The legacy of unhygienic plasma collection in China [editorial]

In the 25-year history of the HIV/AIDS pandemic one of the most remarkable aspects was the epidemic of HIV transmission resulting from unhygienic commercial plasma collection that took place in central China during the early 1990s. An estimated 250 000 people mainly rural peasants were HIV infected in the five most-heavily affected provinces of Henan Anhui Shanxi Hubei and Shandong (total population 334 million). For several years at numerous commercial collection centers the blood from multiple ABO-matched paid plasma donors was combined for more efficient large-volume plasma separation; the pooled cell fraction was then returned to the donors along with the infectious agents that had been present in the blood of the other donors at a given session. This unhygienic practice was largely stopped in the mid-1990s following investigations that found high rates of hepatitis C virus (HCV) and HIV infection among former plasma donors. It has been difficult to determine the total number of donors that was exposed to this very efficient mode of transmission for HIV HCV and other blood-borne pathogens. However in 2003 Chinese officials estimated there were 199 000 former commercial plasma and blood donors living with HIV infection. (excerpt)