Asian Journal of Transfusion Science
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LETTER TO THE EDITOR Table of Contents   
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 213-214
HIV risk associated with nucleic acid testing tested seronegative blood donation where the donor was not preassessed for the risk


Surat Raktadan Kendra and Research Centre, Surat, Gujarat, India

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Date of Web Publication11-Sep-2017
 

How to cite this article:
Ghosh K, Misra K. HIV risk associated with nucleic acid testing tested seronegative blood donation where the donor was not preassessed for the risk. Asian J Transfus Sci 2017;11:213-4

How to cite this URL:
Ghosh K, Misra K. HIV risk associated with nucleic acid testing tested seronegative blood donation where the donor was not preassessed for the risk. Asian J Transfus Sci [serial online] 2017 [cited 2017 Sep 20];11:213-4. Available from: http://www.ajts.org/text.asp?2017/11/2/213/214339


Sir,

Risk assessment forms an important part of donor assessment before allowing the blood donor to donate blood. In India, blood donation camps are extremely crowded, and privacy for counseling and risk assessment is almost nonexistent. It will be interesting to know how many extra HIV donations will pass through the security checks of our system for donors being in an early phase of HIV infection and not detected by any test. This was elegantly worked out in a paper by Yang et al.[1] The authors showed that in the absence of risk assessment questions and counseling, only nucleic acid testing (NAT) for seronegative patients for HIV infection will still cause 49 units of blood to slip through the present window period of 9.1 days of NAT positivity and will cause transfusion of 86 infected blood components.

In India, seroprevalence in general population as well as so-called voluntary blood donor population has remained same at 0.35% in 2015–2016 (0.23%–0.6%),[2] showing that risk assessment questionnaire and counseling are largely ineffective. Several centers have conducted NATs on Indian donors and approximately 1:610–1:2972 (average 1:1500) were found to be NAT positive but seronegative.[3]

India provides us with a scenario as if no risk assessment questionnaire is being administered as evidenced by almost similar seroprevalence for HIV in normal population and blood donor populations; we did an exercise similar to Yang et al.[1] essentially using their model for calculation with some modifications to suit Indian requirement [Table 1].
Table 1: Calculation of blood units from infected donors within nucleic acid testing negative window period for HIV infection

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India collects approximately 10 million units of blood per year and this is donated mainly by 400 million adult males between the age 18 and 65 (2.5%) as female donors form insignificant number of blood donors in India (<10%). National AIDS Control Organization [4] documented approximately 114,736 new HIV infection, of which 80% will be male of the donor age group, i.e., 90,000 males with HIV and could have donated blood. Considering that in India, 2.5% donates blood, i.e., 2200 HIV-positive individuals could have donated blood, and considering a window period of NAT of 9.1 days as taken in Yang et al.'s paper, then, out of 2200 person with new HIV infection, 2200 × 9.1/365, i.e., 54.84 or 55 donations could be in the window period and will slip through the NAT and will be used for various patients.

Considering an average of 1.75 units of concentrates /per collected bag as given in [Table 1], 55 × 1.75 or 96.25, i.e., 100 components will be produced which can transmit infection as HCV is of similar frequency as HIV in India and hepatitis B is five times more; hence, another 100 HCV and 500 hepatitis B will also be transmitted if in India we do everything right and Institute ID-NAT without adhering to the risk assessment questionnaire and donor counseling. With our 950,000[5] men who have sex with men (MSM) and 180,000 intravenous drug user (IVDU)[6] individuals having HIV seroprevalence of 2.9% and 7%, some additional risk will be added, i.e., 17 of MSM and 8 of IVDU HIV and HCV infection and 85 hepatitis B from MSM and 40 from IVDU donor may be expected, leading to a total of 175 additional infections involving 307 components than what has already been described above. Where repeat donors are concerned, the transfusion service is on a much safer ground, but human nature is unpredictable regarding what initiates risk behavior in an individual, so proper donor counseling will still be required.

Hence, the power of donor counseling should never be underestimated even if the most powerful infection detection system like an individual donation, NAT system is universally operative.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Yang H, Anderson SA, Forshee R, Williams A, Epstein JS, Marks PW. Modeling complete removal of risk assessment questions in the USA predicts the risk of HIV exposure in blood recipients could increase despite the use of nucleic acid testing. Vox Sang 2016;110:324-8.  Back to cited text no. 1
[PUBMED]    
2.
Chandra T, Kumar A, Gupta A. Prevalence of transfusion transmitted infection in blood donors: An Indian experience. Transfusion 2009;49:2214-20.  Back to cited text no. 2
    
3.
Hans R, Marwaha N. Nucleic acid testing-benefits and constraints. Asian J Transfus Sci 2014;8:2-3.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
NACO and NIMS. India HIV Estimations 2015, Technical Report, Ministry of Health and Family Welfare, Government of India; 2015. p. 16.  Back to cited text no. 4
    
5.
Thomas B, Mimiaga MJ, Kumar S, Swaminathan S, Safren SA, Mayer KH. HIV in Indian MSM: Reasons for a concentrated epidemic and strategies for prevention. Indian J Med Res 2011;134:920-9.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Wherley S, Chatterjee S. India's growing problem of injecting drug misuse. BMJ 2015;350:h397.  Back to cited text no. 6
    

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Correspondence Address:
Kanjaksha Ghosh
Surat Raktadan Kendra and Research Centre, Surat - 395 002, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajts.AJTS_136_16

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
Online since 10th November, 2006