|Year : 2013 | Volume
| Issue : 3 | Page : 236-239
Seroprevalence of human immunodeficiency virus in voluntary blood donors: Declining trend
Pradhan M Pagaro, Dakshyani Padmakar Pandit, Anand R Patel, Urmi Chaudhari
Department of Pathology, Padmashree Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
|Date of Web Publication||5-Jul-2013|
Pradhan M Pagaro
Department of Pathology, Dr. D.Y. Patil Medical College, Pune - 411 018
Source of Support: None, Conflict of Interest: None
Background: Seroprevalence of human immunodeficiency virus (HIV) in selected groups can produce an indication of secular trends of the infection. In this article, we studied the trend of HIV infection in voluntary blood donors over a period of 7 years. Materials and Methods: The study was conducted in a blood bank of a tertiary care hospital. More than 16,500 donors were screened by enzyme-linked immunosorbent assay for HIV infection over a period of 7 years. Statistical Analysis: Trend analysis was performed to identify the year-wise HIV positivity pattern among the blood donors during the study period. Cochrane-Armitage Chi square for linear trend was applied to the data to observe whether there was any significant decline in HIV seropositivity among the blood donors. Results: In our study, the seroprevalence of HIV declined from 0.57% in 2006 to 0.18% in 2012. This declining trend tended to be statistically significant (Cochrane-Armitage Chi square for linear trend 3.65, P = 0.056). Conclusion: This study indicated the decreasing trend of HIV seropositivity among voluntary blood donors. Long-term surveillance of blood donors can provide important information on the course of the HIV pandemic.
Keywords: Blood donors, human immunodeficiency virus, surveillance
|How to cite this article:|
Pagaro PM, Pandit DP, Patel AR, Chaudhari U. Seroprevalence of human immunodeficiency virus in voluntary blood donors: Declining trend. Med J DY Patil Univ 2013;6:236-9
|How to cite this URL:|
Pagaro PM, Pandit DP, Patel AR, Chaudhari U. Seroprevalence of human immunodeficiency virus in voluntary blood donors: Declining trend. Med J DY Patil Univ [serial online] 2013 [cited 2021 Apr 20];6:236-9. Available from: https://www.mjdrdypu.org/text.asp?2013/6/3/236/114641
| Introduction|| |
India has a population of over 1 billion. According to a fact sheet 2008 update, the total number of adults and children estimated to be living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is between 1.8 and 3.2 million in India, which is much less than the estimate in 2003, which was over 5 million cases.  This decline over time is due to the efforts of both government and non-government organizations, besides a more robust model of estimating the burden of HIV. 
In 1981, a new disease was detected. In 1984, it was confirmed to be caused by a unique retrovirus and was confirmed to be the cause of acquired immunodeficiency syndrome in 1985.  In 1985-1986, HIV infection was first reported in India in a commercial sex worker in the erstwhile Madras. In 1989, HIV was reported in an intravenous drug user in Manipur.  There are six high-prevalence states, namely Tamil Nadu, Karnataka, Maharashtra, Andhra Pradesh, Manipur, and Nagaland. High-risk groups include commercial sex workers, intravenous drug users, and men having sex with men. 
The National AIDS Control Organization was set up in 1992 to carry out an HIV/AIDS prevention, control, and surveillance program effectively. The agenda was set up in three phases. The first phase in 1992-1999 concentrated on blood safety, high-risk groups, increasing awareness, and improving surveillance. The second phase, which ended in 2006, concentrated on providing more responsibility to the states for prevention and targeted intervention for high-risk groups and phase 3 of the program involves building on the foundation of phases 1 and 2 toward more effective measures of prevention and control. Commercial sex workers are responsible for the majority of HIV transmission in India. National AIDS Control Organization (NACO) estimates 86% transmission is due to sexual risk, 2.4% due to intravenous drug users, 2.0% due to blood and blood products, and 3.6% due to perinatal transmission.
In 1989, HIV testing was made mandatory in all blood banks in India.  This study was carried out to ascertain the trend of HIV infections among voluntary blood donors over the years.
| Materials and Methods|| |
Place of Study
Blood bank of a tertiary care teaching hospital in Pune, Maharashtra, in India is one of the highly endemic states of HIV according to NACO. 
The study was conducted from 2006-2012 over a period of 7 years. During this period, 16,598 donors were tested for HIV by the enzyme-linked immunosorbent assay (ELISA) method.
Sample Collection and Lab Testing
5 ml of blood was collected in plain bulb. All of the donors were voluntary blood donors. Testing of the serum was performed using the ELISA technique by experienced technicians using fourth generation ELISA reagents, which detect p24 antigen along with HIV antibody. This antigen appears in blood in the early weeks after infection ahead of the detectable antibody. This reduces the window period for the detection of HIV infection.
The testing was unlinked and anonymous. Since this mode of HIV testing of donors is part of the statutory requirement in blood banks, no separate consent was indicated. HIV-positive units of blood were discarded. All personal details of the person being tested were removed from the blood samples so that the results of HIV testing could not be linked with the identity of the person.
Data were summarized using percentages. Year-wise HIV prevalence among the blood donors was calculated and tabulated. Cochrane-Armitage Chi square for linear trends was used to identify any statistically significant decrease or increase in the prevalence of HIV infection among voluntary blood donors.
| Results|| |
In the present study, there were 16,598 voluntary blood donors during the period from 2006 to 2012. There were 15,671 male donors and only 927 were female donors, indicating the predominance of male donors compared with females. The overall seroprevalence of HIV was 0.373%. Seroprevalence in males was 0.389% as against 0.1% in females, and this difference was statistically significant (P < 0.05). The majority of HIV-positive cases were in the age group of 31-40 years; however, the difference in the prevalence of HIV according to age group was not statistically significant (P > 0.05).
HIV Prevalence Trend Among Blood Donors
As seen from [Table 1] and [Figure 1], HIV seroprevalence declined from 0.57% in 2006 to 0.18% in 2012.
|Figure 1: Trend of human immunodeficiency virus seropositivity among voluntary blood donors (Cochrane-Armitage test for linear trend: Chi square = 3.65, P = 0.056)|
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|Table 1: Year-wise human immunodeficiency virus seroprevalence among voluntary blood donors|
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| Discussion|| |
Blood transfusion is an integral lifesaving procedure of modern medicine; however, it carries the risk of transmission of the deadly virus HIV with great morbidity and mortality. Screening of blood donors is mandatory for such infections. Despite screening, they can still be transmitted during the window period or if the blood is donated by paid and replacement donors. The policy of banning professional blood donors seems to have reduced the risk of prevalence in blood donors since seroprevalence among replacement and paid donors has been reported to be much higher than what was found in the present study. ,,, The prevalence of HIV in our blood bank was 0.373%, which is lower compared to a similar study that reported a prevalence of 0.44%.  In a study during the period 1999-2009, prevalence of HIV among voluntary blood donors ranged from 0.12% (2002) to 0.39% (2005) with a mean of 0.247% using fourth generation ELISA using P 24 antigen.  Purshottam  reported HIV prevalence of 0.07% and Chattoraj  reported a prevalence of 0.13%, whereas Mumtaz et al.  Reported nil seroprevalence among voluntary blood donors. These variations reflect the region-wise differences in HIV endemicity. As found in our study, seroprevalence of HIV has been reported more in males than in females. 
The most important finding of our study was the declining trend in HIV positivity among voluntary blood donors over the 7-year period. There can be many reasons for it. Over the years, awareness of spread of HIV might have improved among the population, making voluntary blood donors with risk behavior abstain from donating blood. Secondly, better training and awareness of health workers at blood banks may be effective in screening out those with high risk of HIV by simple questionnaires administered to prospective blood donors.
A true decline in HIV endemicity is another possibility. Similar declining trends reported by others support the latter view to some extent. Dhruva et al.  Studied the seroprevalence of voluntary donors in the Saurashtra region of Gujarat and observed declining trends over a period of three and a half years, the prevalence falling from 0.76% in 2008 to 0.21% in 2011. Arora et al.  Reported nil prevalence of HIV among voluntary blood donors.
At the international level too, HIV trends appear to have stabilized if not declining. A news release by the World Health Organization (WHO) on November 30, 2011 reported 15% reduction of incidence of new infections over the past decade, and a 22% decline in AIDS-related deaths in the last 5 years. 
HIV seroprevalence among blood donors in a teaching hospital in Ethiopia showed a declining trend over a period of 5 years from 5% in 2003 to 3.1% in 2007. 
The increase in seroprevalence in some years may be due to the blood donors being from high-risk-group areas. This implies that the selection of voluntary blood donors from high-risk groups should be avoided, which will reduce costs, efforts, and wastage of blood. The decrease in the seroprevalence over years indicates the increasing awareness among the population regarding AIDS and the effectiveness of the various control programs. Zero transmission of HIV to the blood recipients to have an HIV-disease-free population should be the main aim of blood banks and national AIDS control programs.  This is only possible through vigorous screening of blood donors, effective control strategies including public awareness programs, and the implementation of adequate public health measures. Proper donor selection, education, uniform implementation of lab screening tests, and adequate supply of blood through voluntary blood donations will ensure safe blood transfusion to the recipients at the optimum level.
| Conclusion|| |
HIV prevalence appears to be declining over the years. This is because of education, awareness, and effective control programs. Ensuring 100% voluntary blood donations, strict selection, and comprehensive and effective screening of donors will ensure safe blood transfusion to the recipient. Introduction of better technology for donor screening and viral inactivation are steps toward making blood and its products very safe; however, such technologies require trained staff, is very costly, and is not possible in India with limited resources. It is hoped that the government will create the arm of health management with empowered trained officers in every district and city and that every blood transfusion will be monitored for adhering to the stipulated norms of quality parameters to prevent any transfusion-transmitted infections. Only then will we be able to reach zero transmission of HIV via blood transfusion.
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