The problem of transfusion-associated acquired immunodeficiency syndrome in Africa: a quantitative approach.
BACKGROUND
Transfusion-associated AIDS accounts for 10% of all cases of AIDS in Africa. The risk of HIV-1 contamination in transfusions continues to exist, even in countries where blood products are screened, because of limitations in test sensitivity, human error, and the window period. Furthermore, 30 African countries do not screen all of their blood products because of resource limitations.


METHODS
This study used decision analysis to compare the survival outcomes of severely anemic patients who are transfused with those of patients who are not transfused. Sensitivity analyses were performed.


RESULTS
When 5% of the blood supply is HIV-1 contaminated, every patient with a 6.6% or greater risk of dying from anemia should be transfused. Detailed results are provided for a wide range of HIV-1 contamination rates.


CONCLUSIONS
This study provides a method for developing and evaluating locality-specific transfusion guidelines. This method can be applied to other regions, including the United States, and to other diseases transmitted by blood products.
Heymann
S J
SJ
Center for Population and Development Studies, Harvard School of Public Health, Boston, MA.
Brewer
T F
TF
D000163:Acquired Immunodeficiency Syndrome / Q000635:transmission*; D000349:Africa; D000740:Anemia / Q000628:therapy; D016913:Blood Component Transfusion / Q000009:adverse effects*; D003661:Decision Support Techniques; D017408:Guidelines as Topic; D015497:HIV-1; D006801:Humans; D012306:Risk; D065227:Transfusion Reaction