Human immunodeficiency virus: a global problem with ongoing implications for transfusion medicine

Abstract

Human immunodeficiency virus (HIV) epidemic continues to expand globally, despite 25 years of unprecedented investment in basic and applied research and major advances in behavioural interventions that reduce transmission and development of therapeutic regimens to treat infected persons. Although transfusion-transmitted HIV is now very rare in developed countries where low-risk donor selection and sensitive serological and nucleic acid amplification technology (NAT) testing are routine, transfusion transmission continues at disturbing rates in some regions of Africa, South-East Asia and Eastern Europe where donor selection is less effective and where NAT screening is not affordable and effective systems to control release of positive units are not always in place. This review will summarize the scope of the global HIV epidemic. Key accomplishments in reducing HIV transmission, particularly by transfusions, and in treating infected persons will be discussed. We will then consider areas where scientific progress has been limited, such as continued frustration in efforts to develop effective prophylactic vaccines and microbicides, the inability to eradicate established infections with antiretroviral drugs or immunotherapeutic approaches, and the problem with development and spread of increasingly diverse viral variants and drug-resistant HIV. Finally, the review will highlight several recent areas where research originally designed to address questions in the context of understanding acute infection for preventing transfusion-transmitted HIV has provided insights into HIV pathogenesis and contributed to improved diagnosis and epidemiologic monitoring of HIV infection on a much broader scale.