In June 2013, four people tested Human Immuno-deficiency Virus (HIV) positive after an alleged blood transfusion at the Mangaldai Civil Hospital. Last year, 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 2011, the media reported that 28 thalassaemic children who received blood transfusion at the Junagarh Civil Hospital were found to be HIV positive. These are only a few examples of transfusion-transmitted HIV infection in India. In reality, HIV infection resulting from blood transfusion has been occuring on a regular basis.
In response to a RTI application filed by Mumbai-based activist Chetan Kothari, the National Aids Control Organisation (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. Uttar Pradesh tops the list with 361 such cases, followed by Gujarat (292). However, NACO said the number revealed in the RTI was based on voluntary disclosure by patients at the Integrated Counselling and Testing Centers and not verified through any scientific means.
HIV is a retrovirus that causes AIDS. The virus primarily attacks the immune defense system, making body extremely vulnerable for opportunistic infections. HIV is transmitted from person to person via body fluids (including blood, semen, vaginal discharge and breast milk), sexual contact with infected persons, sharing needles/syringes with infected persons. Researchers estimate that individuals who receive blood contaminated with HIV have 90% chances of becoming infected. With a high prevalence of HIV among blood donors, this risk is especially high in our country. As collecting HIV-infected blood poses risk to blood bank workers and people who receive transfusion, besides being a waste of 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 HIV infection control in hospitals, including safe blood transfusion. After 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 all these infectious agents. As per NACO guidelines, it is mandatory to screen donors/donated blood for transmissible infections of HIV, HBV, HCV, malaria and syphilis.
Currently, most of the blood banks in India perform rapid spot tests, Enzyme Linked Immunosorbent Assay (ELISA) test or Enhanced Chemiiluminescence Assay (CLIA) test to detect HIV antibodies. These methods cannot detect these antibodies before two weeks of infection. 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 Government should provide NAAT to all the blood banks to reduce the risk of transfusion- transmitted HIV in India.
Despite the availability of tests, there still exists a small 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.
Persons having clinical or laboratory evidence of HIV infection, homosexuals, drug users, sex workers, those having multiple sex partners should resist from donating blood. 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 are very less. Research shows that blood collected from paid or family donors is more likely to be contaminated with HIV.