Need for Stringent Blood Safety Measures. Blood-Borne Infectious Agents
Hemophilia is genetic, so a person is born with hemophilia. It's not acquired in any way like HIV. Blood products such as anti hemophilic factors (AHF) are what generally make lives of hemophilia patients a little easier. These blood products are generally very expensive so persons with hemophilia (pwh) in India tend to depend quite heavily on unsafe wet blood products such as Fresh Frozen plasma or cryoprecipitate that necessarily expose them to blood borne infections such as hepatitis and HIV.
Acquisition of blood-borne infectious agents constitutes a significant complication in hemophilia patients who receives continues blood products. Because of their reliance on repeated factor concentrate infusions, hemophilia patients are exposed to HCV and many other blood-borne viral agents such as HBV, HIV, and cytomegalovirus (CMV). HIV remains the most common cause of death among hemophilia patients.
Roughly 75 percent PWH may die as a result of HIV infection. It is important to emphasize that, overall, strict blood donor screening procedures in conjunction with development of new assay systems for donated blood have reduced the risk of HIV transmission to 1:500,000 units transfused. The risk for HCV is now 1:103,000 units transfused, while that of HBV is 1:63,000 units. It takes 20,000 donors to make up one lot of factor.
Manufacturers say they screen for HIV, but even if ninety-eight percent of tainted blood is caught and two percent of the virus slips through, PWH get exposed to millions of people, who may be HIV+. That's why so many PWH get HIV. Even if one donor had HIV and they donated in that lot with 19,999 other people and the contamination was not detected then it would take only that one donor to contaminate that whole batch of factor. It's truly hard to have a perfect blood supply.
What PWH need is a safer blood supply. Once exposed to HIV a PWH faces the concern with regard to taking protease inhibitors. Since they have prolonged bleeding they use not only more of the highly expensive blood products than they would normally infuse but also need HIV therapies. The cost of treatment skyrockets. Although new anti-viral drugs may prolong the lives of HIV-infected hemophilia patients, bleeding and liver damage are possible drug side effects.
Hemophilia patients with the misfortune of being infected with both HIV and HCV have particular problems, as co-infection may cause HCV to worsen. Another concern area is the fact that many PWH are Hepatitis C+, and when they start taking the anti-viral drugs then the liver count goes up. If one has Hepatitis C+ and is also HIV+ and has to take all these drugs, then it can lead to liver failure or cause progressive liver disease.
Many people do not want to go on to antiviral or protease or cocktail therapy because of their Hepatitis C count or because their liver counts is already really high. So they wait and their viral load gets so high that it takes forever to get it back down.
It's really hard to make decisions about treatments when these complications are added. Further, liver failure resulting from HCV cannot be treated with transplantation in AIDS patients because of the risk of opportunistic infections resulting from post-transplant immunosuppressive regimens.
Research agencies around the world that are working in the field of HIV AIDs support broad program of research on hemophilia and other bleeding disorders with primary focus on ensuring the safety and adequacy of the blood supply and basic mechanisms of bleeding and clotting.
Agencies are directing their research toward prevention of HIV infection and its complications, as well as discovery, development, and evaluation of therapeutic strategies and interventions for HIV/AIDS and its complications.
Perhaps the current positions can be best expressed in the words of Winston Churchill: this is not the end of our struggle to concur hemophilia and not even the beginning of the end. However we can at least say that this is the end of the beginning of our campaign.