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  • Title: Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections?
    Author: Lepage P, Van de Perre P.
    Journal: Infect Control Hosp Epidemiol; 1988 May; 9(5):200-3. PubMed ID: 3372990.
    Abstract:
    We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized. Published data on the significance for spread of HIV of medical injections and blood transfusions in Zaire are reviewed and compared to a survey of nosocomial links to HIV infections in health workers, factory workers and children in Kigali, Rwanda. The Rwandan survey subjects included 156 health workers at the Centre Hospitalier de Kigali, 76 children with AIDS or ARC diagnosed at the same hospital, and 302 male factory workers. Medical injections are slightly more common in HIV positive than negative subjects in 3 reports from Zaire. Injections were not linked to HIV-positive status in Rwanda, unless the individual had been treated for STDs (p0.01), or febrile illness (p0.01). The trend in hospitalized children, who had often received penicillin, quinine or vaccines, suggested that treatments of other conditions, not HIV-related illness, most often transmitted HIV. In urban factory workers, positive HIV status was associated only with infections for treatment of STDs. In children from Zaire, transfusion was strikingly associated with HIV seropositivity. In hospital workers and children from Rwanda, blood transfusions were associated with positive HIV status. It is unlikely that most developing countries in Africa will be able to secure the blood supply by universal testing for HIV, nor will they be able to afford single use syringes. It is possible, however, to improve hospital hygiene by boiling or bleaching equipment, to promote use of oral instead of parenteral drugs, and to improve safety of the blood supply by testing donors, recruiting donors from low risk groups, and using unpaid donors.
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