Transfusion-transmitted HIV infection in India

(He can be reached at drkdharmakanta@yahoo.com)

In May 2016, it was reported that a three and-a-half-year-old boy, who was being treated for burn injuries, acquired HIV infection from blood transfusion at Guwahati Medical College and Hospital. In June 2013, four people tested Human Immuno-deficiency Virus (HIV) positive after an alleged blood transfusion at the Mangaldai Civil Hospital. In 2012, a thalassaemic child receiving blood transfusion in a hospital in Mananthavady, Kerala was found HIV positive. In 2011, the media reported that 28 thalassaemic children who received blood transfusion at the Junagarh Civil Hospital were found to be HIV positive. In 2010, one patient acquired HIV infection following blood transfusion at the Indian Red Cross Society blood bank, Andhra Pradesh. These are only a few examples of transfusion-transmitted HIV infection in India. Actually, HIV infection resulting from blood transfusion has been documented nationwide repeatedly.

In response to an RTI application filed by Mumbai-based activist Chetan Kothari, the National Aids Control Organization (NACO) has revealed that 2,234 persons, including children, got HIV infection between October 2014 and March 2016 due to unsafe blood transfusion across India.

HIV is a retrovirus that causes AIDS. It is transmitted from person to person via body fluids, sexual contact with infected persons, sharing needles/syringes with infected persons and through transfusion with HIV-infected blood. Researchers estimate that individuals who receive blood transfusion that are contaminated with HIV have 90% chances of becoming infected. India with a high prevalence of HIV among blood donors, this risk is especially high. As collecting HIV-infected blood poses risk to blood bank workers and people who receive transfusion, and also waste money and staff time, blood transfusion services should use strategies to avoid collection of such infected-blood.

Following the detection of the first case of transfusion-transmitted HIV infection of India in Vellore in 1987, the Indian Government made HIV screening of donated blood mandatory in India. Using screening to prevent HIV transfusion is a cost-effective way of ensuring supplies of safe blood. In India, NACO has been primarily responsible for hospital HIV infection control including safe blood transfusion from 1992. All the blood banks of India have been modernized, blood transfusion councils have been established at the national and state levels, and stringent quality control parameters have been defined by NACO for zero transmission of HIV via blood transfusion. All the licensed private and government blood banks of India strictly follow the national guidelines approved by NACO. Apart from HIV, there are many infectious agents that can spread via blood. Safe blood should be free from these entire infectious agents. As per the NACO guidelines, it is mandatory to screen donors/donated blood for transmissible infections of HIV, HBV, HCV, malaria and syphilis.

As per NACO, in 1999 transfusion transmitted HIV was 15% of all the cases in India, which has now come down to less than 1%. Though enhanced screening, including the use of thorough questionnaires to exclude possible HIV-exposed donors and highly sensitive lab tests to identify infected blood donations have reduced the risk of blood-born HIV transfusion drastically in India in last 20 years, still cases keep happening over and over again in India. This is an extremely serious issue about blood safety, and the Government needs to address it urgently. Currently, most of the blood banks in India perform Enzyme linked immunosorbent assay (ELISA) test or Enhanced chemiiluminescence assay (CLIA) test to detect HIV antibodies, which the body generates post-infection, and which can be done only after the 14 days window period associated with HIV. The nucleic acid amplification test (NAAT) is a highly sensitive and advanced molecular technique that can detect the presence of HIV RNA or DNA in blood after three days of infection. It can cut down the window period from 14 days to three days as it can directly detect the virus instead of the antibody. The time period from infection with HIV until the body produces evidence of the virus itself or antibodies that can be detected by tests is the 'window period' during which a donor can show negative result despite being infected. A person receiving blood transfusion of such a donor may get HIV infection. The Government should provide NAAT to all the blood banks for screening of donated blood to reduce the risk of transfusion- transmitted HIV in India.

Despite the availability of tests, there is still a narrow chance of the recipient being given infected blood because none of the tests can detect HIV infection from first day of the infection. Pre-donation counselling of donors and self-deferral are the most important tools for getting safe blood, especially in the window period. Blood centres should encourage only people who are at a low risk of HIV infection, and counsel people about the need to be responsible donors and not to give blood if they have been at risk of HIV. It is globally accepted that the best source of safe blood is from known repeated voluntary donors. India is dependent on emergency blood donations from paid donors or family members as voluntary blood donors account less than half of the blood supply. Research shows that blood collected from paid or family donors is more likely to be contaminated with HIV. It is already proved that the Mangaldai case was due to HIV-infected professional blood donor. The Supreme Court has banned professional blood donation since January 1, 1998. HIV-infected family members may be unaware of their infection, but feel obliged to donate blood in order to help their relatives. All the eligible donors of the nation should come forward for repeated voluntary blood donation for safe blood transfusion and to eliminate the case of Transfusion-transmitted HIV infection in India. It is hoped that the Government will take steps to strengthen the public health management, with empowered trained officers in every district. Every healthcare facility practising blood transfusion should be monitored for adhering to the stipulated norms of quality parameters to prevent transfusion transmitted HIV infection in India.