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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. Association of Pharmacogenetic Markers With Atazanavir Exposure in HIV-Infected Women. Clin Pharmacol Ther 2020; 107:315-318. [PMID: 31562781 PMCID: PMC10810687 DOI: 10.1002/cpt.1605] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 02/03/2023]
Abstract
SORCS2 rs73208473 was recently associated with decreased atazanavir (ATV) concentration in the hair of women with seropositive HIV. Herein, we report on a pharmacogenetic study of women with seropositive HIV demonstrating a similar association between rs73208473 and dose-adjusted plasma ATV concentration in African Americans.
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Affiliation(s)
- Bani Tamraz
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Yong Huang
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York – Downstate Medical Center, Brooklyn, New York, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Ruth M. Greenblatt
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
- Great Ormand Street Institute for Child Health, University College London, London, UK
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. A Genome-Wide Association Study Identifies a Candidate Gene Associated With Atazanavir Exposure Measured in Hair. Clin Pharmacol Ther 2018; 104:949-956. [PMID: 29315502 PMCID: PMC6037621 DOI: 10.1002/cpt.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
Hair provides a direct measure of long-term exposure of atazanavir (ATV). We report the results of the first genome-wide association study (GWAS) of ATV exposure measured in hair in an observational cohort representative of US women living with HIV; the Women's Interagency HIV Study. Approximately 14.1 million single nucleotide polymorphisms (SNPs) were analyzed in linear regression-based GWAS, with replication, adjusted for nongenetic predictors collected under conditions of actual use of ATV in 398 participants. Lastly, the PharmGKB database was used to identify pharmacogene associations with ATV exposure. The rs73208473, within intron 1 of SORCS2, resulted in a 0.46-fold decrease in ATV exposure, with the strongest association (P = 1.71×10-8 ) in GWAS. A priori pharmacogene screening did not identify additional variants statistically significantly associated with ATV exposure, including those previously published in ATV plasma candidate pharmacogene studies. The findings demonstrate the potential value of pharmacogenomic GWAS in ethnically diverse populations under conditions of actual use.
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Affiliation(s)
- Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Yong Huang
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, IL
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, CA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY
| | - Peter Bacchetti
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Ruth M. Greenblatt
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, United Kingdom
- Great Ormand Street Institute for Child Health, University College London, United Kingdom
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, NY
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Theodoropoulos N, Nowicki MJ, Chinchilla-Reyes C, Dionne S, Jaramillo A, Mone T, Hasz R, Jendrisak MD, Ladner DP, Ison MG. Deceased organ donor screening for human immunodeficiency virus, hepatitis B virus and hepatitis C virus: Discordant serology and nucleic acid testing results. Transpl Infect Dis 2018; 20. [DOI: 10.1111/tid.12821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/14/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Nicole Theodoropoulos
- Division of Infectious Diseases & Immunology; Department of Medicine; University of Massachusetts; Worcester MA USA
| | - Marek J. Nowicki
- Mendez National Institute of Transplantation; Los Angeles CA USA
| | | | | | - Andrés Jaramillo
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Phoenix AZ USA
- Gift of Hope Organ & Tissue Donor Network; Itasca IL USA
| | | | | | | | - Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative; Comprehensive Transplant Center; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Organ Transplantation; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
| | - Michael G. Ison
- Northwestern University Transplant Outcomes Research Collaborative; Comprehensive Transplant Center; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Organ Transplantation; Department of Surgery; Northwestern University Feinberg School of Medicine; Chicago IL USA
- Division of Infectious Diseases; Department of Medicine; Northwestern University Feinberg School of Medicine; Chicago IL USA
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Mosley JW, Nowicki MJ, Kasper CK, Donegan E, Aledort LM, Hilgartner MW, Operskalski EA, The Transfusion Safety Study Group (. Hepatitis A Virus Transmission
by Blood Products in the
United States. Vox Sang 2017. [DOI: 10.1159/000462666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nabi R, Moldoveanu Z, Wei Q, Golub ET, Durkin HG, Greenblatt RM, Herold BC, Nowicki MJ, Kassaye S, Cho MW, Pinter A, Landay AL, Mestecky J, Kozlowski PA. Differences in serum IgA responses to HIV-1 gp41 in elite controllers compared to viral suppressors on highly active antiretroviral therapy. PLoS One 2017; 12:e0180245. [PMID: 28671952 PMCID: PMC5495342 DOI: 10.1371/journal.pone.0180245] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/27/2017] [Accepted: 06/12/2017] [Indexed: 02/05/2023] Open
Abstract
Mechanisms responsible for natural control of human immunodeficiency type 1 (HIV) replication in elite controllers (EC) remain incompletely defined. To determine if EC generate high quality HIV-specific IgA responses, we used Western blotting to compare the specificities and frequencies of IgA to HIV antigens in serum of gender-, age- and race-matched EC and aviremic controllers (HC) and viremic noncontrollers (HN) on highly active antiretroviral therapy (HAART). Concentrations and avidity of IgA to HIV antigens were measured using ELISA or multiplex assays. Measurements for IgG were performed in parallel. EC were found to have stronger p24- and V1V2-specific IgG responses than HN, but there were no IgG differences for EC and HC. In contrast, IgA in EC serum bound more frequently to gp160 and gag proteins than IgA in HC or HN. The avidity of anti-gp41 IgA was also greater in EC, and these subjects had stronger IgA responses to the gp41 heptad repeat region 1 (HR1), a reported target of anti-bacterial RNA polymerase antibodies that cross react with gp41. However, EC did not demonstrate greater IgA responses to E. coli RNA polymerase or to peptides containing the shared LRAI sequence, suggesting that most of their HR1-specific IgA antibodies were not induced by intestinal microbiota. In both EC and HAART recipients, the concentrations of HIV-specific IgG were greater than HIV-specific IgA, but their avidities were comparable, implying that they could compete for antigen. Exceptions were C1 peptides and V1V2 loops. IgG and IgA responses to these antigens were discordant, with IgG reacting to V1V2, and IgA reacting to C1, especially in EC. Interestingly, EC with IgG hypergammaglobulinemia had greater HIV-specific IgA and IgG responses than EC with normal total IgG levels. Heterogeneity in EC antibody responses may therefore be due to a more focused HIV-specific B cell response in some of these individuals. Overall, these data suggest that development of HIV-specific IgA responses and affinity maturation of anti-gp41 IgA antibodies occurs to a greater extent in EC than in subjects on HAART. Future studies will be required to determine if IgA antibodies in EC may contribute in control of viral replication.
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Affiliation(s)
- Rafiq Nabi
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Zina Moldoveanu
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Qing Wei
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Helen G. Durkin
- Departments of Pathology and Medicine, SUNY Downstate, Brooklyn, NY, United States of America
| | - Ruth M. Greenblatt
- Departments of Medicine and Epidemiology/Biostastistics, University of California, San Francisco, CA, United States of America
| | - Betsy C. Herold
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Marek J. Nowicki
- Department of Pediatrics, University of Southern California, Los Angeles, CA, United States of America
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, D.C., United States of America
| | - Michael W. Cho
- Department of Biomedical Sciences, Iowa State University, Ames, IA, United States of America
| | - Abraham Pinter
- Public Health Research Institute, Rutgers New Jersey Medical School, Newark, NJ, United States of America
| | - Alan L. Landay
- Department of Immunity and Emerging Pathogens, Rush University Medical Center, Chicago, IL, United States of America
| | - Jiri Mestecky
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States of America
- Institute of immunology and Microbiology 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pamela A. Kozlowski
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
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Keller MJ, McGinn AP, Lo Y, Huber A, Espinoza L, Minkoff H, Colie C, Nowicki MJ, D'Souza G, Anastos K. Longitudinal Assessment of Systemic and Genital Tract Inflammatory Markers and Endogenous Genital Tract E. coli Inhibitory Activity in HIV-Infected and Uninfected Women. Am J Reprod Immunol 2016; 75:631-42. [PMID: 27145926 DOI: 10.1111/aji.12518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Stability over time of systemic and mucosal immunity and their associations with bacterial vaginosis (BV) and HIV-specific parameters were assessed. METHOD OF STUDY Immune mediators and HIV viral load in plasma and cervicovaginal lavage (CVL), E. coli inhibition, and Nugent score were measured at three semiannual visits among 94 participants in the Women's Interagency HIV Study. Mixed models identified the factors associated with immune mediators. RESULTS There was higher E. coli inhibition and lower inflammation over time in the genital tract and systemically. BV was consistently associated with higher CVL inflammatory mediators and lower CVL E. coli inhibition. HIV-infected women with higher CD4 counts had lower systemic and genital inflammatory mediators, and genital HIV shedding was associated with higher CVL inflammatory mediators. Use of antiretroviral therapy (ART) was associated with lower plasma and CVL mediators, but higher E. coli inhibition. CONCLUSION HIV and BV are linked to inflammation, and ART may be associated with improved vaginal health.
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Affiliation(s)
| | | | - Yungtai Lo
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ashley Huber
- Albert Einstein College of Medicine, Bronx, NY, USA
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Sarkar M, Bacchetti P, Tien P, Mileti E, French AL, Edlin BR, Keller M, Seaberg E, Nowicki MJ, Young M, Peter MG. Racial/ethnic differences in spontaneous HCV clearance in HIV infected and uninfected women. Dig Dis Sci 2013. [PMID: 23179159 PMCID: PMC3663918 DOI: 10.1007/s10620-012-2486-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS Among individuals without human immunodeficiency virus (HIV), African Americans have lower spontaneous clearance of hepatitis C virus (HCV) than Caucasians, and women have higher clearance than men. Few studies report racial/ethnic differences in acute HCV in HIV infected, or Hispanic women. We examined racial/ethnic differences in spontaneous HCV clearance in a population of HCV mono- and co-infected women. METHODS We conducted a cross sectional study of HCV seropositive women (897 HIV infected and 168 HIV uninfected) followed in the US multicenter, NIH-funded Women's Interagency HIV Study (WIHS), to determine the association of race/ethnicity with spontaneous HCV clearance, as defined by undetectable HCV RNA at study entry. RESULTS Among HIV and HCV seropositive women, 18.7 % were HCV RNA negative, 60.9 % were African American, 19.3 % Hispanic and 17.7 % Caucasian. HIV infected African American women were less likely to spontaneously clear HCV than Hispanic (OR 0.59, 95 % CI 0.38-0.93, p = 0.022) or Caucasian women (OR 0.57, 95 % CI 0.36-0.93, p = 0.023). Among HIV uninfected women, African Americans had less HCV clearance than Hispanics (OR 0.18, 95 % CI 0.07-0.48, p = 0.001) or Caucasians (OR 0.26, 95 % CI 0.09-0.79, p = 0.017). There were no significant differences in HCV clearance between Hispanics and Caucasians, among either HIV infected (OR 0.97, 95 % CI 0.57-1.66, p = 0.91) or uninfected (OR 1.45, 95 % CI 0.56-3.8, p = 0.45) women. CONCLUSIONS African Americans were less likely to spontaneously clear HCV than Hispanics or Caucasians, regardless of HIV status. No significant differences in spontaneous HCV clearance were observed between Caucasian and Hispanic women. Future studies incorporating IL28B genotype may further explain these observed racial/ethnic differences in spontaneous HCV clearance.
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Affiliation(s)
- Monika Sarkar
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143-0358, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Phyllis Tien
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Mileti
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Audrey L. French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - Brian R. Edlin
- Department of Medicine, Division of Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marla Keller
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Seaberg
- Department of Epidemiology and Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Marion G. Peter
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143-0358, USA
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Villacres MC, Kono N, Mack WJ, Nowicki MJ, Anastos K, Augenbraun M, Liu C, Landay A, Greenblatt RM, Gange SJ, Levine AM. Interleukin 10 responses are associated with sustained CD4 T-cell counts in treated HIV infection. J Infect Dis 2012; 206:780-9. [PMID: 22693231 DOI: 10.1093/infdis/jis380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammation persists in treated human immunodeficiency virus (HIV) infection and may contribute to an increased risk for non-AIDS-related pathologies. We investigated the correlation of cytokine responses with changes in CD4 T-cell levels and coinfection with hepatitis C virus (HCV) during highly active antiretroviral treatment (HAART). METHODS A total of 383 participants in the Women's Interagency HIV Study (212 with HIV monoinfection, 56 with HCV monoinfection, and 115 with HIV/HCV coinfection) were studied. HIV-infected women had <1000 HIV RNA copies/mL, 99.7% had >200 CD4 T cells/μL; 98% were receiving HAART at baseline. Changes in CD4 T-cell count between baseline and 2-4 years later were calculated. Peripheral blood mononuclear cells (PBMCs) obtained at baseline were used to measure interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), interleukin 12 (IL-12), and tumor necrosis factor α (TNF-α) responses to Toll-like receptor (TLR) 3 and TLR4 stimulation. RESULTS Undetectable HIV RNA (<80 copies/mL) at baseline and secretion of IL-10 by PBMCs were positively associated with gains in CD4 T-cell counts at follow-up. Inflammatory cytokines (IL-1β, IL-6, IL-12, and TNF-α) were also produced in TLR-stimulated cultures, but only IL-10 was significantly associated with sustained increases in CD4 T-cell levels. This association was significant only in women with HIV monoinfection, indicating that HCV coinfection is an important factor limiting gains in CD4 T-cell counts, possibly by contributing to unbalanced persistent inflammation. CONCLUSIONS Secreted IL-10 from PBMCs may balance the inflammatory environment of HIV, resulting in CD4 T-cell stability.
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Affiliation(s)
- Maria C Villacres
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Aumakhan B, Gange SJ, Beyrer C, Gaydos CA, Minkoff H, Merenstein DJ, Cohen MH, Anastos K, Greenblatt R, Nowicki MJ, Quinn TC. Quantitative and qualitative correlates of cervicovaginal herpes simplex virus type 2 shedding among HIV-infected women in the Women's Interagency HIV Study. Int J STD AIDS 2011; 22:273-7. [PMID: 21571975 DOI: 10.1258/ijsa.2009.009296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We identified demographic, clinical and biological determinants of herpes simplex virus type 2 (HSV-2) shedding among HIV-infected participants in the Women's HIV Interagency Study (WIHS). Cervicovaginal lavage (CVL) specimens from 369 HIV-infected HSV seropositive women were tested with TaqMan polymerase chain reaction (PRC) for detection HSV-2 DNA. Seven percent of women tested positive for HSV-2 DNA in CVL. Significant correlates of the presence of HSV-2 DNA in CVL were being younger, African American or Hispanic race/ethnicity and injecting drugs in the past six months (P < 0.05). A borderline significant trend for reduced viral shedding with higher CD4+ T cell counts was observed (P = 0.08). All women who were never observed with any genital lesions and had consistently negative self-reported history of genital sores throughout the follow-up (n = 29, 8%) were negative for CVL HSV-2 DNA. HSV-2 DNA quantity was significantly associated with having frequent subsequent lesion recurrences (Spearman rho = 0.48, P = 0.016; adjusted prevalence ratio [APR] = 2.5, P = 0.012). Increasing the age of the host was inversely correlated with decreased viral shedding over time. However, a subset of older women continued to shed significant amounts of virus despite passage of time. This study provides genital HSV-2 DNA titre as a quantitative and symptom- and sign-based measures as qualitative predictors of HSV-2 shedding from the lower genital tract among HIV-infected women.
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Affiliation(s)
- B Aumakhan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Nowicki MJ, Vigen C, Mack WJ, Seaberg E, Landay A, Anastos K, Young M, Minkoff H, Greenblatt R, Levine AM. Association of cells with natural killer (NK) and NKT immunophenotype with incident cancers in HIV-infected women. AIDS Res Hum Retroviruses 2008; 24:163-8. [PMID: 18240964 DOI: 10.1089/aid.2007.0119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Evidence indicates that immunosupression is associated with the development of certain cancers. The pathogenesis of HIV disease includes an alteration in innate immunity, mediated through NK and NKT cells. The evaluation of innate immune status in HIV patients prior to cancer diagnosis may identify the specific immunological events preceding the development of malignant disease. We evaluated the association between immunophenotypically defined NK, NKT, and CD8(+) cell percentages and incident malignancies in 1817 HIV(+) women in the Women's Interagency HIV Study (WIHS) who were followed for a median of 7.5 years. A total of 52 incident cancers of 20 different sites were identified. Compared to cancer-free women, cancer cases were older (p < 0.01), more likely to be anti-HCV(+) (p = 0.02), and had higher baseline median HIV RNA levels than controls. The CD8(+), NK, and NKT percents at baseline were not related to cancer risk. However, when time-dependent values for NKT cells were used, higher levels of NKT cells were associated with a reduced risk of cancer (adjusted hazard ratio = 0.67, 95% CI = 0.50, 0.89 per NKT percentage point). In addition to the loss of CD4(+) lymphocytes and an increased risk of opportunistic infections, HCV coinfected individuals may also experience alterations in innate immunity, including reduced NKT and NK cell number and possibly their function. In time-dependent analyses, increased numbers of NKT cells were associated with a reduced risk of cancer. HIV-induced innate immune dysfunction may contribute to the eventual emergence of cancer in the setting of existing coinfections and altered immunosurveillance.
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Affiliation(s)
- Marek J. Nowicki
- Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Cheryl Vigen
- Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Wendy J. Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Eric Seaberg
- Department of Epidemiology, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21218
| | - Alan Landay
- Departments of Immunology/Microbiology and Medicine, Rush University Medical Center, Chicago, Illinois 60612
| | | | - Mary Young
- Division of Infectious Diseases, Georgetown University, Washington, D.C. 20057
| | | | | | - Alexandra M. Levine
- Keck School of Medicine, University of Southern California, Los Angeles, California 90033
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Nowicki MJ, Karim R, Mack WJ, Minkoff H, Anastos K, Cohen M, Greenblatt RM, Young MA, Gange SJ, Levine AM. Correlates of CD4+ and CD8+ lymphocyte counts in high-risk immunodeficiency virus (HIV)-seronegative women enrolled in the women's interagency HIV study (WIHS). Hum Immunol 2007; 68:342-9. [PMID: 17462501 DOI: 10.1016/j.humimm.2007.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 09/28/2006] [Revised: 12/22/2006] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
Studies of human immunodeficiency virus (HIV) infection often compare values from HIV-uninfected controls, including CD4 and CD8 lymphocyte counts. Nonetheless, little is known regarding factors associated with CD4 and CD8 cell numbers in HIV-uninfected individuals. To ascertain potential factors associated with differences in CD4 and CD8 cells among HIV negative women, we studied these cells in a group of 953 women, enrolled as HIV-negative comparators in the Women's Interagency HIV Study. Using standard techniques, we measured CD4 and CD8 cells obtained during study-related visits every six months through visit 20 (maximum of 9.5 years). Results were correlated with demographic and behavioral factors, and data were analyzed using a multiple linear regression approach with generalized estimating equations. At baseline, the median age was 32.4 years, body mass index (BMI) was 26.4 kg/m(2), CD4 cell count was 1010 (range 214-2705)/microL, and CD8 cell count was 542 (range 72-2448)/microL. African-Americans comprised 54%, 24% were Hispanic, and 19% were Caucasian. In multivariate analysis, increasing age (p = 0.0006), increasing BMI (p = 0.001), and current smoking status (p = 0.03) were independent predictors of higher CD4 counts. Multivariate analyses of CD8 cells revealed that lower age (p = 0.001), higher BMI (p = 0.03), Hispanic race/ethnicity (p = 0.01); current smoking (p = 0.006), injection drug use (p = 0.02), and Hepatitis C infection (p = 0.01) were independent predictors of higher CD8 cell counts. Multiple demographic and behavioral factors may influence CD4 and CD8 counts in HIV negative women. These factors must be considered in future analyses comparing lymphocyte subsets in HIV positive and negative women.
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Affiliation(s)
- Marek J Nowicki
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Nowicki MJ, Matsuoka L, Brucal D, Chinchilla C, Mone T, Selby R, Mendez R. High seroprevalence of anti-HTLV-I/II antibodies among solid organ donors necessitates confirmatory testing. Transplantation 2007; 82:1210-3. [PMID: 17102773 DOI: 10.1097/01.tp.0000236031.03510.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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
BACKGROUND Human T-cell lymphotrophic virus (HTLV) type I has been linked to adult T-cell leukemia/lymphoma (ATL) and HTLV-I associated myelopathy (HAM). Transmission of HTLV by blood and organ transplantation has been documented, with some infections leading to clinical disease. Organ donors are tested for anti-HTLV antibodies and donor suitability is determined primarily by results from enzyme immunoassays (EIA). Confirmatory testing is not routinely performed, and the number of false positive organ donors is unknown. METHODS In order to investigate the contemporary seroprevalence of anti-HTLV I/II antibodies among solid organ donors and determine the number of false positive samples, we tested 1,408 specimens from prospective organ donors in 2002 and 2003. All specimens were tested for anti-HTLV antibodies by a commercial EIA. Repeatedly reactive specimens underwent confirmatory testing using a commercial Western blot. RESULTS There were 22 repeatedly EIA reactive donor specimens (1.56%). Five specimens did not undergo further testing because of case shutdown or insufficient sample quantity. HTLV I/II western blot confirmed six positives, whereas five were negative and six were indeterminate. The majority of confirmed specimens were positive for antibodies to HTLV-II. CONCLUSIONS Our data shows that 29% of initially reactive specimens were false positives. With the increasing demand for organs, the unnecessary rejection of organs that are falsely positive for HTLV antibodies becomes of tremendous importance and stresses the need for timely confirmatory testing for HTLV.
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Affiliation(s)
- Marek J Nowicki
- National Institute of Transplantation, Los Angeles, CA 90057, USA.
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Nowicki MJ, Chinchilla C, Corado L, Matsuoka L, Selby R, Steurer F, Mone T, Mendez R, Aswad S. Prevalence of Antibodies to Trypanosoma cruzi among Solid Organ Donors in Southern California: A Population at Risk. Transplantation 2006; 81:477-9. [PMID: 16477238 DOI: 10.1097/01.tp.0000195778.08411.b8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [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
Trypanosoma cruzi, a parasite that causes Chagas' disease, is endemic in parts of Mexico, South America, and Central America. Transmission of T. cruzi infection by solid organ transplantation has been reported in Latin America and recently in the United States. To determine the prevalence of T. cruzi antibodies in Southern California organ donors, 404 samples from deceased organ donors between May 2002 to April 2004 were screened using a qualitative enzyme-linked immunosorbent assay (EIA) and confirmed with an immunofluorescence assay (IFA) available through the Centers for Disease Control (CDC). Six donors were initially reactive by EIA. Three donors were repeatedly reactive after repeat testing and were sent to the CDC for confirmation. One donor (0.25%) had an IFA-confirmed reactivity to anti-T. cruzi antibodies. In areas where there is a high number of immigrants from T. cruzi endemic countries, screening for anti-T. cruzi donor antibodies may be beneficial.
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Affiliation(s)
- Marek J Nowicki
- National Institute of Transplantation, Los Angeles, CA 90057, USA
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14
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Nowicki MJ, Laskus T, Nikolopoulou G, Radkowski M, Wilkinson J, Du WB, Rakela J, Kovacs A. Presence of hepatitis C virus (HCV) RNA in the genital tracts of HCV/HIV-1-coinfected women. J Infect Dis 2005; 192:1557-65. [PMID: 16206070 PMCID: PMC3164119 DOI: 10.1086/491742] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 05/27/2005] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV)-infected women--in particular, those coinfected with human immunodeficiency virus type 1 (HIV-1)--can transmit infection to their children and sex partners. METHODS The present study was conducted to analyze the presence of HCV RNA in cervicovaginal lavage (CVL) fluid from 71 women (58 HCV/HIV-1-coinfected women and 13 HCV-infected, HIV-1-uninfected women) enrolled in the Women's Interagency HIV Study. RESULTS HCV RNA was detected (by a commercial polymerase chain reaction assay) in CVL fluid from 18 (29%) of the HIV-1-infected women and from none of the HIV-1-uninfected women (P<.05). Multivariate analysis revealed that risk factors for the presence of HCV RNA in CVL fluid were HCV viremia (odds ratio [OR], 16.81; P=.02) and HIV-1 RNA in CVL fluid (OR, 19.87; P=.02). This observation suggests local interactions between HIV-1 and HCV in the genital tract compartment. There was no correlation between HCV RNA in CVL fluid and CD4, CD8, or CD3 cell counts, HIV-1 RNA viremia, the number of leukocytes in CVL fluid, or HIV-1 therapy. Furthermore, in 3 of 5 analyzed patients who had a detectable CVL HCV RNA load, we found viral variants differing in the 5' untranslated region that were present neither in plasma nor in peripheral-blood mononuclear cells. CONCLUSIONS Our observations point to the importance of the genital tract compartment, in which local HCV replication could be facilitated by local HIV-1 replication.
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Affiliation(s)
- Marek J Nowicki
- Maternal-Child and Adolescent Center for Infectious Diseases and Virology, University of Southern California, Los Angeles 90033, and Mayo Clinic, Scottsdale, USA.
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15
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Nikolopoulou GB, Nowicki MJ, Du W, Homans J, Stek A, Kramer F, Kovacs A. HCV viremia is associated with drug use in young HIV-1 and HCV coinfected pregnant and non-pregnant women. Addiction 2005; 100:626-35. [PMID: 15847620 PMCID: PMC3118993 DOI: 10.1111/j.1360-0443.2005.01054.x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
AIMS Vertical transmission of HCV is increased among HIV-1/HCV coinfected women and is related to HCV viral load. In this study we assessed clinical and demographic factors associated with HCV viremia in a cohort of young pregnant and non-pregnant mothers coinfected with HIV-1. DESIGN A cross-sectional clinic-based study nested within a prospective cohort study. METHODS From 1988 to 2000, HIV-1 + pregnant and non-pregnant women with children followed in a large maternal, child and adolescent HIV-1 clinic were evaluated for HCV infection using EIA 3.0. HCV RNA levels were determined for HCV antibody + women using polymerase chain reaction. Demographic and clinical characteristics between HCV-RNA(+) and HCV-RNA(-) women and between pregnant and non-pregnant HIV-1/HCV coinfected women were compared using univariate and multivariate analyses. FINDINGS Among 359 HIV-1(+) women, 84 (23%) were HCV-ab + and 49/84 (58%) had detectable HCV-RNA in plasma. Median age was 31. CD4 counts, HIV-1 RNA levels and demographic characteristics were similar for viremic and non-viremic women and pregnant and non-pregnant women. However, viremic women were more likely to report a history of (88% versus 43%; P < 0.001) or active injection drug use (AIDU) (83% versus 29%; P < 0.001). Logistic regression analysis showed that HCV viremia was associated significantly with AIDU (adjusted OR: 15.17; 95% CI: 3.56, 64.56) after adjusting for age, race, number of sexual partners, pregnancy status, CD4 counts and HIV-1 viral load. CONCLUSION In this cohort of young HIV-1 and HCV coinfected women, HCV viremia was associated strongly with active injection drug use, perhaps due to reinfection or reactivation of HCV. Thus, careful evaluation for HCV infection and counseling related to drug use may be necessary.
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Affiliation(s)
- Georgia B Nikolopoulou
- Maternal, Child and Adolescent Center for Infectious Diseases and Virology, Los Angeles County and University of Southern California Medical Center, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA
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16
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Operskalski EA, Mosley JW, Tobler LH, Fiebig EW, Nowicki MJ, Mimms LT, Gallarda J, Phelps BH, Busch MP. HCV viral load in anti-HCV-reactive donors and infectivity for their recipients. Transfusion 2003; 43:1433-41. [PMID: 14507276 DOI: 10.1046/j.1537-2995.2003.00475.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND An attempt has been made to determine the minimum level of HCV nucleic acid in donors associated with infection of recipients. This is important for considerations about assay sensitivity, use of minipool versus single-donation testing, and continued use of serologic testing. STUDY DESIGN AND METHODS A total of 5387 specimens from the Transfusion-Transmitted Viruses Study in the 1970s were screened for antibody to HCV (anti-HCV). The outcome in recipients of seroreactive donations was examined for viremia and seroconversion. Present techniques for both groups included third-generation EIA, RIBA, quantitative RT-PCR assay, and transcription-mediated amplification (TMA) assay. RESULTS A total of 156 recipients of components from 180 anti-HCV-reactive donors were identified. One-hundred seven of these were HCV-naïve before transfusion and received a single, confirmed seropositive unit; 94 (88%) became infected. Eighty-five recipients had donors whose HCV RNA level was quantifiable by RT-PCR (range, 182-3,310,000 copies/mL). Eighty-three (98%) seroconverted. Of the remaining 22, a total of 10 received units positive for HCV RNA detected only by TMA; all 10 recipients seroconverted. Of the remaining 12 recipients of anti-HCV+, TMA-negative units, 1 recipient seroconverted. CONCLUSIONS High rates of transmission were seen at all levels of viremia, and one donor transmitted with undetectable levels in the TMA assay. Current HCV RNA testing will therefore not interdict all infectious units, even with single-donation testing, and serologic screening must be continued.
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Affiliation(s)
- Eva A Operskalski
- Transfusion Viruses Program, Keck School of Medicine, University of Southern California, Los Angeles, California 90089-9560, USA.
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17
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Nowicki MJ, Benning L, Bremer JW, Meyer WA, Hanson C, Brambilla D, Silver S, Kovacs A. Longitudinal variability of human immunodeficiency virus type 1 RNA viral load measurements by nucleic acid sequence-based amplification and NucliSens assays in a large multicenter study. J Clin Microbiol 2001; 39:3760-3. [PMID: 11574612 PMCID: PMC88428 DOI: 10.1128/jcm.39.10.3760-3763.2001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) RNA measurements were evaluated within an externally controlled multilaboratory program. Three external standards (1.5 x 10(3) to 1.5 x 10(6) copies/ml) were included in 814 assay runs by four laboratories. Results indicate that HIV-1 RNA levels can be measured with a precision equal to that of the pre-highly active antiretroviral therapy era (standard deviations, +/-0.16 to 0.25 log10 units).
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Affiliation(s)
- M J Nowicki
- University of Southern California, Pediatrics, Los Angeles, California 90033, USA.
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18
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Affiliation(s)
- E G Hodges
- Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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19
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Abstract
Solitary rectal ulcer syndrome (SRUS) is a rarely reported condition in children. The typical presentation is one of anorectal pain with passage of blood and mucus per rectum in the setting of defecation abnormalities. Diagnosis is made via endoscopy and biopsy. Solitary rectal ulcer syndrome alone is usually a benign condition; however, significant morbidity can occur if complicated by underlying disease states. We report an adolescent with hemophilia A and SRUS who presented with a rectal bleed that required blood transfusion.
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Affiliation(s)
- P R Bishop
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Blair E. Batson Children's Hospital, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
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20
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Affiliation(s)
- P R Bishop
- Department of Pediatrics, Blair E. Batson Children's Hospital, University of Mississippi Medical Center, Jackson 39216, USA
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21
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Abstract
OBJECTIVES Chicken skin mucosa is a newly described endoscopic finding associated with colonic neoplasms in adults. Chicken skin mucosa was sought in children with juvenile polyps to determine the prevalence, endoscopic features, and location. An alternative theory is proposed for the pathogenic mechanism of this finding. METHODS Children having colonoscopy and polypectomy were prospectively evaluated for the presence of chicken skin mucosa. The location of the polyps was determined at colonoscopy; the size of removed polyps was measured during processing of samples in pathology. Biopsies from colonic chicken skin mucosa were stained with hematoxylin and eosin and mucicarmine. RESULTS Over a 1-yr period, 27 juvenile polyps were removed from 15 children at colonoscopy. Eleven of 15 children (73%) were found to have polyps with chicken skin mucosa; overall, 43% of the polyps had associated chicken skin mucosa. Chicken skin mucosa-positive polyps were larger than chicken skin mucosa-negative polyps and were only found in the rectosigmoid colon. Lipid-laden macrophages were found in all samples of chicken skin mucosa tested. CONCLUSIONS Chicken skin mucosa is a common finding in children with juvenile polyps. It probably is the result of local mucosal trauma, rather than a preneoplastic lesion.
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Affiliation(s)
- M J Nowicki
- Department of Pathology, University of Mississippi Medical Center, Jackson 39216, USA
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22
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Finch LA, Nowicki MJ, Mitchell TE, Smith MG, Shenefelt RE, Subramony C. Clinical quiz. Abetalipoproteinemia. J Pediatr Gastroenterol Nutr 2001; 32:310, 315. [PMID: 11345181 DOI: 10.1097/00005176-200103000-00014] [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: 12/10/2022]
Affiliation(s)
- L A Finch
- Division of Pediatric Gastroenterology, University of Mississippi Medical Center, The Blair E. Batson Hospital for Children, Jackson, USA
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23
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Nowicki MJ, Coyle WJ. Severe iron deficiency anemia and asymptomatic nodular gastroduodenitis: an uncommon presentation of Helicobacter pylori infection in a child. Clin Pediatr (Phila) 2001; 40:111-4. [PMID: 11261448 DOI: 10.1177/000992280104000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/13/2023]
Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology, Nutrition Naval Medical Center, Portsmouth, Virginia, USA
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24
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Mosley JW, Nowicki MJ, Wang LF, Laskus T, Rakela JL. Polymerase chain reaction in detecting hepatitis C virus among blood donors. Dev Biol (Basel) 2000; 102:93-6. [PMID: 10794094] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- J W Mosley
- Transfusion Viruses Program, University of Southern California, Los Angeles, USA
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25
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Affiliation(s)
- P R Bishop
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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26
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Affiliation(s)
- P R Bishop
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, USA
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Affiliation(s)
- J F Fitzgerald
- Division of Pediatric Gastroenterology and Nutrition, University of Mississippi Medical Center, The Blair E. Batson Hospital for Children, Jackson, USA
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28
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Affiliation(s)
- P R Bishop
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Blair E. Batson Children's Hospital, University of Mississippi Medical Center, Jackson 39216, USA
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29
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Affiliation(s)
- M J Nowicki
- Division of Peadiatric Gastroentrology and Nutrition, Blair E. Batson Chilren's Hospital, Unversity of Mississippi Medical Center, Jackson, 39216, USA
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30
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31
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Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology and Nutrition, Blair E. Batson Children's Hospital, University of Mississippi Medical Center, Jackson 39216, USA
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32
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Affiliation(s)
- P R Bishop
- Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson 39216, USA
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33
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Affiliation(s)
- S M Stuart
- Department of Pediatrics, Naval Medical Center, Portsmouth, VA 23708, USA
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Abstract
In this chapter, an abbreviated account is presented on the subject of hereditary diseases and the liver. However, it is incomplete because Alagille syndrome, storage disorders, alpha-1-antitrypsin deficiency and Wilson disease are not included as they appear in other chapters of this volume. Biliary atresia is omitted because all available evidence does not support any significant genetic association. Molecular biological techniques have enabled linkage of several liver cholestatic disorders to chromosomal loci, and further characterization of the canalicular bile salt transporter (cBST) will advance our understanding of pathogenetic mechanisms involved in benign and progressive cholestatic syndromes. Disorders that have been treated as separate entities may have common 'roots', exemplified by the concept of the ductal plate malformation in fibropolycystic disease. Whereas the majority of disorders referred to in this chapter present early in life, there are several that are associated with liver failure in the neonatal period, which makes early recognition particularly important. Liver transplantation offers a cure for many hereditary disorders affecting the liver but it is not applicable to all.
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Affiliation(s)
- J R Poley
- Department of Paediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
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35
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Abstract
The presence of jaundice in the neonate, infant or young child presents a broad differential diagnosis. The 'disease' may be benign, as in breast-milk jaundice, or potentially fatal, as in hereditary fructose intolerance. The cause of the jaundice may be a primary hepatic disorder, such as extrahepatic biliary atresia, or secondary to a non-hepatic cause, such as haemolysis or sepsis. There may be significant hepatic injury and dysfunction, as in fulminant viral hepatitis, or simply elevation of plasma bilirubin, as in Gilbert's syndrome. In this chapter we will discuss the familial hyperbilirubinaemia syndromes. This diverse group of disorders is characterized by hepatic dysfunction in the absence of hepatocellular injury. The first section of the chapter will discuss the unconjugated hyperbilirubinaemias: Crigler-Najjar syndrome I, Crigler-Najjar syndrome II and Gilbert's syndrome. The discovery of the gene for bilirubin uridine diphosphate glucuronosyltransferase has increased our understanding of the genetic heterogeneity and clinical presentation of the Crigler-Najjar syndromes. The remainder of the chapter will discuss the conjugated hyper-bilirubinemias: Rotor syndrome and Dubin-Johnson syndrome. These rare diseases share many clinical features; however, they can be readily distinguished by biochemical markers in the urine and bile.
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Affiliation(s)
- M J Nowicki
- Eastern Virginia Medical School, Norfolk, USA
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36
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Affiliation(s)
- M J Nowicki
- Division of Pediatric, Naval Medical Center, Portsmouth, Virginia 23708, USA
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37
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Affiliation(s)
- W J Coyle
- Division of Adult Gastroenterology, Naval Medical Center, Portsmouth, Virginia, USA
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Abstract
BACKGROUND We evaluated the clinical utility of the 13C-xylose breath test for the diagnosis of small bowel bacterial overgrowth in children. METHODS To determine the optimal dose of 13C-xylose, 29 healthy children, 3 to 12 years old, were randomly assigned to receive one of three doses of 13C-xylose (10, 25, or 50 mg). After an overnight fast, the oral dose of 13C-xylose was administered, and breath samples were collected every 30 minutes for 4 hours. Samples were analyzed for 13CO2 by gas chromatography with mass spectrometry. Using the 50 mg dose, we then performed nine breath tests with concurrent duodenal bacterial cultures in 6 children, 3 to 12 years old, with short-bowel syndrome (n = 2), immunodeficiency states (n = 1), and motility disorders (n = 3). RESULTS Excretion of 13CO2 in breath peaked at 2.5 hours in all three control groups. The 50-mg dose produced the highest median peak and the smallest range of 13CO2 excretion in breath within each time period. The time of peak 13CO2 excretion in breath varied among the diseased children; however, the six patients with small-bowel bacterial overgrowth (2 x 10(5)-3.5 x 10(5) gram negative rods) all had peak 13CO2 that exceeded the maximum breath 13CO2 level in breath of the control subjects at the corresponding time period (100% sensitivity). Of the three patients with negative cultures, two had negative breath test results and one had positive results (67% specificity). One subject had normalization of both duodenal culture and breath test results after antibiotic treatment of small-bowel bacterial overgrowth. CONCLUSIONS Our preliminary results suggest that with a dose of 50 mg 13C-xylose, breath test results reliably predict small-bowel bacterial overgrowth in susceptible children.
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Affiliation(s)
- S F Dellert
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Research Foundation, Cincinnati, Ohio, USA
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39
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Abstract
The regulation of the enterohepatic circulation of bile acids has not been fully elucidated. Substrate availability has been shown to have a regulatory role on the ileal uptake of taurocholate (TC) by a positive feedback mechanism. Other mechanisms are likely to be involved in regulating ileal bile acid uptake. The present study was designed to test the hypothesis that the ileal bile acid transporter (iBAT) is glucocorticoid sensitive and that changes in expression are mediated by changes in iBAT synthesis. Adult Sprague-Dawley rats (300-400 g) received intraperitoneal injections with either corticosterone (5 mg/ 100 g body weight) or an equivalent vehicle (control) daily for 3 days. On day 4, ileal brush-border membrane vesicles (BBMV) and hepatic basolateral membrane vesicles (BLMV) were prepared, and TC transport was performed using the rapid filtration technique. Initial velocity was measured at selected time points, and kinetics were calculated over a range of TC concentrations. Ileal RNA was isolated, and Northern analysis of steady-state iBAT mRNA levels was determined. Western blot analysis was performed to quantitate the level of the 48-kDa iBAT protein. The initial velocity of Na(+)-dependent TC uptake at 30 s by ileal BBMV was higher in treated animals (264.3 +/- 64.6 pmol/mg protein) compared with control animals (148.3 +/- 41.1 pmol/mg protein; P = 0.07). The maximal velocity of uptake (Vmax) was significantly higher in treated vs. control animals (1,091 +/- 62.7 vs. 689.1 +/- 55.0 pmol.min-1.mg protein-1, respectively; P = 0.002), whereas there was no significant difference in the Michaelis constant (Km) between the control and treated animals (43.3 +/- 7.2 vs. 35.3 +/- 8.7 microM, respectively; P = not significant). Steady-state iBAT mRNA levels were increased twofold in the treated vs. control groups. Western blot analysis showed that the abundance of the 48-kDa iBAT protein was eightfold higher in the treated animals compared with control. Kinetic analysis of hepatic Na(+)-dependent TC uptake revealed nearly identical Vmax and Km between the study and control animals. Therefore, we conclude that TC transport by ileal BBMV is upregulated by administration of glucocorticoids. The increase in BBMV transport Vmax corresponds to an increase in both iBAT transcript and protein.
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Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Research Foundation, Cincinnati, Ohio 45229, USA
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Affiliation(s)
- V M Tsou
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA
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Mosley JW, Huang W, Stram DO, Nowicki MJ, Hollinger FB, Aach RD, Stevens CE, Barbosa LH, Nemo GJ. Donor levels of serum alanine aminotransferase activity and antibody to hepatitis B core antigen associated with recipient hepatitis C and non-B, non-C outcomes. Transfusion 1996; 36:776-81. [PMID: 8823449 DOI: 10.1046/j.1537-2995.1996.36996420752.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hepatitis virus(es) that are neither hepatitis B (HBV) nor hepatitis C (HCV) (non-B, non-C [NBNC]) may be transmitted by transfusion. The present study assessed donor values for alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) for their association with HCV and NBNC hepatitis outcomes among allogeneic blood recipients. STUDY DESIGN AND METHODS Data on blood donors and recipients enrolled in the Transfusion- Transmitted Viruses Study in four United States cities from 1974 through 1980 were supplemented by anti-HBc testing of donors and anti-HCV evaluation of recipients. Two statistical approaches estimated the value of these indirect tests in detecting donors associated with HCV seroconversion and NBNC hepatitis in recipients. RESULTS For HCV cases, donor ALT alone (at > or = 60 IU/L) had a sensitivity and a specificity of 30 and 96 percent, respectively, and anti-HBc alone (at > or = 60% inhibition) had a sensitivity and specificity of 53 and 86 percent, respectively. The two markers combined had a sensitivity and a specificity of 69 and 83 percent. For NBNC hepatitis cases, each measure had low sensitivity (20%) that was not improved by using both (28%) [corrected]. CONCLUSION The indirect tests proved to be equal in sensitivity to the first-generation anti-HCV tests. The positive predictive power of these indirect tests in the 1980s was sufficient to affect HCV incidence in studies during that period. Improved anti-HCV assays, however, replaced the need for indirect tests. The sensitivity of indirect tests for NBNC hepatitis contributed little.
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Affiliation(s)
- J W Mosley
- University of Southern California, Los Angeles, USA
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42
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Affiliation(s)
- M J Nowicki
- Division of Gastroenterology and Nutrition, Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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43
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Abstract
BACKGROUND & AIMS It was recently reported that two point mutations within the hepatitis B virus (HBV) core promoter region (A to T at position 1762 and G to A at position 1764) are associated with fulminant hepatitis and lead to hepatitis B e antigen (HBeAg)-negative phenotype. The aim of this study was to correlate core promoter sequence variations with HBeAg status and clinical outcome in various forms of HBV infection. METHODS Core promoter region of HBV was amplified by polymerase chain reaction and directly sequenced in 94 patients: 37 patients with fulminant hepatitis, 20 with acute self-limited hepatitis, 30 with chronic hepatitis, and 7 patients with end-stage cirrhosis. RESULTS Core promoter region was found to be heterogenous and no specific changes correlated with HBeAg/anti-HBeAg status or survival in patients with fulminant hepatitis. Substitutions at positions 1762 and 1764 were found in HBV strains from 4 patients (10%) with fulminant hepatitis, 2 patients (10%) with self-limited hepatitis, 8 patients (27%) with chronic hepatitis, and in 5 of 7 patients with end-stage cirrhosis. The majority of these patients were HBeAg positive. CONCLUSIONS Mutations at positions 1762 and 1764 are rarely observed in HBV strains from patients with fulminant hepatitis B in the United States but are common in patients with chronic hepatitis. Even when present, they seem to be insufficient to lead to the HBeAg-negative phenotype.
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Affiliation(s)
- T Laskus
- University of Pittsburgh Medical Center, Pennsylvania, USA
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Nowicki MJ, Balistreri WF. The hepatitis C virus: identification, epidemiology, and clinical controversies. J Pediatr Gastroenterol Nutr 1995; 20:248-74. [PMID: 7608821] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Medical College, Cincinnati, Ohio 45229-3539, USA
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Nowicki MJ, Welch TR, Ahmad N, Kuramoto IK, Mendoza EC, Zeldis JB, Baroudy BM, Balistreri WF. Absence of hepatitis B and C viruses in pediatric idiopathic membranoproliferative glomerulonephritis. Pediatr Nephrol 1995; 9:16-8. [PMID: 7742214 DOI: 10.1007/bf00858957] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The blood-borne hepatitis viruses, hepatitis B virus (HBV) and hepatitis C virus (HCV), have similar epidemiological features. The association of chronic HBV infection and glomerulonephritis is well established, particularly in children. Recent reports have shown an association between HCV infection and glomerulonephritis in adults. In order to assess the role of these hepatotropic viruses in membranoproliferative glomerulonephritis (MPGN) we screened 34 children with idiopathic MPGN for the presence of HBV and HCV infection using highly sensitive polymerase chain reaction techniques for the detection of HBV DNA and HCV RNA. Also, enzyme-linked immunosorbent assays were used to detect the presence of antibody to hepatitis B surface antigen and antibody to HCV. No evidence of HBV or HCV infection was demonstrated in any of the patients. We conclude that HBV and HCV are not significant causes of idiopathic MPGN in children in the United States.
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Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology, Children's Hospital Research Foundation, Cincinnati, Ohio, USA
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Nowicki MJ, Ahmad N, Heubi JE, Kuramoto IK, Baroudy BM, Balistreri WF. The prevalence of hepatitis C virus (HCV) in infants and children after liver transplantation. Dig Dis Sci 1994; 39:2250-4. [PMID: 7924751 DOI: 10.1007/bf02090380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/27/2023]
Abstract
Hepatitis C virus (HCV) is an important cause of liver injury following liver transplantation in adults. We hypothesized that the prevalence of HCV infection in children following liver transplantation would be lower than the prevalence in adults after liver transplantation because HCV-related liver disease leading to liver transplantation in children is low and children require less blood products than adults during transplantation. We therefore performed a cross-sectional study to determine the prevalence of HCV infection in children who had undergone liver transplantation. Serum samples were obtained from 62 of 65 (95.4%) consecutive patients surviving for more than six months after transplantation. Using a second-generation enzyme-linked, immunosorbent assay (ELISA-2) and a second-generation recombinant immunoblot assay (RIBA-II), antibodies to HCV were detected in 5.1% (3 of 59) of the subjects. Using a single-step, polymerase chain reaction (PCR), HCV RNA was detected in 6.2% (4 of 62). All HCV-positive children had undergone liver transplantation before the initiation of routine screening for HCV in blood donors; overall 30 patients were transplanted prior to routine screening of blood products for HCV. The prevalence of HCV in infants and children after liver transplantation in our study is substantially less than the rates reported in adults. This difference may be due, in part, to the lower volume of blood product exposure and to the fact that children, as opposed to adults, rarely have chronic HCV infection as a cause of end-stage liver disease.
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Affiliation(s)
- M J Nowicki
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital Medical Center, Cincinnati, Ohio 45229
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Affiliation(s)
- H H A-Kader
- Children's Hospital Research Foundation, Cincinnati, OH
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Abstract
A novel class of hepatitis B virus mutants in patients with chronic hepatitis B is described. The predicted effect of the mutations is to disrupt the X open reading frame. The location of the genetic alterations within the putative precore promoter also suggests that they may ameliorate precore transcription, which would provide an alternate mechanism for HBeAg(-) escape variation. Definitive conclusions regarding the effects of these mutations must await additional in vitro and in vivo studies.
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Affiliation(s)
- T Laskus
- Mayo Clinic, Rochester, MN 55905
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Mosley JW, Nowicki MJ, Kasper CK, Operskalski EA, Donegan E, Aledort LM, Hilgartner MW. Hepatitis A Virus Transmission by Blood Products in the United States. Vox Sang 1994. [DOI: 10.1111/j.1423-0410.1994.tb00970.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Donegan E, Lee H, Operskalski EA, Shaw GM, Kleinman SH, Busch MP, Stevens CE, Schiff ER, Nowicki MJ, Hollingsworth CG. Transfusion transmission of retroviruses: human T-lymphotropic virus types I and II compared with human immunodeficiency virus type 1. Transfusion 1994; 34:478-83. [PMID: 8023388 DOI: 10.1046/j.1537-2995.1994.34694295061.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.4] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND The incidence of transfusion transmission of human T-lymphotropic virus type I (HTLV-I) and HTLV type II (HTLV-II) has not been compared directly or to that of human immunodeficiency virus type 1 (HIV-1). The effects of refrigerator storage of the blood component on infectivity of the viruses needs definition. STUDY DESIGN AND METHODS The circumstances influencing the transmission of HTLV-I, HTLV-II, and HIV-1 via blood of donors whose sera were stored in a repository and who were retrospectively documented as having been infected at blood donation were examined. Confirmation and typing of anti-HTLV positivity in donors and recipients used polymerase chain reaction, supplemented by specific peptide testing. RESULTS Overall, 27 percent (26/95) of the recipients of blood components from anti-HTLV-I- and -II-positive donors became infected (9 with HTLV-I and 17 with HTLV-II). No recipients of acellular blood components became infected with HTLV-I or -II. There was no probable transmission by components stored > 10 days. The rates of transmission for both viruses were similar: 0 to 5 days' storage, 17 (74%) of 23; 6 to 10 days, 8 (44%) of 18; and 11 to 14, 0 (0%) of 10 (trend, p = 0.0002). In comparison, 89 percent (112/126) of the recipients of anti-HIV-1-positive blood were infected regardless of component type, and no effect on transmission occurred with storage for < 26 days. CONCLUSION Transfusion-transmitted HTLV-I and -II are similar. The data suggest that a donor's lymphocytes become noninfectious when they lose the ability to be activated or to proliferate.
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Affiliation(s)
- E Donegan
- University of California, San Francisco
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