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There is a high incidence of transfusion related HIV infection in Nigeria. This was evident in our pilot study that indicated that the incidence was 1.2% in a teaching hospital in Enugu. In this article, we discuss several possible reasons for the high incidence of transfusion related HIV infections in the Enugu hospital. Firstly, most donors were paid. There was no structured questionnaire to identify populations at risk and to increase self-awareness of the risk of HIV infection. Even if a donor were concerned about having a HIV infection, there was no mechanism for self-deferral. Donated blood is screened only by an ELISA, a test that usually does not detect HIV if contracted within 90 days prior to testing. To control transfusion related HIV infection, the National Blood Transfusion Service (NBTS) was established in 2005, and a National Blood Policy was developed in 2006. Seventeen blood transfusion centers have been set up with support from the private sector, the United States Presidential Emergency Plan for AIDS Relief (PEPFAR), the Safe Blood for Africa (SFA) and the Center for Disease Control (CDC). The goals were to: 1) actively change attitudes to encourage voluntary non-paid donations; 2) to develop and use questionnaires to identify individuals and populations at risk for HIV and to increase self-awareness of the risk for HIV; 3) to introduce mechanisms for self-deferral; 4) to screen blood with antigen testing in addition to the ELISA to detect new HIV infections contracted within16 days prior to testing. An ELISA alone only detects HIV contracted 90 days prior to donation. Despite the regulations introduced by the NTBS, the incidence of HIV infected blood in blood banks is still high. There are multiple reasons for the continued high incidence of transfusion related HIV infections in Nigeria, which includes high endemic incidence of HIV. Another reason is that most donors are still being paid. In teaching hospitals in Nigeria in 2009, about 75% of donors are still paid for donations. The guidelines outlined by NTBS have not been widely implemented. There are an insufficient number of established safe transfusion centers to meet the country's need for safe blood. Although the government administers public health, the private sector accounts for about 70% of all the health facilities in the country. According to the Nigeria National Blood Transfusion Service, more than 80% of blood collected and transfused in Nigerian hospitals is not properly screened. The donor deferral option has not been widely implemented. The ELISA is still the only test used to screen donated blood for HIV. Unfortunately, there is a lack of political will to regulate adequately the screening of donors for infections. An examples of successful reduction of transfusion-related HIV infection in South Africa is discussed that could serve as a role models for addressing this problem in Nigeria. Keywords: HIV | Blood transfusion | Sickle Cell Anaemia | Screening | Blood donations., Background A high incidence of transfusion related HIV infection has been reported in Nigeria (1,2). The incidence of HIV due to transfusions given to children with sickle cell anemia was [...]

There is a high incidence of transfusion related HIV infection in Nigeria. This was evident in our pilot study that indicated that the incidence was 1.2% in a teaching hospital in Enugu. In this article, we discuss several possible reasons for the high incidence of transfusion related HIV infections in the Enugu hospital. Firstly, most donors were paid. There was no structured questionnaire to identify populations at risk and to increase self-awareness of the risk of HIV infection. Even if a donor were concerned about having a HIV infection, there was no mechanism for self-deferral. Donated blood was screened only by an ELISA, a test that usually does not detect HIV if contracted within 90 days prior to testing. To control transfusion related HIV infection, the National Blood Transfusion Service (NBTS) was established in 2005, and a National Blood Policy was developed in 2006. Seventeen blood transfusion centers have been set up with support from the private sector, the United States Presidential Emergency Plan for AIDS Relief (PEPFAR), the Safe Blood for Africa (SFA) and the Center for Disease Control (CDC). The goals were: 1) to actively change attitudes to encourage voluntary non-paid donations; 2) to develop and use questionnaires to identify individuals and populations at risk for HIV and to increase self-awareness of the risk for HIV; 3) to introduce mechanisms for self-deferral; 4) to screen blood with antigen testing in addition to the ELISA to detect new HIV infections contracted within 16 days prior to testing. An ELISA alone only detects HIV contracted 90 days prior to donation. Despite the regulations introduced by the NTBS, the incidence of HIV infected blood in blood banks is still high. There are multiple reasons for the continued high incidence of transfusion related HIV infections in Nigeria, which includes high endemic incidence of HIV. Another reason is that most donors are still being paid. In teaching hospitals in Nigeria in 2009, about 75% of donors are still paid for donations. The guidelines outlined by NTBS have not been widely implemented. There are an insufficient number of established safe transfusion centers to meet the country's need for safe blood. Although the government administers public health, the private sector accounts for about 70% of all the health facilities in the country. According to the Nigeria National Blood Transfusion Service, more than 80% of blood collected and transfused in Nigerian hospitals is not properly screened. The donor deferral option has not been widely implemented. The ELISA is still the only test used to screen donated blood for HIV. Unfortunately, there is a lack of political will to regulate adequately the screening of donors for infections. An examples of successful reduction of transfusion-related HIV infection in South Africa is discussed that could serve as a role model for addressing this problem in Nigeria. Keywords: HIV | Blood transfusion | Sickle Cell Anaemia | Screening | Blood donations, Background A high incidence of transfusion related HIV infection has been reported in Nigeria (1,2). The incidence of HIV due to transfusions given to children with sickle cell anemia was [...]

No relevant conflicts of interest to declare.

Previous studies showed that: (1) increased blood levels of the omega-3 (n3) fatty acids (FA) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are associated with increased steady-state Hb levels and reduced prevalence of the complications of sickle cell disease (SCD); (2) EPA and DHA reduced the number of crisis in a pilot group of 5 HbSS patients. The primary aim of this study was to assess the effects of EPA and DHA in a larger number of patients. SCD causes recurrent vaso-occlusion, ischemia-reperfusion injury and inflammation (Osarogiagbon et al. Blood. 2000, 96: 314–320). A metabolite of DHA (10,17S-docosatriene) protects against ischemia-reperfusion injury by inhibiting leukocyte infiltration and expression of pro-inflammatory genes (Marcheselli et al, J Bio Chem. 2003; 278: 43807–43817. Our hypothesis was that anti-inflammatory properties contribute to the mechanism(s) of action of DHA/EPA in SCD. The secondary objective was to test this hypothesis.Following Institutional Review Board approval and informed consent, 20 HbSS patients (10 Males, 10 Females) were enlisted to receive oral EPA 15mg /kg/day and DHA 10 mg/kg/day with standard treatment of SCD, and reviewed at 2-monthly intervals for 6 months. Standard treatment included folic acid 5 mg daily, pyrimethamine-sulfadoxine (25mg/500mg) 2–3 tablets monthly for malaria prophylaxis, and appropriate management of acute clinical events. To assess the placebo effect of regular clinical monitoring, another group of 8 HbSS patients (2 Males, 6 Females) were enlisted to be reviewed 2-monthly for 6 months, but observed on standard treatment only. Inclusion criteria for both groups were 3 or more crisis/yr and age>5yrs. Exclusion criteria: pregnancy, hydroxyurea or regular transfusion therapy, any other disease e.g diabetes. To reduce the confounding effect of individual variability in severity of SCD, the study was so designed that each participant was his/her own control. Using the Mann-Whitney test, we compared pre- and post-treatment numbers of crisis over 6 months, steady state levels of Hb and plasma unconjugated bilirubin. To test the hypothesis that anti-inflammatory effects contribute to the mode of action DHA/EPA, we compared 3 indices of inflammation pre-and post-treatment: plasma level of interleukin-6 measured by ELISA, peripheral blood neutrophil and platelet counts determined with an automated cell counter.In the omega-3 FA group 4 participants dropped out or were withdrawn from the study: 1 developed recurrent transient ischemic attacks and started regular blood transfusion to prevent stroke; 1 had recurrent severe crisis and began hydroxyurea therapy; 2 were not compliant with follow-up and omega-3 FA therapy. For the 16 evaluable participants (7M and 9F aged 9–33 yrs) the median number of crisis over 6 months reduced from 3 to 0 (p<0.0001) and steady state unconjugated bilirubin from 14.95 umol/l to 8.6 umol/l (p = 0.03). There were no significant differences between pre and post-treatment median neutrophil count (4.94 × 109/l, 4.36 × 109/l, p = 0.32) platelet count (318 × 109/l, 255 × 109/l, p= 0.057) Hb level (7.7 g/dl, 7.5 g/dl, p=1.0) and IL-6 (10.5 pg/ml, 12 pg/ml, p = 0.59).In the standard treatment group, 3 participants (2M, 1F) were not compliant with follow-up. The evaluable 5 female HbSS patients, age 17–26 yrs, had no significant change between months 0 and 6 median number of crisis (1.5, 1, p = 0.12) steady state Hb (7.6 g/dl, 6.6 g/dl, p = 0.54) unconjugated bilirubin 24 umol/l, 30 umol/l, p = 0.84), neutrophil count (5.45 × 109/, 4.66 × 109/, p = 0.15) and platelet count 359 × 109/, 411 × 109/, p = 0.84). Months 0 and 6 plasma IL-6 concentrations could be measured in only 3 participants in the standard treatment group. Since this number is too small for statistical analysis, the respective 0 and 6 month values for the 3 individuals are provided: 8 pg/ml and 7 pg/ml, 9 pg/ml and 9.6 pg/ml, 18 pg/ml and 22 pg/ml.The data suggest that EPA and DHA reduce the number of crisis and steady state hemolysis in SCD, and do not support the hypothesis that these effects are mediated by inhibiting inflammation.No relevant conflicts of interest to declare.