Mumbai-based activist Chetan Kothari filed an RTI query to expose the problems and safety issues with blood transfusions in the country. NACO (National AIDS Control Organization) was forced to reveal that within the last 17 months, there were 2,234 cases of patients infected with HIV through blood transfusion. The 5 states with the highest number of these cases are:
- Uttar Pradesh – 361 cases
- Gujarat – 292 cases
- Maharashtra – 276 cases
- New Delhi – 264 cases
- West Bengal– 135 cases
While these numbers are obviously a cause for concern, NACO was quick to point out that these numbers are based on self-reported transmission and it is not corroborated by any scientific method. This means that although the patients became infected during the same time-frame as their blood transfusion, there is no way to confirm that the transmission is due to the blood transfusion.
It is mandatory for blood banks to test all blood that is collected for HIV, hepatitis B, hepatitis C, malaria and syphilis. Unfortunately, there are several weak links in the chain from the point of collection, to transfusion. The World Health Organization (WHO) recommends that a country should have a minimum of 1 per cent reserve; unfortunately, India has an annual deficit of approximately 25 per cent. This shortage has resulted in a thriving black market for blood with “professional” blood donors and this increases the risk of untested blood making its way into the system.
As per the current government mandate, all donated blood has to go through serological tests (such as the famous ELISA HIV test). These tests do not look for the virus but instead they look for anti-bodies – which are produced as a response of the immune system to a virus. If the donor has been infected with the virus shortly before donating blood, his immune system would not have started to produce the antibodies to fight off the infection, although the virus would already be present in his blood. This means that the test result would be a false negative.
There is a more reliable test – the Nucleic Acid Testing (NAT) is a test that does not search for antibodies within the blood; instead, it searches for traces of the virus, which makes it more reliable. It also shortens the detection time from the time of infection. For example, if a person is infected with the Hepatitis C virus, it could take 60 days to show up in a serological blood test, but it would take only 2-3 days with an NAT test.
To determine the scope of the serological and NAT tests, AIIMS (All India Institute of Medical Science) studied almost 6000 blood samples that passed the ELISA test. When these “clean” samples were put through the NAT, 5 samples were tested positive for the Hepatitis B and Hep C virus. This means that the NAT saved 15 people who would have received the infected blood. The only reason why NAT is not as widely used is because it costs about 10 times more than the affordable ELISA tests.