1
|
Kanık Yüksek S, Arman Bilir Ö, Erat T, Gülhan B, Kanbur ŞM, Bayhan Gİ, Ok Bozkaya İ, Özkaya Parlakay A, Özbek NY. Monitoring of adenoviremia in pediatric patients undergoing hematopoietic stem cell transplantation: Is it alone sufficient to predict adenoviral disease? Pediatr Transplant 2024; 28:e14696. [PMID: 38317343 DOI: 10.1111/petr.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 10/23/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND We aimed to evaluate our pediatric HSCT recipients routinely monitored for adenoviremia and to determine the adequacy of this monitoring in predicting adenoviral disease (AD). METHODS A retrospective cohort of patients who underwent allogeneic HSCT between January 2021 and August 2022, and routinely monitored for adenoviremia by real-time PCR was included in our survey. Demographic and clinical data of the patients were recorded. Incidence rates, risk factors, and mortality rates related to adenoviremia, and AD were analyzed. RESULTS Among 104 HSCTs performed in 94 patients adenovirus (AdV) was revealed in 27 (26%) episodes and adenoviremia in 18 (17.3%) HSCT episodes. AD without adenoviremia developed in nine episodes (8.6%). Disseminated disease was significantly more frequently detected in episodes with adenoviremia (p = .008). GVHD was independent risk factor for AdV detection (OR: 8.6, 95% CI: 2.03-33.7, p = .001). Viremia developed within a shorter time interval after HSCT in isolated episodes of adenoviremia compared to those with concomitant AD (p = .006). Initial and peak viral loads were significantly higher in adenoviremia with AD (p < .001). Mortality was higher in the AdV-detected episodes (p < .001) than in the AdV-undetected episodes. AdV-related mortality was found to be 22.2%. Adenoviremia increased the risk of mortality (OR: 1.2, 95% CI: 0.22-1.33, p = .01). CONCLUSIONS Adenoviremia monitoring is an important process in the detection of AD. Since some patients may develop AD without accompanying by adenoviremia, monitoring for AdV in blood samples should be supported with other monitoring methods in order to evaluate the probable involvement of different organs or systems.
Collapse
Affiliation(s)
- Saliha Kanık Yüksek
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Özlem Arman Bilir
- Department of Pediatric Hematology/Oncology, Paediatric Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Belgin Gülhan
- Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Şerife Mehtap Kanbur
- Department of Pediatric Hematology/Oncology, Paediatric Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Gülsüm İclal Bayhan
- Department of Pediatric Infectious Disease, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - İkbal Ok Bozkaya
- Department of Pediatric Hematology/Oncology, Paediatric Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Aslınur Özkaya Parlakay
- Department of Pediatric Infectious Disease, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Department of Pediatric Hematology/Oncology, Paediatric Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Rosen JG, Ssekubugu R, Chang LW, Ssempijja V, Galiwango RM, Ssekasanvu J, Ndyanabo A, Kisakye A, Nakigozi G, Rucinski KB, Patel EU, Kennedy CE, Nalugoda F, Kigozi G, Ratmann O, Nelson LJ, Mills LA, Kabatesi D, Tobian AAR, Quinn TC, Kagaayi J, Reynolds SJ, Grabowski MK. Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study. J Int AIDS Soc 2024; 27:e26200. [PMID: 38332519 PMCID: PMC10853573 DOI: 10.1002/jia2.26200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Population-level data on durable HIV viral load suppression (VLS) following the implementation of Universal Test and Treat (UTT) in Africa are limited. We assessed trends in durable VLS and viraemia among persons living with HIV in 40 Ugandan communities during the UTT scale-up. METHODS In 2015-2020, we measured VLS (<200 RNA copies/ml) among participants in the Rakai Community Cohort Study, a longitudinal population-based HIV surveillance cohort in southern Uganda. Persons with unsuppressed viral loads were characterized as having low-level (200-999 copies/ml) or high-level (≥1000 copies/ml) viraemia. Individual virologic outcomes were assessed over two consecutive RCCS survey visits (i.e. visit-pairs; ∼18-month visit intervals) and classified as durable VLS (<200 copies/ml at both visits), new/renewed VLS (<200 copies/ml at follow-up only), viral rebound (<200 copies/ml at initial visit only) or persistent viraemia (≥200 copies/ml at both visits). Population prevalence of each outcome was assessed over calendar time. Community-level prevalence and individual-level predictors of persistent high-level viraemia were also assessed using multivariable Poisson regression with generalized estimating equations. RESULTS Overall, 3080 participants contributed 4604 visit-pairs over three survey rounds. Most visit-pairs (72.4%) exhibited durable VLS, with few (2.5%) experiencing viral rebound. Among those with any viraemia at the initial visit (23.5%, n = 1083), 46.9% remained viraemic through follow-up, 91.3% of which was high-level viraemia. One-fifth (20.8%) of visit-pairs exhibiting persistent high-level viraemia self-reported antiretroviral therapy (ART) use for ≥12 months. Prevalence of persistent high-level viraemia varied substantially across communities and was significantly elevated among young persons aged 15-29 years (vs. 40- to 49-year-olds; adjusted risk ratio [adjRR] = 2.96; 95% confidence interval [95% CI]: 2.21-3.96), males (vs. females; adjRR = 2.40, 95% CI: 1.87-3.07), persons reporting inconsistent condom use with non-marital/casual partners (vs. persons with marital/permanent partners only; adjRR = 1.38, 95% CI: 1.10-1.74) and persons reporting hazardous alcohol use (adjRR = 1.09, 95% CI: 1.03-1.16). The prevalence of persistent high-level viraemia was highest among males <30 years (32.0%). CONCLUSIONS Following universal ART provision, most persons living with HIV in south-central Uganda are durably suppressed. Among persons exhibiting any viraemia, nearly half exhibited high-level viraemia for ≥12 months and reported higher-risk behaviours associated with onward HIV transmission. Intensified efforts linking individuals to HIV treatment services could accelerate momentum towards HIV epidemic control.
Collapse
Affiliation(s)
- Joseph Gregory Rosen
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Larry W. Chang
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Victor Ssempijja
- Rakai Health Sciences ProgramEntebbeUganda
- Clinical Monitoring Research Program DirectorateFrederick National Laboratory for Cancer ResearchFrederickMarylandUSA
| | | | - Joseph Ssekasanvu
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
| | | | | | | | - Katherine B. Rucinski
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Eshan U. Patel
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Caitlin E. Kennedy
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
| | | | | | | | - Lisa J. Nelson
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Lisa A. Mills
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Donna Kabatesi
- Division of Global HIV and TBCenters for Disease Control and PreventionKampalaUganda
| | - Aaron A. R. Tobian
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Thomas C. Quinn
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | | | - Steven J. Reynolds
- Rakai Health Sciences ProgramEntebbeUganda
- Division of Infectious DiseasesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
| | - Mary Kathryn Grabowski
- Rakai Health Sciences ProgramEntebbeUganda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
3
|
Shawky H, Tabll AA, Elshenawy RM, Helmy NM, Moustafa RI, Elesnawy YK, Abdelghany MM, El-Abd YS. Glycylglycine promotes the solubility and antigenic utility of recombinant HCV structural proteins in a point-of-care immunoassay for detection of active viremia. Microb Cell Fact 2024; 23:25. [PMID: 38238770 PMCID: PMC10795219 DOI: 10.1186/s12934-024-02297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Although E. coli is generally a well-opted platform for the overproduction of recombinant antigens as heterologous proteins, the optimization of expression conditions to maximize the yield of functional proteins remains empirical. Herein, we developed an optimized E. coli (BL21)-based system for the overproduction of soluble immunoreactive HCV core/envelope proteins that were utilized to establish a novel immunoassay for discrimination of active HCV infection. METHODS The core/E1-E2 genes were amplified and expressed in E. coli BL21 (DE3) in the absence/presence of glycylglycine. The antigenic performance of soluble proteins was assessed against 63 HCV-seronegative (Ab-) sera that included normal and interferent sera (HBV and/or chronic renal failure), and 383 HCV-seropositive (Ab+) samples that included viremic (chronic/relapsers) and recovered patients' sera. The color intensity (OD450) and S/Co values were estimated. RESULTS The integration of 0.1-0.4M glycylglycine in the growth media significantly enhanced the solubility/yield of recombinant core and envelope proteins by ~ 225 and 242 fold, respectively. This was reflected in their immunoreactivity and antigenic performance in the developed immunoassay, where the soluble core/E1/E2 antigen mixture showed 100% accuracy in identifying HCV viremic sera with a viral RNA load as low as 3800 IU/mL, without cross-reactivity against normal/interferent HCV-Ab-sera. The ideal S/Co threshold predicting active viremia (> 2.75) showed an AUC value of 0.9362 (95% CI: 0.9132 to 0.9593), with 87.64, 91.23% sensitivity and specificity, and 94.14, 82.11% positive and negative predictive values, respectively. The different panels of samples assayed with our EIA showed a good concordance with the viral loads and also significant correlations with the golden standards of HCV diagnosis in viremic patients. The performance of the EIA was not affected by the immunocompromised conditions or HBV co-infection. CONCLUSION The applicability of the proposed platform would extend beyond the reported approach, where glycylglycine, low inducer concentration and post-induction temperature, combined with the moderately-strong constitutive promoter enables the stable production of soluble/active proteins, even those with reported toxicity. Also, the newly developed immunoassay provides a cost-effective point-of-care diagnostic tool for active HCV viremia that could be useful in resource-limited settings.
Collapse
Affiliation(s)
- Heba Shawky
- Therapeutic Chemistry Department, Pharmaceutical Industries and Drug Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Ashraf A Tabll
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Reem M Elshenawy
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Naiera M Helmy
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt
| | - Rehab I Moustafa
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt
| | | | - Marwa M Abdelghany
- National Committee for Control of Viral Hepatitis (NCCVH), Ministry of Health and Population, Cairo, Egypt
| | - Yasmine S El-Abd
- Microbial Biotechnology Department, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, 12622, Egypt.
| |
Collapse
|
4
|
Kaya Aksoy G, Erkan M, Koyun M, Çomak E, Toru HS, Mutlu D, Akkaya B, Akman S. Treatment of BK Polyomavirus-Associated Nephropathy in Paediatric Kidney Transplant Recipients: Leflunomide Versus Cidofovir. EXP CLIN TRANSPLANT 2024; 22:29-34. [PMID: 38149668 DOI: 10.6002/ect.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVES BK polyomavirus-associated nephropathy is a clinicopathological entity that negatively affects graft function in kidney transplant recipients. We compared the efficacy of leflunomide and cidofovir to treat BK polyomavirus-associated nephropathy in pediatric kidney transplant recipients. MATERIALS AND METHODS Medical records of pediatric recipients with BK viremia for the period 2004 through 2019 were reviewed retrospectively, and patients diagnosed with BK polyomavirusassociated nephro-pathy were included in the study. A serum BK virus level above 104 copies/mL was accepted as BK viremia. We defined BK polyomavirusassociated nephropathy as detection of BK virus SV40 antigen on immunochemistry staining of renal graft tissue accompanied by signs of tubulointerstitial nephritis or elevated serum creatinine in addition to BK viremia. RESULTS Of 304 kidney transplant recipients, 53 had persistent BK viremia; 36 of these patients (61.1% male) were included in the study with the diagnosis of BK polyomavirus-associated nephropathy. Twelve patients (33.3%) received cidofovir, and 14 (38.8%) received leflunomide. Results were similar between the cidofovir and leflunomide groups for serum creatinine level at last follow-up (0.91 ± 0.29 vs 0.94 ± 0.37 mg/dL, respectively; P = .843) and graft failure rate (8.3% vs 14.2%, respectively; P = .632). Graft failure was observed in 8.3% of patients with BK polyomavirus-associated nephropathy. CONCLUSIONS Leflunomide and cidofovir showed similar efficacy for treatment of BK polyomavirus-associated nephropathy.
Collapse
Affiliation(s)
- Gülşah Kaya Aksoy
- From the Department of Pediatric Nephrology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Pajenda S, Gerges DA, Freire R, Wagner L, Hevesi Z, Aiad M, Eder M, Schmidt A, Winnicki W, Eskandary FA. Acute Kidney Injury and BK Polyomavirus in Urine Sediment Cells. Int J Mol Sci 2023; 24:17511. [PMID: 38139342 PMCID: PMC10744141 DOI: 10.3390/ijms242417511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Polyomaviruses are widespread, with BK viruses being most common in humans who require immunosuppression due to allotransplantation. Infection with BK polyomavirus (BKV) may manifest as BK virus-associated nephropathy and hemorrhagic cystitis. Established diagnostic methods include the detection of polyomavirus in urine and blood by PCR and in tissue biopsies via immunohistochemistry. In this study, 79 patients with pathological renal retention parameters and acute kidney injury (AKI) were screened for BK polyomavirus replication by RNA extraction, reverse transcription, and virus-specific qPCR in urine sediment cells. A short fragment of the VP2 coding region was the target of qPCR amplification; patients with (n = 31) and without (n = 48) a history of renal transplantation were included. Urine sediment cell immunofluorescence staining for VP1 BK polyomavirus protein was performed using confocal microscopy. In 22 patients with acute renal injury, urinary sediment cells from 11 participants with kidney transplantation (KTX) and from 11 non-kidney transplanted patients (nonKTX) were positive for BK virus replication. BK virus copies were found more frequently in patients with AKI stage III (n = 14). Higher copy numbers were detected in KTX patients having experienced BK polyoma-nephropathy (BKPyVAN) in the past or diagnosed recently by histology (5.6 × 109-3.1 × 1010). One patient developed BK viremia following delayed graft function (DGF) with BK virus-positive urine sediment. In nonKTX patients with BK copies, decoy cells were absent; however, positive staining of cells was found with epithelial morphology. Decoy cells were only found in KTX patients with BKPyVAN. In AKI, damage to the tubular epithelium itself may render the epithelial cells more permissive for polyoma replication. This non-invasive diagnostic approach to assess BK polyomavirus replication in urine sediment cells has the potential to identify KTX patients at risk for viremia and BKPyVAN during AKI. This method might serve as a valuable screening tool for close monitoring and tailored immunosuppression decisions.
Collapse
Affiliation(s)
- Sahra Pajenda
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Daniela Anna Gerges
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Raimundo Freire
- Unidad de Investigación, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain;
- Instituto de Tecnologías Biomédicas, Centro de Investigaciones Biomédicas de Canarias, Facultad de Medicina, Universidad de La Laguna, Campus Ciencias de la Salud, 38200 Santa Cruz de Tenerife, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias (UFP-C), 35450 Las Palmas de Gran Canaria, Spain
| | - Ludwig Wagner
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Zsofia Hevesi
- Center for Brain Research, Medical University of Vienna, 1090 Vienna, Austria;
| | - Monika Aiad
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Michael Eder
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Alice Schmidt
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Wolfgang Winnicki
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| | - Farsad Alexander Eskandary
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (L.W.); (M.A.); (M.E.); (A.S.); (W.W.); (F.A.E.)
| |
Collapse
|
6
|
Yilmaz VT, Kisaoglu A, Avanaz A, Dandin O, Ozel D, Mutlu D, Akkaya B, Aydinli B, Kocak H. Predictive Factors of BK Virus Development in Kidney Transplant Recipients and the Effect of Low-Dose Tacrolimus Plus Everolimus on Clinical Outcomes. EXP CLIN TRANSPLANT 2023; 21:727-734. [PMID: 37885288 DOI: 10.6002/ect.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES This study aimed to determine the predictive factors of BK virus viremia/nephropathy in kidney transplant recipients and to evaluate the effects of low-dose tacrolimus plus everolimus. MATERIALS AND METHODS This study included 3654 kidney transplant recipients. The patients were divided into 2 groups: group 1 were BK virus negative (n = 3525, 96.5%) and group 2 were BK virus positive (n = 129, viremia 3.5%, nephropathy 1%). Predictive factors were determined by receiver operating characteristic curve analysis and logistic regression models.We also divided and analyzed patients with BK virus viremia/nephropathy into 2 groups according to immunosuppressive changes. Group 2a had been switched to low-dose tacrolimus plus everolimus (n = 54, 41.9%), and group 2b had been switched to other immunosuppressive protocols (n = 75, 58.1%). RESULTS We found that use of anti-T-cell lymphocyte globulin and tacrolimus, deceased donor transplant, and rejection were predictive factors for BK virus viremia/nephropathy. In addition, patients who had low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor regimens showed a low rate of BK virus development(only 6.2% of all cases). In Group 2a, both the BK polyomavirus-associated nephropathy rate (n = 23 [42.6%] vs n = 12 [16%] in group 2b; P = .001) and viral load (DNA > 104 copies/mL) (n = 49 [90.7%] vs n = 27 [36%] in group 2b; P = .001) were increased versus group 2b. Graft function, graft survival, viral clearance, and rejection rate were similar between the groups after protocol change. CONCLUSIONS BK virus viremia/nephropathy rate was lower in patients who received low-dose calcineurin inhibitor plus mammalian target of rapamycin inhibitor protocols; the low-dose tacrolimus plus everolimus switch protocol after BK virus was more effective and safe than other protocols.
Collapse
Affiliation(s)
- Vural Taner Yilmaz
- From the Department of Internal Medicine, Division of Nephrology Akdeniz University Medical School, Antalya, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Ning J. Disease Not To Be Ignored: The Second Viremia of Coxsackie. Pediatr Infect Dis J 2023; 42:e134-e135. [PMID: 36728670 DOI: 10.1097/inf.0000000000003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Junjie Ning
- Department of pediatrics, First People's Hospital of Zigong City, Sichuan Province, Zigong, China
| |
Collapse
|
8
|
Not A, Saludes V, Gálvez M, Miralpeix A, Bordoy AE, González N, González-Gómez S, Muntané L, Reyes-Urueña J, Majó X, Colom J, Forns X, Lens S, Martró E. Usefulness of dried blood spot samples for monitoring hepatitis C treatment outcome and reinfection among people who inject drugs in a test-and-treat program. J Med Virol 2023; 95:e28544. [PMID: 36727653 DOI: 10.1002/jmv.28544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
Dried blood spots (DBS) are a reliable tool to diagnose viremic hepatitis C virus (HCV) infection. We evaluated the clinical performance of a DBS-based molecular assay for the assessment of cure and reinfection after on-site treatment at a harm reduction center (HRC). Genotyping from DBS samples was also assessed to discriminate reinfection from treatment failure. People who inject drugs (PWID) from an ongoing test-and-treat pilot at the largest HRC in Barcelona were included in the study. HCV-RNA detection from DBS collected after treatment (with follow-up at 12, 36, and 60 weeks) was compared with a molecular point-of-care test using finger-stick blood (GeneXpert). Baseline and follow-up DBS samples were genotyped by NS5B sequencing or commercial real-time PCR. Among treated patients, 193 follow-up DBS samples were tested. The DBS-based assay showed 100% specificity (129/129), and sensitivity ranged from 84.4% to 96.1% according to different viral load cut-offs (from detectable to 3000 IU/mL). Sensitivity as test of cure (follow-up 12) ranged from 85.1% to 97.4%. Among the 64 patients with recurrent viremia, 10.9% had low viral loads (≤1000 IU/mL); HCV genotyping allowed us to classify 73.5% of viremic cases either as reinfection or as treatment failure. DBS samples are useful to assess cure and differentiate reinfection from relapse after HCV antiviral treatment in the real world, facilitating decentralization of treatment and posttreatment follow-up in PWID. However, a fraction of patients presented with low viral loads, limiting viremia detection and genotyping in DBS and, therefore, repeat testing is recommended.
Collapse
Affiliation(s)
- Anna Not
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Genetics and Microbiology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Verónica Saludes
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Mont Gálvez
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Miralpeix
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antoni E Bordoy
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | | | - Sara González-Gómez
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Laura Muntané
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Juliana Reyes-Urueña
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Center for Epidemiological Studies on HIV/AIDS and STIs of Catalonia (CEEISCAT), ASPCAT, Barcelona, Spain
| | - Xavier Majó
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Agència de Salut Pública de Catalunya (ASPCAT), Barcelona, Spain
| | - Joan Colom
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Agència de Salut Pública de Catalunya (ASPCAT), Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Centre in Liver and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Martró
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Genetics and Microbiology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
9
|
Abstract
HIV-1 DNA exists in nonintegrated linear and circular episomal forms and as integrated proviruses. In patients with plasma viremia, most peripheral blood mononuclear cell (PBMC) HIV-1 DNA consists of recently produced nonintegrated virus DNA while in patients with prolonged virological suppression (VS) on antiretroviral therapy (ART), most PBMC HIV-1 DNA consists of proviral DNA produced months to years earlier. Drug-resistance mutations (DRMs) in PBMCs are more likely to coexist with ancestral wild-type virus populations than they are in plasma, explaining why next-generation sequencing is particularly useful for the detection of PBMC-associated DRMs. In patients with ongoing high levels of active virus replication, the DRMs detected in PBMCs and in plasma are usually highly concordant. However, in patients with lower levels of virus replication, it may take several months for plasma virus DRMs to reach detectable levels in PBMCs. This time lag explains why, in patients with VS, PBMC genotypic resistance testing (GRT) is less sensitive than historical plasma virus GRT, if previous episodes of virological failure and emergent DRMs were either not prolonged or not associated with high levels of plasma viremia. Despite the increasing use of PBMC GRT in patients with VS, few studies have examined the predictive value of DRMs on the response to a simplified ART regimen. In this review, we summarize what is known about PBMC HIV-1 DNA dynamics, particularly in patients with suppressed plasma viremia, the methods used for PBMC HIV-1 GRT, and the scenarios in which PBMC GRT has been used clinically.
Collapse
Affiliation(s)
- Carolyn Chu
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
| | - Daniele Armenia
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Charles Walworth
- LabCorp-Monogram Biosciences, South San Francisco, California, USA
| | - Maria M. Santoro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Robert W. Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
10
|
King W, Richhart R, Hernandez Gonzalo D, Zimmerman E. Cytomegaloviral colitis in primary CMV viraemia in a young immunocompetent adult. BMJ Case Rep 2022; 15:e249891. [PMID: 36220260 PMCID: PMC9557276 DOI: 10.1136/bcr-2022-249891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
A man in his 20s presented with a 2-week history of fever, fatigue and diarrhoea. On arrival to the emergency department, he had clinical findings of sepsis. The care team initially suspected sepsis secondary to bacterial colitis and administered antibiotics. Further workup including a stool PCR assay for gastrointestinal pathogens failed to establish a diagnosis, and he had no evidence of immune compromise. Colonoscopy revealed mucosal ulceration presumed to be ulcerative colitis. Histopathology obtained after discharge revealed severe colitis with cytomegalovirus (CMV) inclusions. Serological studies indicated a primary CMV infection. To our knowledge, this is the first report of a primary CMV infection presenting as severe colitis and systemic disease in a young immunocompetent patient without underlying disease.
Collapse
Affiliation(s)
- William King
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Raymond Richhart
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Ellen Zimmerman
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| |
Collapse
|
11
|
van Drimmelen H, Lelie N. Early Dynamics of Hepatitis B Virus (HBV)-DNA and Surface Antigen (HBsAg) in Ramp-Up Phase of Viremia: Implications for Performance Evaluation of Blood Screening Assays. Viruses 2022; 14:v14091942. [PMID: 36146748 PMCID: PMC9503664 DOI: 10.3390/v14091942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
The Common Specifications/EU 2017/746 regulation for market approval of class D in vitro diagnostic devices (IVDs) intended for detection of blood borne viruses requires testing of the International Standard and 10–30 seroconversion panels to demonstrate ‘state of the art’ assay performance. We examined whether these requirements for performance evaluation are reasonable for HBV-DNA and HBsAg assays. For this purpose, we quantified HBsAg and HBV-DNA (genotype A) in the ramp-up phase of five seroconversion panels and demonstrated a remarkably parallel increase in the Log concentration of both analytes over time. Testing of seroconversion panels by three nucleic acid amplification technology (NAT) methods in multiple replicates and probit analysis with sufficient critical samples from all five panels taken together showed detection limits in copies/mL that were comparable to those on a HBV-DNA genotype A standard dilution panel. This indicates that the viral doubling time in the ramp-up phase is equal above and below the quantification limit of the viral load assay. The geometric mean HBsAg (PRISM) cutoff crossing point was 20 days later than the 50% NAT (Ultrio Plus) conversion point equivalent to 1500 (range: 1100–2200) and 4.8 (CI: 3.7–6.4) HBV-DNA copies/mL, respectively. Analytical sensitivity data of different NAT assay versions obtained over a decade demonstrated that the detection limit on the International Standard is not representative of all genotyped reference samples. From our detailed mathematical analysis, we conclude that HBV-DNA and HBsAg standard dilution series are functionally equivalent to seroconversion panels. A general requirement of a 95% detection limit ≤100 HBV-DNA copies/mL for different viral genotypes would be a better-defined regulation for EU market approval of NAT blood screening assays than the testing of multiple seroconversion panels to claim ‘state of the art’ performance.
Collapse
Affiliation(s)
- Harry van Drimmelen
- Biologicals Quality Control (BioQControl), De Droogmakerij 31h, 1851LX Heiloo, The Netherlands
| | - Nico Lelie
- Biologicals Quality Control (BioQControl), De Droogmakerij 31h, 1851LX Heiloo, The Netherlands
- Lelie Research, Parkstraat 2, 1811DK Alkmaar, The Netherlands
- Correspondence:
| |
Collapse
|
12
|
Bengu N, Mchunu N, Mokhethi S, Fillis R, Cromhout G, van Lobenstein J, Graza Y, Kapongo C, Chinniah K, Bhoola R, Adland E, Puertas MC, Ndung’u T, Martinez-Picado J, Archary M, Goulder PJR. Next-generation point-of-care testing in pediatric human immunodeficiency virus infection facilitates diagnosis and monitoring of treatment. Medicine (Baltimore) 2022; 101:e29228. [PMID: 35801794 PMCID: PMC9259159 DOI: 10.1097/md.0000000000029228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Point-of-care (PoC) testing facilitates early infant diagnosis (EID) and treatment initiation, which improves outcome. We present a field evaluation of a new PoC test (Cepheid Xpert® HIV-1 Qual XC RUO) to determine whether this test improves EID and assists the management of children living with human immunodeficiency virus (HIV) infection. We compared 2 PoC tests with the standard-of-care (SoC) test used to detect HIV infection from dry blood spots in newborn infants at high risk of in utero infection. We also evaluated the ability of the PoC tests to detect HIV total nucleic acid (TNA) in children living with HIV infection who had maintained undetectable plasma viremia following very early combination antiretroviral therapy (cART) initiation. Qualitative (Qual) detection of HIV using the Xpert® HIV-1 Qual XC RUO ("RUO") and Xpert® HIV-1 Qual ("Qual") PoC tests was compared in 224 infants with the SoC DBS Roche COBAS® HIV-1/HIV-2 qualitative test. The same 2 PoC tests were also evaluated in 35 older children who had initiated cART before 21 days of age and maintained undetectable plasma viremia for a mean of 25 months. No discrepancies were observed in detection of HIV infection via the 2 PoC tests or the SoC test in the 224 neonates studied, but only 95% of the SoC test results were generated compared with 100% of the PoC test results (P = .0009). The cycle threshold values for the research use only (RUO) assay were the lowest of the 3 assays (P < .0001 in each case). In 6 of the 35 early-treated aviremic children, HIV TNA was detected by RUO but not Qual. The RUO assay outperforms Qual in detecting HIV-1 infection. RUO would therefore potentially improve EID and assist in identifying cART-adherent early-treated children with the lowest HIV TNA levels and the highest HIV cure potential.
Collapse
Affiliation(s)
- Nomonde Bengu
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, Queen Nandi Regional Hospital, Empangeni, South Africa
| | - Noxolo Mchunu
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, Edendale Hospital, Plessislaer, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Sijabulile Mokhethi
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- HIV and TB Clinic, General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu Natal, South Africa
| | - Rowena Fillis
- Department of Paediatrics, Edendale Hospital, Plessislaer, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Gabriela Cromhout
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- *Correspondence: Gabriela Cromhout, HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Durban, KwaZulu Natal 4001, South Africa (e-mail: )
| | - Jeroen van Lobenstein
- HIV and TB Clinic, General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu Natal, South Africa
| | - Yeney Graza
- HIV and TB Clinic, General Justice Gizenga Mpanza Regional Hospital, KwaDukuza, KwaZulu Natal, South Africa
| | - Constant Kapongo
- Department of Paediatrics, Queen Nandi Regional Hospital, Empangeni, South Africa
| | - Kogielambal Chinniah
- Department of Paediatrics, Mahatma Gandhi Memorial Hospital, Phoenix, Durban, KwaZulu Natal, South Africa
| | - Roopesh Bhoola
- Department of Paediatrics, Edendale Hospital, Plessislaer, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Emily Adland
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Thumbi Ndung’u
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States
- Max Planck Institute for Infection Biology, Chariteplatz, Berlin, Germany
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Badalona, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Moherndran Archary
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, Durban, South Africa
| | - Philip J. R Goulder
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
13
|
Pongsakornkullachart K, Chayakulkeeree M, Vongwiwatana A, Kantakamalakul W, Skulratanasak P, Phoompoung P. QuantiFERON-Cytomegalovirus Assay for Prediction of Cytomegalovirus Viremia in Kidney Transplant Recipients: Study From High Cytomegalovirus Seroprevalence Country. Front Cell Infect Microbiol 2022; 12:893232. [PMID: 35646728 PMCID: PMC9135039 DOI: 10.3389/fcimb.2022.893232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Early studies showed the utility of pretransplant QuantiFERON-Cytomegalovirus (QF-CMV) assays for CMV-disease prediction post kidney transplant (KT). However, recent data are conflicting. Methods This prospective cohort study enrolled adult patients undergoing KT between July 2017 and May 2019. Patients with antithymocyte globulin therapy or negative pretransplant CMV IgG were excluded. QF-CMV assays were performed on transplantation day and one month thereafter, and CMV viral loads were obtained 1, 3, and 6 months posttransplantation. The primary outcome was CMV viremia within 6 months. The QF-CMV assay–posttransplant CMV viremia association was analyzed. Results Fifty-five patients were enrolled (male, 58.2%; mean (SD) age, 46.5 (10.2) years). Fifty-two (94.5%) received CMV-seropositive donor kidneys. Over 6 months, 29 patients developed CMV viremia (52.7%), with 14 (25.5%) having significant viremia requiring antiviral therapy. The CMV-viremia incidence of patients with nonreactive and reactive baseline QF-CMV assays did not differ significantly (55.3% and 47.1%; p = 0.573). Among patients with reactive pretransplant QF-CMV assays, there was a trend toward a lower incidence of CMV viremia for those who were persistently reactive at 1 month after KTs, although there was no statistically significant difference (50% vs 83%; p = 0.132). Conclusions Our study could not support the use of single-timepoint pretransplant or 1-month posttransplant QF-CMV assays as a predictor for posttransplant CMV viremia in CMV seropositive KT recipients. Investigation of the association between dynamic QF-CMV-status changes and CMV-viremia incidence are needed.
Collapse
Affiliation(s)
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Attapong Vongwiwatana
- Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wannee Kantakamalakul
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peenida Skulratanasak
- Division of Nephrology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Phoompoung
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- *Correspondence: Pakpoom Phoompoung, ;
| |
Collapse
|
14
|
Phung Q, Lin MJ, Xie H, Greninger AL. Fragment Size-Based Enrichment of Viral Sequences in Plasma Cell-Free DNA. J Mol Diagn 2022; 24:476-484. [PMID: 35569878 PMCID: PMC9127460 DOI: 10.1016/j.jmoldx.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Sequencing of plasma cell-free DNA (cfDNA) is a promising milieu for broad-based cancer and infectious disease diagnostics. The performance of cfDNA sequencing for infectious disease diagnostics is chiefly limited by inadequate analytical sensitivity. The current study investigated whether the analytical sensitivity of cfDNA sequencing for viral diagnostics could be improved by selective sequencing of short cfDNA fragments, given prior observations of shorter fragment size distribution in microbial and cytomegalovirus-derived cfDNA compared with human-derived cfDNA. It shows that the shorter plasma cfDNA fragment size distribution is a general feature of multiple DNA viruses, including adenovirus [interquartile range (IQR), 87 to 165 bp], herpes simplex virus 2 (IQR, 114 to 195 bp), human herpesvirus 6 (IQR, 145 to 176 bp), and varicella zoster virus (IQR, 98 to 182 bp), compared with human (IQR, 148 to 178 bp). It was used to further optimize a size selection-based cfDNA sequencing method, demonstrating an enrichment of viral sequences up to 16.6-fold, with a median fold enrichment of 6.7×, 4.6×, 2.2×, and 10.3× for adenovirus, herpes simplex virus 2, human herpesvirus 6, and varicella zoster virus, respectively. These findings demonstrate a simple yet scalable method for enhanced detection of DNA viremia that maintains the unbiased nature of cfDNA sequencing.
Collapse
Affiliation(s)
- Quynh Phung
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Michelle J Lin
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Hong Xie
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| |
Collapse
|
15
|
Ekiaby ME, Tanaka J, van Drimmelen H, Allain JP, Lelie N. Infectivity of hepatitis B virus (HBV) surface antigen (HBsAg) positive plasma with undetectable HBV-DNA: Can HBsAg screening be discontinued in Egyptian blood donors? J Viral Hepat 2022; 29:330-339. [PMID: 35274395 DOI: 10.1111/jvh.13666] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/03/2022] [Accepted: 02/20/2022] [Indexed: 01/12/2023]
Abstract
HBV infectivity data were reviewed and the 50% infectious dose (ID50 ) was reassessed in different HBsAg positive infection stages enabling modelling of transfusion-transmitted (TT)-HBV infection risk if HBsAg donor screening was replaced by individual donation nucleic acid amplification technology (ID-NAT). Quantitative HBsAg and HBV-DNA assays were performed against international standards to compare the ratio between potential infectious HBV virions and subviral HBsAg particles in Egyptian HBsAg positive blood donors as well as in Japanese chimpanzee samples of known infectivity. HBV-DNA load below the quantification limit of detection was estimated against a reference standard by replicate NAT testing (n = 25). Infectivity of chimpanzee samples collected during ramp-up and declining viremic phase were tested in a human liver chimeric mice (HLCM) model and compared with published infectivity data from different HBsAg positive infection stages. Lowest estimates of ID50 in HBsAg positive plasma were 3-6 HBV virions in chimpanzee studies. Infectivity decreased approximately 10-100-fold in the declining viremic phase using HLCM. In acute-phase samples, HBV to HBsAg particle ratios varied between 1:102 -104 but in HBsAg positive blood donors this particle ratio reached 1:106 -1012 when viral load was below 100 HBV-DNA copies/ml. Modelled TT-HBV risk of an HBsAg positive/ID-NAT nonreactive blood transfusion was estimated at 9%-46% for components containing 20-200 ml of plasma assuming an ID50 of 316 (point estimate between 100 and 1000) virions. In the Egyptian setting, discontinuation of HBsAg donor screening and reliance on ID-NAT alone seems to be unsafe.
Collapse
Affiliation(s)
| | | | | | | | - Nico Lelie
- Lelie Research, Alkmaar, The Netherlands
| |
Collapse
|
16
|
Schneider JA, Hayford C, Hotton A, Tabidze I, Wertheim JO, Ramani S, Hallmark C, Morgan E, Janulis P, Khanna A, Ozik J, Fujimoto K, Flores R, D'aquila R, Benbow N. Do partner services linked to molecular clusters yield people with viremia or new HIV? AIDS 2022; 36:845-852. [PMID: 34873085 PMCID: PMC9397139 DOI: 10.1097/qad.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago. DESIGN Historical cohort study. METHODS We matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012-2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0.5% and identified clusters exhibiting recent and rapid growth according to the Centers for Disease Control and Prevention definition (three new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression. RESULTS There were 5208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% MSM. Of the 537 named partners, 191 (35.6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster [adjusted relative risk 1.82, (0.81-4.06)]. CONCLUSION Partner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.
Collapse
Affiliation(s)
- John A Schneider
- University of Chicago Medicine
- Chicago Center for HIV Elimination
| | | | | | | | - Joel O Wertheim
- Department of Medicine, University of California, San Diego, La Jolla, California
| | | | | | - Ethan Morgan
- College of Public Health, Ohio State University, Columbus, Ohio
| | | | - Aditya Khanna
- School of Public Health, Brown University, Providence, Rhode Island
| | - Jonathan Ozik
- Chicago Center for HIV Elimination
- Department of Public Health Science, University of Chicago, Chicago, Illinois
| | - Kayo Fujimoto
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rey Flores
- University of Chicago Medicine
- Chicago Center for HIV Elimination
| | | | | |
Collapse
|
17
|
Joseph J, Boeke CE, Makadzange EE, Sithole K, Maparo T, Mangwendeza PM, Peter T, Sacks JA, Simbi R, Khan S, Mushavi A. Near-point-of-care viral load testing during pregnancy and viremia at delivery. AIDS 2022; 36:711-719. [PMID: 35025819 DOI: 10.1097/qad.0000000000003173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Assess whether near-point-of-care (POC) viral load testing at the first antenatal care visit (ANC1) increased the proportion of women taking antiretroviral therapy who were virally suppressed at delivery through expedited clinical action. DESIGN Difference-in-difference analysis. METHODS At 20 public sector facilities in Zimbabwe, 10 implemented near-POC viral load testing at ANC1 (August 2019 to November 2020) and 10 used centralized viral load testing at ANC1. Study endpoints included time to result received, clinical action, and unsuppressed viral load (UVL; >1000 copies/ml) at delivery. RESULTS Of 1782 women, only 46% came for ANC1 before their third trimester. Preimplementation, 28% of women received viral load testing at ANC1, increasing to 86% during implementation. In the near-POC viral load arm, women were more likely to receive their result within 30 days of ANC1 sample collection compared with the centralized laboratory arm [54 versus 14%, relative risk (RR): 4.17, 95% confidence interval (CI) 1.82-9.55], as well as receive clinical action among those with UVL (63 versus 8%, RR 7.88; 95% CI 1.53-40.47). However, we did not observe significant changes in risk of UVL at delivery with near-POC viral load (RR 1.02, 95% CI 0.95-1.10). CONCLUSION ANC1 viral load coverage was initially low. Near-POC viral load testing at ANC1 dramatically improved the timeliness of result receipt by patients and clinical action for those with an UVL. Although we did not observe a significant impact of provision of near-POC viral load at ANC1 on re-suppression at delivery, potentially because of late presentation for ANC1, continued near-POC viral load testing during pregnancy and delivery may reduce UVL and mother-to-child transmission risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Trevor Peter
- Clinton Health Access Initiative (CHAI), Boston, USA
| | | | - Raiva Simbi
- Ministry of Health and Child Care (MOHCC), Harare, Zimbabwe
| | - Shaukat Khan
- Clinton Health Access Initiative (CHAI), Boston, USA
| | - Angela Mushavi
- Ministry of Health and Child Care (MOHCC), Harare, Zimbabwe
| |
Collapse
|
18
|
Guerra K, Bocour A, Moore MS, Winters A. Detection of Recurrent Hepatitis C Viremia Using Surveillance Data, New York City. J Public Health Manag Pract 2022; 28:126-129. [PMID: 32956285 DOI: 10.1097/phh.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The introduction of direct-acting antivirals for treating hepatitis C virus (HCV) infection has greatly improved cure rates. However, persons with past HCV infection who engage in high-risk behaviors can be reinfected. Surveillance data from the New York City (NYC) Health Department were used to detect and investigate individuals cured during January 2014 to December 2016 who had a subsequent positive RNA test (recurrence) by April 2018. Clinical interpretation of recurrence was obtained using provider interviews and review of medical records available through Regional Health Information Organizations. Among 6938 cured individuals, 209 recurrence events were detected (2.7 per 100 person-years). Investigations were completed for 62 (30%) events. Of 38 investigated events occurring less than 12 months postcure, 17 (45%) were relapses; of 24 events occurring 12 or more months postcure, only one (4%) was a relapse. Understanding the timing, frequency, and clinical interpretation of HCV recurrence will guide HCV prevention and elimination efforts for NYC.
Collapse
Affiliation(s)
- Kevin Guerra
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Long Island City, New York
| | | | | | | |
Collapse
|
19
|
Murnane PM, Ayieko J, Vittinghoff E, Gandhi M, Katumbi C, Milala B, Nakaye C, Kanda P, Moodley D, Nyati ME, Loftis AJ, Fowler MG, Flynn P, Currier JS, Cohen CR. Machine Learning Algorithms Using Routinely Collected Data Do Not Adequately Predict Viremia to Inform Targeted Services in Postpartum Women Living With HIV. J Acquir Immune Defic Syndr 2021; 88:439-447. [PMID: 34520443 PMCID: PMC8585692 DOI: 10.1097/qai.0000000000002800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adherence to antiretroviral treatment (ART) among postpartum women with HIV is essential for optimal health and prevention of perinatal transmission. However, suboptimal adherence with subsequent viremia is common, and adherence challenges are often underreported. We aimed to predict viremia to facilitate targeted adherence support in sub-Saharan Africa during this critical period. METHODS Data are from PROMISE 1077BF/FF, which enrolled perinatal women between 2011 and 2014. This analysis includes postpartum women receiving ART per study randomization or country-specific criteria to continue from pregnancy. We aimed to predict viremia (single and confirmed events) after 3 months on ART at >50, >400, and >1000 copies/mL within 6-month intervals through 24 months. We built models with routine clinical and demographic data using the least absolute shrinkage and selection operator and SuperLearner (which incorporates multiple algorithms). RESULTS Among 1321 women included, the median age was 26 years and 96% were in WHO stage 1. Between 0 and 24 months postpartum, 42%, 31%, and 28% of women experienced viremia >50, >400, and >1000 copies/mL, respectively, at least once. Across models, the cross-validated area under the receiver operating curve ranged from 0.74 [95% confidence interval (CI): 0.72 to 0.76] to 0.78 (95% CI: 0.76 to 0.80). To achieve 90% sensitivity predicting confirmed viremia >50 copies/mL, 64% of women would be classified as high risk. CONCLUSIONS Using routinely collected data to predict viremia in >1300 postpartum women with HIV, we achieved moderate model discrimination, but insufficient to inform targeted adherence support. Psychosocial characteristics or objective adherence metrics may be required for improved prediction of viremia in this population.
Collapse
Affiliation(s)
- Pamela M. Murnane
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | - James Ayieko
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Monica Gandhi
- Department of Medicine, University of California, San Francisco, USA
| | | | - Beteniko Milala
- University of North Carolina-Project Malawi, Lilongwe, Malawi
| | - Catherine Nakaye
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Peter Kanda
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Dhayendre Moodley
- Centre for the AIDS Programme of Research in South Africa and Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Mandisa E Nyati
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Amy James Loftis
- Institute for Global Health and Infectious Diseases, University of North Carolina Chapel Hill, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pat Flynn
- Department of Infectious Diseases, St. Jude Children’s Research Hospital Memphis, USA
| | - Judith S. Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Craig R. Cohen
- Institute for Global Health Sciences, University of California, San Francisco, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA USA
| |
Collapse
|
20
|
Odayar J, Kabanda S, Malaba TR, Lesosky M, Myer L. Brief Report: Viral Load Monitoring in Pregnancy to Predict Peripartum Viremia in South Africa. J Acquir Immune Defic Syndr 2021; 88:6-9. [PMID: 34050102 DOI: 10.1097/qai.0000000000002738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Enhanced postnatal prophylaxis is recommended in infants of women with viremia during labor, as identified by viral load (VL) testing late in pregnancy. However, data on the use of antenatal VL to predict peripartum viremia are few, particularly in women starting antiretroviral therapy (ART) in pregnancy who experience initial VL declines. METHODS Between January 2016 and August 2017, we identified HIV-infected women who initiated ART (tenofovir, emtricitabine, and efavirenz) antenatally and had a VL <400 copies/mL before delivery in Cape Town, South Africa. VLs were repeated postdelivery, and sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for antenatal VL <100 copies/mL in predicting peripartum VLs <100 and <400 copies/mL were calculated. RESULTS Among 322 women (median age 29 years, 44% with a history of ART use, median gestation of antenatal VL 33 weeks), antenatal VL was <100 copies/mL in 89% and 100-400 copies/mL in 11%. At a median 9 days postpartum, 91%, 7%, and 2% of women had a VL <100, 100-400, and >400 copies/mL, respectively. Sensitivity of antenatal VL <100 copies/mL in predicting peripartum VL <100 copies/mL was 0.95 (95% confidence interval: 0.92 to 0.97), and specificity was 0.71 (95% confidence interval: 0.51 to 0.87; LR+ 3.28, LR- 0.07). Performance was slightly weaker to detect peripartum VL <400 copies/mL but was similar across strata of gestation at antenatal VL and history of ART use. DISCUSSION Antenatal VL is a useful predictor of peripartum viremia in women who started ART in pregnancy and attained a VL <400 copies/mL antenatally and may be used to target enhanced postnatal prophylaxis interventions.
Collapse
Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Siti Kabanda
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
- Currently, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; and
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| |
Collapse
|
21
|
Antuori A, Montoya V, Piñeyro D, Sumoy L, Joy J, Krajden M, González-Gómez S, Folch C, Casabona J, Matas L, Colom J, Saludes V, Martró E. Characterization of Acute HCV Infection and Transmission Networks in People Who Currently Inject Drugs in Catalonia: Usefulness of Dried Blood Spots. Hepatology 2021; 74:591-606. [PMID: 33609288 DOI: 10.1002/hep.31757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Accurate identification of recent HCV infections is critical for tracing the extent and mechanisms of ongoing transmission. We aimed to validate dried blood spot (DBS) samples for the assessment of Hepatitis C virus (HCV) genetic diversity and to determine epidemiological parameters including incidence, determinants of acute infection, and phylogenetic clustering in people who inject drugs (PWID). APPROACH AND RESULTS HCV nonstructural protein 5B next-generation sequencing was performed from plasma and/or DBS in 220 viremic PWID from the HepCdetect II study. No significant differences were found in consensus sequences or Shannon entropy (SE) intrahost diversity estimate between paired plasma/DBS specimens. SE values were used to identify acute infections with 93.3% sensitivity (95% CI, 0.81-1.06) and 95.0% specificity (95% CI, 0.88-1.02) in a set of well-defined controls. An acute HCV infection (either primary infection or reinfection) was detected in 13.5% of viremic participants and was associated with age ≤30 years (OR, 8.09), injecting less than daily (OR, 4.35), ≤5 years of injected drug use (OR, 3.43), sharing cocaine snorting straws (OR, 2.89), and being unaware of their HCV status (OR, 3.62). Annualized HCV incidence was estimated between 31 and 59/100 person-years. On phylogenetic analysis, 46.8% of viremic cases were part of a transmission pair or cluster; age ≤30 years (OR, 6.16), acute infection (OR, 5.73), and infection with subtype 1a (OR, 4.78) were independently associated with this condition. CONCLUSIONS The results obtained from plasma and DBS characterize PWID with acute infection and those involved in ongoing HCV transmission and allow estimating incidence from cross-sectional data. This information is critical for the design and assessment of targeted harm reduction programs and test-and-treat interventions and to facilitate monitoring of HCV elimination in this key population.
Collapse
Affiliation(s)
- Adrián Antuori
- Microbiology DepartmentLaboratori Clínic Metropolitana NordHospital Universitari Germans Trias i PujolInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Genetics and Microbiology DepartmentUniversitat Autònoma de BarcelonaBellaterraSpain
| | | | - David Piñeyro
- High Content Genomics & Bioinformatics UnitInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolProgram of Predictive and Personalized Medicine of CancerBadalonaSpain
| | - Lauro Sumoy
- High Content Genomics & Bioinformatics UnitInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolProgram of Predictive and Personalized Medicine of CancerBadalonaSpain
| | - Jeffrey Joy
- BC Centre for Excellence in HIVVancouverBCCanada
- Department of MedicineUniversity of British ColumbiaVancouverBCCanada
| | - Mel Krajden
- Public Health LaboratoryHepatitis-Clinical Prevention Services British Columbia Centre for Disease ControlVancouverBCCanada
| | - Sara González-Gómez
- Microbiology DepartmentLaboratori Clínic Metropolitana NordHospital Universitari Germans Trias i PujolInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of CataloniaPublic Health Agency of CataloniaBadalonaSpain
- Group 27Biomedical Research Networking Centre in Epidemiology and Public HealthInstituto de Salud Carlos IIIMadridSpain
| | - Jordi Casabona
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of CataloniaPublic Health Agency of CataloniaBadalonaSpain
- Group 27Biomedical Research Networking Centre in Epidemiology and Public HealthInstituto de Salud Carlos IIIMadridSpain
| | - Lurdes Matas
- Microbiology DepartmentLaboratori Clínic Metropolitana NordHospital Universitari Germans Trias i PujolInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Genetics and Microbiology DepartmentUniversitat Autònoma de BarcelonaBellaterraSpain
- Group 27Biomedical Research Networking Centre in Epidemiology and Public HealthInstituto de Salud Carlos IIIMadridSpain
| | - Joan Colom
- Programme for Prevention, Control and Treatment of HIVSTIs and Viral HepatitisPublic Health Agency of CataloniaBarcelonaSpain
| | - Verónica Saludes
- Microbiology DepartmentLaboratori Clínic Metropolitana NordHospital Universitari Germans Trias i PujolInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Genetics and Microbiology DepartmentUniversitat Autònoma de BarcelonaBellaterraSpain
- Group 27Biomedical Research Networking Centre in Epidemiology and Public HealthInstituto de Salud Carlos IIIMadridSpain
| | - Elisa Martró
- Microbiology DepartmentLaboratori Clínic Metropolitana NordHospital Universitari Germans Trias i PujolInstitut d'Investigació en Ciències de la Salut Germans Trias i PujolBadalonaSpain
- Genetics and Microbiology DepartmentUniversitat Autònoma de BarcelonaBellaterraSpain
- Group 27Biomedical Research Networking Centre in Epidemiology and Public HealthInstituto de Salud Carlos IIIMadridSpain
| |
Collapse
|
22
|
He Y, Chen Y, Wang Y, Chen X, Huang H, Yu X, He X, Zeng W, Liu M, Huang B, Chen P. Evaluation of Architect anti-HCV Signal to Cutoff Ratios for Predicting Hepatitis C Viremia Using COBAS AmpliPrep/COBAS TaqMan HCV Quantitative Test. Clin Lab 2021; 66. [PMID: 32776744 DOI: 10.7754/clin.lab.2020.191208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The aim of the study is to evaluate the significance of the Architect anti-HCV signal to cutoff (S/CO) ratios for predicting hepatitis C viremia and determine the optimal S/Co ratio value for Architect anti-HCV assay. METHODS The results of patients who underwent HCV RNA quantitative assays because of positive anti-HCV from January 2015 to August 2019 were retrospectively analyzed, including S/Co ratio values, HCV RNA quantitative results, alanine aminotransferase (ALT), and aspartate transaminase (AST) values. Binary logistic regression and Spearman's correlation coefficient were used to analyze the collected data. Receiver-operating characteristics curve (ROC) was applied to analyze the predicting values of the indexes. RESULTS In total, 811 patients were included in our study and HCV viremia was detected in 342 (42.1%) patients. There is no correlation between anti-HCV S/CO ratio and HCV RNA level. The samples with an S/Co ratio between 1 and 4 (271/271, 100%) were all HCV RNA negative. The area under the ROC curve of anti-HCV S/CO ratio was 0.8714 and the maximal Youden index was 0.681 at an optimal cutoff S/CO ratio value of 8.99. CONCLUSIONS With the cutoff value of 1.0, the Architect anti-HCV assay showed excellent sensitivity but poor specificity in predicting HCV viremia. An S/Co ratio of 8.99 was optimal for further confirmation testing of HCV viremia.
Collapse
|
23
|
Pomar L, Lambert V, Matheus S, Pomar C, Hcini N, Carles G, Rousset D, Vouga M, Panchaud A, Baud D. Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes. Emerg Infect Dis 2021; 27:490-498. [PMID: 33496246 PMCID: PMC7853546 DOI: 10.3201/eid2702.200684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal–fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus–infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January–July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk [aRR] 7.2 [95% CI 0.9–57.6]) or those from noninfected mothers (6.6%, aRR 6.7 [95% CI 3.0–15.1]). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 [95% CI 0.9–5.5]).
Collapse
|
24
|
Gasparini M, Laguardia-Nascimento M, Sales ÉB, Oliveira AGG, Lobato ZIP, Camargos MF, Fonseca Júnior AA. Study of molecular diagnosis and viremia of bluetongue virus in sheep and cattle. Braz J Microbiol 2021; 52:1623-1626. [PMID: 34081316 DOI: 10.1007/s42770-021-00518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/27/2021] [Indexed: 11/27/2022] Open
Abstract
Bluetongue virus (BTV) is an RNA virus that infects cattle and sheep. The objective of this study was to compare two real-time PCRs for the detection of BTV and to monitor Orbivirus viremia in sheep and cattle for 6 months. The PCR results showed the occurrence of infected animals throughout the experiment without records of clinical signs. The number of positive animals reduced during the experiment, but some animals were positive for BTV RNA during the entire experiment. The performance of the two RT-qPCRs for BTV detection techniques used in this work revealed a kappa index of 0.71 for cattle and 0.75 for sheep.
Collapse
Affiliation(s)
- Marcela Gasparini
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil
| | - Mateus Laguardia-Nascimento
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil
| | - Érica Bravo Sales
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil
| | - Anna Gabriella Guimarães Oliveira
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil
| | - Zélia I P Lobato
- Department of Preventive Veterinary Medicine, Veterinary School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Fernandes Camargos
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil
| | - Antônio Augusto Fonseca Júnior
- Laboratório Nacional Agropecuário de Minas Gerais, Avenida Rômulo Joviano, Centro, Pedro Leopoldo, Minas Gerais, ZIP 33600-000, Brazil.
- UNIFEMM - Centro Universitário de Sete Lagoas, Sete Lagoas, Minas Gerais, Brasil.
| |
Collapse
|
25
|
Cotter TG, Aronsohn A, Reddy KG, Charlton M. Liver Transplantation of HCV-viremic Donors Into HCV-negative Recipients in the United States: Increasing Frequency With Profound Geographic Variation. Transplantation 2021; 105:1285-1290. [PMID: 32639400 PMCID: PMC9206877 DOI: 10.1097/tp.0000000000003382] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Direct-acting antiviral therapy made possible the novel practice of utilizing hepatitis C virus (HCV)-viremic (HCV RNA-positive) donors into HCV-negative recipients in the United States. Although initial reports of outcomes have been satisfactory, higher-quality longer-term outcomes remain to be elucidated. METHODS National data were examined from the Organ Procurement and Transplantation Network on adult patients in the United States who underwent a primary, single organ, deceased donor liver transplant from January 1, 2016 to March 31, 2020. Outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA-positive (D HCV+) donors were compared with HCV RNA-negative (D HCV-) donors. RESULTS There has been a 35-fold increase in D HCV+/R- liver transplants over the past 4 y in the United States, from 8 in 2016 to 280 in 2019. There was an almost 6-fold difference in this practice among UNOS geographic regions. Graft survival following D HCV+/R- liver transplantation was excellent, with 1-y rates being 91% and 90% and 2-y rates being 88.5% and 87% for D HCV+/R- and D HCV-/R-, respectively (P = 0.672). In multivariate analysis, adjusting for other donor and recipient attributes, D HCV+/R- was not associated with patient or graft survival. CONCLUSIONS The practice of D HCV+/R- continues to increase without discernible impact on medium-term outcomes. Notable geographic variation exists, suggesting inconsistent perceptions about the impact of D HCV+/R- transplantation on outcomes. These results strengthen the perceived safety in utilizing HCV-viremic donor organs as a donor pool expansion strategy, not only in the United States, but also worldwide.
Collapse
Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, Section of Gastroenterology & Hepatology, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | | | | | | |
Collapse
|
26
|
Ahmed W, Al Obaidli AAK, Joseph P, Smith ER, Khan AA, Anwar S, Chandrasekar T, Al Madani AK, Dastoor HD, Zahid I, Costales FA, Boobes YAR, Al Kindi F, Issa SEK, Hassan MH, George A, Holt SG. Outcomes of patients with end stage kidney disease on dialysis with COVID-19 in Abu Dhabi, United Arab Emirates; from PCR to antibody. BMC Nephrol 2021; 22:198. [PMID: 34039299 PMCID: PMC8152185 DOI: 10.1186/s12882-021-02378-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/09/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals with end-stage kidney disease (ESKD) on dialysis are vulnerable to contracting COVID-19 infection, with mortality as high as 31 % in this group. Population demographics in the UAE are dissimilar to many other countries and data on antibody responses to COVID-19 is also limited. The objective of this study was to describe the characteristics of patients who developed COVID-19, the impact of the screening strategy, and to assess the antibody response to a subset of dialysis patients. METHODS We retrospectively examined the outcomes of COVID19 infection in all our haemodialysis patients, who were tested regularly for COVID 19, whether symptomatic or asymptomatic. In addition, IgG antibody serology was also performed to assess response to COVID-19 in a subset of patients. RESULTS 152 (13 %) of 1180 dialysis patients developed COVID-19 during the study period from 1st of March to the 1st of July 2020. Of these 81 % were male, average age of 52 years and 95 % were on in-centre haemodialysis. Family and community contact was most likely source of infection in most patients. Fever (49 %) and cough (48 %) were the most common presenting symptoms, when present. Comorbidities in infected individuals included hypertension (93 %), diabetes (49 %), ischaemic heart disease (30 %). The majority (68 %) developed mild disease, whilst 13 % required critical care. Combinations of drugs including hydroxychloroquine, favipiravir, lopinavir, ritonavir, camostat, tocilizumab and steroids were used based on local guidelines. The median time to viral clearance defined by two negative PCR tests was 15 days [IQR 6-25]. Overall mortality in our cohort was 9.2 %, but ICU mortality was 65 %. COVID-19 IgG antibody serology was performed in a subset (n = 87) but 26 % of PCR positive patients (n = 23) did not develop a significant antibody response. CONCLUSIONS Our study reports a lower mortality in this patient group compared with many published series. Asymptomatic PCR positivity was present in 40 %. Rapid isolation of positive patients may have contributed to the relative lack of spread of COVID-19 within our dialysis units. The lack of antibody response in a few patients is concerning.
Collapse
Affiliation(s)
- Wasim Ahmed
- SEHA Kidney Care, PO BOX 92900, Abu Dhabi, United Arab Emirates.
| | | | - Princy Joseph
- SEHA Kidney Care, PO BOX 92900, Abu Dhabi, United Arab Emirates
| | | | - Ayaz Ahmad Khan
- SEHA Kidney Care, PO BOX 92900, Abu Dhabi, United Arab Emirates
| | - Siddiq Anwar
- SEHA Kidney Care, PO BOX 92900, Abu Dhabi, United Arab Emirates
| | | | | | | | - Imran Zahid
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Hui A, Altan E, Slovis N, Fletcher C, Deng X, Delwart E. Circovirus in Blood of a Febrile Horse with Hepatitis. Viruses 2021; 13:v13050944. [PMID: 34065502 PMCID: PMC8161410 DOI: 10.3390/v13050944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022] Open
Abstract
Circoviruses infect vertebrates where they can result in a wide range of disease signs or in asymptomatic infections. Using viral metagenomics we analyzed a pool of five sera from four healthy and one sick horse. Sequences from parvovirus-H, equus anellovirus, and distantly related to mammalian circoviruses were recognized. PCR identified the circovirus reads as originating from a pregnant mare with fever and hepatitis. That horse's serum was also positive by real time PCR for equine parvovirus H and negative for the flavivirus equine hepacivirus. The complete circular genome of equine circovirus 1 strain Charaf (EqCV1-Charaf) was completed using PCR and Sanger sequencing. EqCV1 replicase showed 73-74% identity to those of their closest relatives, pig circoviruses 1/2, and elk circovirus. The closest capsid proteins were from the same ungulate circoviruses with 62-63% identity. The overall nucleotide identity of 72% to its closest relative indicates that EqCV1 is a new species in the Circovirus genus, the first reported in genus Equus. Whether EqCV1 alone or in co-infections can result in disease and its prevalence in different equine populations will require further studies now facilitated using EqCV1's genome sequence.
Collapse
Affiliation(s)
- Alvin Hui
- Vitalant Research Institute, San Francisco, CA 94118, USA; (A.H.); (E.A.); (X.D.)
| | - Eda Altan
- Vitalant Research Institute, San Francisco, CA 94118, USA; (A.H.); (E.A.); (X.D.)
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA
| | - Nathan Slovis
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40361, USA; (N.S.); (C.F.)
| | - Caitlin Fletcher
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40361, USA; (N.S.); (C.F.)
| | - Xutao Deng
- Vitalant Research Institute, San Francisco, CA 94118, USA; (A.H.); (E.A.); (X.D.)
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA
| | - Eric Delwart
- Vitalant Research Institute, San Francisco, CA 94118, USA; (A.H.); (E.A.); (X.D.)
- Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA
- Correspondence:
| |
Collapse
|
28
|
Pourakbari B, Mahmoudi S, Mahmoudieh Y, Eshaghi H, Navaeian A, Rostamyan M, Mamishi S. SARS-CoV-2 RNAaemia in children: An Iranian referral hospital-based study. J Med Virol 2021; 93:5452-5457. [PMID: 33969515 PMCID: PMC8242877 DOI: 10.1002/jmv.27065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/17/2021] [Accepted: 05/04/2021] [Indexed: 01/02/2023]
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) RNA is generally detected in nasopharyngeal swabs, viral RNA can be found in other samples including blood. Recently, associations between SARS‐CoV‐2 RNAaemia and disease severity and mortality have been reported in adults, while no reports are available in pediatric patients with coronavirus disease 2019 (COVID‐19). The aim of this study was to evaluate the mortality, severity, clinical, and laboratory findings of SARS‐CoV‐2 RNA detection in blood in 96 pediatric patients with confirmed COVID‐19. Among all patients, 6 (6%) had SARS‐CoV‐2 RNAaemia. Out of the six patients with SARS‐CoV‐2 RNAaemia, four (67%) had a severe form of the disease, and two out of the 6 patients with SARS‐CoV‐2 RNAaemia passed away (33%). Our results show that the symptoms more commonly found in the cases of COVID‐19 in the study (fever, cough, tachypnea, and vomiting), were found at a higher percentage in the patients with SARS‐CoV‐2 RNAaemia. Creatine phosphokinase and magnesium tests showed significant differences between the positive and negative SARS‐CoV‐2 RNAaemia groups. Among all laboratory tests, magnesium and creatine phosphokinase could better predict SARS‐CoV‐2 RNAemia with area under the curve levels of 0.808 and 0.748, respectively. In conclusion, 67% of individuals with SARS‐CoV‐2 RNAaemia showed a severe COVID‐19 and one‐third of the patients with SARS‐CoV‐2 RNAaemia passed away. Our findings suggest that magnesium and creatine phosphokinase might be considered as markers to estimate the SARS‐CoV‐2 RNAaemia.
Collapse
Affiliation(s)
- Babak Pourakbari
- Pediatric Infectious Disease Research CenterTehran University of Medical SciencesTehranIran
| | - Shima Mahmoudi
- Pediatric Infectious Disease Research CenterTehran University of Medical SciencesTehranIran
| | - Yasmine Mahmoudieh
- Department of Molecular and Cell BiologyUniversity of CaliforniaBerkeleyUSA
| | - Hamid Eshaghi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Amene Navaeian
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Maryam Rostamyan
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research CenterTehran University of Medical SciencesTehranIran
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
| |
Collapse
|
29
|
Siddiqi HK, Weber B, Zhou G, Regan J, Fajnzylber J, Coxen K, Corry H, Yu XG, DiCarli M, Li JZ, Bhatt DL. Increased Prevalence of Myocardial Injury in Patients with SARS-CoV-2 Viremia. Am J Med 2021; 134:542-546. [PMID: 33181107 PMCID: PMC7654293 DOI: 10.1016/j.amjmed.2020.09.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) have a high prevalence of detectable troponin and myocardial injury. In addition, a subset of patients with COVID-19 has detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral loads. The objective of this study was to understand the relationship among SARS-CoV-2 viremia, detectable troponin, and myocardial injury in hospitalized patients with COVID-19. METHODS SARS-CoV-2 plasma viral load was measured in plasma samples drawn from patients hospitalized for COVID-19 at 2 academic medical centers. Baseline characteristics and clinically obtained high-sensitivity cardiac troponin T (hs-cTnT) values were abstracted from the medical record. The main outcome was detectable hs-cTnT (≥6 ng/mL) and myocardial injury (hs-cTnT ≥14 ng/mL; >99th percentile for assay). RESULTS A total of 70 hospitalized patients with COVID-19 were included in this study, with 39% females and median age 58 ± 17 years; 21 patients (30%) were found to have detectable SARS-CoV-2 viral load and were classified in the viremia group. Patients with viremia were significantly older than those without viremia. All of the patients with viremia (100%) had detectable troponin during hospitalization compared with 59% of patients without viremia (P = 0.0003). Myocardial injury was seen in 76% of patients with viremia and 38% of those patients without viremia (P = 0.004). CONCLUSIONS Hospitalized patients with COVID-19 with SARS-CoV-2 viremia have a significantly higher prevalence of detectable troponin and myocardial injury during their hospitalization compared with patients who did not. This first report of the relationship among SARS-CoV-2 viremia, detectable troponin, and myocardial injury in patients with COVID-19 points to additional mechanistic pathways that require deeper study to understand the complex interplay among these unique findings, cardiovascular outcomes, and mortality in COVID-19.
Collapse
Affiliation(s)
- Hasan K Siddiqi
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Brittany Weber
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Mass
| | - James Regan
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jesse Fajnzylber
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Kendyll Coxen
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Heather Corry
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Xu G Yu
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Ragon Institute of MGH, MIT and Harvard University, Boston, Mass
| | - Marcelo DiCarli
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Jonathan Z Li
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Deepak L Bhatt
- Heart and Vascular Center, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| |
Collapse
|
30
|
Alkozah M, Hallak R, Bou Akl I, El Zakhem A. Human herpes virus-6 (HHV-6) pneumonitis and meningitis with viraemia in an immunocompetent adult patient. BMJ Case Rep 2021; 14:14/3/e239220. [PMID: 33762272 PMCID: PMC7993180 DOI: 10.1136/bcr-2020-239220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Human herpes virus-6 (HHV-6) infection is a common infection in the paediatric population and is increasingly reported in immunosuppressed adult patients. It has been reported as the causative agent of disease in few case reports in immunocompetent adults. We report herein an unusual case of HHV-6-associated viraemia, pneumonitis and meningitis in a patient who presented with dyspnoea, hypoxia, dry cough and headache. She was treated for atypical pneumonia with no improvement. Meningitis was suspected as headache kept worsening. HHV-6B was detected by PCR in the cerebrospinal fluid, and subsequently, in the bronchoalveolar lavage and serum samples. Studies were negative for the most common primary and secondary immunodeficiency syndromes, and serology could not be performed to differentiate virus reactivation from a primary infection. The patient was successfully treated with ganciclovir and had no residual sequelae.
Collapse
Affiliation(s)
- Maria Alkozah
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rami Hallak
- Pulmonary and Critical Care Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad Bou Akl
- Pulmonary and Critical Care Division, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline El Zakhem
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
31
|
Akpogheneta O, Dicks S, Grant D, Kanneh Z, Jusu B, Edem-Hotah J, Kanneh L, Alhasan F, Gbakie M, Schieffelin J, Ijaz S, Tedder R, Bower H. Boosting understanding of Lassa Fever virus epidemiology: Field testing a novel assay to identify past Lassa Fever virus infection in blood and oral fluids of survivors and unexposed controls in Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009255. [PMID: 33788861 PMCID: PMC8041174 DOI: 10.1371/journal.pntd.0009255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/12/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid. METHODOLOGY/PRINCIPAL FINDINGS Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%- 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%- 81.9%) and 83.3% (72.7%- 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly. CONCLUSIONS/SIGNIFICANCE Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations.
Collapse
Affiliation(s)
- Onome Akpogheneta
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Steve Dicks
- Blood Borne Virus Unit, Public Health England, Colindale, United Kingdom
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Donald Grant
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Zainab Kanneh
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Brima Jusu
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Joseph Edem-Hotah
- Faculty of Nursing, University of Sierra Leone, Freetown, Sierra Leone
| | - Lansana Kanneh
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Michael Gbakie
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - John Schieffelin
- Sections of Infectious Disease, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Samreen Ijaz
- Blood Borne Virus Unit, Public Health England, Colindale, United Kingdom
| | - Richard Tedder
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Hilary Bower
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, United Kingdom
| |
Collapse
|
32
|
Myhre PL, Prebensen C, Jonassen CM, Berdal JE, Omland T. SARS-CoV-2 Viremia is Associated With Inflammatory, But Not Cardiovascular Biomarkers, in Patients Hospitalized for COVID-19. J Am Heart Assoc 2021; 10:e019756. [PMID: 33596668 PMCID: PMC8200723 DOI: 10.1161/jaha.120.019756] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH (COVID‐19 Mechanisms) was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 patients (78%) at day 3. Patients were aged 60±15 (mean ± SD) years, 71 (58%) were men, 68 (55%) were White, and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently men, had more diabetes mellitus, and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin, and ferritin (all <0.001), but comparable levels of cTnT (cardiac troponin T; P=0.09), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; P=0.27) and D‐dimer (P=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT. Conclusions SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04314232.
Collapse
Affiliation(s)
- Peder L. Myhre
- Division of MedicineDepartment of CardiologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloNorway
| | - Christian Prebensen
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloNorway
- Division of MedicineDepartment of Infectious DiseasesAkershus University HospitalLørenskogNorway
| | | | - Jan Erik Berdal
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloNorway
- Division of MedicineDepartment of Infectious DiseasesAkershus University HospitalLørenskogNorway
| | - Torbjørn Omland
- Division of MedicineDepartment of CardiologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloNorway
| |
Collapse
|
33
|
Sarteschi G, Di Biagio A, Focà E, Taramasso L, Bovis F, Celotti A, Mirabella M, Magnasco L, Mora S, Giacomini M, Bassetti M. Viremia copy-years and risk of estimated glomerular filtration rate reduction in adults living with perinatal HIV infection. PLoS One 2020; 15:e0240550. [PMID: 33057418 PMCID: PMC7561100 DOI: 10.1371/journal.pone.0240550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
Among people with perinatal HIV infection (PHIV), non-communicable diseases, such as chronic kidney disease, are increasing. Both HIV replication and antiretroviral therapy are recognised causes of renal impairment. Objective of the study is to describe the impact of viremia copy-years (VCY) and antiretroviral therapy on trend of estimated glomerular filtration rate (eGFR) in a cohort of adults with perinatal HIV infection. We conducted a multicentre observational study in sixty adults living with PHIV across a 9-year period, from January 2010 to December 2018. The mean values of eGFR were analysed at the first (T0) and last year of observation (T1). VCY was defined as the area under HIV-RNA curve during the study period. We analysed data according to antiretroviral therapy: tenofovir disoproxil (TDF), non-nucleoside reverse transcriptase inhibitors (NNRTI), boosted protease inhibitors (PI/b), integrase inhibitors (INI). We observed a mean overall eGFR reduction from 126.6 mL/min (95%CI: 119.6–133.5) to 105.0 mL/min (95%CI: 99.55–110.6) (p<0.001). Older age, higher baseline eGFR, higher VCY and longer exposure to INI treatment were associated with eGFR reduction at univariate analysis. In the multivariate model, older age (p = 0.039), baseline eGFR (p<0.001) and VCY (p = 0.069), were retained. We also observed a longer exposure to PI/b and INI in patients with lower control on HIV-RNA, expressed as VCY>2 log10. Our study outlines a progressive eGFR reduction in young adults with PHIV, related to the lower control on HIV-RNA VCY and related to aging.
Collapse
Affiliation(s)
- Giovanni Sarteschi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- * E-mail: (GS); (ADB)
| | - Emanuele Focà
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Lucia Taramasso
- Department of Pathophysiology and Transplantation, Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- MultidisciplinAry ResearCh in Health Science (MACH), Milan, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna Celotti
- Infectious and Tropical Diseases Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Michele Mirabella
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Magnasco
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Sara Mora
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino Hospital, Genoa, Italy
| |
Collapse
|
34
|
Thijssen M, Tacke F, Beller L, Deboutte W, Yinda KC, Nevens F, Laleman W, Van Ranst M, Pourkarim MR. Clinical relevance of plasma virome dynamics in liver transplant recipients. EBioMedicine 2020; 60:103009. [PMID: 32979836 PMCID: PMC7519289 DOI: 10.1016/j.ebiom.2020.103009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The role of the microbiome in liver transplantation (LT) outcome has received a growing interest in the past decades. In contrast to bacteria, the role of endogenous viral communities, known as the virome, is poorly described. Here, we applied a viral metagenomic approach to study the dynamic evolution of circulating viruses in the plasma of LT recipients and its effect on the clinical course of patients. METHODS Patients chronically infected with hepatitis B virus (HBV) that received a LT due to endstage liver disease were included in this study. Longitudinal plasma samples were collected pre- and post-LT. Intact viral particles were isolated and sequenced on an Illumina HiSeq 2500 platform. Short read libraries were analysed with an in-house bioinformatics pipeline. Key endpoints were the dynamics of viral families and post-LT complications. FINDINGS The initiation of immunosuppression induced a bloom of the Anelloviridae that dominated the post-LT plasma virome. A variety of post-LT complication were observed. Nephrotoxicity was reported in 38% of the patients and was associated with a high abundance of anelloviruses. Besides nephrotoxicity, 16 (67%) patients experienced flares of viral or bacterial infections in post-transplant follow-up. These flares were recognized by an increased burden of anelloviruses (p < 0.05). Interestingly, no mortality was observed in patients infected with human pegivirus. INTERPRETATION These findings suggest a diagnostic potential for the Anelloviridae family in post-LT complications. Furthermore, the impact of human pegivirus infection on post-transplant survival should be further investigated. FUNDING This trial was supported by Gilead Sciences grant number BE-2017-000133.
Collapse
Affiliation(s)
- Marijn Thijssen
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Leen Beller
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Ward Deboutte
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Kwe Claude Yinda
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Van Ranst
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium
| | - Mahmoud Reza Pourkarim
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Clinical and Epidemiological Virology, Herestraat 49, Post box 1040, BE-3000 Leuven, Belgium; Health Policy Research Centre, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran; Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
| |
Collapse
|
35
|
Roshandel MR, Nateqi M, Lak R, Aavani P, Sari Motlagh R, F Shariat S, Aghaei Badr T, Sfakianos J, Kaplan SA, Tewari AK. Diagnostic and methodological evaluation of studies on the urinary shedding of SARS-CoV-2, compared to stool and serum: A systematic review and meta-analysis. Cell Mol Biol (Noisy-le-grand) 2020; 66:148-156. [PMID: 33040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/05/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023]
Abstract
Investigating the infectivity of body fluid can be useful for preventative measures in the community and ensuring safety in the operating rooms and on the laboratory practices. We performed a literature search of clinical trials, cohorts, and case series using PubMed/MEDLINE, Google Scholar, and Cochrane library, and downloadable database of CDC. We excluded case reports and searched all-language articles for review and repeated until the final drafting. The search protocol was registered in the PROSPERO database. Thirty studies with urinary sampling for viral shedding were included. A total number of 1,271 patients were enrolled initially, among which 569 patients had undergone urinary testing. Nine studies observed urinary viral shedding in urine from 41 patients. The total incidence of urinary SARS-CoV-2 shedding was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively. The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08. The pertaining RR urine compared to blood and stool positive rates were 0.20 and 0.33, respectively. Our review concludes that not only the SARS-CoV-2 can be excreted in the urine in eight percent of patients but also its incidence may have associations with the severity of the systemic disease, ICU admission, and fatality rates. Moreover, the findings in our review suggest that a larger population size may reveal more positive urinary cases possibly by minimizing biases.
Collapse
Affiliation(s)
| | - Masoud Nateqi
- Center for Biotechnology and Genomics, Texas Tech University, Lubbock, TX, USA
| | - Ramin Lak
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pooya Aavani
- Department of Biology, Emory University, Atlanta, Georgia, USA
| | | | | | - Tannaz Aghaei Badr
- Urology Department of Icahn School of Medicine, Mount Sinai Hospitals, NY, USA
| | - John Sfakianos
- Urology Department of Icahn School of Medicine, Mount Sinai Hospitals, NY, USA
| | - Steven A Kaplan
- Urology Department of Icahn School of Medicine, Mount Sinai Hospitals, NY, USA
| | - Ashutosh K Tewari
- Urology Department of Icahn School of Medicine, Mount Sinai Hospitals, NY, USA
| |
Collapse
|
36
|
Atilla E, Ateş C, Uslu A, Ataca Atilla P, Dolapçı I, Tekeli A, Topçuoğlu P. Prospective Analysis of Hemorrhagic Cystitis and BK Viremia in Allogeneic Hematopoietic Stem Cell Transplantation. Turk J Haematol 2020; 37:186-192. [PMID: 31852035 PMCID: PMC7463211 DOI: 10.4274/tjh.galenos.2019.2019.0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
Objective BK virus (BKV) infection has been shown to be related to hemorrhagic cystitis (HC) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). There are conflicting data regarding the association between BKV titers in plasma and clinical disease as well as the risk factors for BKV-related HC. Our aim is to study the risk factors and relationship with plasma BK viral load for development of HC in a prospective analysis. Materials and Methods We prospectively evaluated 59 patients who received allo-HSCT between 2014 and 2016 by quantitative BK virus polymerase chain reaction (PCR) (Altona Diagnostics, Germany) from blood samples at days 0, 30, 60, and 90 after allo-HSCT. The patients were monitored for signs and symptoms of HC. Results HC was diagnosed in 22 patients (37%) at a mean of 100 days (range: 0-367 days). In multivariate analysis, the usage of cyclophosphamide (sub-distribution hazard ratio [sdHR]: 7.82, confidence interval [CI]: 1.375-39.645, p=0.02), reactivated CMV (sdHR: 6.105, CI: 1.614-23.094, p=0.008), and positive BKV viremia (sdHR: 2.15, CI: 1.456-22.065, p=0.01) significantly increased the risk of developing HC. Patients with higher viral loads at day 30 and day 60 were diagnosed with more severe HC (p<0.001). Median BK viral loads of >101.5 copies/mL at day 0 (sensitivity 0.727, specificity 0.875), >98.5 copies/mL at day 30 (sensitivity 0.909, specificity 0.875), and >90.0 copies/mL at day 60 (sensitivity 0.909, specificity 0.875) were indicative of HC. Conclusion Our study showed that administration of cyclophosphamide, CMV reactivation, and BK virus positivity were associated with HC. Plasma BK virus PCR titers at days 0, 30, and 60 after transplant were sensitive tools for predicting clinically proven HC.
Collapse
Affiliation(s)
- Erden Atilla
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Can Ateş
- Van Yüzüncü Yıl University Faculty of Medicine, Department of Biostatistics, Van, Turkey
| | - Atilla Uslu
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Pınar Ataca Atilla
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| | - Istar Dolapçı
- Ankara University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | - Alper Tekeli
- Ankara University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | - Pervin Topçuoğlu
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
| |
Collapse
|
37
|
Pierini S, Incampo E, Bokor D, Dadone V, Ornaghi M, Zanini F, Gentile F, Mancarella S. [Coagulopathy in COVID-19: pathophysiology]. G Ital Cardiol (Rome) 2020; 21:483-488. [PMID: 32555563 DOI: 10.1714/3386.33633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
On March 11, 2020, just after 2 months from the first cases of coronavirus disease 2019 (COVID-19) in China, the Director-General of the World Health Organization stated that COVID-19 has to be considered as a pandemic. Italian doctors were the first protagonists, after the Chinese ones, in the management of this disease. Clinical observations showed that, in addition to the respiratory infection, a systemic inflammatory response occurs, which leads to coagulation disorders and consequent venous thromboembolism as well as other thrombotic complications. We here review the available literature on this issue to better understand the pathophysiological mechanisms of coagulopathy useful to draw future clinical and therapeutic conclusions.
Collapse
Affiliation(s)
| | | | | | | | | | - Fabio Zanini
- U.O.C. Medicina, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo (MI)
| | | | - Sandro Mancarella
- U.O.C. Medicina, ASST Nord Milano, Ospedale Bassini, Cinisello Balsamo (MI)
| |
Collapse
|
38
|
Yamei Y, Yanbo Z, Yuhong J, Xueyan B. Infection prevention and control in blood purification centers during the COVID-19 epidemic: a single institution experience from Zhejiang, China. Infez Med 2020; 28:126-127. [PMID: 32532950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
not available.
Collapse
Affiliation(s)
- Yang Yamei
- Blood Purification Centre, Ningbo First Hospital, Zhejiang, PR China
| | - Zhang Yanbo
- Blood Purification Centre, Ningbo First Hospital, Zhejiang, PR China
| | - Jin Yuhong
- Blood Purification Centre, Ningbo First Hospital, Zhejiang, PR China
| | - Bian Xueyan
- Blood Purification Centre, Ningbo First Hospital, Zhejiang, PR China; Nephrology Department, Ningbo First Hospital, Zhejiang, PR China
| |
Collapse
|
39
|
Meara A, Lamoreaux B, Steigleman H, Yedimenko J, Jarjour W, Rovin B, Parikh S, Ayoub I, Ardoin SP. Frequency of Cytomegalovirus Seropositivity and Viremia in a Midwestern University Lupus Population. J Clin Rheumatol 2020; 26:157-159. [PMID: 32453289 DOI: 10.1097/rhu.0000000000001390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alexa Meara
- From the Department of Internal Medicine, and Division of Rheumatology and Immunology, Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Downs IL, Shaia CI, Zeng X, Johnson JC, Hensley L, Saunders DL, Rossi F, Cashman KA, Esham HL, Gregory MK, Pratt WD, Trefry JC, Everson KA, Larcom CB, Okwesili AC, Cardile AP, Honko A. Natural History of Aerosol Induced Lassa Fever in Non‑Human Primates. Viruses 2020; 12:E593. [PMID: 32485952 PMCID: PMC7354473 DOI: 10.3390/v12060593] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022] Open
Abstract
Lassa virus (LASV), an arenavirus causing Lassa fever, is endemic to West Africa with up to 300,000 cases and between 5000 and 10,000 deaths per year. Rarely seen in the United States, Lassa virus is a CDC category A biological agent inasmuch deliberate aerosol exposure can have high mortality rates compared to naturally acquired infection. With the need for an animal model, specific countermeasures remain elusive as there is no FDA-approved vaccine. This natural history of aerosolized Lassa virus exposure in Macaca fascicularis was studied under continuous telemetric surveillance. The macaque response to challenge was largely analogous to severe human disease with fever, tachycardia, hypotension, and tachypnea. During initial observations, an increase trend of activated monocytes positive for viral glycoprotein was accompanied by lymphocytopenia. Disease uniformly progressed to high viremia followed by low anion gap, alkalosis, anemia, and thrombocytopenia. Hypoproteinemia occurred late in infection followed by increased levels of white blood cells, cytokines, chemokines, and biochemical markers of liver injury. Viral nucleic acids were detected in tissues of three non‑survivors at endpoint, but not in the lone survivor. This study provides useful details to benchmark a pivotal model of Lassa fever in support of medical countermeasure development for both endemic disease and traditional biodefense purposes.
Collapse
Affiliation(s)
- Isaac L. Downs
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Carl I. Shaia
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Xiankun Zeng
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Joshua C. Johnson
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD 21702, USA
| | - Lisa Hensley
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD 21702, USA
| | - David L. Saunders
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Franco Rossi
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Kathleen A. Cashman
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Heather L. Esham
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Melissa K. Gregory
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - William D. Pratt
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - John C. Trefry
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Defense Threat Reduction Agency, Fort Belvoir, VA 22060, USA
| | - Kyle A. Everson
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Charles B. Larcom
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA;
| | - Arthur C. Okwesili
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Anthony P. Cardile
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
| | - Anna Honko
- US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA; (I.L.D.); (C.I.S.); (X.Z.); (J.C.J.); (L.H.); (D.L.S.); (F.R.); (K.A.C.); (H.L.E.); (M.K.G.); (W.D.P.); (J.C.T.); (K.A.E.); (A.C.O.); (A.H.)
- Investigator at National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA 02118, USA
| |
Collapse
|
41
|
Singh N, Winston DJ, Razonable RR, Lyon GM, Silveira FP, Wagener MM, Stevens-Ayers T, Edmison B, Boeckh M, Limaye AP. Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial. JAMA 2020; 323:1378-1387. [PMID: 32286644 PMCID: PMC7157180 DOI: 10.1001/jama.2020.3138] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Despite the use of a cytomegalovirus (CMV) prevention strategy of antiviral prophylaxis for high-risk CMV-seronegative liver transplant recipients with seropositive donors, high rates of delayed-onset postprophylaxis CMV disease occur. An alternate approach, preemptive therapy (initiation of antiviral therapy for early asymptomatic CMV viremia detected by surveillance testing), has not previously been directly compared with antiviral prophylaxis in these patients. OBJECTIVE To compare preemptive therapy with antiviral prophylaxis in CMV-seronegative liver transplant recipients with seropositive donors for the prevention of CMV disease. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of preemptive therapy vs antiviral prophylaxis in 205 CMV-seronegative liver transplant recipients with seropositive donors aged older than 18 years. The trial was conducted at 6 academic transplant centers in the United States between October 2012 and June 2017, with last follow-up in June 2018. INTERVENTIONS Patients were randomized 1:1 to receive either preemptive therapy (valganciclovir, 900 mg, twice daily until 2 consecutive negative tests a week apart) for viremia detected by weekly plasma CMV polymerase chain reaction for 100 days (n = 100) or valganciclovir, 900 mg, daily for 100 days as antiviral prophylaxis (n = 105). MAIN OUTCOMES AND MEASURES The primary outcome was incidence of CMV disease by 12 months, defined as CMV syndrome (CMV viremia and clinical or laboratory findings) or end-organ disease. Secondary outcomes included acute allograft rejection, opportunistic infections, graft and patient survival, and neutropenia. RESULTS Among 205 patients who were randomized (mean age, 55 years; 62 women [30%]), all 205 (100%) completed the trial. The incidence of CMV disease was significantly lower with preemptive therapy than antiviral prophylaxis (9% [9/100] vs 19% [20/105]; difference, 10% [95% CI, 0.5% to 19.6%]; P = .04]). The incidence of allograft rejection (28% vs 25%; difference, 3% [95% CI, -9% to 15%]), opportunistic infections (25% vs 27%; difference, 2% [95% CI, -14% to 10%]), graft loss (2% vs 2%; difference, <1% [95% CI, -4% to 4%]), and neutropenia (13% vs 10%; difference, 3% [95% CI, -5% to 12%]) did not differ significantly for the preemptive therapy vs antiviral prophylaxis group, respectively. All-cause mortality at last follow-up was 15% in the preemptive therapy vs 19% in the antiviral prophylaxis group (difference, 4% [95% CI, -14% to 6%]; P = .46). CONCLUSIONS AND RELEVANCE Among CMV-seronegative liver transplant recipients with seropositive donors, the use of preemptive therapy, compared with antiviral prophylaxis, resulted in a lower incidence of CMV disease over 12 months. Further research is needed to replicate these findings and assess long-term outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01552369.
Collapse
Affiliation(s)
- Nina Singh
- University of Pittsburgh, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Drew J. Winston
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | | | | | | | - Michael Boeckh
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | |
Collapse
|
42
|
Rolland M, Tovanabutra S, Dearlove B, Li Y, Owen CL, Lewitus E, Sanders-Buell E, Bose M, O’Sullivan A, Rossenkhan R, Labuschagne JPL, Edlefsen PT, Reeves DB, Kijak G, Miller S, Poltavee K, Lee J, Bonar L, Harbolick E, Ahani B, Pham P, Kibuuka H, Maganga L, Nitayaphan S, Sawe FK, Eller LA, Gramzinski R, Kim JH, Michael NL, Robb ML. Molecular dating and viral load growth rates suggested that the eclipse phase lasted about a week in HIV-1 infected adults in East Africa and Thailand. PLoS Pathog 2020; 16:e1008179. [PMID: 32027734 PMCID: PMC7004303 DOI: 10.1371/journal.ppat.1008179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023] Open
Abstract
Most HIV-1 infected individuals do not know their infection dates. Precise infection timing is crucial information for studies that document transmission networks or drug levels at infection. To improve infection timing, we used the prospective RV217 cohort where the window when plasma viremia becomes detectable is narrow: the last negative visit occurred a median of four days before the first detectable HIV-1 viremia with an RNA test, referred below as diagnosis. We sequenced 1,280 HIV-1 genomes from 39 participants at a median of 4, 32 and 170 days post-diagnosis. HIV-1 infections were dated by using sequence-based methods and a viral load regression method. Bayesian coalescent and viral load regression estimated that infections occurred a median of 6 days prior to diagnosis (IQR: 9–3 and 11–4 days prior, respectively). Poisson-Fitter, which analyzes the distribution of hamming distances among sequences, estimated a median of 7 days prior to diagnosis (IQR: 15–4 days) based on sequences sampled 4 days post-diagnosis, but it did not yield plausible results using sequences sampled at 32 days. Fourteen participants reported a high-risk exposure event at a median of 8 days prior to diagnosis (IQR: 12 to 6 days prior). These different methods concurred that HIV-1 infection occurred about a week before detectable viremia, corresponding to 20 days (IQR: 34–15 days) before peak viral load. Together, our methods comparison helps define a framework for future dating studies in early HIV-1 infection. HIV-1 infected individuals rarely know when they became infected but knowing when an infection occurred provides critical information regarding HIV-1 pathogenesis and epidemiology. Using a unique cohort in which infection was known to have occurred in a narrow interval, we investigated methods to estimate the timing of infections. Several methods suggested that HIV-1 infection typically occurs a median of one week before the infection can be detected by HIV-1 RNA testing. Going forward, we provide a strategy that can be used to elucidate the origin of an acute/early infection.
Collapse
Affiliation(s)
- Morgane Rolland
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
- * E-mail:
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Bethany Dearlove
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Yifan Li
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Christopher L. Owen
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Eric Lewitus
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Eric Sanders-Buell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Meera Bose
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - AnneMarie O’Sullivan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Raabya Rossenkhan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | | | - Paul T. Edlefsen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Daniel B. Reeves
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Gustavo Kijak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Shana Miller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Kultida Poltavee
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Jenica Lee
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Lydia Bonar
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Elizabeth Harbolick
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Bahar Ahani
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Phuc Pham
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Lucas Maganga
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | | | - Fred K. Sawe
- Kenya Medical Research Institute/U.S. Army Medical Research Directorate-Africa/Kenya-Henry Jackson Foundation MRI, Kericho, Kenya
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Robert Gramzinski
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | | | - Nelson L. Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States of America
| | | |
Collapse
|
43
|
Nagel A, Dimitrakopoulou E, Teig N, Kern P, Lücke T, Michna D, Korn K, Steininger P, Shahada K, Neumann K, Überla K. Characterization of a universal screening approach for congenital CMV infection based on a highly-sensitive, quantitative, multiplex real-time PCR assay. PLoS One 2020; 15:e0227143. [PMID: 31917817 PMCID: PMC6952102 DOI: 10.1371/journal.pone.0227143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
The majority of congenital cytomegalovirus (cCMV) infections are asymptomatic at birth and therefore not diagnosed. Approximately 10–15% of these infants develop late-onset hearing loss and other developmental disorders. Implementation of a universal screening approach at birth may allow early initiation of symptomatic interventions due to a closer follow-up of infants at risk and offers the opportunity to consider treatment of late-onset disease. Real-time PCR assays for the detection of CMV DNA in buccal swab samples demonstrated feasibility and good clinical sensitivity in comparison to a rapid culture screening assay. Because most cCMV infections remain asymptomatic, a universal screening assay that stratifies CMV infected infants according to low and high risk of late-onset cCMV disease could limit the parental anxiety and reduce follow-up costs. We therefore developed and characterized a screening algorithm based on a highly-sensitive quantitative real-time PCR assay that is compatible with centralized testing of samples from universal screening and allows to determine CMV DNA load of saliva samples either as International Units (IU)/ml saliva or IU/105 cell equivalents. 18 of 34 saliva samples of newborns that tested positively by the screening algorithm were confirmed by detection of CMV DNA in blood and/or urine samples obtained during the first weeks of life. All screening samples that could not be confirmed had viral loads of <2.3x105 IU/ml saliva (median: 6.8x103) or 1.3x105 IU/105 cell equivalents (median: 4.0x102). The viral load of screening samples with confirmed cCMV infection ranged from 7.5x102 to 8.2x109 IU/ml saliva (median: 9.3x107) or 1.5x102 to 5.6x1010 IU/105 cell equivalents (median: 3.5x106). Clinical follow-up of these newborns with confirmed cCMV infection should reveal whether the risk of late-onset cCMV disease correlates with CMV DNA load in early life saliva samples and whether a cut-off can be defined identifying cCMV infected infants with or without risk for late-onset cCMV disease.
Collapse
Affiliation(s)
- Angela Nagel
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | - Emmanouela Dimitrakopoulou
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Norbert Teig
- Department of Pediatrics, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Peter Kern
- Department of Gynecology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Lücke
- Department of Pediatrics, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dariusz Michna
- Department of Pediatrics, Elisabeth-Hospital Essen, Germany
| | - Klaus Korn
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
| | - Khalid Shahada
- Audiology and Balance Center, Hamad Medical Corporation, Doha, Qatar
| | - Katrin Neumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
| |
Collapse
|
44
|
Vubil A, Nhachigule C, Loquiha O, Meggi B, Mabunda N, Bollinger T, Sacks JA, Jani I, Vojnov L. Viral load assay performs comparably to early infant diagnosis assay to diagnose infants with HIV in Mozambique: a prospective observational study. J Int AIDS Soc 2020; 23:e25422. [PMID: 31912960 PMCID: PMC6948022 DOI: 10.1002/jia2.25422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/26/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Viral load testing is essential to manage HIV disease, especially in infants and children. Early infant diagnosis is performed using nucleic-acid testing in children under 18 months. Resource-limited health systems face severe challenges to scale-up both viral load and early infant diagnosis to unprecedented levels. Streamlining laboratory systems would be beneficial to improve access to quality testing and to increase efficiency of antiretroviral treatment programmes. We evaluated the performance of viral load testing to serve as an early infant diagnosis assay in children younger than 18 months. METHODS This study was an observational, prospective study, including children between one and 18 months of age who were born to HIV-positive mothers in 134 health facilities in Maputo City and Maputo Province, Mozambique. Dried blood spot specimens from heel or toe pricks were collected between January and April 2018, processed using SPEX buffer for both assays, and tested for routine EID and VL testing using the Roche CAP/CTM HIV-1 Qualitative v2 and Roche CAP/CTM HIV-1 Quantitative v2 assays respectively. The sensitivity, specificity and positive and negative predictive values were estimated using the EID results as the reference standard. RESULTS A total of 1021 infants were included in the study, of which 47% were female. Over 95% of mothers and children were on antiretroviral treatment or received antiretroviral prophylaxis respectively. The sensitivity and specificity of using the viral load assay to detect infection were 100% (95% CI: 96.2 to 100%) and 99.9% (95% CI: 99.4 to 100%). The positive and negative predictive values were 99.0% (95% CI: 94.3 to 100%) and 100% (95% CI: 99.6 to 100%). The McNemar's test was 1.000 and Cohen's kappa was 0.994. CONCLUSIONS The comparable performance suggests that viral load assays can be used as an infant diagnostic assay. Infants with either low levels of viraemia or high cycle threshold values should be repeat tested to ensure the result is truly positive prior to treatment initiation, regardless of assay used. Viral load assays could replace traditional early infant diagnosis testing, substantially streamlining molecular laboratory services for children and lowering costs, with the additional advantage of providing baseline viral load results for antiretroviral treatment management.
Collapse
Affiliation(s)
| | | | - Osvaldo Loquiha
- Clinton Health Access InitiativeMaputoMozambique
- Department of Mathematics and InformaticsUniversidade Eduardo MondlaneMaputoMozambique
| | | | | | | | | | - Ilesh Jani
- Instituto Nacional de SaudeMaputoMozambique
| | | |
Collapse
|
45
|
Abstract
A 63-year-old man presented to the hospital with generalised weakness, fatigue and a 22 kg weight loss 4 months after being diagnosed with sarcoidosis on a mediastinal lymph node biopsy, with minimal improvement in symptoms on prednisone and methotrexate therapy. On arrival, he was found to have a haemoglobin of 57 g/L and platelet count of 82×109/L. Further work-up revealed six of eight diagnostic criteria for haemophagocytic lymphohistiocytosis (HLH): fever >38.9°C, splenomegaly, cytopaenia, hypertriglyceridaemia, haemophagocytosis and elevated ferritin >31 000 ng/mL. He was also found to have Epstein-Barr viraemia with greater than 17 000 copies. Bone marrow biopsy showed the presence of haemophagocytic histiocytes and evidence of classic Hodgkin's lymphoma. He was started on HLH-94 protocol. Later treatment was switched to lymphoma-directed therapy and he finished six cycles of A+AVD (brentuximab vedotin, doxorubicin, vinblastine and dacarbazine) with end-of-treatment positron emission tomography/CT and bone marrow negative for lymphoma.
Collapse
Affiliation(s)
- Blaine Knox
- Department of Cancer Biology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Daulath Singh
- Internal Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Hanh Mai
- Department of Cancer Biology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kamran Mirza
- Department of Cancer Biology, Loyola University Medical Center, Maywood, Illinois, USA
| |
Collapse
|
46
|
Studer N, Lutz H, Saegerman C, Gönczi E, Meli ML, Boo G, Hartmann K, Hosie MJ, Moestl K, Tasker S, Belák S, Lloret A, Boucraut-Baralon C, Egberink HF, Pennisi MG, Truyen U, Frymus T, Thiry E, Marsilio F, Addie D, Hochleithner M, Tkalec F, Vizi Z, Brunetti A, Georgiev B, Ludwig-Begall LF, Tschuor F, Mooney CT, Eliasson C, Orro J, Johansen H, Juuti K, Krampl I, Kovalenko K, Šengaut J, Sobral C, Borska P, Kovaříková S, Hofmann-Lehmann R. Pan-European Study on the Prevalence of the Feline Leukaemia Virus Infection - Reported by the European Advisory Board on Cat Diseases (ABCD Europe). Viruses 2019; 11:v11110993. [PMID: 31671816 PMCID: PMC6893802 DOI: 10.3390/v11110993] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/26/2019] [Accepted: 10/27/2019] [Indexed: 01/09/2023] Open
Abstract
Feline leukaemia virus (FeLV) is a retrovirus associated with fatal disease in progressively infected cats. While testing/removal and vaccination led to a decreased prevalence of FeLV, recently, this decrease has reportedly stagnated in some countries. This study aimed to prospectively determine the prevalence of FeLV viraemia in cats taken to veterinary facilities in 32 European countries. FeLV viral RNA was semiquantitatively detected in saliva, using RT-qPCR as a measure of viraemia. Risk and protective factors were assessed using an online questionnaire to report geographic, demographic, husbandry, FeLV vaccination, and clinical data. The overall prevalence of FeLV viraemia in cats visiting a veterinary facility, of which 10.4% were shelter and rescue cats, was 2.3% (141/6005; 95% CI: 2.0%–2.8%) with the highest prevalences in Portugal, Hungary, and Italy/Malta (5.7%–8.8%). Using multivariate analysis, seven risk factors (Southern Europe, male intact, 1–6 years of age, indoor and outdoor or outdoor-only living, living in a group of ≥5 cats, illness), and three protective factors (Northern Europe, Western Europe, pedigree cats) were identified. Using classification and regression tree (CART) analysis, the origin of cats in Europe, pedigree, and access to outdoors were important predictors of FeLV status. FeLV-infected sick cats shed more viral RNA than FeLV-infected healthy cats, and they suffered more frequently from anaemia, anorexia, and gingivitis/stomatitis than uninfected sick cats. Most cats had never been FeLV-vaccinated; vaccination rates were indirectly associated with the gross domestic product (GDP) per capita. In conclusion, we identified countries where FeLV was undetectable, demonstrating that the infection can be eradicated and highlighting those regions where awareness and prevention should be increased.
Collapse
Affiliation(s)
- Nadine Studer
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| | - Hans Lutz
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| | - Claude Saegerman
- Department of Infectious and Parasitic Diseases, Research Unit of Epidemiology and Risk Analysis Applied to Veterinary, Fundamental and Applied Research for Animal and Health (FARAH) Center, Faculty of Veterinary Medicine, University of Liège, B-4000 Liège, Belgium.
| | - Enikö Gönczi
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| | - Marina L Meli
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| | - Gianluca Boo
- Department of Geography, University of Zurich, 8057 Zurich, Switzerland.
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany.
| | - Margaret J Hosie
- MRC- University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK.
| | - Karin Moestl
- Institute of Virology, Department for Pathobiology, University of Veterinary Medicine, 1210 Vienna, Austria.
| | - Séverine Tasker
- Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, UK & Chief Medical Officer, Linnaeus Group, Shirley, Solihull B90 4BN, UK.
| | - Sándor Belák
- Swedish University of Agricultural Sciences (SLU), Department of Biomedical Sciences and Veterinary Public Health (BVF), 750 07 Uppsala, Sweden.
| | - Albert Lloret
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | | | - Herman F Egberink
- University of Utrecht, Faculty of Veterinary Medicine, Department of Infectious Diseases and Immunology, 3584 CL Utrecht, Netherlands.
| | - Maria-Grazia Pennisi
- Dipartimento di Scienze Veterinarie, Università di Messina, 98168 Messina, Italy.
| | - Uwe Truyen
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany.
| | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Faculty of Veterinary Medicine, Warsaw University of Life Sciences-SGGW, 02-787 Warsaw, Poland.
| | - Etienne Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, B-4000 Liège, Belgium.
| | - Fulvio Marsilio
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, 64100 Teramo, Italy.
| | - Diane Addie
- Veterinary Diagnostic Services, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH, UK.
| | | | - Filip Tkalec
- Veterinarska klinika Kreszinger, 10360 Sesvete, Zagreb, Croatia.
| | - Zsuzsanna Vizi
- University of Veterinary Medicine, 1078 Budapest, Hungary.
| | - Anna Brunetti
- School of Veterinary Medicine, University of Glasgow, Glasgow G61 1QH, UK.
| | - Boyko Georgiev
- Institute of Biology and Immunology of Reproduction, 1113 Sofia, Bulgaria.
| | - Louisa F Ludwig-Begall
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, FARAH Research Centre, Faculty of Veterinary Medicine, Liège University, B-4000 Liège, Belgium.
| | - Flurin Tschuor
- Kleintierklinik BolligerTschuor AG, Fachtierärzte für Kleintiere, 4665 Oftringen - Zofingen, Switzerland.
| | - Carmel T Mooney
- School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Catarina Eliasson
- Jamaren - Swedish Veterinary Feline Study Group, 275 71 Lövestad, Sweden.
| | | | | | - Kirsi Juuti
- CatVet Kissaklinikka, 00400 Helsinki, Finland.
| | - Igor Krampl
- Slovak Small Animal Veterinary Association, 821 02 Bratislava, Slovakia.
| | - Kaspars Kovalenko
- Faculty of Veterinary Medicine, Latvia University of Lifesciences and Technologies, LV-3004 Jelgava, Latvia.
| | - Jakov Šengaut
- Jakov Veterinary Centre, Gerosios Vilties g. 1, LT-03147 Vilnius, Lithuania.
| | | | - Petra Borska
- Small Animal Emergency Clinic, 637 00 Brno-Jundrov, Czech Republic.
| | - Simona Kovaříková
- Department of Animal Protection, Welfare and Behavior, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, 612 42 Brno, Czech Republic.
| | - Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, and Center for Clinical Studies, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland.
| |
Collapse
|
47
|
Qin L, Qiu Z, Hsieh E, Geng T, Zhao J, Zeng X, Wan L, Xie J, Ramendra R, Routy JP, Li T. Association between lymphocyte subsets and cytomegalovirus infection status among patients with systemic lupus erythematosus: A pilot study. Medicine (Baltimore) 2019; 98:e16997. [PMID: 31574798 PMCID: PMC6775378 DOI: 10.1097/md.0000000000016997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/26/2019] [Accepted: 08/06/2019] [Indexed: 11/04/2022] Open
Abstract
This study aimed to determine the association between different lymphocyte subsets and cytomegalovirus (CMV) infection status in patients with systemic lupus erythematosus (SLE). We performed a retrospective study among SLE patients with CMV infection and collected patient socio-demographic and clinical characteristics, as well as their recorded circulating lymphocyte subsets. Univariate and multivariable logistic regression analyses examined the relationship between CMV infection status and lymphocyte subset counts. We included 125 hospitalized patients with SLE, consisting of 88 with documented CMV infection and 37 without any evidence of CMV or other infections. Among the 88 CMV-infected patients, 65 (73.8%) patients developed CMV disease and 23 (26.2%) presented as CMV viremia. Compared to uninfected patients (1520 ± 101 cells/μL), lymphocytes remained stable among those with CMV viremia (1305 ± 272 cells/μL, P = .995). However, compared to their uninfected counterparts, there was a marked decrease in lymphocytes among patients with CMV disease (680 ± 513 cells/μL, P < .001). Analysis of lymphocyte subsets via flow cytometry showed that CD4+ T cell, CD8+ T cell, and natural killer cell counts were lower among those with CMV disease compared to those with CMV viremia and those without infection. Further, multivariable analysis showed that total lymphocyte (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998-1.000, P = .007) and CD4+ T cell counts (OR 0.99, 95% CI 0.992-0.998, P = .003) were negatively associated with CMV disease. Our findings support a potential inverse relationship between lymphopenia, specifically CD4+ T-cell lymphopenia, and CMV disease among hospitalized SLE patients.
Collapse
Affiliation(s)
- Ling Qin
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Center for AIDS Research
| | - Zhifeng Qiu
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Center for AIDS Research
- Clinical Immunology Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Evelyn Hsieh
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Taoran Geng
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Center for AIDS Research
| | | | | | - Lu Wan
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing Xie
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Center for AIDS Research
- Clinical Immunology Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rayoun Ramendra
- Department of Microbiology and Immunology, McGill University
| | - Jean Pierre Routy
- Chronic Viral Illnesses Service and Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital
- Center for AIDS Research
- Clinical Immunology Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
48
|
Freiman JM, Wang J, Easterbrook PJ, Horsburgh CR, Marinucci F, White LF, Kamkamidze G, Krajden M, Loarec A, Njouom R, Nguyen KV, Shiha G, Soliman R, Solomon SS, Tsertsvadze T, Denkinger CM, Linas B. Deriving the optimal limit of detection for an HCV point-of-care test for viraemic infection: Analysis of a global dataset. J Hepatol 2019; 71:62-70. [PMID: 30797050 PMCID: PMC7014921 DOI: 10.1016/j.jhep.2019.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/03/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Affordable point-of-care tests for hepatitis C (HCV) viraemia are needed to improve access to treatment in low- and middle-income countries. Our aims were to determine the target limit of detection (LOD) necessary to diagnose the majority of people with HCV eligible for treatment, and identify characteristics associated with low-level viraemia (LLV) (defined as the lowest 3% of the distribution of HCV RNA) to understand those at risk of being misdiagnosed. METHODS We established a multi-country cross-sectional dataset of first available quantitative HCV RNA measurements linked to demographic and clinical data. We excluded individuals on HCV treatment. We analysed the distribution of HCV RNA and determined critical thresholds for detection of HCV viraemia. We then performed logistic regression to evaluate factors associated with LLV, and derived relative sensitivities for significant covariates. RESULTS The dataset included 66,640 individuals with HCV viraemia from across the world. The LOD for the 95th and 99th percentiles were 3,311 IU/ml and 214 IU/ml. The LOD for the 97th percentile was 1,318 IU/ml (95% CI 1,298.4-1,322.3). Factors associated with LLV, defined as HCV RNA <1,318 IU/ml, were younger age 18-30 vs. 51-64 years (odds ratios [OR] 2.56; 95% CI 2.19-2.99), female vs. male sex (OR 1.32; 95% CI 1.18-1.49), and advanced fibrosis stage F4 vs. F0-1 (OR 1.44; 95% CI 1.21-1.69). Only the younger age group had a decreased relative sensitivity below 95%, at 93.3%. CONCLUSIONS In this global dataset, a test with an LOD of 1,318 IU/ml would identify 97% of viraemic HCV infections among almost all populations. This LOD will help guide manufacturers in the development of affordable point-of-care diagnostics to expand HCV testing and linkage to care in low- and middle-income countries. LAY SUMMARY We created and analysed a dataset from 12 countries with 66,640 participants with chronic hepatitis C virus infection. We determined that about 97% of those with viraemic infection had 1,300 IU/ml or more of circulating virus at the time of diagnosis. While current diagnostic tests can detect as little as 12 IU/ml of virus, our findings suggest that increasing the level of detection closer to 1,300 IU/ml would maintain good test accuracy and will likely enable development of more affordable portable tests for use in low- and middle-income countries.
Collapse
Affiliation(s)
- J Morgan Freiman
- Boston Medical Center, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA.
| | - Jianing Wang
- Boston Medical Center, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA
| | | | - C Robert Horsburgh
- Department of Biostatistics, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA; Department of Epidemiology, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA; Global Health, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA
| | | | - Laura F White
- Department of Biostatistics, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA
| | | | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Anne Loarec
- Epicentre, Medecins Sans Frontières, Paris, France
| | | | - Kihn V Nguyen
- National Hospital of Tropical Diseases, Hanoi, Viet Nam
| | - Gamal Shiha
- Department of Internal Medicine, University of Mansoura, Egypt; Egyptian Liver Research Institute and Hospital, Mansoura, Egypt
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital, Mansoura, Egypt
| | - Sunil S Solomon
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India; Johns Hopkins University School of Medicine, Baltimore, USA
| | | | | | - Benjamin Linas
- Boston Medical Center, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA; Department of Epidemiology, Section of Infectious Diseases, Boston University School of Public Health, Boston, USA.
| |
Collapse
|
49
|
Abstract
Background Previous trials have investigated the effect of hepatitis C on lung functions; however, the role of viral load levels is unclear. The aim of this study was to investigate the effect of HCV viremia status on lung functions. Methods This study was in 60 patients with chronic hepatitis C (CHC). Patients were classified into three groups (non-viremic, low-viremic and high-viremic) based on serum HCV RNA levels. Spirometric parameters (FEV1, FVC, FEV1/FVC) and the proportion of patients with spirometric abnormalities were compared between three groups. Results High-viremic and low-viremic patients showed a significantly higher prevalance of spirometric abnormality than observed in non-viremic patients (p=0.02). Moreover, there was a significant moderate correlation between viremia level and the percentage of spirometric abnormalities (Cramer's U value=0.452, p=0.002). High-viremic patients were 14.2 times more likely to exhibiting pulmonary dysfunction than non-viremic patients. Additionally, spirometric parameters FEV1 and FVC were significantly reduced in high-viremic and low-viremic patients compared to those in non-viremic patients (p=0.013 and p<0.001 respectively). Conclusion These results indicate that persistent HCV infection may be associated with reduced pulmonary functions, especially in patients with high viremia levels. Therefore, these patients should be carefully monitored for lung function.
Collapse
Affiliation(s)
- Tayibe Bal
- Department of Infection Disease and Clinical Microbiology, Siirt State Hospital, Siirt, Turkey
| | - Yusuf Onlen
- Department of Infection Disease and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Cenk Babayigit
- Department of Chest Disease, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Yusuf Yumer
- Department of Chest Disease, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Selma Ilkay Sahin
- Department of Infection Disease and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| |
Collapse
|
50
|
Nguyen TT, Lemee V, Bollore K, Vu HV, Lacombe K, Thi XLT, Luong QA, Dubos C, Plantier JC, Thi HD, Laureillard D, Lemoine M, Tuaillon E. Confirmation of HCV viremia using HCV RNA and core antigen testing on dried blood spot in HIV infected peoples who inject drugs in Vietnam. BMC Infect Dis 2018; 18:622. [PMID: 30514229 PMCID: PMC6280470 DOI: 10.1186/s12879-018-3529-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Nucleic acid tests performed on blood samples collected on Dried Blood Spot (DBS) and detection of HCV core antigen (HCVcAg) are two approaches that may facilitate access to HCV diagnosis in low and middle incomes countries. In this study we evaluate HCV RNA and HCV antigen testing on DBS in HIV/HCV co-infected peoples who inject drugs in Vietnam. METHOD One hundred and four HIV/HCV seropositive patients managed in outpatient care at the Haiphong Viet Tiep hospital were included in this study from February to March, 2014 (ANRS 12262 study). RESULTS Eighty-six subjects were tested positive for HCV RNA in serum, median (IQR): 6.9 log10 IU/ml (5.6-7.4 log10 IU/ml). Genotypes consisted of 57 G1 (69%), 3 G3 (4%), and 22 G6 (27%). HCV RNA was detected on DBS specimens in 79 out 86 subjects with chronic hepatitis C (sensitivity 92.5%; 95% CI: 85.1-96.9%). HCV RNA level on DBS and serum was moderately correlated (r = 0.24; p = 0.05) suggesting a degradation of HCV RNA due to transportation and storage conditions. HCVcAg was detected in 75/86 dB specimens (sensitivity: 87.2%; 95% CI: 78.3-93.4%), with a strong positive relationship between DBS HCVcAg and serum HCV RNA levels (r = 0.80; P < 0.0001). CONCLUSIONS Quantification of HCVcAg on DBS appears to benefit from substantial stability under prolonged storage conditions but with a lower analytical sensitivity compared to DBS HCV RNA testing. Detection of HCV RNA on DBS is an interesting approach for confirming viral replication in HCV seropositive persons but the impact of pre-analytical conditions on the integrity of HCV RNA needs to be controlled.
Collapse
Affiliation(s)
- Truong Tam Nguyen
- University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Véronique Lemee
- Normandie Univ., CHU Rouen, Laboratoire de Virologie, Rouen, France
| | - Karine Bollore
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Hai Vinh Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Sorbonne Universités, Université Paris 06, INSERM S 1136, iPLESP, Paris, France
| | | | | | - Charline Dubos
- Normandie Univ., CHU Rouen, Laboratoire de Virologie, Rouen, France
| | | | - Huong Duong Thi
- Department of Public Health, University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Nîmes, Montpellier, France
| | - Maud Lemoine
- Department of Hepatology, St Mary’s Hospital, Imperial College, London, UK
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
| |
Collapse
|