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Diaz ACMB, Witkin SS, de Almeida C, Mendrone A, Rocha V, Costa SF, Ramos JF, Mendes-Correa MC. Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation. Rev Inst Med Trop Sao Paulo 2024; 66:e11. [PMID: 38324877 PMCID: PMC10846481 DOI: 10.1590/s1678-9946202466011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.
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Affiliation(s)
- Ana Claudia Marques Barbosa Diaz
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
| | - Steven Sol Witkin
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
- Weill Cornel Medicine, Department of Obstetrics and Gynecology New York, New York, USA
| | - Cesar de Almeida
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Ciências Médicas, São Paulo, São Paulo, Brazil
| | - Alfredo Mendrone
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Laboratório de Investigação Médica em Patogênese e Terapia Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Laboratório de Investigação Médica em Patogênese e Terapia Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratorio de Investigação Médica em Virologia (LIM-49, São Paulo, São Paulo, Brazil
| | - Jessica Fernandes Ramos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil
| | - Maria Cassia Mendes-Correa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
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Luz E, Marques M, Netto EM, Campos LM, Amaral S, Santana I, Marques EL, Brites C. HIV, HTLV, and Hepatitis B and C Infection in Blood Donors in Bahia, Brazil from 2008 to 2017. Viruses 2022; 14:v14112323. [PMID: 36366422 PMCID: PMC9692744 DOI: 10.3390/v14112323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Although blood transfusion is an important therapeutic resource, transfusion-transmitted infections (TTIs) are still a cause for concern. Measures to mitigate this risk involve improvement of donor screening criteria and improvements in laboratory tests, especially the use of nucleic acid test (NAT). In this retrospective study we evaluated HIV, HTLV, HCV and HBV infection rates in blood donors of the Hematology and Hemotherapy Foundation of Bahia (Hemoba), Brazil, through serological and NAT results and the characteristics of donors. From February/2008 to December/2017, 777,446 blood donations were made. Most donors were male, aged 25-44 years, black and mixed race, and single or divorced. The density-type incidence (DTI; per 100,000) for each virus was 91.1 for HBV; 66.5 for HCV; 54.3 for HIV; and 33.9 for HTLV, with a decreasing trend observed over the period studied, except in the last biennium. NAT detected only 1 donor in immunological window for HIV (0.46/100,000 donations) and 3 donors in immunological window for HBV (1.8/100,000 donations). Serological positivity for all viruses studied was higher in the metropolitan region of Salvador, the state capital. Conclusion: DTI rates show a decreasing trend over the years studied, with a predominance of HBV infection. NAT allowed the detection of donors in immunological window periods, having an important role in improving transfusion safety.
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Affiliation(s)
- Estela Luz
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, BA, Brazil
- Laboratório de Pesquisa em Infectologia, Hospital Universitário Professor Edgard Santos, Salvador 40110-060, BA, Brazil
- Fundação Bahiana de Infectologia, Salvador 40110-160, BA, Brazil
| | - Marinho Marques
- Fundação de Hematologia e Hemoterapia da Bahia, Salvador 40286-240, BA, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador 41180-045, BA, Brazil
| | - Eduardo Martins Netto
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, BA, Brazil
- Laboratório de Pesquisa em Infectologia, Hospital Universitário Professor Edgard Santos, Salvador 40110-060, BA, Brazil
- Fundação Bahiana de Infectologia, Salvador 40110-160, BA, Brazil
| | | | - Sávio Amaral
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, BA, Brazil
- Laboratório de Pesquisa em Infectologia, Hospital Universitário Professor Edgard Santos, Salvador 40110-060, BA, Brazil
- Fundação Bahiana de Infectologia, Salvador 40110-160, BA, Brazil
| | - Iraildes Santana
- Fundação de Hematologia e Hemoterapia da Bahia, Salvador 40286-240, BA, Brazil
| | | | - Carlos Brites
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, BA, Brazil
- Laboratório de Pesquisa em Infectologia, Hospital Universitário Professor Edgard Santos, Salvador 40110-060, BA, Brazil
- Fundação Bahiana de Infectologia, Salvador 40110-160, BA, Brazil
- Correspondence:
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Nishiya AS, de Almeida-Neto C, Witkin SS, Ferreira SC, Salles NA, Nogueira FAH, Oliveira CDL, Rocha V, Mendrone Júnior A. Improved detection of hepatitis C virus-positive blood donors and determination of infection status. Transfus Med 2022; 33:159-164. [PMID: 36251615 DOI: 10.1111/tme.12930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/11/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In low-risk populations, variability in the sensitivity of current serological tests for Hepatitis C virus (HCV) blood donor screening may lead to the presence of false-positive results. This contributes to the unnecessary loss of blood donor samples as well as to difficulty in accurate donor counselling. The present study determined the optimal cut-off value of a chemiluminescent immunoassay for identification of HCV-reactive blood donors. STUDY DESIGN AND METHODS In a retrospective cross-sectional analysis of 193 973 blood donations, 578 samples that were positive for HCV antibody in a chemiluminescent immunoassay and/or RNA screening tests were identified. Blood from 379 of these positive samples was available for retesting by a second confirmatory HCV immunoassay followed by a receiver operating characteristic (ROC) curve analysis. Donors were also recalled for a new analysis. RESULTS Only 71 (18.7%) blood samples remained HCV-positive upon retesting, while 233 (61.5%) now tested negative and 75 (19.8%) yielding indeterminate results. A signal to cutoff ratio ≥4.32 was determined as the best differential threshold between a positive and negative result, increasing the positive predictive value from 27.3% to 66.7%. CONCLUSION Using a higher threshold for an HCV-positive blood sample enhances the chemiluminescent immunoassay screening test´s accuracy and helps to improve donor counselling and notification processes.
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Affiliation(s)
- Anna S Nishiya
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cesar de Almeida-Neto
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Steven S Witkin
- Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil.,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, USA
| | - Suzete C Ferreira
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Nanci A Salles
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil
| | | | | | - Vanderson Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Churchill Hospital, Oxford University, Oxford, UK
| | - Alfredo Mendrone Júnior
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and targeted therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Mota Pereira F, Neves Santos FL, da Conceição Almeida Chagas M, Perez Carreiro R, Kalabric Silva L, Galvão Castro B, Rios Grassi MF. Seroprevalence and Spatial Distribution of Hepatitis C Virus in Bahia, Brazil. Am J Trop Med Hyg 2021; 105:991-998. [PMID: 34424863 PMCID: PMC8592152 DOI: 10.4269/ajtmh.20-1615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/06/2021] [Indexed: 12/13/2022] Open
Abstract
In Salvador, which is the capital of the Brazilian state of Bahia, it has been estimated that 1.5% of the general population is infected with hepatitis C virus (HCV); however, the circulation of HCV throughout the state remains unknown. The present retrospective study aimed to determine anti-HCV seroprevalence and describe the geographic distribution of hepatitis C in Bahia. Data from HCV serological tests submitted to the Bahia Central Laboratory of Public Health between 2004 and 2013 were analyzed. Serology for HCV was performed using the AxSYM anti-HCV enzymatic microparticle immunoassay and chemiluminescence immunoassay. A subgroup of samples with detectable HCV-RNA was genotyped using the linear array hepatitis C virus genotyping assay. A total of 247,837 samples were analyzed. The median age of the studied population was 31 years (interquartile range, 25–44 years), and the female:male ratio was 3.9:1. The global seroprevalence of HCV in Bahia was estimated to be 1.3% (3,230/247,837), corresponding to an infection rate of 21.2/100,000 inhabitants. The seroprevalence of HCV was higher among males and increased with age. The presence of anti-HCV antibodies was detected throughout all mesoregions of Bahia, and the municipality with the highest infection rate was Ipiaú (112.04 cases/100,000 inhabitants). Genotypes 1 and 3 were found to be the most prevalent, followed by genotypes 2, 4, and 5. Our results provide evidence of the widespread distribution of previous HCV infection throughout the state of Bahia.
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Affiliation(s)
- Felicidade Mota Pereira
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil.,Gonçalo Moniz Public Health Central Laboratory, Laboratorio Central de Saúde Pública da Bahia, Salvador, Bahia, Brazil
| | | | | | - Roberto Perez Carreiro
- Center for Integration of Data and Health Knowledge, Centro de Integração de Dados e Conhecimentos para Saúde, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil
| | - Luciano Kalabric Silva
- Bahiana School of Medicine and Public Health, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Bernardo Galvão Castro
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil.,Bahiana School of Medicine and Public Health, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - Maria Fernanda Rios Grassi
- Advanced Public Health Laboratory, Gonçalo Moniz Institute, Fiocruz-BA, Salvador, Bahia, Brazil.,Bahiana School of Medicine and Public Health, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
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Madeira HS, da Silva CM, Scapini NC, de Peder LD, Teixeira JJV. Correlation between serology and nucleic acid amplification test in blood donors who are reactive for hepatitis B virus, hepatitis C and human immunodeficiency virus and evaluation of the epidemiological profile of infected people in blood centers in the State of Paraná. Saudi Pharm J 2021; 29:586-596. [PMID: 34194265 PMCID: PMC8233538 DOI: 10.1016/j.jsps.2021.04.019] [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: 09/09/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare the results of conventional serological tests and molecular technology (NAT, Nucleic Acid Amplification Test), identify donors in the diagnostic window period, and determine the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among the samples of blood donors blocked by serological screening. Methods A retrospective cross-sectional study was carried out by analyzing blood donor information contained in the database of 20 blood centers in Paraná, from January 2018 to December 2019. Results A total of 1,496 blood bags were reactive for HBV, HCV, or HIV in serological and/or NAT tests. The 20th Regional Health (RH) Unit had the greatest number of unfit individuals with altered screening for the three infections, with a prevalence of 0.70%. The lowest number of blocked blood donors occurred in the 15th RH, with a prevalence of 0.08%. The highest prevalence of HBV occurred in the 8th RH, with a reagent serology of 0.34% and a positive NAT of 0.17%. For HCV, the prevalence for reagent serology was 0.28%, while that for NAT was 0.02%, which occurred in the 20th RH. For HIV and for NAT, the prevalence of blood donors with positive serology occurred in the 20th RH, at 0.25% and 0.04%, retrospectively. The 13th RH had the highest prevalence of HIV in relation to NAT, that is, conventional serology in concomitance with NAT technology, at 0.07%. During the 2-year period, only 1 reactive donor in the 9th was found for NAT (HBV), in a diagnostic window. Conclusion In Paraná’s blood centers, the inability to donate due to HBV, HCV, and HIV, occurred mainly in initial donors, men, those with >8 years of education, aged 16–45 years, married, and O positive. The most affected regions were located in the west and northwest of Paraná. Most of the results showed a discrepancy between the methodologies used.
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Affiliation(s)
- Heloise Skiavine Madeira
- Clinical Analyses Laboratory, University Center of Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
| | - Claudinei Mesquita da Silva
- Clinical Analyses Laboratory, University Center of Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
- Post-Graduate Program in Health Sciences, Maringá State University, Maringá, Paraná, Brazil
| | | | - Leyde Daiane de Peder
- Clinical Analyses Laboratory, University Center of Assis Gurgacz Foundation, Cascavel, Paraná, Brazil
- Post-Graduate Program in Biosciences and Physiopathology, Maringá State University, Maringá, Paraná, Brazil
- Corresponding author at: University Center of the Assis Gurgacz Foundation, Cascavel, Paraná, Brazil.
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Pessoni LL, Aquino ÉCD, Alcântara KCD. Prevalence and trends in transfusion-transmissible infections among blood donors in Brazil from 2010 to 2016. Hematol Transfus Cell Ther 2019; 41:310-315. [PMID: 31409582 PMCID: PMC6978541 DOI: 10.1016/j.htct.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 02/12/2019] [Accepted: 03/22/2019] [Indexed: 01/27/2023] Open
Abstract
Background Assessing trends in the rate of transfusion-transmissible infections (TTIs) in blood donors is critical to the monitoring of the blood supply safety and the donor screening effectiveness. The objective of this study was to conduct a trend analysis of TTIs and associated demographic factors of donors at a public blood bank in the central Brazil. Methods A retrospective analysis (2010–2016) of blood donation data was performed to determine the prevalence of markers for TTIs. Multinomial and multivariate logistic regression were used to verify the association between the explanatory variables and TTIs. The trend was evaluated with the Prais Winsten’s regression analysis. Results The prevalence of TTIs was 4.04% (5,553 donors) among 137,209 donors, with a steady trend in the analyzed period. The seroprevalence for the hepatitis B virus (HBV), syphilis, hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease, and human T-lymphotropic virus (HTLV) were 1.63%, 0.87%, 0.46%, 0.21%, 0.21% and 0.09%, respectively. The prevalence of HBV decreased (b = −0.021, p < 0.001), while syphilis increased (b = 0.112; p = 0.001), during the period investigated. The probability for a positive test for TTI was higher among donors with a low level of education, aged ≥30 years old, without stable marital status, and first-time donors. Conclusions Even with the reduction in HBV, the increased rate of syphilis may have contributed to the fact that the overall rate of TTIs did not decrease in the evaluated period.
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Levi JE. Emerging Infectious Agents and Blood Safety in Latin America. Front Med (Lausanne) 2018; 5:71. [PMID: 29594126 PMCID: PMC5861148 DOI: 10.3389/fmed.2018.00071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/01/2018] [Indexed: 12/05/2022] Open
Abstract
Historically, emerging infectious agents have been an important driving force toward the enhancement of blood safety, illustrated by the sharp reduction in the transmission of infectious agents by blood transfusion after human immunodeficiency virus (HIV) epidemics. In general, Latin American (LATAM) countries have introduced screening for microorganisms with proven blood transmission with some delay in comparison to developed countries, but, nowadays, all LATAM countries comply with a minimum standard of screening which includes Hepatitis B, C, HIV, Treponema pallidum, and Trypanosoma cruzi. Noticeably, all those agents, in addition to HTLV, cause chronic infections. By contrast, in the last decade, the region has witnessed explosive outbreaks of arboviral diseases, representing a new challenge to the blood system, threatening not only blood safety but also availability. So far, the clinical impact of transfusion-transmitted Dengue, Chikungunya, or Zika has not been evident, precluding immediate reaction from the authorities. A number of other arboviruses are endemic in the region and may, unpredictably, originate new epidemics. Several measures must be taken in preparedness for the potential emergence of another arbodisease.
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