Outbreak of HIV seropositivity among commercial plasma donors in Pune, India

Transfusion-Associated HIV Infection in Mexico Related to Paid Blood Donors; HIV Epidemic

The objective of the study was to describe the clinical, epidemiological profile and conditional incubation period in a group of transfusion-associated HIV-infected (TAHI) patients seen in five national tertiary care centres in Mexico from 1983 to April 1998. Date of transfusions, AIDS diagnoses, opportunistic infections and malignancies were collected. The incubation period was estimated through a non-parametric conditional analysis.

One hundred and fifty-seven TAHI cases were analysed. The frequency of TAHI by year of transfusion was: 0.6% in 1980 and 1981, 4.5% in 1984, 22.4% in 1985, 54.5% in 1986, 10.3% in 1987, 0.6% in 1988, 1.9% in 1989 and 1990, 1.3% in 1993 and 0.6% in 1994 and 1996. The median incubation period was 4.3 years.

A well-defined epidemic period of HIV-infection among blood-recipients was identified that coincided with the HIV-epidemic among paid donors. TAHI patients in Mexico developed AIDS in a shorter time than that described for other populations.

Eighteen-year follow-up report of the surveillance and prevention of an HIV/AIDS outbreak amongst plasma donors in Hebei Province, China

Background

There has been a clear increase in HIV-1 infection cases in recent years in Hebei Province, China, and transmission via blood is one of the risk factors in the early. This article aimed to investigate the HIV infection rate and control efficiency among the paid blood donor population over a period of 18 years.

Methods

From 1995–2013, HIV/AIDS cases among former blood donors in Hebei Province were registered and closely monitored to collect data of all-cause mortality, intervention measures to prevent family transmission, disease transmission between couples as well as between mothers and infants, and HAART therapy outcomes.

Results

A total of 326 cases were identified as directly infected with HIV/AIDS during plasma donation in Hebei Province. Of these, 146 cases (44.8 %) were identified in the same year as infection; 180 cases (55.2 %) were identified 1–18 years after infection because they did not participate in the 1995 screening. The final case was identified in February 2012. By 2013, the mortality rate and survival rate of plasma donor-related HIV/AIDS was 54.9 % and 45.1 %, respectively. The identified transmission rate between couples was 11.3 % (8/71); this rate during the same year as infection was 3.3 % (1/30), and the rate 4–17 years after HIV infection was 17.1 % (7/41). Approximately 91.2 % (145/159) of married women of childbearing age did not have children after being informed of HIV infection. Only 8.8 % (14/159) of these women had children after being informed of HIV infection. The mother-to-infant transmission rate was 38.5 % (5/13).

The HAART coverage rate has increased from 10.1 % (16/159) in 2003 to 83.6 % (127/152) in 2013. Since 1999, the HIV mortality rate has trended up; by 2013, the cumulative mortality rate reached 54.9 % (179/326). After HAART was initiated in China, the death rate decreased to some extent. Second generation transmission (via couple or mother-to-infant transmission) among blood donor-related HIV cases accounted for approximately 4.0 % (13/326). All first- or second-generation cases were infected with HIV-1 subtype B.

Conclusions

In this accident of HIV-infection among plasma donors in Hebei Province, a total of 339 direct and second-generation cases have been identified over 18 years of monitoring. Favorable clinical results have been achieved using intervention measurements and antiviral therapy.

HIV among plasma donors and other high-risk groups in Henan, China

OBJECTIVE

To describe the characteristics and changes of HIV/AIDS epidemic in different areas and high-risk populations in Henan, China.

METHODS

Serological surveys were conducted among former plasma donors (FPDs), female sex workers, drug users, sexually transmitted disease clinic attendees, men who have sex with men, and long-distance truck drivers in different areas of Henan Province. Data originated from the sentinel surveillance surveys conducted between 2004 and 2006, a special epidemiological study of HIV among FPDs in 2004 and the HIV/AIDS case-reporting system were analyzed.

RESULTS

By December 2006, a total of 35,232 HIV cases had been reported from 159 counties in Henan. HIV prevalence among FPDs was 8.6% (range: 0.09%-13.0%). Sentinel surveillance data collected between 2004 and 2006 indicated HIV prevalence from 0% to 0.80% in female sex workers; 0% to 0.86% in drug users; 0% to 1.39% in sexually transmitted disease clinic attendeess; 0% to 1.35% in long-distance truck drivers; and 0.88% to 2.67% in men who have sex with men.

CONCLUSIONS

HIV/AIDS epidemic in Henan is primarily centered among FPDs infected before 1996. Sexual transmission of HIV is increasing among other risk groups. Condom use and HIV testing and counseling need to be promoted to stop the spread of HIV.

Prevalence and phylogenetic analysis of TT virus DNA in Western India

In western India, TT virus (TTV) DNA positivity varied from 6.7% (5 of 75) in chronic hepatitis patients to 24.4% (10 of 41) in hemophiliacs; 7.4% (4 of 54) of voluntary blood donors had circulating TTV DNA. Phylogenetic analysis revealed a predominance of genotype 1a. In India, TTV is transmitted mainly by nonparenteral routes and is not an important cause of chronic liver diseases.

Hepatitis E virus: can it be transmitted parenterally?

Of 200 voluntary blood donors screened for hepatitis E virus (HEV) RNA, employing the reverse transcription-polymerase chain reaction (RT-PCR), three were found to be positive (1.5%). None of the HEV RNA-positive blood donors had any symptoms at the time of blood donation or during subsequent follow-up. One donor was positive for immunoglobulin M (IgM) antibodies to HEV, with a raised serum alanine aminotransferase (ALT) level, whereas the other two donors were negative for both immunoglobulin G (IgG) and IgM antibodies to HEV. Follow-up blood samples collected 2-5 months later from HEV RNA-positive blood donors demonstrated the presence of IgG anti-HEV antibodies. Overall seroprevalence of IgG anti-HEV was 18.6%. Retrospective studies on samples collected from commercial blood donors and haemophiliacs revealed IgG anti-HEV positivity to be 24. 6% (46/191) and 24.4% (22/90) and statistically not different (P>0. 1) from the prevalence among voluntary blood donors and an age-matched normal population, respectively. However, a highly significant proportion of the paid plasma donors, with a high prevalence of IgG antibodies to human immunodeficiency virus and hepatitis C virus, were positive for IgG antibodies to HEV (54/71, 76%, P<0.001), indicating a possible role of blood-derived HEV in the transmission of the virus among plasma donors. These results demonstrate the possible risk of transfusion-associated hepatitis E in hyperendemic areas.

The AIDS epidemic and commercial plasmapheresis

In 1986 an epidemic of HIV infection among paid plasma donors was identified in Mexico; paid donors were iatrogenically infected in a plasmapheresis center. These paid donors sold both plasma and blood: they provided one-third of blood consumed in 1986. This led to infection of blood recipients, mainly women of childbearing age. Blood transfusion is the leading cause of AIDS in women in Mexico. The male:female ratio decreased from 30:1 in 1986 to 5:1 1990; that coincided with the increase of transfusion-associated AIDS cases. Mexico prohibited the blood trade in 1987, ending the epidemic in paid donors and recipients. latrogenic infection of paid donors in plasmapheresis facilities could help to explain the explosive AIDS epidemic in central Africa and Haiti in the 1980s. There is a temporal and geographical coincidence in the early eighties between that AIDS epidemic, high numbers of hepatitis B asymptomatic carriers and an increased production of serum inactivated hepatitis B vaccine. Plasmapheresis facilities in these developing countries may have taken advantage of the high prevalence of hepatitis B asymptomatic carriers in their populations to obtain plasma for exportation through brokers to developed countries where the vaccine and other plasma products were manufactured. This hypothesis is relevant to establishing preventive policies and warrants further investigation.

The human immunodeficiency virus epidemic in India. Current magnitude and future projections

Since the first case of the human immunodeficiency virus (HIV) infection was documented in India in 1986, there has been an explosive increase in HIV transmission. In this review we describe the chronology of the HIV epidemic in India, preliminary information about the clinical presentation of the acquired immunodeficiency syndrome (AIDS), the biological and behavioral aspects of HIV transmission in the Indian setting, and projections regarding the future of the HIV epidemic in India. Using recent data obtained by searching the computerized literature and published abstracts, conference proceedings, and publications from the government of India, we show that India is experiencing a major epidemic of HIV transmission in high-risk populations of commercial sex workers, sexually transmitted disease clinic patients, intravenous drug users, and commercial blood donors. There is also evidence of recent spread of the epidemic from these high-risk groups to other risk groups in India, and from urban centers to rural populations. It is estimated that 1.6 million people are currently infected with HIV in India. At the present rate of transmission, India will have the largest number of HIV-infected individuals of any country in the world by the end of this decade, with more than 5 million infected individuals. Because limited data are available, comprehensive and well-designed epidemiologic surveys are urgently needed to adequately characterize the HIV epidemic in India and to help implement targeted and effective educational and prevention-oriented programs.