The Lancet Volume 359, Number 9304 / 02 February 2002 Correspondence Japanese HIV-blood trial Sir--In his Oct 6 news item, J Watts1 suggests a brief comment would be of interest on the irony of the dismissal of charges that Takeshi Abe, the Japanese government's leading advisor on blood products in the mid-1980s, had contributed to the death of patients by failing to recognise the risk of non-heat-treated blood products--ie, antihaemophiliac factor VIII concentrates. Under Abe's presidency of the XIIth Congress of the International Society on Thrombosis and Haemostasis in 1989, we presented a report of the immunosuppressive effect of commercially available non-heat-treated factor VIII concentrates, which were grossly contaminated with factor XIII in the purification procedure at the time.2 Factor XIII, the lesser-known culprit than the more widely acknowledged HIV-1, is a contributing factor to immunosuppression in AIDS-associated haemophilia3 and, even today, as reported by Craven and colleagues,4 has remained consistently ignored in discussions of the impropriety of the use of factor VIII concentrates. The clinical importance of factor-VIII-induced immunosuppression to the predisposition to HIV-1 in haemophiliacs has been borne out by the high frequency of immune aberrations in HIV-1-seronegative compared with seropositive haemophiliacs.3 This finding suggests that such aberrations are due to factors other than HIV-1. Also relevant is the variation in geographical incidence of AIDS-associated haemophilia in the USA relative to the source (purity) of blood coagulation concentrate received.3 Haemophiliacs in New York City, for example, an area representative of one of the highest number of AIDS-associated cases in the USA,3 were principal recipients of factor VIII concentrates containing the greatest amount of factor XIII contaminant and suppressive activity.2 The profits for plasma suppliers were, at the time, huge, and entrepreneurs at the time paid little attention to the health status of blood donors and to the purification process for the isolation of factor VIII.5 Not limited to Japan, these careless and criminal practices were global and have included France, Germany, Italy, Switzerland, and the USA. In fact, in the case of Japan, it was the US blood suppliers who sold untreated factor VIII concentrates to the Japanese at discounted prices.3 Japanese doctors and hospitals then profited by claiming the higher official price from insurance schemes.3 Attention to the non-viral impurities in factor VIII would not have eliminated AIDS-associated haemophilia in its entirety. However, dependent on the commercial source of factor VIII received, haemophiliacs may have received a double whammy--ie, HIV-1-contaminated concentrate and concentrate that suppresses their immunity. In the current age of the use of recombinant factor VIII, if nothing else, let us at least recognise for the individuals who have perished, that HIV-1 was not the only culprit.
Richard J Ablin
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