Clinical performance of Determine HBsAg 2 rapid test for Hepatitis B detection

Hepatitis B virus (HBV) infection is estimated to affect 292 million people worldwide, 90% of them are unaware of their HBV status. The Determine HBsAg 2 (Alere Medical Co, Ltd Chiba Japan [Now Abbott]) is a rapid test that meets European Union (EU) regulatory requirements for Hepatitis B surface antigen 2 (HBsAg) analytical sensitivity, detecting the 0.1 IU/mL World Health Organization (WHO) International HBsAg Standard. This prospective, multicentre study was conducted to establish its clinical performance. 351 evaluable subjects were enrolled, 145 HBsAg-positive. The fingerstick whole blood sensitivity and specificity were 97.2% and 98.5% (15' reading, reference assay cut-off 0.05 IU/mL), sensitivity increasing to 97.9% with the prespecified cut-off 0.13 IU/mL (EU regulations). The venous whole blood, serum and plasma sensitivity was 97.2%, 97.9%, and 98.6%, respectively (15' reading); reaching 99%, 99.5% and 100% specificity. A testing algorithm following up an initial positive fingerstick test result with plasma/serum test demonstrates 100% specificity. The Determine HBsAg 2 test gives 15-minute results with high sensitivity and specificity, making it an ideal tool for point-of-care testing, with the potential to enable large-scale population-wide screening to reach the WHO HBV diagnostic targets. The evaluated test improves the existing methods as most of the reviewed rapid tests do not meet the EU regulatory requirements of sensitivity.

Recurrent hepatobiliary sepsis in a patient with von Meyenburg complexes: a case report and review of the literature

The von Meyenburg complex (VMC) is a rare, congenital malformation of the ductal plate. It is typically asymptomatic and usually discovered incidentally. We report a unique case of recurrent life-threatening hepatobiliary sepsis caused by VMC and a review of the literature. A 62-year-old man presented with recurrent episodes of life-threatening hepatobiliary sepsis. Extensive investigations only showed that he has VMCs without any other source of sepsis or underlying immunodeficiency states. Despite prolonged courses of antibiotics which resolved each episode of sepsis, he suffers repeated recurrences of hepatobiliary sepsis. Liver transplantation is now being considered in view of his refractoriness to medical therapy. As VMC can present with severe hepatobiliary sepsis, it is therefore essential to recognise its presence. This case adds to the literature the atypical but life-threatening clinical presentation of VMC.

Autoimmunity and HIV

PURPOSE OF REVIEW

This review focuses on some of the recent advances in the understanding of HIV immunopathogenesis and the diagnosis and treatment of several autoimmune conditions associated with HIV in the era of potent antiretroviral therapy.

RECENT FINDINGS

Chronic immune activation with progressive immune exhaustion are central features of HIV pathogenesis. The role of self-reactive T cells in the generation and maintenance of this process has recently been described. The understanding of the impact of immune dysregulation on the generation of autoimmune phenomena in HIV infection remains incomplete. The diagnosis of autoimmune diseases in the context of HIV is often difficult due to similarities in clinical presentations and laboratory markers. The antiretroviral therapy-associated immune reconstitution syndrome can present as autoimmune disease.

SUMMARY

The cause, frequency and prognosis of autoimmune conditions associated with HIV infection remain somewhat uncertain. Their management is often empirical with the use of novel immunosuppressive medication.

Tuberculosis complicating treatment of hepatitis C in an HIV-infected haemophilia A patient

Pegylated interferon (pegIFN)/ribavirin has been established as the treatment of choice for chronic hepatitis C in HIV co-infected individuals [1-3]. We report the case of an individual who was well prior to treatment, but was diagnosed with tuberculous adenitis after receiving 12 weeks of pegIFN/ribavirin therapy. The association of pegIFN and ribavirin therapy with tuberculosis (TB) has not been described previously.