Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

392 Abstracts 23255-23259

12th World AIDS Conference

Objective: To identify strategies to improve blood safety in Africa.
Methods: From April-September 1994, we collected demographic, risk factor
and laboratory data on all blood donors in 5 hospitals in western Kenya and one
in Central Kenya. Sera were tested for HIV, HBV, and syphilis. Using univariate
analysis, we evaluated factors associated with HIV and HBV infection in donors
recruited through campaigns at secondary schools (campaign donors) and by
family members (family donors).
Results: Of 1,868 donors, 76% were men and 61% were campaign donors.
Factors significantly associated with HIV and HBV-infected donors
Female Male Married Family donors Report gonorrhea
HIV OR: 6.84, 95% OR: 3.36, 95% OR: 6.51, 95% OR: 2.53, 95%
Cl: 1.10-2.50 Cl: 2.21-5.11 Cl: 3.44-12.58 Cl: 1.40-4.57
HBV OR: 3.68, 95% OR: 1.76, 95% OR: 2.00, 95%
Cl: 1.72-8.78 CI: 1.12-2.80 Cl: 1.05-3.81
Age >30 Repeat donors Reside W. Kenya Syphilis Positive Genital ulcer
HIV OR: 1.85,95% OR: 2.56, 95% OR: 4.43, 95% OR: 4.14, 95% OR: 3.97, 95%
Cl: 1.20-2.86 Cl: 1.68-3.90 Cl: 2.23-9.07 Cl: 2.70-11.40 Cl: 2.90-4.78
Factors associated with HIV but not with HBV.
Of 120 HIV-infected donors, only 6 also were HBV-infected. Among campaign
donors, 1.7%, 4% and 0.7% were HIV, HBV-infected and had reactive syphilis test,
respectively. Among family donors, 10%, 7% and 4% were HIV, HBV-infected,
and had reactive syphilis test, respectively. No campaign donors from Central
Kenya were HIV-infected. Deferral of donors reporting gonorrhea would eliminate
15% infected donations for either HIV, HBV, or both, at a cost of 8% of the blood
supply.
Conclusions: Although deferral of donors who report gonorrhea could be a
viable strategy, reliance on young, school based, campaign donors continues to
be the best strategy to ensure blood supply safety in Africa. Studies are needed to
define the social, cultural, or economic factors associated with low HIV prevalence
among campaign donors from Central Kenya.
23255 The homozygous defect in the CCR5 gene gives a high
degree of protection against HIV infection also when
inoculated parenterally
Bernd Kupfer1, R. Kaiser1, B. Matz', H.H. Brackmann2, K.E. Schneweis1.
1Institut F Medizinische Mikrobiologie, Sigmund Freud Str. 25, Bonn; 2lnstitut F
Experimentelle Hiatologie, Bonn, Germany
Objectives: To determine the prevalence of the homozygous delta 32 deletion
within the CC chemokine receptor 5 (CCR5) in multiply exposed HIV-infected
and non-infected hemophiliacs. Futhermore to investigate the role of this genetic
defect for parenteral virus transmission.
Design: 94 HIV-infected and 77 equally exposed non-infected hemophiliacs
were analysed retrospectively for the genotype of the CCR5 gene.
Methods: Chromosomal DNA of the hemophiliacs was isolated from whole
blood. A portion of the CCR5 gene was amplified by PCR. Amplicons were
digested with EcoRI. The resulting DNA fragments were separated by agarose
gelelectrophoresis and stained with ethidium bromide.
Results: 8/77 (10.4%) of the exposed, non-infected patients showed the homozygous delta 32 deletion in the CCR5 gene, whereas none of 94 HIV-infected
hemophiliacs displayed this genetic defect. The difference is statistically significant
(p < 0.002).
Conclusions: Our findings indicate that, despite of the predominance of CD4+
T cells in the blood the CCR5-expressing monocytes/macrophages are the premier targets of primary HIV-infection, even if the virus is inoculated parenterally.
S23256 Risk factors for blood donors with serological markers
for the human inmunodeficiency virus
Angel Guerra Marquez1, Malagon Martinez2, Alvarado Maldonado2,
Berges Garcia2, Pichardo Martinez2. 1Genaro Garcia Ret 24-14 Col Jardin
Balbuena; 2Banco Central De Sangre Centro Medico La Raza IMSS Mexico,
Mexico
Objetive: To evaluate the risk factors for blood donors with positive serological
markers for the Human Immunodeficiency Virus (HIV) and the reasons why such
risk factors were not documented during the donor selection process, nor considered important by the donors themselves when answering the Self-Exclusion
Questionnaire (SEQ).
Materials and Methods: A prospective descriptive survey was carried out with
blood donors who, after having been accepted in the selection process and not
having excluded themselves through the SEQ, showed positive serology to HIV
as determined by both ELISA and Western Blot testing. Epidemiological and
risk-factor data was collected both for the donors as well as for their sexual
parther(s). The donors were also questioned regarding the reasons why they
did not provide information regarding such risk factors. Results: From January
to December 1997, 34 donors have been notified as HIV(+): 32 males and 2

females; ages 20 to 43 years (median 28.5); 16 singles, 14 married and 4 with
domestic partners. Sexual preference: 17 heterosexuals, 10 bisexuals and 7
homosexuals. Risk factors: more than one stable sexual partner 25/34; donor's
sexual partner having sexual contact with other persons 13/34; intercourse with
sex workers 6/34; sexual partner with HIV/AIDS 2/34; sexual partner had undergone blood transfusion 2/34. Reasons for not informing of risk factors: did not

consider themselves at risk 27/34; required to donate blood 6/34; social pressure
to donate blood 1/34. None of the donors were subject to workplace risk, blood
transfusion risk or IV drug use.
Conclusions: The risk factors identified in this group are directly correlated
to their sexual activity. Although none of the donors acknowledged a risk factor
when donatin blood, they all admired having a risk when they were notified of
being HIV(+). The main reason for denying their sexual risk factor was the knowledge that they would be tested anyway for HIV antibodies, therefore they did not
consider it important to tell the truth about their sexual activity. It is important to
expand the information for the candidates being screened for blood donations
regarding the importance of their participation during the selection process.
23257 HIV Seroprevalence among blood donors in Cameroon
from 1990 to 1996
Jean Baptiste Tapko1, A.M. Kouinche2, M. Toukam2, Marc Leroy Guiffo3,
R. Gandji4, L. Kaptue5. 1PO. Box 12913, Yaounde; 2General Hospital, Yaounde;
3Provincial Hospital, Ebolowa; 4Laquitinie Hospital, Yaounde; 5CHU, Yaounde,
Cameroon
Objectives: To evaluate the evolution of HIV Seroprevalence among blood donors
in Douala and Yaounde main hospitals from 1990 to 1996.
Design: Retrospective analytical study.
Methods: 51144, Blood donors: 41352 from Douala and 9792 from Yaounde,
mean age 33 years (18-65 years), 18.7% females ands 81.3% males were
recruited.
HIV screening was done by ELISA method and the confirmation of positive
results by the WESTERN BLOT.
Results: From 1990 to 1996 the evolution of HIV Seroprevalence among blood
donors was: 1990: 0.5%; 1991: 1.50%; 1992: 2.85% 1993: 3.65%; 1994: 4.50%;
1995: 5.5%; 1996: 5.9%.
Conclusion: The HIV Seroprevalence among blood donors has been increasing each year; and this is compared to the general population, the evolution is
almost the same (0.,5% in 1990 and 6.0% in 1997.
This raises the problem of selecting blood donors from the low risk population,
which can be achieved only through a well defined National Transfusion Policy.
S23258 Safety issues in blood handling and transfusion in the
context of HIV/AIDS in Bangladesh
Ismat Bhuiya1, S. Hossain2, P.K. Streatfield3, U. Rob2. House CES (B) 21;
Road 118; Gulshan Dhaka 1212; 2Population Council Dhaka; 3Formerly
Population Council Dhaka, Bangladesh
Objectives: To assess the situation of blood screening facilities in relation to
STD/HIV/AIDS and to explore the high risk behaviour of professional blood
donors (PBDs).
Study Design: Cross-sectional.
Methods: The study was carried out by using quantitative and qualitative research methods during 1993-95. It included blood collection facilities in Dhaka city
and PBDs in additional five major cities. Data were collected from 50 staff members of the facilities through interviewing and from 288 PBDs through in-depth
interviewing and unobtrusive observations.
Results: The level of knowledge about HIV/AIDS and other transmissible diseases among the staff of the blood collection facilities was very poor. They were
also unaware about the consequences of unsafe blood handling and unscreened
transfusion. Blood was rarely been screened for any of the transmissible diseases
before transfusion. Medical history and high risk behaviour of the blood donors
was not collected. The majority of the PDBs were illiterate and had never heard
about HIV/AIDS. Over 30% of the PDBs had a history of penile ulcer or purulent
urethral discharge. Nearly 60% of the PBDs had a history of jaundice. One
seventh and over one-fifth of the PDBs had been selling blood knowing that their
blood was positive for syphilis and/or hepatitis B respectively. Over three-fourth
of the PDBs had multiple sex partners most of whom were Commercial Sex
Workers. Condom was rarely been used by the PDBs.
Conclusion: In the absence of appropriate knowledge and protective measures
during blood handling the staff at the blood handling facilities have been at great
risk. Transfusion of unscreened blood from PBDs also put the recipients at great
risk of acquiring transfusion transmissible diseases. Appropriate interventions are
urgently needed to improve the situation.
S23259 | Incidence of HIV seropositivity at the blood bank in
Jodhpur, India
Anil Purohit1 3, N.M. Mehta2, R. Behra2, J. Chakraborty1, B.L. Jain2,
N.M. Singhvi4, K.K. Sharma2. 1c/o Judy Suleski, Dept. of Physiology &
Molecular Medicine Medical College of Ohio, 3035 Arlington Avenue, Toledo,
Ohio; 3BIDMC Harvard Medical School, Boston; Medical College of Ohio,
Toledo, OH, USA; 2Dr. S. N. Medical College, Jodphur, RA; 4Rajasthan
Government, Jaipur, RA, India

Objective: Incidence of HIV seropositivity in blood donors, STD and tuberculosis
patients at the blood bank in Jodhpur.
Design: Retrospective.
Method: Beginning in 1993, blood samples were collected and tested for HIV
positive incidence in different groups at Dr. S. N. Medical College, Jodhpur,
Rajasthan, India. The groups included: (i) voluntary blood donors; (ii) related