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Martins ML, Barbosa-Stancioli EF, da Silva-Malta MCF, Nunes SM. The importance of confirmatory assays in testing blood donors for human T-cell lymphotropic virus. Vox Sang 2024; 119:257-264. [PMID: 38223953 DOI: 10.1111/vox.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND OBJECTIVES Serological HTLV-1/2 screening is mandatory for blood donor candidates in Brazil. Our objective was to analyse HTLV test results in blood donors submitted for screening and confirmatory assays in a Brazilian blood bank. MATERIALS AND METHODS Retrospective analysis (2017-2022) results of chemiluminescence immunoassays and confirmatory tests for HTLV-1/2 in reactive donors were performed. During the analysed period, three sets of assays were used: (1) Architect rHTLV-I/II + HTLV Blot 2.4 (Western blot [WB]); (2) Alinity s HTLV I/II Reagent Kit + INNO-line immunoassay (LIA) HTLV I/II Score (LIA); (3) Alinity + WB. RESULTS The analysed period comprised a total of 1,557,333 donations. The mean percentage of HTLV reactive donors using the Architect assay was 0.14%. With the change to the Alinity assay, that percentage dropped 2.3-fold (0.06%). The reactivity rate in the confirmatory tests (1064 samples) ranged from 13.5% to 30.2%, whereas 58.3%-85.9% of samples were non-reactive. The highest rates of positive (30.2%) and indeterminate (11.5%) results were seen using LIA. Considering all analysed samples, those with signal/cut-off ratio (S/CO) >50 were positive in confirmatory tests (positive predictive value, PPV = 100%), whereas samples with S/CO ≤6 are very unlikely to be truly positive (PPV = 0). CONCLUSION The use of the Alinity assay reduced the frequency of false-positive results. Confirmatory tests are important to identify true HTLV infection in blood donors, because more than 58% of initially reactive individuals are confirmed as seronegative. Categorizing S/CO values is useful for assessing the likelihood of true HTLV-1/2 infection.
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Affiliation(s)
| | - Edel Figueiredo Barbosa-Stancioli
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Sônia Mara Nunes
- Laboratório de Sorologia, Fundação HEMOMINAS, Belo Horizonte, Brazil
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2
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Puccioni-Sohler M, Poton AR, Cabral-Castro MJ, Yamano Y, Taylor G, Casseb J. Human T Lymphotropic Virus 1-Associated Myelopathy: Overview of Human T Cell Lymphotropic Virus-1/2 Tests and Potential Biomarkers. AIDS Res Hum Retroviruses 2022; 38:924-932. [PMID: 35819286 DOI: 10.1089/aid.2022.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Human T cell lymphotropic virus (HTLV)-1-associated myelopathy is a chronic, disabling inflammatory disorder of the spinal cord caused by HTLV-1 infection. The diagnosis of HTLV-1-associated myelopathy (HAM) is based on clinical and laboratorial findings. The disease is characterized by the presence of spastic paraparesis associated with detection of anti-HTLV-1 antibodies or HTLV-1 genomes in blood and cerebrospinal fluid (CSF). New inflammatory markers have been proposed for the diagnosis and assessment of the prognosis of HAM. We reviewed the laboratory diagnostic and potential surrogate markers for HAM. The serological screening tests for detection of anti-HTLV-1/2 antibodies are highly sensitive and specific, but confirmation and typing of HTLV-1 or HTLV-2 infection by other serological or molecular methods are essential. Detection of intrathecal anti-HTLV-1 antibodies and quantification of the HTLV-1 provirus in CSF provide additional evidence for diagnosis especially in atypical cases or where alternative causes of neuroinflammation cannot be excluded. The CXC motif chemokine ligand 10 and neopterin in serum and CSF are now emerging as inflammatory markers with prognostic value and for HAM monitoring and management. In addition, measures of neurodegeneration, such as neurofilament light chain in the CSF and blood, may also contribute to the HAM prognosis. This review is useful for clinicians and researchers evaluating potential benefits and limitations of each biomarker in clinical practice. The advent of new markers makes it necessary to update the criteria for the best evidence-based approach and for worldwide consensus regarding the use of diagnostic and surrogate markers for HAM.
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Affiliation(s)
- Marzia Puccioni-Sohler
- Department of Internal Medicine, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program, Department of Infectious and Parasitic Diseases, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Jorge Cabral-Castro
- Department of Immunology, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Graham Taylor
- Section of Virology, Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Jorge Casseb
- Department of Dermatology, Faculty of Medicine, Sao Paulo University, Sao Paulo, Brazil
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Franco GDM, da Rocha AS, Cox LJ, Daian E Silva DSDO, da Silveira E Santos DM, Martins ML, Romanelli LC, Ishak R, Vallinoto ACR, Bomfim MRQ, Caterino-de-Araujo A, Coelho-Dos-Reis JGA, da Fonseca FG, Barbosa-Stancioli EF. Multi-Epitope Protein as a Tool of Serological Diagnostic Development for HTLV-1 and HTLV-2 Infections. Front Public Health 2022; 10:884701. [PMID: 35677763 PMCID: PMC9168532 DOI: 10.3389/fpubh.2022.884701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
A multi-epitope protein expressed in a prokaryotic system, including epitopes of Env, Gag, and Tax proteins of both HTLV-1 and HTLV-2 was characterized for HTLV-1/2 serological screening. This tool can contribute to support the implementation of public policies to reduce HTLV-1/2 transmission in Brazil, the country with the highest absolute numbers of HTLV-1/2 infected individuals. The chimeric protein was tested in EIA using serum/plasma of HTLV-infected individuals and non-infected ones from four Brazilian states, including the North and Northeast regions (that present high prevalence of HTLV-1/2) and Southeast region (that presents intermediate prevalence rates) depicting different epidemiological context of HTLV-1/2 infection in our country. We enrolled samples from Pará (n = 114), Maranhão (n = 153), Minas Gerais (n = 225) and São Paulo (n = 59) states; they are from blood donors' candidates (Pará and Minas Gerais), pregnant women (Maranhão) and HIV+/high risk for sexually transmitted infection (STI; São Paulo). Among the HTLV-1/2 positive sera, there were co-infections with viral (HTLV-1 + HTLV-2, HIV, HCV, and HBV), bacterial (Treponema pallidum) and parasitic (Trypanosoma cruzi, Schistosma mansoni, Strongyloides stercoralis, Entamoeba coli, E. histolytica, and Endolimax nana) pathogens related to HTLV-1/2 co-morbidities that can contribute to inconclusive diagnostic results. Sera positive for HIV were included among the HTLV-1/2 negative samples. Considering both HTLV-1 and HTLV-2-infected samples from all states and different groups (blood donor candidates, pregnant women, and individuals with high risk for STI), mono or co-infected and HTLV-/HIV+, the test specificity ranged from 90.09 to 95.19% and the sensitivity from 82.41 to 92.36% with high accuracy (ROC AUC = 0.9552). This multi-epitope protein showed great potential to be used in serological screening of HTLV-1 and HTLV-2 in different platforms, even taking into account the great regional variation and different profile of HTLV-1 and HTLV-2 mono or co-infected individuals.
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Affiliation(s)
- Gabriela de Melo Franco
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Anderson Santos da Rocha
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Laura Jorge Cox
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Danielle Soares de Oliveira Daian E Silva
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Débora Marques da Silveira E Santos
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Marina Lobato Martins
- GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil.,Serviço de Pesquisa, Fundação HEMOMINAS, Belo Horizonte, Brazil
| | - Luis Claudio Romanelli
- GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil.,Serviço de Pesquisa, Fundação HEMOMINAS, Belo Horizonte, Brazil
| | - Ricardo Ishak
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Antonio C R Vallinoto
- Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará (UFPA), Belém, Brazil
| | | | | | - Jordana G A Coelho-Dos-Reis
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
| | - Flávio Guimarães da Fonseca
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Edel Figueiredo Barbosa-Stancioli
- Laboratório de Virologia Básica e Aplicada, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,GIPH-Indisciplinary HTLV Research Group, Belo Horizonte, Brazil
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4
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Madugula KK, Joseph J, DeMarino C, Ginwala R, Teixeira V, Khan ZK, Sales D, Wilson S, Kashanchi F, Rushing AW, Lemasson I, Harhaj EW, Janakiram M, Ye BH, Jain P. Regulation of human T-cell leukemia virus type 1 antisense promoter by myocyte enhancer factor-2C in the context of adult T-cell leukemia and lymphoma. Haematologica 2022; 107:2928-2943. [PMID: 35615924 PMCID: PMC9713551 DOI: 10.3324/haematol.2021.279542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
Adult T-cell leukemia and lymphoma (ATLL) is an intractable T-cell neoplasia caused by a retrovirus, namely human T-cell leukemia virus type 1 (HTLV-1). Patients suffering from ATLL present a poor prognosis and have a dearth of treatment options. In contrast to the sporadic expression of viral transactivator protein Tax present at the 5' promoter region long terminal repeats (LTR), HTLV-1 bZIP gene (HBZ) is encoded by 3'LTR (the antisense promoter) and maintains its constant expression in ATLL cells and patients. The antisense promoter is associated with selective retroviral gene expression and has been an understudied phenomenon. Herein, we delineate the activity of transcription factor MEF (myocyte enhancer factor)-2 family members, which were found to be enriched at the 3'LTR and play an important role in the pathogenesis of ATLL. Of the four MEF isoforms (A to D), MEF-2A and 2C were highly overexpressed in a wide array of ATLL cell lines and in acute ATLL patients. The activity of MEF-2 isoforms were determined by knockdown experiments that led to decreased cell proliferation and regulated cell cycle progression. High enrichment of MEF-2C was observed at the 3'LTR along with cofactors Menin and JunD resulting in binding of MEF-2C to HBZ at this region. Chemical inhibition of MEF-2 proteins resulted in the cytotoxicity of ATLL cells in vitro and reduction of proviral load in a humanized mouse model. Taken together, this study provides a novel mechanism of 3'LTR regulation and establishes MEF-2 signaling a potential target for therapeutic intervention for ATLL.
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Affiliation(s)
- Kiran K. Madugula
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Julie Joseph
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Catherine DeMarino
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, USA
| | - Rashida Ginwala
- Fox Chase Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa Teixeira
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA,Instituto de Ciencias Biológicas, Universidad de Pernambuco, Recife, PE, Brazil
| | - Zafar K. Khan
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Dominic Sales
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sydney Wilson
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Fatah Kashanchi
- Laboratory of Molecular Virology, George Mason University, Manassas, VA, USA
| | - Amanda W. Rushing
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Isabelle Lemasson
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Edward W. Harhaj
- Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, PA, USA
| | | | - B. Hilda Ye
- Department of Cell Biology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pooja Jain
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA,P. Jain
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5
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Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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6
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Gonçalves MG, Fukasawa LO, Campos KR, Higa FT, Caterino-de-Araujo A. Development and Validation of Multiplex Quantitative Real-Time PCR Assays for Simultaneous Detection and Differentiation of HTLV-1 and HTLV-2, Using Different PCR Platforms and Reagent Brands. Front Microbiol 2022; 13:831594. [PMID: 35369428 PMCID: PMC8965094 DOI: 10.3389/fmicb.2022.831594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Brazil currently has the highest number of individuals infected with human T-lymphotropic virus 1- and 2- (HTLV-1 and HTLV-2) globally. At present, neither molecular protocols nor commercial assays are available for HTLV-1/-2 diagnosis or validated by the Brazilian Ministry of Health regulatory agency (ANVISA). We developed and validated two in-house multiplex quantitative real-time PCR for HTLV-1/-2 (mqPCR_HTLV) assays, targeting the pol and tax genes, for the simultaneous identification of HTLV-1, HTLV-2, and the albumin reference gene. The robustness of the assays was evaluated on two platforms using seven commercial master mix formulations. The reactions employed double plasmids (pHTLV1-Alb and pHTLV2-Alb) for the standard curve’s construction and for expressing the detection limit of the assays. They were able to detect 10 and 10 copies of HTLV-1 and 10 and 70 copies of HTLV-2 for the tax and pol targets, respectively. High efficiency was obtained using both the platforms and all the reagents evaluated and were successfully reproduced by other analysts. DNA samples from HTLV-1/-2-infected and non-infected patients and from HIV/HTLV-coinfected patients were evaluated to determine the feasibility of their use in routine diagnosis. The mqPCR_HTLV (pol and tax) assays demonstrated an overall specificity of 100% and a sensitivity of 97.4% when testing samples from patients without HIV infection, and sensitivities of 77.1% (pol) and 74.6% (tax) in samples from HIV/HTLV-coinfected patients. In addition, they resolved the issue of HTLV western blotting (WB) indeterminate and WB-untyped results in 45.5 and 66.7% of cases, respectively. The developed mqPCR_HTLV (pol and tax) assays indicated their feasibility for efficient and reliable HTLV diagnosis in various core facility laboratories under different conditions and supplies.
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Affiliation(s)
- Maria Gisele Gonçalves
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Lucila Okuyama Fukasawa
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Karoline Rodrigues Campos
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Fábio Takenori Higa
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Adele Caterino-de-Araujo
- Centro de Imunologia, Instituto Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
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7
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Epidemiological and molecular profile of blood donors infected with HTLV-1/2 in the state of Pará, northern Brazil. Braz J Microbiol 2021; 52:2001-2006. [PMID: 34498218 DOI: 10.1007/s42770-021-00609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/01/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Human T-lymphotropic virus (HTLV) is a retrovirus of the genus Deltaretrovirus, which belongs to the family Retroviridae. The most important types are HTLV-1 and HTLV-2. It is estimated that between five and 10 million individuals are infected with HTLV-1, worldwide. Studies in the state of Pará indicate that it has the third highest prevalence of HTLV infections of any Brazilian state. The present study describes the epidemiological, serological, and molecular profile of blood donors from the state of Pará that were classified as unfit due to infection by HTLV-1 and 2. METHODS The present study is based on a descriptive, retrospective, and cross-sectional review of the epidemiological, serological, and molecular data on blood donations, between January 2015 and December 2019. The data were obtained from the blood bank system and were digitalized to form a database in the Statistical Package for Social Sciences program, version 20. Descriptive statistics were used to determine the absolute and relative frequencies of the qualitative variables. For the quantitative variables, the mean, standard deviation, and minimum and maximum values were calculated. A p < 0.05 significance level was adopted for all analyses. RESULTS A total of 632 samples were analyzed, of which 496 (78%) had no detectable proviral DNA and 136 (22%) had detectable HTLV. The HTLV-1 was detected in most (78%; 106/136) of these samples, while only 30 (22%) were detected for HTLV-2. The HTLV proviral DNA was detected primarily in females (69.1%), with a mean age of 40 years, with the highest frequencies of detection being recorded in single individuals (66.2%), first-time donors (74.3%), and individuals that had graduated high school (44.1%). The molecular confirmation of HTLV showed that three-quarters (78%) of the serologically reactive individuals were negative for either types 1 or 2, so the epidemiological profile of these individuals was significantly different from their detectable profile. CONCLUSIONS The HTLV is neglected in Brazil; there is thus a clear need for further research in the area of regional hemotherapy and hematology services, in order to contribute to the definition of regional infection profiles, that will be fundamental to the development of effective prophylactic practices for the prevention of the infection and the dissemination of knowledge on the dangers of HTLV in the community.
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Caterino-de-Araujo A, Barbosa-Stancioli EF, Alonso Neto JB, Aragón MG, Galvão-Castro B, Ishak R, Rosadas C. Laboratory diagnosis of human T-lymphotropic virus in Brazil: assays, flowcharts, challenges, and perspectives. Rev Soc Bras Med Trop 2021; 54:e01752021. [PMID: 34105630 PMCID: PMC8186893 DOI: 10.1590/0037-8682-0175-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/26/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION We present a data analysis and review of recent studies regarding the laboratory diagnosis of human T-lymphotropic virus 1 and 2 (HTLV-1/2) infections in Brazil. METHODS Target populations, available diagnostic serological assays (screening and complementary tests), molecular assays (in-house), causes of false-positive and false-negative results, and flowcharts were analyzed. RESULTS A table presents the target populations, two diagnostic flowcharts (depending on laboratory infrastructure and study population), and recent research that may improve how HTLV-1/2 is diagnosed in Brazil. CONCLUSIONS: Our results support the implementation of public policies to reduce HTLV-1/2 transmission and its associated diseases.
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Affiliation(s)
- Adele Caterino-de-Araujo
- Instituto Adolfo Lutz, Centro de Imunologia, Laboratório de Pesquisa em HTLV, São Paulo, SP, Brasil
| | - Edel Figueiredo Barbosa-Stancioli
- Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Laboratório de Virologia Básica e Aplicada, Belo Horizonte, MG, Brasil
| | - José Boullosa Alonso Neto
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, Brasília, DF, Brasil
| | - Mayra Gonçalves Aragón
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
| | - Bernardo Galvão-Castro
- Escola Bahiana de Medicina e Saúde Pública, Centro Integrativo e Muldisciplinar de Atendimento ao Portador de HTLV, Salvador, BA, Brasil
| | - Ricardo Ishak
- Universidade Federal do Pará, Instituto de Ciências Biológicas, Laboratório de Virologia, Belém, PA, Brasil
| | - Carolina Rosadas
- Imperial College Healthcare NHS Trust, St. Mary's Hospital, National Centre for Human Retrovirology, London, United Kingdom
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9
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Anti-Human T-Cell Leukemia Virus Type 1 (HTLV-1) Antibody Assays in Cerebrospinal Fluid for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis. J Clin Microbiol 2021; 59:JCM.03230-20. [PMID: 33658267 PMCID: PMC8091837 DOI: 10.1128/jcm.03230-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 11/20/2022] Open
Abstract
The anti-human T-cell leukemia virus type 1 (HTLV-1) antibody assay in common use has changed from the particle agglutination (PA) method to chemiluminescent immunoassay (CLIA) and chemiluminescent enzyme immunoassay (CLEIA). These assays were validated in serum but not in cerebrospinal fluid (CSF). However, anti-HTLV-1 antibody positivity in CSF is a requisite for diagnosing HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). We qualitatively compared the assays in CSF from 47 HAM/TSP patients diagnosed using PA, 15 HTLV-1 carriers (HCs), and 18 negative controls. In determining the positivity or negativity of CSF anti-HTLV-1 antibodies, we used serum cutoff points for CLIA and CLEIA because CSF cutoff points had not been decided. Truth table analysis revealed that the performance of CLIA was closer to that of PA and that CLEIA had low sensitivity. CSF antibodies from HAM/TSP patients were all positive by PA and CLIA but 83.0% positive by CLEIA. CSF antibodies from HCs were positive in 73.3%, 80.0%, and 6.7% by PA, CLIA, and CLEIA, respectively. Receiver operator characteristic curve analysis for CSF revealed that with the default cutoff point used for serum, CLIA and PA had comparable performances and CLEIA was less sensitive. The best performances of CLIA and CLEIA with adjusted cutoff points were 94.8% sensitivity and 95.5% specificity and 89.7% sensitivity and 95.5% specificity, respectively. We conclude that low-sensitivity CLEIA can underdiagnose HAM/TSP and that CLIA is a better alternative to PA in anti-HTLV-1 antibody assay for CSF with the current cutoff points.
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10
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Gomes Y, Caterino-de-Araujo A, Campos K, Gonçalves MG, Leite AC, Lima MA, Araújo A, Silva MT, Espíndola O. Loop-Mediated Isothermal Amplification (LAMP) Assay for Rapid and Accurate Confirmatory Diagnosis of HTLV-1/2 Infection. Viruses 2020; 12:v12090981. [PMID: 32899621 PMCID: PMC7552020 DOI: 10.3390/v12090981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022] Open
Abstract
Laboratory diagnosis of human T-lymphotropic viruses (HTLV) 1 and 2 infection is performed by serological screening and further confirmation with serological or molecular assays. Thus, we developed a loop-mediated isothermal nucleic acid amplification (LAMP) assay for the detection of HTLV-1/2 in blood samples. The sensitivity and accuracy of HTLV-1/2 LAMP were defined with DNA samples from individuals infected with HTLV-1 (n = 125), HTLV-2 (n = 19), and coinfected with HIV (n = 82), and compared with real-time polymerase chain reaction (qPCR) and PCR-restriction fragment length polymorphism (RFLP). The overall accuracy of HTLV-1/2 LAMP (95% CI 74.8-85.5%) was slightly superior to qPCR (95% CI 69.5-81.1%) and similar to PCR-RFLP (95% CI 79.5-89.3%). The sensitivity of LAMP was greater for HTLV-1 (95% CI 83.2-93.4%) than for HTLV-2 (95% CI 43.2-70.8%). This was also observed in qPCR and PCR-RFLP, which was associated with the commonly lower HTLV-2 proviral load. All molecular assays tested showed better results with samples from HTLV-1/2 mono-infected individuals compared with HIV-coinfected patients, who present lower CD4 T-cell counts. In conclusion, HTLV-1/2 LAMP had similar to superior performance than PCR-based assays, and therefore may represent an attractive alternative for HTLV-1/2 diagnosis due to reduced working time and costs, and the simple infrastructure needed.
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Affiliation(s)
- Yago Gomes
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
- Correspondence: (Y.G.); (M.T.S.); (O.E.)
| | - Adele Caterino-de-Araujo
- Laboratory of HTLV Research, Immunology Center, Adolfo Lutz Institute, São Paulo 01246-000, Brazil; (A.C.-d.-A.); (K.C.); (M.G.G.)
| | - Karoline Campos
- Laboratory of HTLV Research, Immunology Center, Adolfo Lutz Institute, São Paulo 01246-000, Brazil; (A.C.-d.-A.); (K.C.); (M.G.G.)
| | - Maria Gisele Gonçalves
- Laboratory of HTLV Research, Immunology Center, Adolfo Lutz Institute, São Paulo 01246-000, Brazil; (A.C.-d.-A.); (K.C.); (M.G.G.)
| | - Ana Claudia Leite
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
| | - Marco Antonio Lima
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
| | - Abelardo Araújo
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
| | - Marcus Tulius Silva
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
- Correspondence: (Y.G.); (M.T.S.); (O.E.)
| | - Otávio Espíndola
- Laboratory for Clinical Research in Neuroinfections, Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (A.C.L.); (M.A.L.); (A.A.)
- Correspondence: (Y.G.); (M.T.S.); (O.E.)
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Erythroderma: a prospective study of 309 patients followed for 12 years in a tertiary center. Sci Rep 2020; 10:9774. [PMID: 32555205 PMCID: PMC7300014 DOI: 10.1038/s41598-020-66040-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/14/2020] [Indexed: 02/08/2023] Open
Abstract
Erythroderma is characterized by erythema and scaling affecting more than 80% of the body surface area. It is potentially life-threatening, and diagnosis of the underlying disease is a challenge. Despite laboratory improvements, many cases remain idiopathic. We aimed to analyze clinical and laboratory findings of 309 erythrodermic patients to find clues to the etiologic diagnosis. We performed a prospective study at the University of São Paulo Medical School, from 2007 to 2018, with patients with acquired erythroderma. Clinical, laboratory, histology, and molecular biology data were collected. The median age at diagnosis was 57 years, with a male-to-female ratio of 2.2. Eczema was the most frequent etiology (20.7%), followed by psoriasis (16.8%), Sézary syndrome (12.3%), drug eruption (12.3%), atopic dermatitis (8.7%), and mycosis fungoides (5.5%). Other diagnoses (6.8%) included pemphigus foliaceous, paraneoplastic erythroderma, adult T-cell leukemia/lymphoma, dermatomyositis, pityriasis rubra pilaris, lichen planus, bullous pemphigoid, and leprosy. In 52 patients (16.8%), it was not possible to elucidate erythroderma etiology. Atopic dermatitis developed erythroderma at an earlier age (median 25 years; P = 0.0001). Acute onset was associated with drug reactions and atopic dermatitis (median time from erythroderma to diagnosis of 1 and 1.5 months, respectively; P = 0.0001). Higher immunoglobulin E levels were observed in atopic dermatitis (median 24,600 U/L; P = 0.0001). Histopathology was helpful and was consistent with the final diagnosis in 72.4%. Monoclonal T-cell proliferation in the skin was observed in mycosis fungoides (33.3%) and Sézary syndrome (90.9%). At the last assessment, 211 patients (69.3%) were alive with disease, 65 (21.7%) were alive without disease, and 27 (9.1%) died with active disease. Erythroderma is a challenging syndrome with a difficult diagnostic approach. Younger age and higher immunoglobulin E levels are associated with atopic dermatitis; acute onset is observed in drug eruptions and atopic dermatitis. Histopathology and molecular biology tests are essential tools in the investigation of erythroderma.
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12
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Ji H, Chang L, Yan Y, Jiang X, Sun H, Guo F, Wang L. A Strategy for Screening and Confirmation of HTLV-1/2 Infections in Low-Endemic Areas. Front Microbiol 2020; 11:1151. [PMID: 32582093 PMCID: PMC7283491 DOI: 10.3389/fmicb.2020.01151] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 02/01/2023] Open
Abstract
Serological tests have been widely used for detecting human T-cell lymphotropic virus type 1/2 (HTLV-1/2) antibodies in the endemic areas, but their performance in low-risk populations is rarely reported. The aim of this study was to evaluate the performance of four HTLV-1/2 screening assays and to discuss a strategy for diagnosis of HTLV-1/2 infection in a non-endemic area. At the present study, 1546 specimens repeatedly reactive (RR) by one screening ELISA were collected from blood centers/banks from January 2016 to April 2019. Avioq-ELISA, Murex-ELISA, Roche-ECLIA and Fujirebio-CLIA were independently performed on each plasma sample and compared to WB and LIA confirmatory tests. Positive or indeterminate specimens with blood available were quantified by qPCR. The results showed that 48 samples were finally confirmed as HTLV-1 positive, 13 were HTLV positive, 151 were indeterminate, and 387 were negative. All the WB-positive samples were also LIA-positive. Roche-ECLIA showed the highest sensitivity that was able to detect 91.8% positives and combined with the Murex-ELISA would significantly increase the positive detection rate (98.4%). In addition, LIA yield more indeterminate and HTLV-untyped results than WB (152 vs. 27), but was able to resolve infection status of some individuals with an indeterminate WB. Besides, 3 WB indeterminate and 1 LIA-untyped samples were confirmed as HTLV-1 positive by qPCR. Based on these findings, we put forward a proper test strategy for HTLV-1/2 diagnosis in low-prevalence areas. If possible, the Roche-ECLIA with the highest sensitivity is suggested as a second screening assay in primary labs. If not, all RR specimens are recommended to be firstly retested by Roche-ECLIA and Murex-ELISA in the reference lab. Secondly, samples reactive to any one of the two tests were quantified by qPCR, and then the NAT-negatives were furtherly submitted to LIA for confirmation. Thereby, the cost can be reduced and the diagnostic accuracy would be improved.
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Affiliation(s)
- Huimin Ji
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Le Chang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Ying Yan
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Xinyi Jiang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huizhen Sun
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Guo
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China
| | - Lunan Wang
- National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing, China.,Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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13
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Caterino-de-Araujo A, Campos KR, Petrucci TVB, da Silva RX, Lemos MF, Moreira RC. Surveillance of human retroviruses in blood samples from patients with hepatitis B and C in São Paulo, Brazil. Rev Soc Bras Med Trop 2020; 53:e20190378. [PMID: 32049201 PMCID: PMC7083377 DOI: 10.1590/0037-8682-0378-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Human retroviruses and the hepatitis B and C viruses (HBV and HCV, respectively) share routes of transmission; thus, coinfections occur and could alter subsequent disease outcomes. A preliminary study on human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in serum samples from HBV- and HCV-infected individuals in São Paulo revealed 1.3% and 5.3% rates of coinfection, respectively. These percentages were of concern since they were detected in HTLV-endemic regions and in high-risk individuals in Brazil. The present study was conducted to extend and confirm these data. METHODS HTLV-1/2 and human immunodeficiency virus (HIV) infection status were identified in 1,984 sera for HBV and HCV viral load quantification - 1,290 samples from HBV-infected individuals (53.3% men, mean age: 47.1 years) and 694 samples from HCV-infected individuals (56.3% men, mean age: 50.1 years). HTLV-1/2 antibodies were detected by enzyme immunoassay, followed by western blotting and line immunoassay; HIV infection was detected by enzyme immunoassay. RESULTS HTLV-1/-2 infection was detected in 1.9% HBV-infected individuals (0.7% HTLV-1 and 1.2% HTLV-2) and in 4.0% (2.4% HTLV-1 and 1.6% HTLV-2) HCV-infected individuals; HIV infection was detected in 9.2% and 14.5%, respectively. Strong associations with HTLV and HIV, male sex, and older age were found in HBV/HTLV and HCV/HTLV-coinfected individuals (p<0.05). CONCLUSIONS HTLV-1 and HTLV-2 were confirmed to be prevalent in individuals with HBV and HCV in São Paulo; coinfected individuals deserve further clinical and laboratory investigation.
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Affiliation(s)
- Adele Caterino-de-Araujo
- Laboratório de Pesquisa em HTLV, Centro de Imunologia, Instituto
Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de
São Paulo, São Paulo, SP, Brasil
| | - Karoline Rodrigues Campos
- Laboratório de Pesquisa em HTLV, Centro de Imunologia, Instituto
Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de
São Paulo, São Paulo, SP, Brasil
| | - Tamirez Villas Boas Petrucci
- Laboratório de Pesquisa em HTLV, Centro de Imunologia, Instituto
Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de
São Paulo, São Paulo, SP, Brasil
| | - Rafael Xavier da Silva
- Laboratório de Pesquisa em HTLV, Centro de Imunologia, Instituto
Adolfo Lutz, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de
São Paulo, São Paulo, SP, Brasil
| | - Marcílio Figueiredo Lemos
- Laboratório de Hepatites, Núcleo de Doenças de Transmissão
Sanguínea e Sexual, Centro de Virologia, Instituto Adolfo Lutz, Coordenadoria de
Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP,
Brasil
| | - Regina Célia Moreira
- Laboratório de Hepatites, Núcleo de Doenças de Transmissão
Sanguínea e Sexual, Centro de Virologia, Instituto Adolfo Lutz, Coordenadoria de
Controle de Doenças, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP,
Brasil
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14
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Line Immunoassay for Confirmation and Discrimination of Human T-Cell Lymphotropic Virus Infections in Inconclusive Western Blot Serum Samples from Brazil. J Clin Microbiol 2019; 58:JCM.01384-19. [PMID: 31597749 PMCID: PMC6935901 DOI: 10.1128/jcm.01384-19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/07/2019] [Indexed: 01/04/2023] Open
Abstract
Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. To add information concerning the improved ability of the LIA in relation to WB when applied to samples of individuals from different risk groups from Brazil, we performed the present study. Three groups were analyzed: group 1 (G1), with 62 samples from HIV/AIDS patients from São Paulo, SP (48 WB indeterminate and 14 HTLV untypeable); group 2 (G2), with 24 samples from patients with hepatitis B or hepatitis C from São Paulo (21 WB indeterminate and 3 HTLV untypeable; 17 HIV seropositive); and group 3 (G3), with 25 samples from an HTLV outpatient clinic in Salvador, Bahia (16 WB indeterminate and 9 HTLV untypeable; all HIV seronegative). Overall, the LIA confirmed HTLV-1/2 infection (HTLV-1, HTLV-2, or HTLV) in 66.1% (G1), 83.3% (G2), and 76.0% (G3) of samples. Interestingly, the majority of WB-indeterminate results were confirmed by the LIA as being HTLV-2 positive in G1 and G2 but not in G3, in which the samples were defined as being HTLV-1 or HTLV positive. These results agree with the virus types that circulate in such patients of different regions in Brazil and emphasize that the LIA is the best serological test for confirming HTLV-1 and HTLV-2 infections, independently of being applied in HTLV-monoinfected or HTLV-coinfected individuals.
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Padalko E, Lagrou K, Delforge ML, Jansens H, Ectors N, Pirnay JP, Klykens J, Sokal E, Muylle L, Libois A, Vanderkelen A, Verbeken G, Matthys C, Goossens D, Hanssens G, Baltes M, Beele H. Biological tests carried out on serum/plasma samples from donors of human body material for transplantation: Belgian experience and practical recommendations. Cell Tissue Bank 2018; 19:681-695. [PMID: 30159824 PMCID: PMC6280847 DOI: 10.1007/s10561-018-9721-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 08/22/2018] [Indexed: 12/22/2022]
Abstract
This paper on the biological tests carried out on serum/plasma samples from donors of human body material (HBM) is the result of a project of the working Group of Superior Health Council of Belgium formed with experts in the field of HBM and infectious serology. Indeed, uncertainty about the interpretation of biological test results currently leads to the sometimes unjustified cancelling of planned donations or the rejection of harvested HBM, whilst more sophisticated diagnostic algorithms would still allow the use of organs or HBM that would otherwise have been rejected. NAT tests will not be discussed in this publication. In the first part some general aspects as the need for a formal agreement between the Tissue Establishment l and the laboratory responsible for the biological testing, but also some specifications regarding testing material, the choice of additional biological tests, and some general aspects concerning interpretation and reporting are discussed. In a second part, detailed information and recommendations concerning the interpretation are presented for each of the mandatory tests (human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis) is presented. A number of not mandatory, but regularly used optional serological tests (e.g. for the detection of antibodies to Toxoplasma gondii, Epstein-Barr virus, human T cell leukemia virus and cytomegalovirus) are also extensively discussed. Although the project was meant to provide clarification and recommendations concerning the Belgian legislation, the majority of recommendations are also applicable to testing of donors of tissues and cells in other (European) countries.
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Affiliation(s)
- Elizaveta Padalko
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University/University Hospital, De Pintelaan 185, 2P8, 9000, Ghent, Belgium.
- School of Life Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium.
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium.
| | - Katrien Lagrou
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- KU Leuven and University Hospitals of Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Marie-Luce Delforge
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Université Libre de Bruxelles/Hopital Erasme, Route de Lennik 808, 1070, Brussels, Belgium
| | - Hilde Jansens
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Nadine Ectors
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- KU Leuven and University Hospitals of Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Jean-Paul Pirnay
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Brussels, Belgium
| | - Johan Klykens
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- KU Leuven and University Hospitals of Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Etienne Sokal
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Centre de Thérapie Cellulaire, Cliniques Universitaires St Luc, Université Catholique de Louvain, 10 av Hippocrate, B 1200, Brussels, Belgium
| | - Ludo Muylle
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Agnes Libois
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- CHU Saint-Pierre, Université Libre de Bruxelles, 322 rue haute, 1000, Brussels, Belgium
| | - Alain Vanderkelen
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Brussels, Belgium
| | - Gilbert Verbeken
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Bruynstraat 1, 1120, Brussels, Belgium
| | - Conny Matthys
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University/University Hospital, De Pintelaan 185, 2P8, 9000, Ghent, Belgium
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
| | - Dominique Goossens
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- Red Cross, Namur, Belgium
| | - Geert Hanssens
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
- , Sint-Genesius-Rode, Belgium
| | - Muriel Baltes
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
| | - Hilde Beele
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University/University Hospital, De Pintelaan 185, 2P8, 9000, Ghent, Belgium
- Working Group on Cells, Tissues and Organs of the Superior Health Council of Belgium, Brussels, Belgium
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Performance of Commercially Available Serological Screening Tests for Human T-Cell Lymphotropic Virus Infection in Brazil. J Clin Microbiol 2018; 56:JCM.00961-18. [PMID: 30232131 PMCID: PMC6258847 DOI: 10.1128/jcm.00961-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022] Open
Abstract
Serological screening for human T-cell lymphotropic virus type 1 (HTLV-1) is usually performed using enzyme-linked immunosorbent assay (ELISA), particle agglutination, or chemiluminescence assay kits. Due to an antigen matrix improvement entailing the use of new HTLV antigens and changes in the format of HTLV screening tests, as well as newly introduced chemiluminescence assays (CLIAs), a systematic evaluation of the accuracy of currently available commercial tests is warranted. We aimed to assess the performance of commercially available screening tests for HTLV infection diagnosis. A diagnostic accuracy study was conducted on a panel of 397 plasma samples: 200 HTLV-negative plasma samples, 170 HTLV-positive plasma samples, and 27 plasma samples indeterminate by Western blotting (WB). WB-indeterminate samples (i.e., those yielding no specific bands for HTLV-1 and/or HTLV-2) were assessed by PCR, and the results were used to compare agreement among the commercially available ELISA screening tests. For performance analysis, WB-indeterminate samples were excluded, resulting in a final study panel of 370 samples. Three ELISA kits (Murex HTLV-1/2 [Murex], anti-HTLV-1/2 SYM Solution [SYM Solution], and Gold ELISA HTLV-1/2 [Gold ELISA]) and one CLIA kit (Architect rHTLV-1/2) were evaluated. All screening tests demonstrated 100% sensitivity. Concerning the HTLV-negative samples, the SYM Solution and Gold ELISA kits had specificity values of >99.5%, while the Architect rHTLV-1/2 test presented 98.1% specificity, followed by Murex, which had a specificity of 92.0%. Regarding the 27 samples with WB-indeterminate results, after PCR confirmation, all ELISA kits showed 100% sensitivity but low specificity. Accuracy findings were corroborated by the use of Cohen's kappa value, which evidenced slight and fair agreement between PCR analysis and ELISAs for HTLV infection diagnosis. Based on the data, we believe that all evaluated tests can be safely used for HTLV infection screening.
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Alessio L, Minichini C, Starace M, Occhiello L, Caroprese M, Di Caprio G, Sagnelli C, Gualdieri L, Pisaturo M, Onorato L, Scotto G, Macera M, De Pascalis S, Sagnelli E, Coppola N. Low prevalence of HTLV1/2 infection in a population of immigrants living in southern Italy. PLoS Negl Trop Dis 2018; 12:e0006601. [PMID: 29940042 PMCID: PMC6034900 DOI: 10.1371/journal.pntd.0006601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/06/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS To assess the prevalence of HTLV-1 and HTLV-2 infections in a cohort of immigrants living in southern Italy. FINDINGS We screened for antibody to HTLV-1/2 infection 1,498 consecutive immigrants born in endemic areas (sub-Saharan Africa or southern-Asia) by a commercial chemiluminescent microparticle immunoassay. If confirmed in a Western blot assay, which differentiates anti-HTLV-1 from anti-HTLV-2, the positive sera were tested for specific HTLV RNA by a home-made PCR. The immigrants investigated were more frequently males (89.05%), young (median age 26 years), with a low level of education (median schooling 6 years), born in sub-Saharan Africa (79.70%). They had been living in Italy for a median period of 5 months. Only one (0.07%) subject was anti-HTLV-1 -positive/HTLV-1 RNA-negative; he was an asymptomatic 27-year-old male from Nigeria with 6 years' schooling who stated unsafe sexual habits and unsafe injection therapy. CONCLUSIONS The data suggest screening for HTLV1 and HTLV-2 infections all blood donors to Italy from endemic countries at least on their first donation; however, a cost-effectiveness study is needed to clarify this topic.
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Affiliation(s)
- Loredana Alessio
- Infectious Diseases Unit, AORN Sant’ Anna and San Sebastiano, Caserta, Italy
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
| | - Carmine Minichini
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Starace
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Laura Occhiello
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mara Caroprese
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
| | - Giovanni Di Caprio
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Caterina Sagnelli
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
- Medical center, Centro Suore Missionarie della Carità, Naples, Italy
| | - Luciano Gualdieri
- Medical Center, Centro per la Tutela della Salute degli Immigrati, Naples, Italy
| | - Mariantonietta Pisaturo
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Margherita Macera
- Medical Center, Centro Sociale ex Canapificio, Caserta, Italy
- Medical Center, Centro di Accoglienza “La tenda di Abramo”, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, AORN Sant’ Anna and San Sebastiano, Caserta, Italy
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
- * E-mail:
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Medeiros ACM, Vidal LRR, Von Linsingen R, Ferin AN, Bessani Strapasson T, de Almeida SM, Raboni SM, Carvalho NS, Bordignon Nogueira M. Confirmatory molecular method for HTLV-1/2 infection in high-risk pregnant women. J Med Virol 2018; 90:998-1001. [PMID: 29288577 DOI: 10.1002/jmv.25014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/18/2017] [Indexed: 11/07/2022]
Abstract
Human T-cell lymphotropic virus types 1/2 (HTLV-1/2) are transmitted through sexual intercourse, transfusion of blood components, and vertical transmission, predominantly through breastfeeding. Six hundred forty-three pregnant women from a high-risk prenatal care unit at a general hospital were tested by serological tests using chemiluminescence (CMIA) for screening, followed by a molecular confirmatory test. Four patients (0.6%) tested positive for HTLV-1/2 by CMIA, two samples (0.3%) for each patient were confirmed as having HTLV-1 or HTLV-2 by PCR. The results show the importance of inclusion of HTLV-1/2 screening for pregnant women in high-risk prenatal care and the need for a molecular biological method to confirm HTLV-1/2 infection.
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Affiliation(s)
- Ana C M Medeiros
- Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil.,Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná, Paraná, Brazil
| | - Luine R R Vidal
- Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil
| | - Renate Von Linsingen
- Pos doctorate of the Post Graduate Program in Gynecology and Obstetric, Universidade Federal do Paraná, Paraná, Brazil
| | - Aline N Ferin
- Scientific Iniciation Program, Department of Clinical Analysis, Universidade Federal do Paraná, Paraná, Brazil
| | | | - Sergio M de Almeida
- Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Sonia M Raboni
- Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil
| | - Newton S Carvalho
- Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná, Paraná, Brazil.,Department of Gynecology and Obstetrics Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Meri Bordignon Nogueira
- Virology Section, Clinical Analyses Laboratory, Clinical Hospital, Universidade Federal do Paraná, Paraná, Brazil.,Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná, Paraná, Brazil.,Scientific Iniciation Program, Department of Clinical Analysis, Universidade Federal do Paraná, Paraná, Brazil
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19
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Campos KR, Gonçalves MG, Caterino-de-Araujo A. Short Communication: Failures in Detecting HTLV-1 and HTLV-2 in Patients Infected with HIV-1. AIDS Res Hum Retroviruses 2017; 33:382-385. [PMID: 27750018 DOI: 10.1089/aid.2016.0191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Changes in retrovirus acquisition/transmission behaviors have been reported in Brazil, with a concerning increase in HIV-1-infected individuals aged 15-39 years. In São Paulo, HIV-1/HTLV-1 and HIV-1/HTLV-2 coinfections have been associated with intravenous drug use and failure to detect HTLV-1/2 (human T cell lymphotropic virus types 1 and 2) with immunosuppression and the use of highly active antiretroviral therapy (HAART). Negative results for HTLV serologic [western blotting (WB)] and molecular [real-time PCR pol (qPCR)] confirmatory assays have been reported, whereas the best sensitivity has been found for INNO-LIA (LIA). In this study, we expand our previous data by analyzing a group of young patients (n = 1,383; median age 35.6 years) who recently acquired HIV by sexual contact, the majority of whom were HAART naïve, and comparing the performances of four HTLV confirmatory assays: LIA, WB, qPCR, and PCR-RFLP (tax). We confirmed HTLV infection in 58 (4.2%) blood samples: 29 HTLV-1, 24 HTLV-2, 1 HTLV-1+HTLV-2, and 4 HTLV. LIA, WB, qPCR, and PCR-RFLP sensitivities were 94.8%, 82.8%, 79.2%, and 74.5%, respectively. Associations of HTLV infection with female gender (OR = 2.28, 1.31-4.00) and age >40 years (p < .0001) were detected. The results confirm the low sensitivities of molecular assays and the best performance of LIA in detecting HTLV-1/2 in such patients. We hypothesize that the negative PCR results are due to the presence of defective provirus and/or low proviral load circulating in such patients, with inconclusive WB coinciding with the seroconversion period. Corroborating the associations obtained, repeated exposure is required for HTLV sexual transmission/acquisition, which is more efficient from male to female.
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Affiliation(s)
- Karoline Rodrigues Campos
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Maria Gisele Gonçalves
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | - Adele Caterino-de-Araujo
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
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20
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Campos KR, Gonçalves MG, Costa NA, Caterino-de-Araujo A. Comparative performances of serologic and molecular assays for detecting human T lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in patients infected with human immunodeficiency virus type 1 (HIV-1). Braz J Infect Dis 2017; 21:297-305. [PMID: 28343818 PMCID: PMC9428028 DOI: 10.1016/j.bjid.2017.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 11/04/2022] Open
Abstract
The present study evaluated several techniques currently available (commercial kits and in-house assays) for diagnosing human T lymphotropic viruses types 1 and 2 in two groups of patients enrolled at HIV/AIDS specialized care services in São Paulo: Group 1 (G1), n = 1608, 1237 male/371 female, median age 44.3 years old, majority using highly active antiretroviral therapy (HAART); G2, n = 1383, 930 male/453 female, median age of 35.6 years old, majority HAART naïve. Enzyme immunoassays [(EIA) Murex and Gold ELISA] were employed for human T lymphotropic viruses types 1 and 2 screening; Western blotting (WB), INNO-LIA (LIA), real-time PCR pol (qPCR), and nested-PCR-RFLP (tax) were used to confirm infection. Samples were considered human T lymphotropic viruses types 1 and 2 positive when there was reactivity using at least one of the four confirmatory assays. By serological screening, 127/2991 samples were positive or borderline, and human T lymphotropic virus infection was confirmed in 108 samples (three EIA-borderline): 56 human T lymphotropic virus type 1 [G1 (27) + G2 (29)]; 45 human T lymphotropic virus type 2 [G1 (21) + G2 (24)]; one human T lymphotropic virus type 1 + human T lymphotropic virus type 2 (G2); six human T lymphotropic virus [G1 (2) + G2 (4)]. Although there were differences in group characteristics, human T lymphotropic viruses types 1 and 2 prevalence was similar [3.1% (G1) and 4.2% (G2), p = 0.113]. The overall sensitivities of LIA, WB, qPCR, and PCR-RFLP were 97.2%, 82.4%, 68.9%, and 68.4%, respectively, with some differences among groups, likely due to the stage of human T lymphotropic virus infection and/or HAART duration. Indeterminate immunoblotting results were detected in G2, possibly due to the seroconversion period. Negative results in molecular assays could be explained by the use of HAART, the occurrence of defective provirus and/or the low circulating proviral load. In conclusion, when determining the human T lymphotropic virus infection, the findings highlight that there is a need to consider the blood samples with borderline results in screening assays. Of all the tested assays, LIA was the assay of choice for detecting human T lymphotropic virus type 1 and human T lymphotropic virus type 2 in human immunodeficiency virus type 1-infected patients.
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Affiliation(s)
- Karoline Rodrigues Campos
- Secretaria de Estado da Saúde de São Paulo, Instituto Adolfo Lutz, Centro de Imunologia, São Paulo, SP, Brazil
| | - Maria Gisele Gonçalves
- Secretaria de Estado da Saúde de São Paulo, Instituto Adolfo Lutz, Centro de Imunologia, São Paulo, SP, Brazil
| | - Nadia Aparecida Costa
- Secretaria de Estado da Saúde de São Paulo, Instituto Adolfo Lutz, Centro de Imunologia, São Paulo, SP, Brazil
| | - Adele Caterino-de-Araujo
- Secretaria de Estado da Saúde de São Paulo, Instituto Adolfo Lutz, Centro de Imunologia, São Paulo, SP, Brazil.
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21
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Retroviruses and Retroviral Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Cánepa C, Salido J, Ruggieri M, Fraile S, Pataccini G, Berini C, Biglione M. Low Proviral Load is Associated with Indeterminate Western Blot Patterns in Human T-Cell Lymphotropic Virus Type 1 Infected Individuals: Could Punctual Mutations be Related? Viruses 2015; 7:5643-58. [PMID: 26516904 PMCID: PMC4664970 DOI: 10.3390/v7112897] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND indeterminate Western blot (WB) patterns are a major concern for diagnosis of human T-cell lymphotropic virus type 1 (HTLV-1) infection, even in non-endemic areas. OBJECTIVES (a) to define the prevalence of indeterminate WB among different populations from Argentina; (b) to evaluate if low proviral load (PVL) is associated with indeterminate WB profiles; and (c) to describe mutations in LTR and tax sequence of these cases. RESULTS Among 2031 samples, 294 were reactive by screening. Of them, 48 (16.3%) were WB indeterminate and of those 15 (31.3%) were PCR+. Quantitative real-time PCR (qPCR) was performed to 52 HTLV-1+ samples, classified as Group 1 (G1): 25 WB+ samples from individuals with pathologies; Group 2 (G2): 18 WB+ samples from asymptomatic carriers (AC); and Group 3 (G3): 9 seroindeterminate samples from AC. Median PVL was 4.78, 2.38, and 0.15 HTLV-1 copies/100 PBMCs, respectively; a significant difference (p=0.003) was observed. Age and sex were associated with PVL in G1 and G2, respectively. Mutations in the distal and central regions of Tax Responsive Elements (TRE) 1 and 2 of G3 were observed, though not associated with PVL.The 8403A>G mutation of the distal region, previously related to high PVL, was absent in G3 but present in 50% of WB+ samples (p = 0.03). CONCLUSIONS indeterminate WB results confirmed later as HTLV-1 positive may be associated with low PVL levels. Mutations in LTR and tax are described; their functional relevance remains to be determined.
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Affiliation(s)
- Camila Cánepa
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Jimena Salido
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Matías Ruggieri
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Sindy Fraile
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Gabriela Pataccini
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Carolina Berini
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
| | - Mirna Biglione
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, UBA-CONICET, Paraguay 2155, piso 11, C1121ABG, CABA, Argentina.
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23
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Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Piccinini V, Liumbruno GM, Grazzini G. Human T-lymphotropic virus and transfusion safety: does one size fit all? Transfusion 2015; 56:249-60. [PMID: 26388300 DOI: 10.1111/trf.13329] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 12/17/2022]
Abstract
Human T-cell leukemia viruses (HTLV-1 and HTLV-2) are associated with a variety of human diseases, including some severe ones. Transfusion transmission of HTLV through cellular blood components is undeniable. HTLV screening of blood donations became mandatory in different countries to improve the safety of blood supplies. In Japan and Europe, most HTLV-infected donors are HTLV-1 positive, whereas in the United States a higher prevalence of HTLV-2 is reported. Many industrialized countries have also introduced universal leukoreduction of blood components, and pathogen inactivation technologies might be another effective preventive strategy, especially if and when generalized to all blood cellular products. Considering all measures available to minimize HTLV blood transmission, the question is what would be the most suitable and cost-effective strategy to ensure a high level of blood safety regarding these viruses, considering that there is no solution that can be deemed optimal for all countries.
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Affiliation(s)
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health.,Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health.,Immunohaemathology and Transfusion Medicine Unit, Azienda Ospedaliera Città Della Salute e Della Scienza, Turin, Italy
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24
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Caterino-de-Araujo A, Sacchi CT, Gonçalves MG, Campos KR, Magri MC, Alencar WK. Short Communication: Current Prevalence and Risk Factors Associated with Human T Lymphotropic Virus Type 1 and Human T Lymphotropic Virus Type 2 Infections Among HIV/AIDS Patients in São Paulo, Brazil. AIDS Res Hum Retroviruses 2015; 31:543-9. [PMID: 25464979 DOI: 10.1089/aid.2014.0287] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
During the 1990s, high prevalences of HIV/human T lymphotropic virus type 1 (HTLV-1) and HIV/human T lymphotropic virus type 2 (HTLV-2) coinfections were detected in São Paulo, Brazil in association with intravenous drug use (IDU). The current prevalences and risk factors for HIV/HTLV-1/-2 were evaluated in 1,608 patients attending the AIDS/STD Reference and Training Center in São Paulo. Blood samples were analyzed for HTLV-1/2-specific antibodies using enzyme immunoassays (EIA Murex HTLV-I+II, Diasorin, and Gold ELISA HTLV-I+II, REM) and immunoblotting (HTLV Blot 2.4, MP Biomedicals and INNO-LIA HTLV-I/II, Innogenetics) and for the pol proviral DNA segments of HTLV-1 and HTLV-2 by "in-house" real-time PCR. These analyses revealed that 50 (3.11%) of the samples were HTLV positive, including 25 (1.55%) that were HTLV-1 positive, 21 (1.31%) that were HTLV-2 positive, and 4 (0.25%) that were HTLV positive (untypeable). The median age of the HIV/HTLV-coinfected individuals was 50 years versus 44 years in the overall population (p=0.000). The risk factors associated with HIV/HTLV-1/-2 coinfections were female gender (OR 3.26, 1.78-5.95), black/pardo color (OR 2.21, 1.21-4.03), infection with hepatitis B virus (HBV) (OR 4.27, 2.32-7.87) or hepatitis C virus (HCV) (OR 24.40, 12.51-48.11), and intravenous drug use (IDU) (OR 30.01, 15.21-59.29). The current low prevalence of HTLV-1/2 in HIV-infected patients in São Paulo could be explained in part by programs providing IDUs with sterile needles and syringes and changes in the drug usage patterns of individuals from injecting cocaine to smoking crack cocaine.
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Affiliation(s)
- Adele Caterino-de-Araujo
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Cláudio Tavares Sacchi
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Maria Gisele Gonçalves
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Karoline Rodrigues Campos
- Centro de Imunologia, Instituto Adolfo Lutz, Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Mariana Cavalheiro Magri
- Laboratório de Investigação Médica em Hepatologia por Vírus–LIM 47, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wong Kuen Alencar
- Vigilância Epidemiológica, Centro de Referência e Treinamento em DST/Aids de São Paulo, São Paulo, SP, Brazil
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25
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Proviral load determination of HTLV-1 and HTLV-2 in patients' peripheral blood mononuclear cells by real-time PCR. Methods Mol Biol 2014. [PMID: 24158833 DOI: 10.1007/978-1-62703-670-2_25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
TaqMan real-time PCR assays were developed to determine the proviral load (PVL) of human T-cell leukemia viruses type 1 and 2 (HTLV-1 and HTLV-2) in peripheral blood mononuclear cells (PBMCs) of infected subjects. In particular, separate single-plex assays for HTLV-1 tax-1, and HTLV-2 tax-2 and pol-2 genes were designed for quantitation of HTLV-1 and HTLV-2 PVLs. The specificity of both tax-2 and pol-2 assays was verified by testing the DNA extracted from C10, a chronically HTLV-1-infected cell line, used as a negative control. As far as HTLV-2 assay, the specificity was checked by testing C344 cells which are stably infected by HTLV-2. Quantitative determination of HTLV PVLs was obtained by performing standard reference curves by a serial dilution of DNA extracted from C10 and C344 cells, assuming one proviral genome per C10 cell and two per C344 cell. The human albumin gene, of which there are 2 copies per cell, was quantified in the same reactions to normalize the results. Intra-assay reproducibility was checked by running 30 replicates of the same sample in a plate (coefficient of variance <6 %), while inter-assay reproducibility was measured by amplifying the same sample in three independent experiments (coefficient of variance <6 %).
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26
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Magri MC, Costa EAS, Caterino-de-Araujo A. LTR point mutations in the Tax-responsive elements of HTLV-1 isolates from HIV/HTLV-1-coinfected patients. Virol J 2012; 9:184. [PMID: 22947305 PMCID: PMC3487954 DOI: 10.1186/1743-422x-9-184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Virology Journal 2011, 8:535, Neto et al. described point mutations into Tax-responsive elements (TRE) of the LTR region of HTLV-1 isolates from asymptomatic carriers from Sao Paulo, Brazil, and hypothesized that the presence of the G232A mutation in the TRE-1 increase viral proliferation and consequently the proviral load (PvL), while the A184G mutation in the TRE-2 do not have such effect. FINDINGS We performed the real-time PCR assay (pol) and sequenced LTR region of HTLV-1 isolates from 24 HIV/HTLV-1-coinfected patients without HTLV-1-associated diseases from the same geographic area. These sequences were classified as belonging to the transcontinental subgroup A of the Cosmopolitan subtype a. The frequency of G232A mutation (16/24, 66.7%) was high as much as 61.8% reported by Neto's in HTLV-1 asymptomatic carriers with high PvL. High frequency (13/24, 54.2%) of double mutations G232A and A184G was also detected in HIV/HTLV-1-coinfected patients. We did not quantify PvL, but comparative analyses of the cycle threshold (Ct) median values of the group of isolates presenting the mutated-types sequences (Ct 33.5, n = 16) versus the group of isolates with the wild-type sequences (Ct 32, n = 8) showed no statistical difference (p = 0.4220). CONCLUSION The frequencies of mutated-type sequences in the TRE-1 and TRE-2 motifs were high in HIV/HTLV-1-coinfected patients from Sao Paulo, Brazil. If these LTR point mutations have predictive value for the development of HTLV-1-associated diseases or they correspond to the subtype of virus that circulate in this geographic area has to be determined.
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Affiliation(s)
- Mariana Cavalheiro Magri
- Immunology Department, Instituto Adolfo Lutz, Av, Dr, Arnaldo, 355, 11° andar, São Paulo, SP, 01246-902, Brazil
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27
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A new and frequent human T-cell leukemia virus indeterminate Western blot pattern: epidemiological determinants and PCR results in central African inhabitants. J Clin Microbiol 2012; 50:1663-72. [PMID: 22403426 DOI: 10.1128/jcm.06540-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Human T-cell leukemia virus (HTLV) indeterminate Western blot (WB) serological patterns are frequently observed in plasma/serum from persons living in intertropical areas. In the framework of ongoing projects on HTLV-1/2 and related viruses in Central Africa, we systematically analyzed plasma from villagers living in South Cameroon by WB. The group included 1,968 individuals (mean age, 44 years; age range, 5 to 90 years; 978 women/990 men), both Bantus (1,165) and Pygmies (803). Plasma samples were tested by WB analysis (MPD HTLV Blot 2.4) and interpreted according to the manufacturer's instructions. Only clear bands were considered in the analysis. Among the 1,968 plasma samples, 38 (1.93%) were HTLV-1, 13 (0.66%) were HTLV-2, and 6 (0.3%) were HTLV WB seropositive. Furthermore, 1,292 (65.65%) samples were WB sero-indeterminate, including 104 (5.28%) with an HTLV-1 Gag-indeterminate pattern (HGIP) and 68 (3.45%) with a peculiar yet unreported pattern exhibiting mostly a strong shifted GD21 and a p28. The other 619 (31.45%) samples were either WB negative or exhibited other patterns, mostly with unique p19 or p24 bands. DNA, extracted from peripheral blood buffy coat, was subjected to PCR using several primer pairs known to detect HTLV-1/2/3/4. Most DNAs from HTLV-1- and HTLV-seropositive individuals were PCR positive. In contrast, all the others, from persons with HTLV-2, HGIP, new WB, and other indeterminate patterns, were PCR negative. Epidemiological determinant analysis of the persons with this new peculiar WB pattern revealed that seroprevalence was independent from age, sex, or ethnicity, thus resembling the indeterminate profile HGIP rather than HTLV-1. Moreover, this new pattern persists over time.
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28
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Caterino-de-Araujo A, Magri MC, Costa EAS, Manuel RCR. Human T-lymphotropic virus type 1 infection in a patient with arthritis in mozambique: molecular characterization of human T-lymphotropic virus type 1 isolate. AIDS Res Hum Retroviruses 2011; 27:1255-7. [PMID: 21495877 DOI: 10.1089/aid.2011.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adele Caterino-de-Araujo
- Immunology Department, Adolfo Lutz Institute, Secretary of Health of São Paulo, São Paulo, S.P., Brazil
- Faculdade de Ciências Farmacêuticas–University of São Paulo, São Paulo, S.P., Brazil
- Coordenadoria de Controle de Doenças, Secretary of Health of São Paulo, São Paulo, S.P., Brazil
| | - Mariana Cavalheiro Magri
- Immunology Department, Adolfo Lutz Institute, Secretary of Health of São Paulo, São Paulo, S.P., Brazil
- Faculdade de Ciências Farmacêuticas–University of São Paulo, São Paulo, S.P., Brazil
| | - Emanuela Avelar Silva Costa
- Immunology Department, Adolfo Lutz Institute, Secretary of Health of São Paulo, São Paulo, S.P., Brazil
- Coordenadoria de Controle de Doenças, Secretary of Health of São Paulo, São Paulo, S.P., Brazil
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