82 percent in 1991. Among 44,446 donors tested, 7 (0.016%) were HIV-1 p24 antigen positive but antibody negative.

CONCLUSION

The exclusion of paid donors and the use of p24 antigen testing are justified in northern Thailand. Additional strategies to exclude donors at very high risk and to attract those at low risk for infection should be developed and evaluated to increase blood transfusion safety in this and other, similar populations.

HIV epidemic in Punjab

A total of 58890 subjects were screened for HIV infection between June 1987 to December 1992. Out of these, 42776 were blood donors and only 9 were positive for HIV by ELISA; 2749 were foreign students and 35 were confirmed positive both by ELISA and Western blot. Out of the remaining high risk subjects, 141 of 13365 were confirmed to be HIV positive with a cumulative positivity rate of 10.5 per thousand. Out of the 141 confirmed sero positives, 47 had full blown disease and 25 were dead by the time of compilation of data. Thirty seven i.e., 24.6 per cent had acquired infection through unscreened blood/products/haemodialysis. Thus Punjab has shown a steady rise of HIV infection over the last five years and the incidence of blood borne infection is very high.

Sentinel surveillance of HIV-1 infection in Tamilnadu, India

The objective was to determine the time trends in the prevalence of HIV infection and to evaluate appropriate preventive intervention in different population groups. Sentinel surveillance of HIV-1 infection by anonymous unlinked technique was carried out in Tamilnadu from December 1989 to March 1993. The sentinel population monitored were attendees of STD clinics, blood donors and antenatal mothers. The results of HIV seropositivity were compared for each 6-month period. During the study period there was 10-fold rise of HIV seropositivity among STD patients (1% to 10%), 2-fold rise among antenatal attendees (0.37% to 0.76%), and 3-fold rise in blood donors (0.24% to 0.72%). There was a steady increase in the incidence of HIV infection among those with high risk behaviour (STD attendees) as well as in the general population. This information is of value in planning and evaluation of preventive and control programmes in India.

Blood safety in developing countries

This study, based on responses to a questionnaire, was undertaken to define problems in and formulate solutions for improving blood safety in developing countries as part of an effort to monitor the status of blood transfusion services globally. Despite improvements between 1988 and 1992, only 66% of developing countries (DGCs) and 46% of least developed countries (LDCs) screen all blood donations for antibodies to human immunodeficiency viruses; 72% DGCs and 35% LDCs test all donations for hepatitis B surface antigen and 71 and 48%, respectively, for syphilis. The antihuman globulin test is performed routinely in 62% DGCs and 23% LDCs, and inadequate quality assurance in all aspects of preparatory testing is a major weakness in many countries. The blood supply is usually insufficient: none of the LDCs and 9% of the DGCs collect 30 units or more per 1,000 of the population annually. Blood donor systems are totally voluntary and non-remunerated in 15% DGCs and 7% LDCs; 80% DGCs and 93% LDCs rely totally or partially on replacement donors and 25% of both groups on paid donations. The proportion of repeat donors is low (medians: 47% in DGCs, 20% in LDCs), and discard rates for collected blood are often high (up to 33%). Most of the blood collected is transfused as whole blood, and most DGCs and LDCs have inadequate supplies of plasma substitutes for management of acute haemorrhage. The reasons for these problems and suggested solutions are discussed.

Changes in blood transfusion practices after the introduction of consensus guidelines in Mwanza region, Tanzania

OBJECTIVE

To assess the effect of introducing consensus guidelines on avoidable blood transfusions in Mwanza region, Tanzania.

METHODS

Avoidable blood transfusions were determined among 842 blood transfusion recipients in eight hospitals in 1991. In a workshop with senior health workers from the region, consensus guidelines for the prescription of blood transfusions were developed and introduced in the hospitals and after 7 months intervention data were collected on 1042 blood transfusion recipients. The 1991 and 1992 data were compared to estimate the change in the proportion of avoidable blood transfusions.

RESULTS

In blood transfusion recipients aged < 5 years there was a significant reduction in the proportion of avoidable blood transfusions from 257 (52%) out of 498 to 197 (33%) out of 595 (P < 0.001), especially at the peripheral hospitals. For children the proportion decreased from 25 to 17% (P < 0.05) and for operated patients the percentage remained at 24%. In pregnant women there was a significant increase in the proportion of avoidable blood transfusions from 10 to 27% and in adults from 37 (25%) out of 146 to 121 (50%) out of 242. The improvement in peripheral hospitals was offset by a similar deterioration in the referral hospital, thus no overall reduction was achieved in the proportion of avoidable blood transfusions.

CONCLUSION

The development and introduction of consensus guidelines was not sufficient to change prescribing practice. The proportion of avoidable blood transfusions decreased only in hospitals where compliance was maintained through regular clinic meetings and strict supervision by senior medical staff.

Rising trend in the prevalence of HIV infection among blood donors

The prevalence of HIV infection among blood donors was analysed, for the five year period from April 1988 to March 1993. All donors were patients' relatives or volunteers; no paid/commercial donors were accepted. Each year between 14,084 and 15,544 donor blood samples were screened by ELISA and those found reactive were tested by Western blot. Western blot positive samples were considered to be infected with HIV. The prevalence rates were 1.5 per 1000 (1988-89), 1.1 per 1000 (1989-90 and 1990-91) 1.9 per 1000 (1991-92) and 3.1 per 1000 (1992-93). When the mean prevalence rate over the first three years [1.3 per 1000 (1988-89 to 1990-91)] was compared to the prevalence in 1991-92 (1.9/1000), increase was statistically significant (P < 0.05). The prevalence rate in 1992-93 (3/1000) was significantly higher than that of the previous year (P < 0.01). These data suggest that the prevalence of HIV infection in blood donors is increasing and this could be a reflection of the rising prevalence of HIV infection in the general population.

Blood donor counselling for HIV: results of a multi-country feasibility study

A qualitative characterisation study was conducted by the World Health Organisation's Global Programme on AIDS, and the International Federation of Red Cross and Red Crescent Societies, in six developing countries in order to determine the feasibility of introducing blood donor counselling into procedures for blood donation at blood transfusion sites. After careful preparation of consultants, in-country visits were made to include structured discussions with key BTS and Red Cross, and national AIDS programme staff, and donors, and observations of relevant facilities. Necessary resources, management requirements, obstacles to and options for blood donor counselling were explicated, together with information on the role of HIV testing in motivating blood donation, and problems associated with this and with donor notification. Blood donor counselling is seen as feasible, provided minimum conditions can be established to ensure appropriate standards and availability of resources.

Anaemia, blood transfusion practices, HIV and mortality among women of reproductive age in western Kenya

Severe anaemia among women in sub-Saharan Africa is frequently treated with blood transfusions. The risk of transmission of human immunodeficiency virus (HIV) through blood products has led to a re-evaluation of the indications for transfusions. Prospective surveillance of women admitted to a district hospital in western Kenya was conducted from 1 December 1990 to 31 July 1991, for haemoglobin (Hb) transfusion status, and outcome. Of the 2986 enrolled women (mean Hb 10.4 g/dL, SD +/- 2.6, median age 24.4 years), 6% were severely anaemic (Hb < 6.0 g/dL). Severe anaemia was associated with a higher mortality rate (10.7% vs. 1.4%, odds ratio (OR) = 8.2, 95% confidence interval (CI) 2.6, 34.2) compared with women with Hb > or = 6.0 g/dL. Decreased mortality rates in hospital were observed with increasing Hb values (OR = 0.43, 95% CI 0.19, 0.98), but blood transfusions did not improve survival in hospital (OR = 1.56, 95% CI 0.22, 11.03). The attributable mortality due to HIV infection and severe anaemia was 75% and 31%, respectively. Maternal/child health care services must include prevention strategies for HIV transmission and the prevention, recognition, and treatment of severe anaemia.

Transfusion associated HIV infection in patients with haematologic disorders in southern India

Seventy patients with congenital coagulation disorders (group A) and 202 other patients (group B) attending the Haematology clinic at the Christian Medical College and Hospital, Vellore (India) were screened for HIV infection between March 1989 and April 1991. Fifty five patients in group A and 131 patients in group B had received blood or blood products in the past. Nineteen transfused patients (9 in group A and 10 in group B) had received blood or blood products exclusively from the hospital blood bank and none of them was HIV infected. Among the remaining 167 transfused patients, 14 (30.4%) of the 46 patients in group A and 6 (4.9%) of the 121 patients in group B were found to be positive for HIV. In group A, 13 of the 14 infected patients had received commercially available cryoprecipitate which was thus found to be the most frequent source of infection. In group B the source of infection was most probably unscreened HIV infected blood which was transfused.

Potential deferral criteria predictive of human immunodeficiency virus positivity among blood donors in Thailand

BACKGROUND

To develop deferral criteria to prevent human immunodeficiency virus (HIV) transmission by recently infected blood donors in the seronegative "window" phase, routine data on donors at a university hospital were examined for factors predicting seropositivity.

STUDY DESIGN AND METHODS

Records of all 281 HIV-positive blood donors from August 1987 through September 1991 were retrospectively compared with those of 1076 randomly selected control donors matched only by year of donation. Four controls were selected for each HIV-positive donor.

RESULTS

The prevalence of HIV in 102,684 donor units during the period rose from 0.02 percent in 1987 to 0.52 percent in 1991. Multivariable analysis revealed that male sex (odds ratio [OR] = 26.4), VDRL test positivity (OR = 3.0), age 21 to 30 years (OR = 2.2; referent: 16-20-year-old group), and replacement donorship (OR = 1.4; referent: voluntary donors) were independent factors significantly associated with HIV positivity among these donors (p < 0.05). Since replacement donorship cannot be avoided, only male sex, age 21 to 30 years, and VDRL test positivity were considered as potential criteria. When these findings were extrapolated to all donors in 1990 and 1991, those with all three or only two (excluding VDRL test, because the results are known only after donation) of these high-risk factors had HIV positivity probabilities of 2.2 and 1.0 percent, respectively. These probabilities were, respectively, 4.9 times (95% CI: 2.9 8.3) and 4.1 times (3.1, 5.4) the risk among other donors. However, applying such criteria would have eliminated 1.5 and 31.2 percent, respectively, of all HIV-negative donors in 1990 and 1991. The latter deferral proportion is too high to be acceptable.

CONCLUSION

In Thailand, improved donor deferral criteria addressing sexual risk factors could lead to decreased probability of window-period donation, with an acceptable rate of deferral. Additional p24 antigen testing may be indicated for donors at increased risk for HIV infection, specifically, men aged 21 to 30.

Strategies for laboratory HIV testing: an examination of alternative approaches not requiring Western blot

Advances in laboratory tests for antibodies to human immunodeficiency virus (HIV) have permitted the development of alternative HIV testing strategies that do not require use of the Western blot approach. Three strategies are proposed. In strategy I, sera are tested for HIV antibody using an enzyme-linked immunosorbent assay (ELISA)/rapid/simple (ERS) test; in strategy II, sera reactive in an initial ERS test are retested using a second ERS test; strategy III involves retesting with a third ERS test all sera reactive in two previous ERS tests. Where the objective is identification of asymptomatic HIV-infected individuals, strategy III is proposed where HIV prevalences in the study population are < or = 10%, and strategy II at prevalences > 10%. Strategy II is recommended where the diagnosis of HIV-related disease requires HIV testing. For serosurveillance, strategy II is recommended if the prevalence is < or = 10%, and strategy I if the prevalences are > 10%. Use of strategy I is recommended for transfusion and transplantation safety, at any prevalence. Lower-cost laboratory HIV testing will permit such testing to become more widely available.

The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital

OBJECTIVES

To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria.

DESIGN

A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year.

SETTING

University hospital and clinics in Ile-Ife, Nigeria.

PARTICIPANTS

Hospital personnel with potential occupational exposure to patients' blood.

RESULTS

Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall: 2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition.

CONCLUSIONS

The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.

Excluding blood donors at high risk of HIV infection in a west African city

OBJECTIVE

To examine the potential impact of deferral of blood donors at high risk of HIV infection in a west African city where blood is screened for HIV antibodies but no other special measures are taken to protect the blood supply.

DESIGN

Cross sectional study.

SETTING

National Blood Transfusion Centre and Project RETRO-CI, an international collaborative AIDS research project, Abidjan, Côte d'Ivoire.

SUBJECTS

1257 male first time blood donors.

INTERVENTIONS

Blood donors were interviewed about demographic and behavioural characteristics and tested for HIV antibodies by enzyme immunoassay and, if positive, synthetic peptide based tests.

MAIN OUTCOME MEASURES

HIV antibody status in relation to presence of behavioural risk factors; calculation of sensitivity, specificity, and predictive values of specific criteria for excluding HIV infected donors.

RESULTS

The overall prevalence of HIV infection was 11.4%. The most important risk factors for HIV positivity were prostitute contact and being aged 30-39 years. For identifying seropositive donors individual criteria had sensitivity, specificity, and positive predictive values ranging from 15% to 98%, 38% to 91%, and 17% to 30% respectively. Prostitute contact in the past five years would have excluded 31% of all donors and 73% of HIV infected donors. 27% of those excluded would have been HIV positive.

CONCLUSIONS

The widespread assumption that donor deferral is not feasible in sub-Saharan Africa needs reassessment. In Abidjan this approach was well accepted and potentially effective. Donor deferral requires evaluation as a strategy for improving blood safety in resource poor areas with high rates of HIV infection.

Transmission of HIV infection by seronegative blood in Thailand

In Thailand, the prevalence of HIV infection in the general population and in donor blood (DB) has sharply increased since 1987. The HIV seropositive rate in DB was increased from 0.0065 per cent in 1987 to 0.95 per cent in 1993 (150 times in 6 years). Heterosexual transmission is the major route of spreading. Therefore, HIV seronegative blood (SNB) poses significant hazard to the recipients because of the risk of viraemia during the window period of early HIV infection. In Thailand HIV Ab screening in all units of blood was started in 1987 and was compulsory nationwide in early 1989. Donor self exclusion (DSE) has been implemented since 1990. It is not fully effective in the prevention of transfusion associated AIDS (TAA) because of many limiting factors. However, DSE should be promoted to practice in every blood bank particularly those that can not do HIV Ag screening. During 1990-1992, there were 30 reported cases of TAA by SNB. The study of risk figure (HIV Ag positive-neutralization with HIV Ab negative) in DB was 1:3,400 and 1:10,000 in two reports in 1991. Under all these circumstances, the national AIDS committee has documented the policy to do HIV Ag screening in every unit of blood from August 1991 and allocated a 10 million baht budget (year 1992) for Ag testing. Several hospitals and NBC reported the risk figures which varied from 1:3,400 to 1:25,000. A certain amount of blood is processed to 2-4 blood components given to 2-4 patients which will increase the number of TAA by SNB.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS in Nicaragua: epidemiological, political, and sociocultural perspectives

The AIDS epidemic in Nicaragua is several years behind that in the United States and neighboring countries of Central and South America. A combination of events, including the isolation caused by the war of the U.S.-backed Contra army against the Sandinista government, the complete economic embargo imposed on Nicaragua by the United States in 1985, self-sufficiency for blood products, and a low rate of recreational injectable-drug use, have contributed to this situation. Since the Sandinistas were defeated in the general election of 1990, people have returned to Nicaragua from areas where HIV is more prevalent, such as Honduras and the United States. It is probable that many HIV-infected persons have now entered the country. Because of the high rates of sexually transmitted diseases and cultural factors such as "machismo," HIV is likely to spread rapidly by heterosexual transmission, unless effective, culturally appropriate education and sexually transmitted disease prevention programs are implemented now.

Blood transfusion practices and blood-banking services in a Kenyan hospital

OBJECTIVES

To identify ways to improve the operation of blood-screening programs and to decrease the inappropriate use of blood by evaluating blood-transfusion practices and blood-banking services in a Kenyan hospital.

DESIGN

Prospective cohort.

SETTING

The study was conducted in a rural district hospital in western Kenya between September 1990 and July 1991.

METHODS

We collected data on all transfusion requests (blood donation, grouping, HIV screening) and blood recipients (age, sex, diagnosis, and for a 3-month period on the pediatric, maternity, and female wards, admission hemoglobin and outcome).

RESULTS

During the 11-month study period, 799 patients received 927 transfusions: 67% were children < 15 years of age, 27% were adult women and 6% were adult men. Transfusions were often delayed due to reliance on patient-recruited donors. Patients who received blood donated on or after the date of request waited longer for transfusion (median, 3 days) than patients who received blood that had been banked and screened before the request (median, 1 day). Patient-recruited donors had a higher HIV-seropositivity rate than volunteer donors (13.4 and 4.6%, respectively; chi 2 test, P < 0.001). Overall, 47% of pediatric transfusions were classified as inappropriate: 23% did not meet the criteria of having hemoglobin < 5.0 g/dl and clinical evidence of respiratory distress, and 27% were transfused 2 or more days after requested. Among adults, 68% received one unit of blood or less.

CONCLUSIONS

Improved laboratory services, reduction of unnecessary transfusions, and increased recruitment of volunteer donors are critical for improving the appropriate and timely use of blood and reducing transfusion-associated HIV transmission.

The frequency of blood-born viral infections in a population of multitransfused Brazilian patients

The frequency of viral markers for hepatitis B (HBV) and C (HCV), human immunodeficiency virus-1 (HIV-1) and human T-lymphotropic virus-1 (HTLV-1) was evaluated in 32 Brazilian beta-thalassemia multitransfused patients. Additionally the serum concentrations of ferritin and alanine aspartate transaminase (ALAT) were determined. The results show a high prevalence of markers of infection by HBV (25.0%) and HCV (46.8%) and a low prevalence of markers for HIV-1 and HTLV-1. No correlations were demonstrated between the presence of the hepatitis markers and the number of units transfused or the serum concentrations of ferritin and ALAT.

Prevalence of antibodies to hepatitis C virus in populations at low and high risk for sexually transmitted diseases in Rio de Janeiro

In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarily donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. The prevalence of RIBA 2 confirmed HCV infection among the blood donors was 2.08%, which is well above the reported prevalence in similar populations from developed western countries. Among the HIV infected homosexuals, the encountered prevalence was 7.96% (p < 0.0005). For the whole group with sexually acquired HIV infection, the prevalence was 8.02% (p < 0.000005). Anti-HBc antibodies were more frequently present in anti-HCV RIBA-2 confirmed positive blood donors than in controls (p < 0.001). 33.3% of the HCV-positive blood donors and 11.04% controls were found to be anti-HBc positive (p < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Screening of blood donors for antibody to human immunodeficiency virus type 1

29,575 blood donors of whom about 20% were voluntary were screened for HIV 1. During the three years period 1988 to 1990 four different tests kits were used. Three were ELISA methods and one an agglutination method. Comparison of the monthly seropositivity for each year showed variations of 0.9 to 4.4% for the first year, 1.4 to 10% for the second year and 0.2 to 6.9% for the third year. The differences in the standard errors were found to be significant. These wide differences are suggested to be due to many factors including the use of different screening kits, many first time donors and inability to perform repeat tests on positive samples.

Detection of antibodies to HIV-infection among high risk groups in Bihar (India)

Total of 4567 sera samples obtained from high risk groups viz. blood donors, patients attending skin/VD clinics have been examined for HIV-antibodies. None of them showed seropositivity. Since in Bihar, interaction with foreigners is not common as it is in the metropolitan cities of India, this may be one of the chief reasons for not finding any HIV-seropositive case so far. 7% of blood donors showed VDRL positive reaction. Both competitive ELISA and particulate-agglutination tests on 375 sera samples gave identical negative result.

Increasing risk of transfusion-associated AIDS as the pandemic spreads: experience in Maiduguri, Nigeria

Complacency and financial considerations have led many hospitals in developing countries with low HIV antibody prevalence to disregard the importance of pre-screening for HIV antibodies blood meant for transfusion. This report shows that during the year 1987 in which mandatory screening of donated blood was introduced at the University of Maiduguri Teaching Hospital, HIV antibody prevalence in donated blood units was 0%. However, four years later the prevalence had risen to 2.76%. This observation underlines the increasing risk to which transfusion recipients are exposed if given unscreened blood as HIV spreads with time. This spread can be rapid.

Transfusion associated AIDS in Mexico. Clinical spectrum, conditional latency distribution, and survival

There is very little information on the clinical spectrum and the incubation period among AIDS patients in Latin America. This study reports the clinical spectrum, survival, and the incubation period for a group of Mexican patients infected with HIV-1 as a result of contaminated blood transfusion. We analyzed data from 39 patients of whom date of transfusion and diagnosis were known. The clinical spectrum of the disease was compared with a group of AIDS Mexican patients infected by sexual route. The prevalence distribution of opportunistic infections was similar in both groups. However, there was a significant difference in the distribution of opportunistic malignancies, i.e., Kaposi's sarcoma was observed only in the homosexual group. AIDS developed within 48 months after infection (3% within 12 months after transfusion, 50% within 29 months, 75% within 36 months, and the remaining within four years). The mean survival was of nine months after AIDS is made, the survival in this group of AIDS Mexican patients was similar to that observed in other HIV-1 exposed risk groups in Mexico. These findings suggest that the route of exposure to HIV-1 may have prognostic implications in the natural history of this infection in the Mexican population.

Prevention of blood-borne HIV transmission using a decentralized approach in Shaba, Zaire

OBJECTIVE

To prevent blood transfusion-acquired HIV infection with a decentralized approach to HIV screening of blood donors, using an instrument-free rapid test.

SETTING

Shaba province, Zaire (496,877 km2).

METHODS

The programme consisted of training health-care workers, distribution of a rapid HIV-antibody test (DuPont's HIVCHEK) for screening of all blood donations, and quality control of testing by a regional reference centre.

RESULTS

Over a 2-year period, 11,940 rapid tests were distributed to 37 hospitals, covering 75% of all hospital beds outside the copper mine's health system in Shaba. Eighty-five per cent of the tests were used to screen blood donors (5.4% positive test rate) and 13% to test patients (39.7% positive test rate). At least 265 cases of HIV-positive blood donation were prevented, at an estimated cost of 137-279 ECU per case. Only 26% of initially positive specimens reached the central laboratory for supplemental testing, and sterile transfusion equipment and blood-grouping reagents were frequently unavailable. The lack of transport and communications and a deteriorating health system were major constraints.

CONCLUSIONS

District hospitals in Africa are often long distances from major cities, difficult to reach for most of the year, and perform a small number of transfusions. In this context a classical centralized regional blood bank may not be a feasible option to ensure safe blood transfusions. However, safe blood transfusion can be achieved with a decentralized approach using a rapid test, provided that minimum standards of health-care services are available.