Early transfusion and length of survival in acquired immune deficiency syndrome: experience with a population receiving medical care at a public hospital

An extensive body of literature has attributed an immunosuppressive, and potentially deleterious, effect to blood transfusion. The possibility of a deleterious effect of transfusion on the subsequent survival of acquired immune deficiency syndrome (AIDS) patients was investigated in a public hospital-based cohort of 569 AIDS patients not treated with zidovudine and followed in a retrospective cohort study. With controls for the effects of baseline anemia, mode of initial disease manifestation of AIDS, most prevalent cause of death, and several other morbidities, a highly significant (p < 0.001) reduction was observed in the subsequent length of survival associated with the transfusion of packed red cells in the first trimester of the illness. However, when the most stringent assumptions with regard to control for illness severity were applied, this association was marginally significant (p = 0.055) only when transfusion was analyzed as a categorical variable. Analysis of transfusion as a continuous variable in this latter case failed to demonstrate a significant association. In this way, the findings substantiated but did not prove the hypothesis that the transfusion of packed red cells may be detrimental in patients with AIDS. There is a need for an experimental study directly comparing currently available alternative technologies to the transfusion of packed red cells to resolve the issue.