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Bronze M, Aitken SC, Wallis CL, Steegen K, Stuyver LJ, de Wit TFR, Stevens W. Evaluation of an affordable HIV-1 virological failure assay and antiretroviral drug resistance genotyping protocol. J Virol Methods 2013; 194:300-7. [PMID: 23994150 DOI: 10.1016/j.jviromet.2013.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/08/2013] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Abstract
HIV-1 RNA viral load is the preferred tool to monitor virological failure during antiretroviral therapy (ART) exposure. Timely detection of virological failure can reduce the prevalence and complexity of HIV-1 drug resistance. This field evaluation further characterizes a two-step approach to identify virological failure, as a measure of ART adherence, and detect HIVDR mutations in the reverse transcriptase (RT) gene of HIV-1. Two hundred and forty-eight (248) samples were tested; 225 from South African HIV-1 participants enrolled in the PharmAccess African Studies to Evaluate Resistance (PASER) cohort, forty of which had paired dried blood spot (DBS) samples and 23 HIV-1 negative samples. A newly developed virological failure assay (ARTA-VFA) was used on all samples, and those with a viral load >5000 RNA copies/ml were genotyped with a shortened RT protocol to detect HIVDR (ARTA-HIVDR(ultralight)). The ARTA-VFA showed good precision and linearity as compared to a commercial reference assay (NucliSENS EasyQ v1.2, Roche) with an R(2) of 0.99. Accuracy studies illustrated standard deviations of <1 log RNA copies/ml for plasma and DBS ARTA-VFA results compared to the reference method. The ARTA-VFA's intended use was to deliver qualitative results either < or >5000 RNA copies/ml. No significant differences in the proportion of results < or > either the 5000 RNA copies/ml or 1000 RNA copies/ml cut-off were noted for plasma indicating either cut-off to be useful. Significant differences were noted in these proportions when DBS were used (P=0.0002), where a 5000 RNA copies/ml cut-off was deemed more appropriate. The sensitivity and specificity of the ARTA-VFA with plasma were 95% and 93% and 91% and 95% for DBS using a 5000 RNA copies/ml cut-off. The ARTA HIVDR(ultralight) assay was reliable for plasma and DBS samples with a viral load >5000 RNA copies/ml, with amplification and sequencing success rates of 91% and 92% respectively for plasma, and 95% and 80% respectively for DBS. HIVDR profiles for plasma and DBS were 100% concordant with the reference assay. This study evaluated a previously described combination of two assays potentially useful in assessing HIV-1 virological failure and resistance, showing good concordance with reference assays. These assays are simple to perform and are affordable, viable options to detect virological failures in certain resource limited settings. The assays' compatibility with DBS sampling extends the access of HIV-1 virological monitoring to more remote settings.
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Van Rie A, Page-Shipp L, Hanrahan CF, Schnippel K, Dansey H, Bassett J, Clouse K, Scott L, Stevens W, Sanne I. Point-of-care Xpert® MTB/RIF for smear-negative tuberculosis suspects at a primary care clinic in South Africa. Int J Tuberc Lung Dis 2013; 17:368-72. [PMID: 23407225 DOI: 10.5588/ijtld.12.0392] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To assess the clinical utility and cost of point-of-care Xpert® MTB/RIF for the diagnosis of smear-negative tuberculosis (TB). DESIGN Cohort study of smear-negative TB suspects at a South African primary care clinic. Participants provided one sputum sample for fluorescent smear microscopy and culture and an additional sample for Xpert. Outcomes of interest were TB diagnosis, linkage to care, patient and provider costs. RESULTS Among 199 smear-negative TB suspects, 16 were positive by Xpert, 15 by culture and 7 by microscopy. All cases identified by Xpert began anti-tuberculosis treatment the same or next day; only one of five Xpert-negative culture-positive cases started treatment after 34 days. Xpert at point of care offered similar diagnostic yield but a faster turnaround time than smear and culture performed at a centralized laboratory. Compared to smear plus culture, Xpert (at US$9.98 per cartridge) was US$3 less expensive per valid result (US$21 vs. US$24) and only US$6 more costly per case identified (US$266 vs. US$260). CONCLUSION Xpert is an effective method of diagnosing smear-negative TB. It is cost saving for patients, especially if performed at point of care, but it is costly for health care providers. Data-driven studies are needed to determine its cost-effectiveness in resource-poor settings with diverse diagnostic practices.
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. THU0235 Identifying and quantifying prognostic factors in systemic sclerosis-related interstitial lung disease using a time-varying covariate survival model. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Charlesworth J, Stankovich J, Lewis P, Byron J, Stevens W, Sahhar J, Proudman S, Roddy J, Nash P, Tymms K, Brown M, Zochling J. THU0005 An immunochip based interrogation of scleroderma susceptibility variants. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nikpour M, Baron M, Hudson M, Carreira P, Hunzelmann N, Frech T, Sahhar J, Nash P, Roddy J, Schrieber L, Stevens W, Proudman S. SAT0202 Early Accrual of Organ Damage in Systemic Sclerosis: Rationale for Forming a Multinational Inception Cohort of Patients with Scleroderma (The Insync Study). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. FRI0243 Extent of disease on high-resolution CT lung is a predictor of decline and mortality in systemic sclerosis-related interstitial lung disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Thakkar V, Stevens W, Prior D, Moore O, Byron J, Patterson K, Hissaria P, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Celermajer D, Gabbay E, Youssef P, Proudman S, Nikpour M. THU0258 N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nikpour M, Baron M, Hudson M, Carreira P, Hunzelmann N, Frech T, Sahhar J, Nash P, Major G, Youssef P, Roddy J, Zochling J, Proudman S, Stevens W. FRI0372 Early mortality in systemic sclerosis: rationale for forming a multinational inception cohort of patients with scleroderma (the insync study). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Van Rie A, Page-Shipp L, Mellet K, Scott L, Mkhwnazi M, Jong E, Omar T, Beylis N, Stevens W, Sanne I, Menezes CN. Diagnostic accuracy and effectiveness of the Xpert MTB/RIF assay for the diagnosis of HIV-associated lymph node tuberculosis. Eur J Clin Microbiol Infect Dis 2013; 32:1409-15. [PMID: 23660698 DOI: 10.1007/s10096-013-1890-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/25/2013] [Indexed: 11/25/2022]
Abstract
Xpert MTB/RIF (Xpert) is recommended for human immunodeficiency virus (HIV)-associated pulmonary tuberculosis but not extrapulmonary tuberculosis. We assessed the performance of Xpert for HIV-associated lymph node tuberculosis (LNTB), the most common type of extrapulmonary tuberculosis. Among HIV-infected adults suspected of LNTB presenting for fine needle aspirate (FNA) at a South African hospital, we assessed the diagnostic accuracy of Xpert using either FNA culture or a composite of microscopy, culture, and cytology as the reference standard, and evaluated the impact of different diagnostics on patient management. Among 344 adults with valid FNA culture and Xpert results, 84 (24 %) were positive on microscopy, 149 (43 %) on culture, 152 (53 %) on Xpert, and 181 (57 %) had a cytology result suggestive of tuberculosis. Using liquid culture as the reference standard, the specificity of a single Xpert was suboptimal (88.2 %) but the sensitivity was high [93.3 %, 95 % confidence interval (CI) 87.6-96.6] and increased with decreasing CD4 count (from 87.0 % for CD4 >250 to 98.6 % for CD4 <100 cells/mm(3)). Using a composite reference standard reduced the sensitivity to 79.2 % but increased the specificity to 98.6 %. All Xpert-positive patients initiated treatment within one day, compared to 70 % of culture-positive but Xpert-negative and 13 % of culture- and Xpert-negative but cytology-positive patients. Xpert is accurate and effective and could be endorsed as the initial diagnostic for HIV-associated LNTB.
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Roberts T, Murch S, La Gerche A, Stevens W, Conron M, MacIsaac A, Prior D, Burns A. Pulmonary Index of Microvascular Resistance (PIMR) using PressureWire: First Report in 38 Human Subjects. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stevens G, Loh J, Kolbe J, Stevens W, Elder C. Comparison of recommendations for radiotherapy from two contemporaneous thoracic multidisciplinary meeting formats: co-located and video conference. Intern Med J 2012; 42:1213-8. [DOI: 10.1111/j.1445-5994.2012.02817.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/10/2012] [Indexed: 12/18/2022]
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Thakkar V, Stevens W, Prior D, Byron J, Patterson K, Hissaria P, Moore O, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Youssef P, Proudman S, Nikpour M, Launay D, Sitbon O, Cordier JF, Hachulla E, Mouthon L, Gressin V, Rottat L, Clerson P, Simonneau G, Humbert M, Carreira P, Carmona L, Joven BE, Denton CP, Allanore Y, Walker UA, Matucci-Cerinic M, Muller-Ladner U, Hsu V, Cheng Q, Steen V. S.4.1 N-terminal pro-brain natriuretic peptide levels predict incident pulmonary arterial hypertension in SSc. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Byron J, Thakkar V, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M, Moore O, Goh N, Corte T, Rouse H, Hennessy O, Byron J, Thakkar V, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M, Tourkina E, Dyer S, Reese C, Oates JC, Hofbauer A, Bonner M, Visconti RP, Zhang J, Silver RM, Hoffman S, Liu X, Mayes M, Tan F, Harper B, Gonzalez E, Draeger H, Sharif R, Reveille J, Arnett F, Assassi S, Bogatkevich G, Akter T, Atanelishvili I, Liang J, Spyropoulos D, Silver R. S.2.1 Identifying and quantifying prognostic factors in SSc-related interstitial lung disease using a time-varying covariate survival model. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Charlesworth J, Stankovich J, Lewis P, Byron J, Stevens W, Sahhar J, Proudman S, Roddy J, Nash P, Tymms K, Brown M, Zochling J, Leask A, Parapuram S, Shiwen X, Denton C, Abraham D, Liu S, Vettori S, Brock M, Iwamoto N, Maurer B, Jungel A, Gay RE, Calcagni M, Valentini G, Distler JH, Gay S, Distler O, Assassi S, Mayes M, Liu X, Harper B, Gonzalez E, Draeger H, Zhou X, Khanna D, Furst D, Tan F. S.8.1 An immunochip-based interrogation of scleroderma susceptibility variants. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Coller J, Stevens W, MacIsaac A, Pang B, McLellan A, Prior D. Reproducibility of Echocardiographic Estimates of Pulmonary Haemodynamics and RV Function in Patients with Scleroderma. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sladek CD, Stevens W, Levinson SR, Song Z, Jensen DD, Flynn FW. Characterization of nuclear neurokinin 3 receptor expression in rat brain. Neuroscience 2011; 196:35-48. [PMID: 21939739 DOI: 10.1016/j.neuroscience.2011.08.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
Abstract
Ligand-induced translocation of the G-protein-coupled receptor, neurokinin 3 (NK3-R), to the nucleus of hypothalamic neurons was reported using antibodies (ABs) raised against the C-terminal region of NK3-R. The current work was undertaken to substantiate the ability of NK3-R to enter the nucleus and identify which portion of the NK3-R molecule enters the nucleus. ABs directed at epitopes in the N-terminal and second extracellular loop of the rat NK3-R molecule were used to evaluate western blots of whole tissue homogenates and nuclear fractions from multiple brain areas. Specificity of the protein bands recognized by these ABs was demonstrated using Chinese hamster ovary (CHO) cells transfected with rat or human NK3-R. Both ABs prominently recognized a diffuse protein band of ∼56-65 kDa (56 kDa=predicted size) and distinct ∼70-kDa and 95-kDa proteins in homogenates of multiple brain areas. The ∼95-kDa protein recognized by the extracellular loop AB was enriched in nuclear fractions. Recognition of these proteins by ABs directed at different regions of the NK3-R supports their identification as NK3-R. The size differences reflect variable glycosylation and possibly linkage to different cytosolic and nuclear proteins. Recognition of protein bands by both ABs in nuclear fractions is consistent with the full-length NK3-R entering the nucleus. Hypotension increased the density of the ∼95-kDa band in nuclear fractions from the supraoptic nucleus indicating activity-induced nuclear translocation. Since NK3-R is widely distributed in the CNS, the presence of NK3-R in nuclei from multiple brain regions suggests that it may broadly influence CNS gene expression in a ligand-dependent manner.
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Stevens W, Addo-Yobo E, Roper J, Woodcock A, James H, Platts-Mills T, Custovic A. Differences in both prevalence and titre of specific immunoglobulin E among children with asthma in affluent and poor communities within a large town in Ghana. Clin Exp Allergy 2011; 41:1587-94. [PMID: 21810123 PMCID: PMC3505371 DOI: 10.1111/j.1365-2222.2011.03832.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reports from several African countries have noted an increasing prevalence of asthma in areas of extensive urbanization. OBJECTIVE To investigate the relevance of allergen-specific sensitization and body mass index (BMI) to asthma/wheezing and exercise-induced bronchospasm (EIB) among children from affluent and poorer communities within a large town in Ghana. METHODS Children with physician-diagnosed asthma and/or current wheezing aged 9-16 years (n=99; cases) from three schools with differing socio-economic backgrounds [urban affluent (UA), urban poor (UP) or suburban/rural (SR)] were recruited from a cross-sectional study (n=1848) in Kumasi, Ghana, and matched according to age, sex and area of residence with non-asthmatic/non-wheezy controls. We assayed sera for IgE antibodies to mite, cat, dog, cockroach, Ascaris and galactose-α-1,3-galactose. RESULTS Children from the UA school had the lowest total serum IgE. However, cases from the UA school had a higher prevalence and mean titre of sIgE to mite (71.4%, 21.2 IU/mL) when compared with controls (14.3%, 0.8 IU/mL) or cases from UP (30%, 0.8 IU/mL) and SR community (47.8%, 1.6 IU/mL). While similar findings were observed with EIB in the whole population, among cases there was no difference in IgE antibody prevalence or titre between children with or without EIB. BMI was higher among UA children with and without asthma; in UP and SR communities, children with EIB (n=14) had a significantly higher BMI compared with children with asthma/wheezing without EIB (n=38) (18.2 vs. 16.4, respectively, P<0.01). CONCLUSIONS AND CLINICAL RELEVANCE In the relatively affluent school, asthma/wheezing and EIB were associated with high titre IgE antibodies to mite, decreased total IgE, and increased BMI. This contrasted with children in the urban poor school and suggests that changes relevant to a Western model of childhood asthma can occur within a short geographical distance within a large city in Africa.
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Stevens W. GOOD CLINICAL LABORATORY PRACTICE (GCLP): THE NEED FOR A HYBRID OF GOOD LABORATORY PRACTICE AND GOOD CLINICAL PRACTICE GUIDELINES/STANDARDS FOR MEDICAL TESTING LABORATORIES CONDUCTING CLINICAL TRIALS IN DEVELOPING COUNTRIES. ACTA ACUST UNITED AC 2011; 10:83-9. [PMID: 14660298 DOI: 10.1080/10529410390262727] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There has been a significant increase in the number of clinical drug trials (particularly phase III) being conducted in developing countries for infectious diseases such as HIV, malaria, and tuberculosis. Laboratory results provided by medical testing laboratories in the region are critical to ensuring the safety of patients and the generation of good quality data. A number of well accepted Good Clinical Practice (GCP) and Good Laboratory Practice (GLP) guidelines govern the conduct of clinical trials internationally. Good Clinical Practice guidelines remain too vague with respect to sample analysis to ensure practical implementation in these laboratories. In their strictest sense, Good Laboratory Practice guidelines refer to the analysis of samples from non-clinical studies. A specific set of minimum standards or requirements for practical implementation of clinical trial requirements in medical testing laboratories in the developing world is urgently required.
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Sabato V, Verweij M, Bridts C, De Clerck L, Stevens W, Schiavino D, Ebo D. Human Basophils Express the Inhibitory Receptor CD300a (IRp60). J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Backer HJ, Stevens W, Dost N. Les propriétés du groupe sulfonyle: I. Sur la bromuration d'allylsulfones. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19480670606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Backer HJ, Stevens W. Condensation de la Benzile avec les Acides Oxy-, Thio- et Sélénodiacétiques. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19400590503] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Buisman JAK, Stevens W, Vliet JVD. Investigations on sterols: I. A new synthesis of 7-dehydrocholesterol (provitamin D). ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19470660205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Backer HJ, Bolt CC, Stevens W. La 3,4-Diphénylthiophènesulfone et son Hydrogénation. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19370561108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schijf R, Stevens W. Mixed carboxylic acid anhydrides: VII. Synthesis of some mixed formic acid anhydrides. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/recl.19660850611] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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