Prevention of transfusion-associated HIV transmission in Kinshasa, Zaire: HIV screening is not enough.

The purpose of this study was to develop a strategy to reduce transfusion-related HIV transmission which went beyond the limits of routine HIV screening of blood donors. Current blood transfusion practices were assessed in 1044 patients for whom staff physicians had requested a transfusion between 5 September and 19 October, 1988. Children under 5 years of age with malaria, and pregnant women with acute anaemia requiring blood transfusion were the two highest risk groups. Many of the transfusions were given without an obvious medical indication; 22.7% (214 out of 955) of the recipients were transfused without prior laboratory tests [haemoglobin (Hb) or haematocrit (Hct)], 7.2% with Hb greater than 6g/100ml or Hct greater than 25% and 16.6% without clinical signs of severe anaemia (pulse less than 100/min without shortness of breath). The data of this study were used to organize a workshop for all the physicians responsible for blood transfusions in Kinshasa and two nearby health zones. A consensus statement on the indications for blood transfusion was developed. Subsequently, transfusion centres adopted this consensus statement instead of previous guidelines.

Human immunodeficiency virus infection among employees in an African hospital.

To define the prevalence and course of human immunodeficiency virus (HIV) infection, we examined prospectively a cohort of 2002 adult hospital workers in Kinshasa, Zaire. From 1984 to 1986 the prevalence of HIV infection increased from 6.4 percent to 8.7 percent. Over the two years there was a cumulative incidence of new HIV infection of 3.2 percent. The prevalence was higher among women (16.9 percent) and men (9.3 percent) under the age of 30 than among women (9.0 percent) and men (6.2 percent) over 30. Prevalence rates were similar among physicians (5.6 percent), laboratory workers (2.9 percent), and clerical workers (7.9 percent), but they were higher among female nurses (11.4 percent) and manual workers (11.8 percent). Despite marked differences in the intensity of nosocomial exposure, female nurses had similar infection rates on the female internal medicine ward (9.9 percent), in pediatrics (10.8 percent), and in the delivery room (10.7 percent). The attributable risk of HIV infection from a transfusion was 5.9 percent. Neither medical injections nor scarification was a risk factor for HIV infection. Of the 101 seropositive asymptomatic employees in the 1984 survey, 16 percent had AIDS-related complex, 3 percent had AIDS, and 12 percent had died of AIDS by 1986. Previous studies have revealed a seroprevalence of 8.4 percent among women attending an antenatal clinic near the hospital in 1984 and 1986, and of 5.8 percent (in 1984) and 6.5 percent (in 1986) among men donating blood at the hospital's blood bank. We conclude that there is a continuing high prevalence of HIV infection among hospital workers in Kinshasa, Zaire, which appears to be representative of that in the community and not nosocomial.

Epidemiology of HIV infection in Africa.

HIV infection in Africa is primarily acquired through heterosexual activity, accounting for up to 80% of cases. Prostitutes and sexually promiscuous individuals are at particularly high risk of acquiring infection via this route. In the general population, women between the ages of 18 and 30 years are at increased risk of transmission. The role of cofactors, particularly concurrent sexually transmitted diseases (STDs), appears to facilitate heterosexual spread. These groups represent opportunities for targeted prevention programs aimed at education, increased condom use, prompt treatment of STDs, and reduction in the number of sexual partners. HIV infection acquired via blood transfusion may account for up to 10% of new cases of HIV infection. Children with malaria and nutritionally induced anemias are at special risk of acquiring infection by this route. Early treatment of malaria, surveillance for and treatment of malnutrition, adoption of rigorous criteria for blood transfusion, and implementation of machine-independent, low cost HIV screening programs in transfusion centers will help prevent these infections. As the epidemiology of HIV infection becomes better understood, other opportunities for technologically appropriate, cost-effective interventions will become available and will facilitate African HIV control and prevention programs.