Re: HIV Window period and safe blood transfusion

[Guest guest]

Dear Forum,

I have been reading some of the responses to this question.

I think there are some issues which need understanding:

1. The issue raised was not of Rapid tests but that of . Rapid

tests are only to be used in emergencies.

2. When you compare the time taken for , NAT is as efficient. NAT

for all 3 - HIV, HBV and HCV takes just about 5-6 hours, and does not delay

results or product release.

3. Blood Safety is dependant on many factors. Reduced and Rational use

of Blood, Autologous Blood, and Regular Repeat Voluntary Donations and Good

Pre-Donor Screening all go a long way in making Blood Safer.

4. But given the high prevalence of infections in India; a very small

pool of genuine regular repeat voluntary donors; ignorance amongst donors;

difficulty in thorough pre-donor screening in large camps; use of low

sensitivity kits and rapid tests; a fragmented blood bank sector with over 2300

blood banks; blood banks with problems of low volume, lack of trained manpower,

instruments, and technicians; focus on cost rather than quality; and an emphasis

only on HIV with lower resources, focus and awareness about Hepatitis - Blood

Screening becomes very, very important.

In a multi-centre study conducted in India, it was found that 1 in 1528 units of

blood may still be infected after being cleared by serological () tests.

This study conducted in Delhi included 8 centres from across the country and

included PGI, SGPGI, Apollo Hospital, Rotary, Bombay Hospital etc.

Every week there is some story about HIV infections through Blood.

Whether it is West Bengal or Kerala, AIIMS or Safdurjung. There have been

scandals all over the world from Japan to Canada. Recently infections were

detected in Denmark, Peru, Kazakhstan and even USA from either Transfusions or

Transplants. Canada is paying Billions for Hepatitis C spread through blood.

Most Hepatitis infections go undetected for years because they are

asymptomatic, and are not covered by the media because of lack of hype. Many

court cases are either ongoing or have happened, where a victim has sued a

hospital or blood bank for infections from Blood Transfusion. These include,

AIIMS, Safdurjung, KEM Mumbai, Breach Candy Mumbai, Apollo Delhi, Escorts Delhi,

PGI Chandigarh etc.

Payments for TTIs have ranged from Rs. 50,000 to Rs. 18,00,000 (Eighteen Lakhs).

A young boy who acquired HIV at Safdurjung

Hospital has now sued the Government for Rs. 30,00,000 (Thirty Lakhs). A study

done on over 500 Thallessemics showed an infection rate of 6% for HIV, 8% for

HBV and 16% for HCV. Where are they getting this infection?

Is blood safety not a priority? Is prevention not important? Is saving a few

thousand infections a year irrelevant. Even if the victims are thallessemics,

children or innocent patients. Do we need to wait for more legal action before

India wakes up?

The blood safety norms in India today are due to a PIL in the Supreme Court.

The judgment says that 'safe blood' must be provided to all. What is Safe Blood?

In my view 'Safe' means safest possible. Are we providing that?

NAT can help reduce these infections. NAT is available in India now and when

done in addition to ELISA, on Individual Donations (ID), can provide 'safe

blood'. NAT is used not only in the developed countries like USA, Australia

Japan, Canada, Singapore, Hong Kong and most of Europe but also in South Africa,

Egypt, Slovenia, Slovakia, Lithuania, Thailand and now even Malaysia, Indonesia

etc.

ID-NAT has been available in India and is easy to perform, is both highly

sensitive and specific, and very cost effective. Indraprastha Apollo Hospital in

Delhi has been testing all their blood with NAT since April 2006, and their

yield is about 1 in 3000. Now ID-NAT is also available at Rotary TTK Blood Bank,

Bangalore and will be available at Apollo Chennai, Jeevan Blood Bank Chennai,

Indu Blood Bank Baroda, Artemis Hospital Gurgaon this month. Even the Armed

Forces, AIIMS and NACO have planned NAT.

And Yes, NAT comes at a cost. The additional cost of ID-NAT (for all 3

markers HIV, HBV and HCV) will add Rs. 300-500 per component in a centre doing

over 80% components. There are 250 Million mobile/cell phones in India, whose

monthly average bill is Rs. 344. You decide whether ID-NAT adds enough

incremental value or not? Or better still -let the patient decide.

My family has suffered - a hepatitis C infection - through blood. We were not

given any choices.

I think every citizen should either be offered NAT tested blood or given the

choice to decide. That is what the Supreme Court offered, and that is what every

patient takes for granted.

Sumit Bagaria

President

Hemogenomics Pvt Ltd

551, HAL 2nd Stage,

5th Cross, Indranagar,

Bangalore - 560038, INDIA

Ph: +91-80-25264646 / 25270405

Mobile: +91-9845042005

Fax: +91-80-25270404

e-mail: sumit_bagaria@...