Zhang Li

Letter to the Editor: Risk Factors for Death in Subjects with Transfusion-Related HIV Infection in Rural China

95 Dear Editor: Disease progression of HIV infection is affected by both viral and host factors. Studies among people with transfusion-acquired HIV infection have shown that rapid death or disease progression in recipients may be associated with older age, male gender, poor health status at transfusion, more transfusions, and donor’s disease status.1–3 In China, unregulated paid plasma/blood donation practices in the early 1990s caused many HIV and other blood-borne infections in rural communities, and is the second largest contributor to the HIV/AIDS epidemic.4 The Chinese government began to take firm actions beginning in 1996 by shutting down illegal and unqualified collection stations, and creating new laws and regulations on blood collection such as the “Law of Blood Donation” in 1998 and the updated version of “Regulation on Blood Stations” in 2005. Since April 2004, the China CARE project has provided free antiretroviral therapy (ART) to these HIV-infected rural residents. We investigated the transfusion-related factors associated with mortality among ARTnaive individuals with HIV infection caused by blood transfusion in rural China. HIV testing laboratories or hospitals in China are required by law to report new HIV/AIDS cases to the local Center for Disease Control and Prevention (CDC). Staff from the local CDC contact infected individuals to collect demographic data, including HIV risk factors, and to provide information and education to reduce further transmission. Cases are then reported to the national China CDC. Study subjects for this analysis were identified from the HIV/AIDS reporting system in Yuncheng Prefecture, Shanxi Province, in central China. Study subjects were included if they had: (1) a single blood/plasma transfusion; (2) no cancer, heart disease, or anemia (potentially life-shortening diseases) at transfusion; and (3) no other identifiable high-risk HIV behaviors, such as injection drug use, commercial sex activity, or blood/plasma donation. Medical records were reviewed and transfusion data abstracted. Survival analyses were performed to assess the factors associated with death (SAS software, version 9.1, SAS Institute, Cary, NC). Data were censored on March 31, 2004. Blood specimens were collected for HIV-1 subtype analyses. The study protocol and informed consent were approved by the institutional review board of the