Blood transfusion risk

Blood transfusion risk

Estimate of the residual risk of transfusion-transmitted human immunodeficiency virus infection in sub-Saharan Africa: a multinational collaborative study

Sub-Saharan Africa remains the epicenter of the human immunodeficiency virus (HIV) pandemic. However, there is a lack of multicentre data on the risk of transfusion-transmitted HIV from blood centres in sub-Saharan Africa. The incidence of HIV infections in blood donations collected in the main blood banks of five countries (Burkina Faso, Congo, Ivory Coast, Mali, and Senegal) was determined to estimate the current transfusion risk of HIV infection using the incidence rate/window period model. The risk of transfusion-transmitted HIV infections associated with the window period varied from 1 in 90,200 donations (Senegal) to 1 in 25,600 (Congo). Considering the five participating blood centres as a whole, the incidence rate of HIV-positive donors per 100,000 person-years was 56.6 (95% confidence interval [CI], 47.1-67.9); the residual risk was 34.1 (95% CI, 7.8-70.7) per 1 million donations, which represents 1 in 29,000 donations (95% CI, 1/128,000-1/14,000). Residual risk estimates varied according to the country. This is potentially due to a lower incidence of HIV infection in the general population or to a more efficient selection of blood donors in the countries with the lowest risk. The estimates of the transfusion risk of HIV infection in each country are important, both to assess the impact of current preventative strategies and to contribute data to policy decisions to reinforce transfusion safety.

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Editors’ note: This is this first published study estimating the residual risk of transfusion-related HIV transmission after standard blood screening using HIV incidence among repeat donors in five sub-Saharan African countries. The result – 1 in 29,000 donations in Burkina Faso, Congo, Ivory Coast, Mali, and Senegal – contrasts markedly with the estimate for South Africa of 1 in 479,000. South Africa uses nucleic acid testing (NAT), the more expensive but efficacious option employed for blood donation screening in industrialised countries. NAT identifies donors with HIV infection who are in the pre-seroconversion window period, after infection and before HIV antibodies appear. WHO estimated in 2005 that up to 5% of HIV transmissions in sub-Saharan Africa were transfusion-related. NAT would improve transfusion safety significantly in this highest prevalence region in the world, with a cheaper interim option being some form of combination antigen/antibody testing. Regardless, it is important to strengthen donor selection by restricting donation to volunteer, unpaid, regular donors at low risk of blood-borne infections and sexually transmitted infections. Upstream prevention of blood transfusion-related HIV transmission entails avoiding unnecessary transfusions, along with prevention and timely management of anaemia caused by obstetrical haemorrhage, nutritional deficiencies, and malaria and other infections.