|LETTERS TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 117-118
Possible transmission of human immunodeficiency virus through blood transfusion in Pakistan
Usman Waheed, Hasan Abbas Zaheer
Safe Blood Transfusion Programme, Ministry of National Health Services, Government of Pakistan; Department of Pathology and Blood Bank, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
|Date of Web Publication||22-Apr-2019|
Dr. Usman Waheed
Safe Blood Transfusion Programme, Ministry of National Health Services, Government of Pakistan; Department of Pathology and Blood Bank, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Waheed U, Zaheer HA. Possible transmission of human immunodeficiency virus through blood transfusion in Pakistan. Glob J Transfus Med 2019;4:117-8
|How to cite this URL:|
Waheed U, Zaheer HA. Possible transmission of human immunodeficiency virus through blood transfusion in Pakistan. Glob J Transfus Med [serial online] 2019 [cited 2019 May 21];4:117-8. Available from: http://www.gjtmonline.com/text.asp?2019/4/1/117/256775
Human immunodeficiency virus (HIV) is a retrovirus principally involving the human immune system  and is responsible for the acquired immunodeficiency syndrome (AIDS) in humans. According to the Joint United Nations Programme on HIV/AIDS estimates, HIV has infected >70 million people since its outbreak and is responsible for the death of nearly 35 million people. At the end of 2016, 36.7 million population was found to be living with HIV globally.
Since the first case of AIDS reported almost four decades ago in 1981, HIV has moved on from being an essentially untreatable infection to one extremely susceptible to a variety of treatment regimens. In 1985, the Food and Drug Administration (U.S. FDA) granted a license for commercial use of first HIV ELISA test. In the same year, clinical trials of antiretrovirals (ARVs) initiated and FDA legalized first ARV in 1987 named 3′-azido-2′,3′-dideoxythymidine, zidovudine.
In sharp contrast to the global trends, the HIV prevalence is continuously growing in Pakistan and the country has now entered into classic Asian epidemic model of HIV where after establishment among high-risk groups, its transmission to the general public is rapid. Fear, stigma, and ignorance have contributed heavily to HIV transmission in Pakistan. The first HIV case in Pakistan was reported in 1988 while the current incidence rate is 0.07% with low ARV coverage (9.39%). In addition, there is a big gap between the identified and actual cases as only 16.09% cases are identified. Existing HIV-infected patients (estimated 0.150 million) are mostly expatriated migrant workers along with their spouse and children.
Globally, the HIV transmission due to contaminated blood and blood components transfusion has been reported repeatedly since 1982. Safety of blood and blood products is a major concern in Pakistan and HIV detection among blood donors is on the rise. In September 2018, a report of HIV transmission through blood transfusion was reported in the media where a mother and her newborn acquired HIV after a blood transfusion from an HIV-positive donor (confirmed later). The case was referred to and investigated by the Punjab Blood Transfusion Authority (PBTA). The PBTA team took blood samples of both recipients (mother and her newborn) and the blood donor who was a family relative. The samples were tested by highly sensitive chemiluminescence immunoassay (CLIA) and confirmed the presence of HIV. Due to maternal HIV antibodies transfer through the placenta, the infection status of the newborn was not reconfirmed as he died within 2 weeks while the mother in December 2018. Further laboratory analysis was not done to confirm whether the virus in the recipients of blood transfusion, remaining samples, and the donor are the same.
The donor informed that he had donated 22 times in the past few years. The PBTA was able to trace only one earlier donation three months ago. The recipient (a female) was found, tested by highly sensitive CLIA and was traced to be HIV-positive. All these cases occurred in unlicensed private blood banks that were screening for HIV on rapid manual devices. The blood banks were sealed by the authority and infected cases were registered by the provincial AIDS control program and are being treated.
The main reasons for HIV spread through blood transfusion in Pakistan are the use of sub-standard rapid screening devices which are not evaluated and validated at a national level. In addition, the existing system relies on the family/replacement donors instead of the internationally recommended voluntary nonremunerated blood donors.
The national Safe Blood Transfusion Programme, Ministry of National Health Services, is implementing blood safety system reforms  which also cover the regulation of the blood sector. Under the reform agenda, the blood transfusion authorities have been made functional and grant licenses to only those blood banks with proper systems to ensure the quality and safety of blood products. The Programme is also developing a national system for the evaluation, selection, and validation of all assays used for screening of blood in close coordination with the Drug Regulatory Authority of Pakistan.
To promote the culture of voluntary blood donations, the Programme has taken concrete steps initiating with the formulation of a national blood donor policy which outlines two strategies, including the strengthening of blood donor organizations and the conversion of replacement donors to voluntary blood donors as many of these donors are regular and suitable to become voluntary donors. In the National Strategic Framework, Cluster 3: Core business identified donor management, including community interface as a key priority area. In the recent past, the programme, as the key national partner, has proactively partnered with the social media giant, Facebook and launched a blood donation feature in Pakistan as part of its community service initiative. The Feature Hub makes it easier for people to sign up to become blood donors and it also helps connect these voluntary donors with people and organizations in need of blood. The Programme has also interacted with Cristiano Ronaldo and the double Oscar winner filmmaker, Sharmeen Obaid Chinoy, who are now the ambassadors of blood safety in the country.
The promotion of voluntary blood donation concept along with regulation of blood sector will reduce the risk of HIV transmission through blood transfusions in Pakistan.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Miedema F, Hazenberg MD, Tesselaar K, van Baarle D, de Boer RJ, Borghans JA. Immune activation and collateral damage in AIDS pathogenesis. Front Immunol 2013;4:298.
Broder S. The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic. Antiviral Res 2010;85:1-8.
GBD 2015 HIV Collaborators. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: The global burden of disease study 2015. Lancet HIV 2016;3:e361-87.
Khanani RM, Hafeez A, Rab SM, Rasheed S. Human immunodeficiency virus-associated disorders in Pakistan. AIDS Res Hum Retroviruses 1988;4:149-54.
National AIDS Control Programme, Ministry of National Health Services, Government of Pakistan. Available from: http://www.nacp.gov.pk/
. [Last accessed on 2019 Jan 03].
Ammann AJ, Cowan MJ, Wara DW, Weintrub P, Dritz S, Goldman H, et al.
Acquired immunodeficiency in an infant: Possible transmission by means of blood products. Lancet 1983;1:956-8.
Waheed U, Farooq A, Arshad M, Usman J, Zaheer HA. Surveillance of human immunodeficiency virus in blood donors of Islamabad, Pakistan: A meta-analysis. Pak Armed Forces Med J 2017;67:860-67.
Zaheer HA, Waheed U. Blood safety system reforms in Pakistan. Blood Transfus 2014;12:452-7.
Zaheer HA, Waheed U. Impact of regulation of blood transfusion services in Islamabad, Pakistan. Glob J Transfus Med 2016;1:29-31. [Full text]