PRE-PRINT VERSION THE BURDEN OF HIV AND AIDS ON BLOOD BANK RESERVE IN NORTHEAST NIGERIA

(Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene, 2007, 101: 618-620. DOI: 10.1016/j.trstmh.2006.09.008.)

S.G. Ahmed Department Of Haematology College Of Medical Sciences University Of Maiduguri PMB 1069, Maiduguri Borno State, Nigeria U.A. Ibrahim Department of Paediatrics University Of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria M.B. Kagu Department Of Haematology University Of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria CORRESPONDENCE TO Dr S.G. Ahmed E-mail address: [email protected]

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SUMMARY This study was conducted to evaluate the burden of HIV/AIDS on blood bank reserves at the University of Maiduguri Teaching Hospital, Nigeria, during 1995—2005. The number of admissions due to HIV/AIDS rose from 43 in 1995 to 447 in 2005, and the proportion of blood units used in transfusing patients with HIV/AIDS rose steadily from 3% in 1995 to 19% in 2005. The proportion of blood units used in managing obstetric patients was also high and fluctuated between 36% and 50% during the period of study. Controlling the spread of HIV, effective treatment of patients with antiretroviral drugs and setting up a functional national blood transfusion service could lessen the rising burden of transfusion in Nigeria and improve blood availability for maternal and child health care. KEY WORDS: HIV; AIDS; Blood transfusion; Blood banks; Nigeria

INTRODUCTION The anaemia of HIV infection is basically an anaemia of chronic disease, which is often aggravated by AIDS-related opportunistic infections, medications and malignancies (Bain, 1997). Therefore, patients with HIV and AIDS require blood transfusions at some stage during the course of their illness. In Nigeria, there is no functional national blood transfusion service, hence individual hospital blood banks are charged with the overwhelming and daunting responsibility of donor recruitment and screening, as well as production and storage of blood and blood products. Consequently, most Nigerian blood banks have an inadequate blood bank reserve with a precarious donor panel, and persistent scarcity of blood and blood products (Ahmed et al., 1999). In view of the high incidence of anaemia and frequent need for transfusion in the management of HIV and AIDS in Nigeria (Idoko, 1998), this study was conducted to determine the burden of HIV and AIDS on the blood bank reserve at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, northeast Nigeria.

MATERIALS AND METHODS This study was an 11-year retrospective review of the blood bank records of the UMTH for the period 1995—2005. For each year, the number of blood units used in transfusing

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anaemic patients with HIV infections and AIDS was determined and expressed as a percentage of the total number of blood units that were donated in the hospital. Similarly, the number and proportion of blood units used in transfusing obstetric patients were determined. In this study ‘blood units’ refers to those units that tested negative for infectivity markers of HIV (1 and 2), hepatitis (B and C) and syphilis. Data on the annual number of admissions due to HIV/AIDS was retrieved from the medical records department of the hospital.

RESULTS The results are shown in Figure 1. The number of blood units donated rose slightly from 2036 in 1995 to 2140 in 2005, giving an average increment of 10.4 units per annum. However, during the same period the number of blood units used to transfuse HIV/AIDS patients rose from 61 in 1995 to 407 in 2005, giving an average increment of 34.6 units per annum. The number of admissions due to HIV/AIDS rose ten-fold from 43 in 1995 to 447 in 2005. Similarly, the proportions of blood units used in transfusing HIV/AIDS patients rose steadily from 3% in 1995 to 19% in 2005. The proportion of blood used in managing obstetric patients was high and fluctuated between 36% and 50% of donated units during the period under study.

DISCUSSION The relatively low annual increase in safe blood units donated is a reflection of the strong apathy of the Nigerian populace towards blood donation (Ahmed et al., 1999). However, the proportion of blood units used in transfusing patients with HIV infection and AIDS rose steadily from 1995 to 2005, consistent with the observed rise in the number of admissions due to HIV infection and AIDS and a reflection of the rising prevalence of HIV in Nigeria (FMH, 2004). Sentinel surveys in Nigeria have shown a steady rise in HIV prevalence from 1.8% in 1991 to around 5% in 2003, which translates to about 4 million Nigerians living with HIV and AIDS (FMH, 2004). This trend would certainly result in a greater number of cases of HIV infections and AIDS with a proportionate rise in the need for blood transfusion. The transfusion requirements of Nigerian patients with HIV and AIDS are high because, apart from the background AIDS associated anaemia of

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chronic disease, which is the most important form of anaemia in HIV and AIDS patients in western countries, other factors contribute to the development of anaemia in the Nigerian patients. These include a higher incidence of tuberculosis and other opportunistic infections, parasitic infestations, recurrent malaria, poverty and malnutrition (Haas and Des Prez, 1994).

The government could limit the rising burden of HIV and AIDS on the Nigerian blood bank reserves by intensifying efforts towards controlling the spread of HIV infection, through prompt treatment of opportunistic infections and by sustainable provision of antiretroviral drugs. Despite governmental and non-governmental efforts to provide antiretroviral drugs across Africa, less than one-quarter of those who need the drugs actually receive them (WHO, 2005). However, ongoing programmes such as the American-sponsored Presidential Emergency Plan for AIDS Relief (PEPFAR) have the potential to significantly and positively affect antiretroviral drug distribution and patient coverage within Nigeria in the near future. In developing countries, including Nigeria, the maternal and child mortality rates are very high and an adequate blood supply is needed to help reduce these rates. Furthermore, in this study the proportion of blood used in managing obstetric patients was found to be high. The rising transfusion burden due to HIV and AIDS has a negative effect on blood availability for other conditions that require transfusion. There is a clear need to strengthen the blood donor base in Nigeria. The current collaborative efforts being made by the Nigerian government and the Safe Blood for Africa Foundation, aimed at providing an organized national blood transfusion service, are commendable but need to be sustained in order to augment the availability and safety of donor blood in Nigeria. In developed countries, the treatment of HIV and AIDS anaemia with the use of recombinant erythropoietin has been shown to be effective in improving the conditions of many patients (Abrams et al., 2000). This single mode of treatment has the potential to reduce transfusion requirements and alleviate the transfusion burden due to HIV and AIDS, but the high cost of erythropoietin prohibits its use in Nigerian and many other African patients. This underlines the need for the government to strengthen blood bank reserves by setting up a functional national blood transfusion service in Nigeria.

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REFERENCES: Abrams, D.I., Steinhart, C., Frascino, R., 2000. Epoietin alfa therapy for anaemia in HIV infected patients. Int. J. STD AIDS 11, 659-665. Ahmed, S.G., Hassan, A.W., Obi, S.O., 1999. The pattern of blood donation in northeast Nigeria. Niger. J. Surg. Res. 1, 76-78. Bain, B.J., 1997. The haematological features of HIV infection. Br. J. Haematol. 99, 1-8. FMH, 2004. 2003 National HIV sero-prevalence sentinel survey. Federal Ministry of Health, Abuja, Nigeria. Haas, D.W., Des Prez, R.M., 1994. Tuberculosis and acquired immunodeficiency syndrome: a historical perspective on recent developments. Am. J. Med. 96, 439-450. Idoko, J.A., 1998. Management of opportunistic infections and malignancies in HIV/AIDS. Niger. J. Med. 7, 21-24. WHO, 2005. Scaling up anti-retroviral therapy in resource limited settings, in: Treatment guidelines for a public health approach. World Health Organization, Geneva.

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Figure 1: Blood donations, admissions due to HIV/AIDS, and number of blood units used in transfusing HIV/AIDS patients and obstetric patients at the University of Maiduguri Teaching Hospital Maiduguri, northeast Nigeria, 1995—2005.

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