The tragic history of AIDS in the haemophilia population: 1982 –1984.

During the first four decades of the 20th century, life for patients with haemophilia was at best miserable. Usually disabled before the age of 20, life expectancy for these patients averaged 27 years because of early deaths, often from bleeding into vital organs [1]. Because of the improvements in transfusion technology made during World War II [2–3], hemophilic patients could receive infusions of fresh whole blood or fresh frozen plasma containing the missing clotting factor. As a result, the life expectancy for a severe hemophilic patient reached 39.7 years by 1960, but the crippling effects of repeated bleeds left a substantial proportion of the population disabled and unemployed. Development of cryoprecipitate and subsequent fractionation procedures in the 1960s allowed storage of a therapeutic form of clotting factor VIII (FVIII), the missing clotting factor in haemophilia A [4–6]. Commercial adaptation yielded lyophilized clotting factor concentrates that immediately raised the missing clotting factor to normal levels, could be carried with patients on trips and could be self-administered. Both patients and physicians regarded clotting factor concentrates as the ultimate solution to haemophilia. Home care programs grew and comprehensive haemophilia treatment centres (HTC) developed [7–9]. Patients attending HTCs experienced substantial improvement of medical care and better quality of life as dependency on the medical community decreased. Mortality rates fell dramatically, employment levels increased, and school and work absences diminished greatly as hospitalisations and complications of haemophilia decreased [10–11]. Life expectancy reached 60 by 1980, nearly that of normal males.Consequently, plasma demand rose significantly, and the need for volume rather than quality drove the plasma industry.

Plasma was often obtained from paid donors who had high risks of blood-borne diseases (those who were extremely poor, prisoners, alcoholics, etc.) [2]. As a result, clotting factor concentrates, derived from pools of up to 20 000 donors with inadequate donor screening and infective agent testing, almost uniformly infected patients with hepatitis [12–13]. Considering the enhanced quality of life and increased longevity, these high infectivity rates were deemed an acceptable risk by patients, physicians, industry and government; viral inactivation technology was not vigorously pursued.

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