Depressive symptoms in blood donors notified of HIV infection.

OBJECTIVES: Understanding more about the psychological state of persons notified of human immunodeficiency virus (HIV) infection is critical for designing notification and counseling programs that will have the most positive effect. METHODS: The subjects were blood donors who had been notified of HIV infection by the New York Blood Center. A nurse elicited a medical history, performed a limited medical examination, and asked the subjects to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. The subjects completed another questionnaire approximately 2 weeks later. RESULTS: The average depressive symptom scores for both men and women were substantially higher than scores typically found in representative population samples. More than a quarter of the men and more than a third of the women reported seeking psychological or psychiatric services in the first few weeks following notification. CONCLUSIONS: Anticipating and meeting individuals' psychological needs may be necessary if HIV screening programs are to address effectively the needs of persons infected with HIV.

Behavior changes after notification of HIV infection.

BACKGROUND: To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. METHODS: Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. RESULTS: Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. CONCLUSIONS: To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors.

Human T-cell lymphotropic virus in volunteer blood donors.

Serum samples collected in 1985 and 1986 from 18,257 donors to the Greater New York Blood Program were screened by enzyme-linked immunoassay for antibody to human T-cell lymphotropic virus (anti-HTLV). Fifteen samples (0.08%) were confirmed positive: 7 by radioimmunoprecipitation assay (RIPA) alone, 6 by Western blot alone, and 2 by combined results from both tests. One donor, whose original test result was uninterpretable because multiple nonspecific bands were present on RIPA, clearly tested positive on subsequent specimens. Follow-up testing of individuals with this type of result may be needed to resolve their HTLV status. Anti-HTLV prevalence increased with age and was significantly more common in black or Hispanic donors and in those born in the Caribbean than in other donors. All anti-HTLV-positive donors were negative for antibody to HIV-1, and only one donor (7% of those positive) would have been excluded by any of the routine donor screening tests used at that time.

Health education about AIDS among seropositive blood donors.

The New York Blood Center is developing a health education and psychosocial support program for blood donors who are notified that they are HIV antibody positive. The goals of that program are: to provide accurate and intelligible information about the test results to notified donors; to encourage behavior that will reduce the likelihood of spreading the virus; to encourage notified donors to behave in ways that will reduce the probability that they will develop AIDS; and to provide support and facilitate functional coping responses. This article reviews the theoretical and empirical work which informs the intervention program, and it describes how the program is being implemented.

PIP: The New York Blood Center has developed a health education and psychosocial support program for blood donors who are positive for the human immunodeficiency virus (HIV) antibody. The goals of this program are: 1) to provide accurate, understandable information about the test results to donors; 2) to encourage behavior that will reduce the likelihood of spreading HIV infection; 3) to encourage notified donors to behave in ways that will reduce their probability of developing acquired immunodeficiency syndrome (AIDS); and 4) to provide support and facilitate functional coping responses. Notification must be part of a multifaceted intervention plan that draws upon theoretical models of health behavior and persuasive communications as well as on past experience in other public health programs. Most blood donors in the US are learning of the results of their HIV antibody test by letter, telephone, or in a short personal interview with blood center personnel. There are indications, however, that such abbreviated procedures will not result in the desired behavioral changes. In the New York program, initial counseling time is spent developing a realistic assessment of risk and helping donors to deal with their emotional reactions. After people have developed a better understanding of the information and have been reassured, it is important to help them cope with changes in sexual practices that are recommended for their safety and that of others. Individuals are also helped to develop specific action plans for dealing with the threat of AIDS and reassured that they are capable of coping successfully. Blood donors are the 1st group in the US to be systematically screened for HIV antibodies. Thus, the information gained from programs such as this will be critical for program development as screening is extended to other groups in the years ahead.

Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Evidence of volunteer blood donor cooperation.

We studied whether volunteers giving blood to the Greater New York Blood Program (GNYBP) cooperated with procedures implementing public health recommendations intended to decrease the risk of acquired immunodeficiency syndrome (AIDS) transmission by blood transfusion. Predonation medical screening was expanded to exclude donors who might be ill with AIDS. To exclude possible asymptomatic carriers of the disease, members of groups at increased risk of AIDS were asked either not to give blood or to give it for laboratory studies. A confidential questionnaire, administered to all donors after medical screening, provided the vehicle for donors to advise the GNYBP whether their donation was for laboratory studies or for patient transfusion. We found that the number of male donors decreased; AIDS-related questions in medical history led to a 2 percent increase in donor rejections; 97 percent of donors said their blood could be used for transfusions; 1.4 percent said their blood could be used for laboratory studies only; and 1.6 percent did not respond. Only units designated for transfusion were released to hospitals. People who indicated that their donation was for laboratory studies had a higher prevalence of markers for hepatitis B virus and of antibodies to cytomegalovirus. White cell counts and helper/suppressor T lymphocyte ratios were not significantly different in the two groups. We conclude that volunteer donors have cooperated with the established procedures. None of the laboratory assays identified blood units donated by individuals who, based on information about AIDS high-risk groups, designated their donation for laboratory studies.

Hormonal regulation of fibrinogen synthesis in cultured hepatocytes.

Most of what was originally known of the effects of hormones on fibrinogen synthesis was based, as noted above, on experiments involving surgical removal of endocrine glands. Some caution should be exercised when using such in vivo experiments to derive the hormonal requirements of fibrinogen synthesis, however, since multiple hormonal alterations often occur in these animals. The development of a variety of ex vivo systems has allowed investigators to more carefully control the hepatocellular environment. The work of several laboratories, including our own, has now made it clear that hormones and other agents directly stimulate hepatocellular synthesis of fibrinogen. From the studies summarized here, using chick embryo hepatocytes as a model, several generalizations emerge: Fibrinogen synthesis may be considered to be a "constitutive" liver function, since hepatocytes cultured without serum, hormones or other macromolecular supplements synthesize this protein at a basal rate for several days. Addition of certain hormones (e.g. T3, dexamethasone, insulin), individually and in physiological concentrations, elicits an increase in fibrinogen production, varying with each agent in onset, dose, minimum exposure required and accompanying effects on the synthesis of other plasma proteins. Glucocorticoids and thyroid hormones are similar in the selectivity of their stimulation (neither affects albumin or transferrin synthesis) but differ in that thyroid hormones need to be present for just a short "triggering" period. The stimulation of fibrinogen synthesis by insulin occurs only following prolonged exposure to concentrations 10-times higher than the very low doses to which albumin synthesis responds rapidly.

Issues for informed consent.

Informed consent from a cytapheresis donor is the culmination of a complex decision making process during which the blood collecting agency presents sufficient information to enable the donor to make a free choice whether or not to donate. The institution bears the responsibility for providing all information relevant to the donor's decision, whether favorable or unfavorable. At no other stage of its contact with the donor can a collecting agency discharge its public trust more meaningfully. Thus, informed consent is not only the greatest altruistic expression from the unrelated volunteer donor, or the expression of deepest commitment to the family for the related donor, it is also the fullest expression of the value which the institute places on the autonomy of the donor. The foundation upon which the concept of informed consent rests has been laid by law, medicine, government, ethics, and religion. Although the procedures accompanying the informed consent process appear bureaucratic, they should be viewed as the components of a remarkable, dynamic process. The consent of a donor to undergo cytapheresis is an eloquent statement of the value he or she places on the importance of another human being's life.

Transfusion of granulocyte rich buffy coats to neutropenic patients.

Granulocyte rich buffy coats were transfused to infected neutropenic patients when leukapheresis donors were not available. Efficacy of transfusions was evaluated from data supplied by hospitals administering them. Buffy coats separated from ACD blood contained a mean of 4.9 X 10(8) granulocytes. Fifty-seven patients received a course consisting of a mean of 3.8 transfusions. Of these, 27 received a mean of 17.5 units per transfusion and had a survival rate of 44.4%, which was not significantly different from the 50.0% found in 30 who received a mean of 11.1 units per transfusion. No significant difference in survival rate was found between 31 patients with acute leukemia and 26 with other disorders or 38 patients with positive and 19 with negative cultures. Finally, no significant difference in survival rate was noted between patients who received a course of greater than or equal to four transfusions or less than or equal to three transfusions in any of the above groups. Survival rates were less than those generally reported following similar courses of leukapheresis units. Buffy coat transfusions consisting of a mean of approximately 17.5 units as produced during this study have therefore been shown to be not generally beneficial. The increased survival seen in some studies utilizing leukapheresis products may relate in part to the larger number of granulocytes they contained. Greater benefit from buffy coat transfusions might result if the number of granulocytes infused were increased. Evaluation of possible efficacy associated with transfusions of increased numbers of buffy coat units further enriched with granulocytes may be justified when leukapheresis donors are not available.