Transfusion-Transmitted HIV Infection in India

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com) 

In May 2016, it was reported that a three-and-a-half-year-old boy, who was being treated for burn  injuries, acquired Human Immunodeficiency Virus (HIV) infection from blood transfusion at Guwahati Medical College and Hospital. In June 2013, four people tested HIV positive after an alleged blood transfusion at Mangaldai Civil Hospital. In 2012, a thalassaemic child receiving a blood transfusion at a hospital in Mananthavady, Kerala, was found HIV positive. In 2011, the media reported that 28 thalassaemic children who received blood transfusions at Junagarh Civil Hospital were found to be HIV positive. In 2010, one patient acquired an HIV infection following a blood transfusion at the Indian Red Cross Society blood bank, Andhra Pradesh. These are only a few examples of transfusion-transmitted HIV infections in India. Actually, HIV infection resulting from blood transfusion has been documented nationwide repeatedly. As per a report, the National AIDS Control Organisation (NACO), in an RTI, has revealed that around 1,342 people in 2018-19 and 7,218 people between 2014 and 2019 got HIV infections due to 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 HIV-contaminated blood transfusions have a 90 per cent chance of becoming infected. In India, which has a high prevalence of HIV infection among blood donors, this risk is especially high. As collecting HIV-infected blood poses a risk to blood bank workers and people who receive transfusions and also wastes money and staff time, blood transfusion services should use strategies to avoid the collection of such infected blood.

Following detection of the first case of transfusion-transmitted HIV infection in India in Vellore in 1987, the government made HIV screening of donated blood mandatory. Screening donated blood 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, since 1992. Nowadays, the National Blood Transfusion Council (NBTC), a part of the NACO, is the apex policy-making body for blood and its component-related issues in India. At the state level, the State Blood Transfusion Council (SBTC) coordinates with the NBTC.

All the blood centres in India have been modernised, blood transfusion councils have been established at the national and state levels, and stringent quality control parameters have been defined by NBTC for zero transmission of HIV via blood transfusion. All licensed blood centres in India strictly follow the national guidelines approved by NBTC.

Despite such elaborate efforts, blood transfusions remain a source of HIV infections not just in India but globally. The percentage, however, varies considerably between high-income and low-income countries.

As per NACO, 20 years ago, nearly 8 to 10 per cent of total HIV infections in India were coming from blood transfusions, which has currently come down to less than one per cent. Though enhanced screening, including the use of thorough questionnaires to exclude possible HIV-exposed donors and highly sensitive laboratory tests to identify HIV-infected blood donations, has reduced the risk of transfusion-transmitted HIV infection drastically in the 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 centres in India perform enzyme-linked immunosorbent assay (ELISA) tests to detect HIV antibodies, which the body generates post-infection and which can be detected only after the 14-day 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 3 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 a negative result despite being infected. A person receiving a blood transfusion from such a donor may get an HIV infection. The government should provide NAAT to all the blood centres for screening of donated blood to reduce the risk of transfusion-transmitted HIV.

Despite the availability of highly sensitive laboratory tests, there is still a narrow chance of the recipient being given infected blood, as none of the laboratory tests can detect HIV infection from the first day of infection. Pre-donation counselling of blood donors and self-deferral are the most important tools for getting safe blood, especially in the window period. Blood centres should encourage only people to donate blood who are at a low risk of HIV infection and counsel people about the need to be responsible blood donors and not to give blood if they have been at risk of HIV infection. It is globally accepted that the best source of safe blood is from known, repeated, voluntary blood donors. But, India is still dependent on emergency blood donations from paid donors or members of the family, as the national level of voluntary blood donation is not yet 100 per cent. Research shows that blood collected from paid blood donors is more likely to be contaminated with HIV. It is already proved that the Mangaldai case was due to HIV-infected paid blood donors. The Supreme Court has banned paid blood donation since January 1, 1998. All the blood banks in India should be connected with the e-blood banking system, an electronic database of blood donors including biometric data and their medical history to prevent liars and dubious paid blood donors and people infected with HIV from donating blood. Sometimes, HIV-infected members in the family may be unaware of their infection and donate blood to save their relatives. Therefore, all the eligible blood 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. The government should take steps to strengthen the public health management with empowered trained officers in every district to monitor all blood banks for adhering to the stipulated norms of quality parameters to prevent transfusion-transmitted HIV infection in India.