Transfusion-associated Acquired Immunodeficiency Syndrome Research Articles

HIV Disease and Aging

HIV Disease and Aging

Acute Renal Failure Attributable to Ciprofloxacin in a Patient With the Acquired Immunodeficiency Syndrome

In a recent article, Lo et al¹found ciprofloxacin to induce nephrotoxicity in five patients with cancers. Ciprofloxacin was mainly indicated for the treatment of chemotherapy-induced neutropenic febrile episodes. We report an acute renal failure that occurred in a patient with the acquired immunodeficiency syndrome (AIDS) within a few days of initiating ciprofloxacin therapy. <h3>Report of a Case.</h3> A 38-year-old man was admitted to the hospital because of cavitary pneumonia. He had been diagnosed as having had transfusion-associated AIDS and hepatitis C virus infection since 1991. There was a history of several opportunistic infections, including<i>Pneumocystis carinii</i>pneumonia, chronic cryptosporidiosis, and enterocolitis caused by<i>Giardia lamblia</i>. Several days before admission to the hospital, he noticed severe weakness, fever, malaise, and a productive cough. The chest roentgenogram revealed a cavitary abscess with fluid in the left inferior lobe. A sputum culture yielded results positive for<i>Pseudomonas aeruginosa</i> Intravenous antibiotic therapy

Acute renal failure attributable to ciprofloxacin in a patient with the acquired immunodeficiency syndrome

In a recent article, Lo et al¹found ciprofloxacin to induce nephrotoxicity in five patients with cancers. Ciprofloxacin was mainly indicated for the treatment of chemotherapy-induced neutropenic febrile episodes. We report an acute renal failure that occurred in a patient with the acquired immunodeficiency syndrome (AIDS) within a few days of initiating ciprofloxacin therapy. <h3>Report of a Case.</h3> A 38-year-old man was admitted to the hospital because of cavitary pneumonia. He had been diagnosed as having had transfusion-associated AIDS and hepatitis C virus infection since 1991. There was a history of several opportunistic infections, including<i>Pneumocystis carinii</i>pneumonia, chronic cryptosporidiosis, and enterocolitis caused by<i>Giardia lamblia</i>. Several days before admission to the hospital, he noticed severe weakness, fever, malaise, and a productive cough. The chest roentgenogram revealed a cavitary abscess with fluid in the left inferior lobe. A sputum culture yielded results positive for<i>Pseudomonas aeruginosa</i> Intravenous antibiotic therapy

Demographic differences in cumulative incidence rates of transfusion-associated acquired immunodeficiency syndrome.

To describe the demographic patterns of blood transfusion in the United States, the authors analyzed the cumulative incidence rate of transfusion-associated acquired immunodeficiency syndrome (AIDS) (total cases reported from June 1981 through May 1993 per million population) by sex, race/ethnicity, age (at transfusion), and geographic area. Except for a high rate in infants, the rate increased with age, peaking at ages 55-64 years in men and at 65-74 years in women. Overall, the rate in males was 1.7 times that in females. By age, the rate in males was significantly higher than that in females only at ages 0-4 years and 45-84 years, when the rate in males was 2-3 times that in females. Overall, the rates in blacks and Hispanics were twice the rate in non-Hispanic whites. By age, the rates in blacks and Hispanics were significantly higher only at ages 0-4 years and 15-54 years, when they were 2-5 times those in whites, respectively. By state of residence, the incidence of transfusion-associated AIDS was correlated with the rate of all other AIDS cases (Spearman correlation coefficient, 0.83; p = 0.0001). Most of these demographic differences probably reflect differences in exposure to blood transfusion and in the incidence of conditions requiring transfusions.

Treatment Outcomes in Patients With Adult Thrombotic Thrombocytopenic Purpura—Hemolytic Uremic Syndrome

Plasma treatment has improved the outcomes in adults with thrombotic thrombocytopenic purpura (TTP)-hemolytic uremic syndrome (HUS). We reviewed our experience in treating unselected patients to determine the clinical outcomes and to evaluate the treatments given in addition to plasma. A chart review of all cases of TTP and HUS in adults treated at the Toronto (Ontario) Hospital, the largest treatment center for adults with TTP-HUS in the province of Ontario, was conducted. Sixty-seven episodes of TTP-HUS in 52 consecutive adult patients were treated during a 12-year period. Plasma was the primary form of therapy, and most patients received plasma exchange. A complete hematologic remission was achieved in 65 of 67 episodes; however, two patients in remission were brain-dead. The time to complete remission varied from 3 to 58 days (median, 13 days). The death rate during the acute illness was 8%. Long-term sequelae included relapses, persisting renal impairment, hepatitis, and transfusion-associated acquired immunodeficiency syndrome. Relapses occurred in 21% of patients during a median follow-up of 1.1 years (range, 0.1 to 18 years). Analyses of the treatment given in addition to plasma did not demonstrate a significant benefit in terms of reducing the illness duration, mortality, or long-term sequelae. While most patients recovered from TTP-HUS, deaths still occurred and many patients suffered long-term complications. The role of the treatments given in addition to plasma is uncertain.

The problem of transfusion-associated acquired immunodeficiency syndrome in Africa: a quantitative approach.

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. 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. 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. 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.

A model-based estimate of the mean incubation period for AIDS in homosexual men.

Because of the difficulty in identifying the date of exposure to type 1 of the human immunodeficiency virus (HIV-1) infection in persons other than transfusion recipients, studies of the incubation periods for acquired immunodeficiency syndrome (AIDS) have been limited. When data from a cohort of 84 homosexual and bisexual men that provided the information to determine the years of conversion of sera infected with HIV-1 were analyzed, a model for the proportion likely to develop AIDS and the incubation period for AIDS in homosexual men could be derived. The maximum likelihood estimate for the proportion of infected homosexual men developing AIDS is 0.99 (90% confidence interval ranging from 0.38 to 1). Furthermore, the maximum likelihood estimate for the mean incubation period for AIDS in homosexual men is 7.8 years (90% confidence interval ranging from 4.2 years to 15.0 years), which is close to the estimate of 8.2 years for adults developing transfusion-associated AIDS.

A model-based approach to characterize the incubation period of paediatric transfusion-associated acquired immunodeficiency syndrome.

Traditional statistics, such as the average, currently provide a misleading statistical description of the incubation periods of paediatric transfusion-associated acquired immunodeficiency syndrome (TA-AIDS). Two types of length-biased sampling, left censoring and right censoring, occur in the 37 cases diagnosed before 1986 and reported to the Centers for Disease Control by 15 September 1986. To correct for these problems, we propose a truncated Weibull distribution with use of a maximum likelihood technique. This approach suggests that the mean incubation period of paediatric TA-AIDS cases is 2.4 years with a 90 per cent confidence interval ranging from 1.5 years to 7.2 years. The mode is 1.25 years. These estimates are much shorter than those recently published for adults, therefore the success of TA-AIDS prevention strategies may be seen sooner in the paediatric age group.

Syngeneic Leukocytes Together With Suramin Failed to Improve Immunodeficiency in a Case of Transfusion-Associated AIDS After Syngeneic Bone Marrow Transplantation

A 22-year-old man who underwent syngeneic bone marrow transplantation (BMT) for acute lymphoblastic leukemia acquired a human immunodeficiency virus (HIV) infection by transfusion of blood products from a donor at risk. The manifestations were acute encephalopathy together with immune thrombocytopenia in the early posttransplant period, and acquired immunodeficiency syndrome (AIDS) developed 20 months after BMT. Because he had a syngeneic donor, the possibility of reconstituting the immune system was investigated by repeated transfer of healthy syngeneic lymphocytes and by combining repeated transfer of syngeneic lymphocytes with the antiviral agent suramin to protect the infused leukocytes from being attacked by HIV. No improvement was observed clinically or in the patient's immune functions by these efforts.

Syngeneic leukocytes together with suramin failed to improve immunodeficiency in a case of transfusion-associated AIDS after syngeneic bone marrow transplantation

A 22-year-old man who underwent syngeneic bone marrow transplantation (BMT) for acute lymphoblastic leukemia acquired a human immunodeficiency virus (HIV) infection by transfusion of blood products from a donor at risk. The manifestations were acute encephalopathy together with immune thrombocytopenia in the early posttransplant period, and acquired immunodeficiency syndrome (AIDS) developed 20 months after BMT. Because he had a syngeneic donor, the possibility of reconstituting the immune system was investigated by repeated transfer of healthy syngeneic lymphocytes and by combining repeated transfer of syngeneic lymphocytes with the antiviral agent suramin to protect the infused leukocytes from being attacked by HIV. No improvement was observed clinically or in the patient's immune functions by these efforts.

Photodynamic therapy of viral contaminants with potential for blood banking applications.

A photodynamic method has been evaluated as a means of eradicating viral contaminants with the potential for rendering blood safe for transfusion. Herpes simplex virus type 1 (HSV-1) was tested under flowing conditions in culture media or in blood supplemented with the virus. Hematoporphyrin derivative was used as the sensitizer and was photoactivated with visible light at 630 nm and 5 J/cm2. HSV-1 in suspension both in culture medium as well as in blood was shown to be killed. The human immunodeficiency virus was also found to be photoinactivated in flowing cell culture medium and, thus, potentially may be inactivated in blood. These findings extend our previous studies which demonstrated that enveloped viruses can be photoinactivated with hematoporphyrin derivative in a static fluid system. Analysis of blood cell number, red cell lysis, plasma proteins, and other standard hematological tests showed no significant change. The possibility that transfusion-associated acquired immunodeficiency syndrome (AIDS) may result from a blood unit infected with human immunodeficiency virus that tested negative makes it imperative that a safe and effective means of viral killing be developed. The system reported here offers promise as an effective approach to this problem.

Acquired immunodeficiency syndrome and directed blood donations. A dilemma for American medicine.

The devastating consequences of transfusion-associated acquired immunodeficiency syndrome have led some patients and physicians to propose recipient-orchestrated (directed) donations as a method of improving the safety of blood transfusions. This method is not safer than volunteer blood donation and introduces several legal, ethical, and administrative problems. Blood banks should discourage the use of directed blood donations, and physicians should work to educate the public about the lack of benefit of directed donations and their potential risks.

Estimating the risks of transfusion‐associated acquired immune deficiency syndrome and human immunodeficiency virus infection

The risk of transfusion-associated acquired immunodeficiency syndrome (AIDS) has been difficult to estimate because of the long and variable incubation period. Mathematical modeling suggests there may eventually be 2100 cases among persons aged 13 to 65 who received transfusions between 1978 and 1984. An estimated 12,000 living transfusion recipients of all ages from these years are infected with the human immunodeficiency virus, the virus that causes AIDS. Secondary transmission might be prevented by testing and counseling recipients, but the likelihood of infection in any single recipient is small.

Transfusion-associated acquired immunodeficiency syndrome.

AbstractThe acquired immunodeficiency syndrome (AIDS) is the most severe manifestation of infection with a newly recognized retrovirus known as HTLV‐III/LAV (human T‐lymphotropic virus type III/lymphadenopathy‐associated virus). Persons with AIDS have a severe disorder of the immune system that renders them susceptible to a number of opportunistic infections and cancers. Over 80% die within 2 years of diagnosis. Thousands of people have developed AIDS. Most are homosexual/bisexual men or intravenous drug users in the United States or highly sexually active heterosexuals in central Africa or Haiti. Many countries, however, are reporting rapid increases in the number of cases. A small proportion of AIDS patients have been infected by contaminated clotting‐factor concentrates or by blood transfusions. Although AIDS is a rare complication of blood transfusions, it has evoked more fear of transfusions than other more common infectious agents.Strategies for preventing transfusion‐associated AIDS have been suggested by investigations of recipients who have developed disease, donors who have transmitted infection, and components that served as vehicles of transmission. HTLV‐III/LAV antibody tests are now available for screening blood before transfusion. The effectiveness of the prevention strategies and the properties of the HTLV‐III/LAV antibody tests are reviewed.

Transfusion-Associated Acquired Immunodeficiency Syndrome—What Is the Risk?

Relatively few pediatricians will ever care for a child with the acquired immunodeficiency syndrome (AIDS); yet, all will be asked questions about this disease. Parents want to know the risk of their children acquiring AIDS. The fear and even panic surrounding AIDS continues to escalate. To educate our patients and control panic, we must understand the disease and the routes of transmission. It is now clear that AIDS is one end of the spectrum of illness caused by the human immunodeficiency virus (HIV, formerly called HTLV-III/LAV). The virus is present in blood and body fluids. It is transmitted from person to person by sexual contact and by exchange of blood.

Individual and Institutional Liability for Transfusion-Acquired Diseases

A 1985 JAMA SPECIAL COMMUNICATION 1 presented a rather pessimistic view of the risk of liability to hospitals, blood banks, and physicians for transfusion-associated acquired immunodeficiency syndrome (AIDS). Relatively recent alterations in the legal classification of blood and blood products, now statutory law in 45 of the 50 states (exceptions are New York, New Jersey, Minnesota, New Hampshire, and Vermont), have modified the outlook for those at risk of transfusion-associated AIDS lawsuits. Under current law, a blood recipient who suffers a transfusion-related injury or contracts a transfusion-related disease may only prevail in court if actual negligence on the part of the blood bank, hospital, and/or physician is proved. Negligence only exists where the defendants fail to follow generally accepted professional guidelines including those relating to informed consent, indications for transfusion, and emergency and nonemergency situations. In this instance, the screening guidelines of the American Association of Blood Banks or other

The Effectiveness of Voluntary Self-Exclusion on Blood Donation Practices of Individuals at High Risk for AIDS

To the Editor.— As of Jan 13,1986, two hundred sixty-one cases of blood product transfusion-associated acquired immunodeficiency syndrome (AIDS) had been reported in the United States. 1 In March 1983, the American Red Cross joined with the American Association of Blood Banks and the Council of Community Blood Centers in requesting that homosexual men at risk for AIDS voluntarily exclude themselves from blood donation. 2 Because of the long latency period of human T-cell lymphotropic retrovirus type III/lymphadenopathy-associated virus (HTLV-III/LAV), it has been difficult to determine the effectiveness of this request for voluntary selfexclusion prior to the introduction of routine screening of all donated blood for antibodies to HTLV-III/LAV. As part of an ongoing study, we retrospectively reviewed blood donation records in the New Orleans metropolitan area to determine if any of 187 persons who had been diagnosed as having AIDS or AIDS-related complex (ARC) had donated blood between January

The use of the binomial distribution in establishing an association between high-risk donors and transfusion-associated AIDS.

In the first seven cases of transfusion-associated acquired immunodeficiency syndrome (TA-AIDS) with completion of blood donor investigations, there was identification of at least one person (a high-risk donor--HRD) in each donor set who might have transmitted the disease. Using three definitions of an HRD, we estimated the prevalence of HRDs in the overall donor population and used the binomial distribution to calculate the probabilities of finding at least the observed numbers of donor sets with one or more HRDs. These probabilities--0.028, 0.007 and 0.014, respectively--allowed us to reject the null hypothesis that the number of cases of TA-AIDS exposed to an HRD was not greater than that expected by chance, based on the total number of donors to which each case was exposed and the estimated proportion of HRDs in the overall donor population. We concluded that there was a statistically significant association between HRDs and TA-AIDS.

Predictive value of a screening test for antibodies to HTLV-III.

A test for the detection of antibodies to HTLV-III is available and will be widely used to screen donated blood to prevent transfusion-associated acquired immunodeficiency syndrome (AIDS). Based upon the sensitivity and specificity, the authors calculated the expected predictive values for different groups of asymptomatic individuals using Bayes' theorem. The prevalence of HTLV-III infection has great impact upon the positive and negative predictive values of the test. For a member of the general population there is a less than 3% chance that a positive test represents a true positive. High-risk patients, such as hemophiliacs, with a positive test will have a greater than 95% chance of actually having antibodies to HTLV-III, but the negative predictive value of the test in this group is less than ideal. The authors recommend that all positive tests for HTLV-III be confirmed by more specific methods when obtained in low-risk people. Members of high-risk groups for AIDS should continue to refrain from donating blood, despite the availability of the screening test.

A model-based approach for estimating the mean incubation period of transfusion-associated acquired immunodeficiency syndrome.

The incubation period, representing the interval between the date of exposure and the date of diagnosis, can be firmly ascertained in transfusion-associated cases of acquired immunodeficiency syndrome (AIDS). However, because the observation period of all transfusion-infected persons may be short compared with the average incubation period for AIDS, many cases with long incubation periods have not yet been diagnosed. Thus, the simple average of 2.6 years tends to underestimate the true mean. To correct for this underestimation bias, we assumed that the underlying distribution of the incubation periods is a member of a broad class of probability densities. Then, by maximum likelihood techniques, the mean incubation period for transfusion-associated AIDS was estimated to be 4.5 years, with the 90% confidence interval ranging from 2.6 to 14.2 years. The long incubation period has important consequences for infected individuals and implications for public health intervention and prevention policy.