Human Immunodeficiency Virus Ab Research Articles

Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019.

To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as "p24 Ag only", nine (2.09%) as "both p24 and HIV Ab" and 417 (96.98%) as "HIV Ab only". The "p24 Ag only" group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for "p24 Ag only" and 10 for "HIV Ab only". Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the "p24 Ag only" while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons' health and to reduce HIV transmission chain.

Combined Treatment with Tenofovir (C9H14N5O4P), Emtricitabine (C8H10FN3O3S) and Efavirenz (C14H9ClF3NO2) in Multiple Spleen Abscesses with Bacterial and Fungal Etiology in HIV Infected Patients

Patients with human immunodeficiency virus (HIV) infection represent a risk group for developing spleen abscesses. The paper presents a short review and case illustration, describing the characteristics and underling treatment of HIV-infected patients with infectious comorbidities. There are few reports in literature of multiple spleen abscesses with double, microbial and fungal etiology in HIV-infected patients. A 35 years old male patient was referred to the Infectious Diseases Clinic with prolonged fever. In the last 2 years he had worked as a waiter and had multiple unprotected sexual contacts. The physical examination showed: fever, tongue and pharynx with Candida albicans deposits, enlarged cervical, submandibular, axillar, inguinal lymph nodes and splenomegaly. Biological tests including HIV antibodies (Ab) ELISA, CD4, HIV Western blot test, cultures and paraclinical investigations-abdominal ultrasonography and computed tomography were performed. There was a significant inflammatory response, HIV Ab were positive, CD4 cells=17/�L and Western blot HIV test was positive. Abdominal ultrasonography showed: splenomegaly with 3 hypoechogenic round images (13-17mm) at the superior pole, in the hilum and inferior pole. HIV infection stage C3 with oropharyngeal candidiasis and multiple splenic abscesses were diagnosed. After 6 weeks of antibiotic and antifungal therapy total splenectomy was performed. The cultures from splenic abscess contents revealed Acinetobacter baumannii and Cryptococcus neoformans. Under appropriate antibiotic and antifungal treatment, the postoperatory evolution was favorable.

Transfusion-transmitted infections in hemophilia patients who underwent surgical treatment: a study from a single center in north China.

IntroductionTransfusion-transmitted infections (TTIs) continue to be a major challenge among hemophilia patients. This study was conducted to investigate the prevalence of TTIs including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and syphilis in patients with hemophilia who received surgical treatment due to bone or joint lesions in the Department of Orthopedics.Material and methodsThe present study was conducted from July 1996 to November 2016 in Beijing, China. A total of 189 patients who underwent orthopedic procedures were enrolled. Blood samples were obtained from the patients and were tested for hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCV Ab) and human immunodeficiency virus antibody (HIV Ab).ResultsAmong 189 hemophilia patients included in the study, 54 (28.6%) tested positive for TTI. Seroprevalence for HBsAg was found in 8 (4.2%) cases, HCV Ab in 48 (25.4%) cases, HIV Ab in 2 (1.1%) cases, and syphilis in 1 (0.5%) case. No statistically significant difference in the numbers of patients with positive HCV Ab was seen between hemophilia A (26.0%) and B (20.0%) (p = 0.786). The seroprevalence of HCV Ab (12.1%) in 66 hemophilia patients diagnosed after 1995 was significantly lower than that (32.5%) among hemophilia patients diagnosed before or in 1995 (p = 0.003).ConclusionsThough few patients have become positive for HBsAg and HIV Ab, HCV is still the major virus of concern for hemophiliacs who have undergone orthopedic procedures. Hepatitis B vaccination should be given to the high-risk population including hemophilia patients as soon as possible.

Prevalence of HIV Infection among Hemodialysis Patients

Human immunodeficiency virus (HIV) belongs to human retrovirus family and transmitted by blood transfusion and blood products. 36.9 million People were living with HIV infection worldwide in 2014 approximately 1 , during which 2 million (1.9–2.2 million) new infections with HIV had occurred. End-stage renal disease (ESRD) patients treated by hemodialysis (HD) are more susceptible for infection by human immunodeficiency virus infection. Renal failure can be an associated condition or could be a direct consequence of HIV infection 2 , 3 . Advanced HIV disease which is indicates by a low CD4 cell count is development of renal diseases subsequently 4 , however many other causes now may cause renal failure in patients with HIV, including drug-induced toxicity, hypertensive nephroangiosclerosis, and diabetes 5 . HIV infection and hemodialysis have same consequences such as cardiovascular diseases, immunosuppression, anemia, weight loss, and osteodystrophy 6 , 7 . Compared with rate of infection with other viral infection such as hepatitis B virus (HBV) or hepatitis C virus (HCV), the risk of HIV infection among hemodialysis patients is lower as the contact with contaminated sources. Although intensive HIV research has been done for 20 years, we have a little knowledge about mortality risk factor in ESRD on HIV-infected patients. Hemodialysis patients who have HIV-infected are assumed to a high risk for death 4 . The finding the current study demonstrated the prevalence of HIV in hemodialysis patients which was conducted in 5 hemodialysis centers in Tehran province, Iran, in the 2016. All the enrolled participants were informed about study and written informed consent was obtained. Statistical analysis was performed by SPSS version 16 (SPSS Inc, Chicago, IL, USA). Among 360 patients, 213 (59.17%) of patients were men and 147 (40. 83%) were females; the mean age of patients was 53.43. HIV Ab was negative in all cases. This result has been confirmed in other studies as well 8 . The highest frequency for duration of dialysis is 1-5 years. Nowadays viral transmission via hemodialysis routes is controlled and limited since more effective screening of blood donor. Screening and early diagnosis of kidney disease will improve outcomes in patients with HIV infection. Considering all of these evidences, further studies are recommended strongly to evaluate the real prevalence of HIV in these patients.

Transfusion Transmissible Viral Infections Risk at Two Teaching Hospitals Blood Banks in Nigeria

Background/ Objectives: Transfusion Transmissible viral infections such as HIV, HBV and HCV are infectious agents that can pose a threat to blood safety. The aim of this study is to determine the prevalence and coinfection of Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) among blood donors tested negative to these viruses by rapid test devices. Materials and Methods: Two hundred and twelve (212) healthy blood donors (108 and 104 from UATH and NAUTH respectively) certified fit for blood donation were recruited for this study. One hundred and nine eighty (198) samples that were seronegative for HBsAg, HIV, HCV and Syphilis by rapid test were examined for the presence of HBsAg, Anti-HCV and HIV (Ab + Ag) using 4TH generation ELISA. Qualitative conventional PCR was used to confirm ELISA positive sera for HBV DNA, HIV RNA and HCV RNA. Results: Out of 198 blood donor samples negative for HBV, HCV and HIV by rapid test, 13.7%, 13.7% and 8.1% were positive by ELISA for HBV, HIV and HCV respectively. Twelve samples (6.1%) have coinfection of TTIs. One (1) sample out of the 12 samples is co-infected with these three viral (HBV, HCV and HIV) agents. Of the 28 samples positive for HBV by ELISA, 20 (71.4%) were positive for HBV DNA, 8 (36.4%) of 22 positive samples by HIV ELISA were positive for HIV RNA and 4 (28.6%) of 14 samples were positive for HCV RNA (p=0.0001). Conclusion and Recommendations: There is a high prevalence of transfusion transmissible viral infections among blood donors at our study population. This study therefore recommends blood donors in these Hospitals in particular and Nigeria in general be screened for HIV, HCV and HBsAg using ELISA 4th generation test kits and Nucleic Acid Testing (NAT).

Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infection in Multi-Transfused Thalassemic Patients, Kermanshah, Iran, 2015

Background: Repeated blood transfusions in Thalassemic patients predispose them to blood-borne infections including Hepatitis B, Hepatitis C, and human immunodeficiency virus. These infections cause cirrhosis, portal hypertension, and acquired immunodeficiency syndrome. Objectives: The current study aimed at determining the prevalence of these infections in Thalassemic patients of Kermanshah province, Iran. Methods: Thalassemic patients registered at Mohammad Kermanshahi university hospital were included. Demographic data, history of blood transfusions, Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBC Ab), Hepatitis B surface antibody (HBs Ab), Hepatitis C antibody, and Human immunodeficiency virus (HIV) antibody were extracted. Serologic tests were done using the third-generation enzyme linked immunosorbent assay (ELISA) and positive Hepatitis C virus (HCV) Ab and HIV Ab results was confirmed by Western Blotting. Results: A total number of 232 patients were enrolled (111 females and 121 males), among whom HBsAg and HIV Ab were both negative. Positive HBS Ab was reported in 222 subjects (95.7%) and 19 cases (8.2%) had positive HBC Ab. Immunity to hepatitis B was the result of vaccination in 87.5% of cases. Hepatitis C antibody was positive in 14 cases (6%). Finally, a significant relationship was found between HCV infection and blood transfusion done before 1996. Conclusions: High rate of hepatitis C was found to be due to the lack of screening for HCV Ab among blood donors before 1996. The negative HBS Ag can be justified by regular hepatitis B vaccination program in patients with thalassemia. The lack of HIV infection was concluded to be attributed to the low prevalence of this virus in the general population and blood donors as well as proper screening methods.

Prevalence of HBV, HCV and HIV Infections Among Syrian Refugees in Kurdistan Region, Iraq

Background: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are public health problems worldwide. Population mobility such as that occurs in war may play a role in changing the prevalence of infectious diseases. Objectives: This study was conducted to determine the prevalence of HBV, HCV and HIV among Syrian refugees in Iraq and compare it to native Iraqis. Methods: In this cross-sectional study, 880 Syrian refugees and 2975 native Iraqi volunteers were recruited. Subjects were tested for evidence of hepatitis B surface antigen (HBsAg), HCV antibody (Ab) and HIV Ag and Ab. Results: From a total of 880 refugees, 34 cases (3.86%) were positive for HBsAg. None of the recruited samples was positive for HCV. For the indigenous people, 2975 subjects agreed to contribute in the project. Among them, 30 (1.09%) were positive for HBsAg and only one was positive for HCV. All the examined samples were negative for HIV in both populations. Conclusions: While the prevalence rates of HCV and HIV are low and almost the same, the prevalence of HBV among the refugees is nearly fourfold higher than that found in indigenous population. This may put extra burden on health institutions in the host country.

Epidemiological Aspects of Hepatitis B and C and Human Immunodeficiency Viruses Among Hemodialysis Patients in Mazandaran Province, Iran

BackgroundHemodialysis patients are potentially susceptible to infection with blood-borne viral agents, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).ObjectivesThe aim of this study was to evaluate the prevalence and incidence of HBV, HCV, and HIV infections in hemodialysis patients.Patients and MethodsThis study was carried out in 482 hemodialysis patients who had been referred to eight dialysis centers in the Mazandaran province in Iran from 2012 - 2014. HBs Ag, HCV Ab, HBs Ab and HIV Ab were assessed every three months for two years. The patients’ demographic characteristics, including age, gender, area of residence, and duration of dialysis, were noted. The prevalence of each virus was also determined.ResultsFrom a total of 482 patients, 253 (52.5%) males and 229 (47.5%) females were evaluated. The mean age of all patients was 54.96 ± 16.1 years, and all participants were HIV negative. One subject had both HBV and HCV infections. HBs Ag and anti-HCV were detected in 10 (2.1%) and 40 (8.27%) patients, respectively. The mean age of HCV-positive patients was 55.4 ± 16.4, while HCV-negative patients were an average of 51.6 ± 10.7 years old (P = 0.002). The incidence of HCV was higher in people from 40–59 years of age (P < 0.001). No patients had HBV, and incidence of HCV was 0.5% in the first year and 0.75 in the second year. No cases of HIV were identified.ConclusionsThe results show that the prevalence rates of HBV and HCV in hemodialysis patients were moderate to low in the Mazandaran province. Based upon the obtained levels of these viruses, these incidence rates are therefore reasonable.

The Role of Hepatitis B Core Antibody Testing in Improving Blood Safety in Resource-Limited Countries Study on Voluntary Blood Donors Fayoum, Egypt

Background: Transmission of hepatitis B virus (HBV) via hepatitis B surface antigen (HBsAg) negative blood donors has been reported. HBsAg is still the only mandatory HBV screening test of blood donors in Egypt due to high cost of DNA testing of all collected blood. Many resource- limited countries have implemented screening antibodies to hepatitis B core antigen (anti-HBc) to further improve transfusion safety. The objective of study was to evaluate the significance of screening to reduce the risk of transfusion transmitted HBV infection in Egypt. Study Design and Methods: The study was conducted on 800 voluntary blood donors negative for HBsAg, hepatitis C antibody (HCVAb) and human immunodeficiency virus Ab. They were subjected to screening for anti- HBV core antibodies (total). Anti-HBc-positive samples were further tested for the antibodies to HBsAg (anti-HBs), and anti-HBc alone sera were tested for HBV DNA. Results: Among 800 healthy voluntary donors, 99 (12.37%) were anti-HBc-positive including 78 anti-HBs positive. The remaining 21 donors were alone, 2 of which (9.52%) were HBV DNA-positive. Conclusion: Greater consideration should be given to the implementation of as an additional screening test for blood donors in Egypt as the most cost-effective measure for further improvement of transfusion safety.

Homogeneity study of the internal quality control sera for immunodiagnosis of HIV/AIDS

Introduction: The present study reports the data from the first homogeneity assessment of samples composing the serum panels produced at the Immunology Center of Instituto Adolfo Lutz, Sao Paulo. These samples have been distributed to the public laboratories and those partaking in the Brazilian Unified Health System, and to the participants in the Internal Quality Control Program for human immunodeficiency virus (HIV) antibody (Ab) testing. Objective: To assess the homogeneity of serum samples in panels from different lots for HIV/acquired immunodeficiency syndrome (AIDS) immunodiagnosis by using the statistical method to ensure quality of the reference material. Method: Sera homogeneity was evaluated by means of enzyme-linked immunoassay/enzyme immunoassay (ELISA/EIA) for detection of HIV Ab, and the one-way analysis of variance was employed for analyzing the data. No statistically significant differences were found among the several serum vials. Conclusion: The sera dispensed in the vials were homogeneous in the respective lots.

Seroprevalence of Transfusion Transmissible Infections (TTIs) among blood donors in a tertiary care hospital, central India: A prospective study

Background: Blood transfusion having some risks of transfusion transmissible infections (TTIs) in the recipients especially when blood is collected during window period. In Africa, about 10-15% of human immunodeficiency virus (HIV) transmission had been related to blood transfusions. Aims: The aim of this study is to present the prevalence of TTIs among the apparently healthy donors, both voluntary as well as replacement donors. Settings and Design: This was a prospective study, carried out in a blood bank attached to a tertiary care hospital, Central India. Materials and Methods: All blood bags collected from these blood donors during the study period were screened for TTIs like hepatitis B surface antigen (HBsAg; Hepalisa, J. Mitra), anti-HIV antibodies (HIV Ab; HIV 3rd generation kit for detection of antibodies to HIV1 and HIV2, J. Mitra), anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra), and Venereal Diseases Research Laboratory (VDRL) reactivity (Carbogen kit, Tulip Diagnostics). Serum were separated from all blood bags and serological test was performed according to the instructions provided by the manufacturers of respective kit. All seroreactive blood bags were considered as positive for TTIs and the blood bags were discarded. Statistical Analysis: A total of 10,582 blood donors were selected for blood donation after clinical history and brief medical examination by medical officer. Blood bags collected from them were screened for TTIs. Among the total blood bags screened, 273 (2.57%) were found positive for transfusion transmissible infectious diseases. Results: Among TTIs, the most common infection was hepatitis B followed by HIV infection in our study. Prevalence of coinfection in our study was very low (0.01%). Voluntary donations have low seroreactivity (2.40%) for TTIs as compared to replacement donations (3.20%). Conclusions: Multiple infections have a very small but definite risk to the recipients, recieving blood and blood products. Hepatitis B was the most common infection in our study. The incidence of coinfection was very low in our study. Prevalence of TTIs was more among replacement donors as compared to the voluntary donors. So, it is possible to improve the safety of blood and blood product by the promotion of voluntary donation, selection of low-risk donors, and use of highly sensitive laboratory screening test.

English

BACKGROUND: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) share common route of infection and have high degree of epidemiological similarity with respect to high risk groups with human immunodeficiency virus (HIV). These conditions are linked with sexually transmitted infections but very less documentation is available regarding HBV and HCV infection in STI patients from this region. METHOD: A total of 278 clinically suspected cases of Sexually Transmitted Infection (STI) patients attending STI clinic were studied for seroprevalence of HBV, HCV and HIV along with age and sex matched healthy controls. Their age, sex, occupation and literacy level were also studied. RESULTS: The most common age group seeking medical advice belonged to sexually active group (18-40 years). Labourers showed highest prevalence of HBsAg (26.02%), HIV (10.04%) and HCV (5.42%). Higher prevalence of HBsAg (20.16%) and HIV (9.67%) seen in patients having only primary education. Seroprevalence of HBsAg, HIV and anti HCV Ab was 14.38%, 7.55% and 3.23% respectively in STI patients particularly more in ulcerative type whereas in controls their prevalence was 2.87%, 1.07% and 0.35% respectively. CONCLUSION: The present study showed that high prevalence of HBsAg, HIV and HCV is associated with male sex, low educational status and syndromic type of associated STI. An interesting finding is that seroprevalence of HCV is more in ulcerative STI similar to HBV and HIV. It suggests that sexual route of transmission of HCV is likely specially if there is breach in continuity of mucosal surface. KEY WORD: HBV, HCV, HIV, STI clinic attendees, epidemiological markers.

Outcome of Intravenous Immunoglobulin-Transmitted HTLV-I, Hepatitis B, Hepatitis C, and HIV infections.

Since each unit of Intravenous Immunoglobulin (IVIG) is obtained from different blood donors, blood-borne viral diseases is of high importance. We aimed at investigating the prevalence of various viral infections: Human T-cell Lymphotropic Virus Type 1 (HTLV-I), Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among patients referred for IVIG therapy section in Mashhad University of Medical Sciences, Mashhad, Iran. A prospective study was conducted on 130 IVIG recipients admitted to different wards of our Medical Centre: Immunology, Hematology, and Neurology, in 2010. After filling the informed consent form, a 5 cc blood sample was initially taken from each patient. Viral infections including HTLV-I Ab, HIV-Ab, HBsAg, HBc-Ab, and HBV-Ab were assessed using the ELISA technique before and after six three months treatment. Test results for HTLV-I Ab, HBsAg, HBc Ab, HIV Ab, and HCV Ab were negative in all cases before IVIG therapy. After receiving IVIG, two female cases with CIDP showed positive results for HBV Ab (0.8%) and HBS Ag (0.8%) with ELISA and only one patient confirmed with PCR. There was not any significant relation between HBV Ag (P=0.14) and HBC Ab with type of disorder (P=0.66). This study showed that HTLV-I viral replication and the other investigated viral transmissions do not occur in plasma; therefore, the IVIG products are safe.

Occult hepatitis B virus infection among Egyptian blood donors

To identify blood donors with occult hepatitis B virus (HBV) infection (OBI) to promote safe blood donation. Descriptive cross sectional study was conducted on 3167 blood donors negative for hepatitis B surface antigen (HBsAg), hepatitis C antibody (HCV Ab) and human immunodeficiency virus Ab. They were subjected to the detection of alanine aminotransferase (ALT) and aspartate transaminase (AST) and screening for anti-HBV core antibodies (total) by two different techniques; [Monoliza antibodies to hepatitis B core (Anti-HBc) Plus-Bio-Rad] and (ARC-HBc total-ABBOT). Positive samples were subjected to quantitative detection of antibodies to hepatitis B surface (anti-HBs) (ETI-AB-AUK-3, Dia Sorin-Italy). Serum anti-HBs titers > 10 IU/L was considered positive. Quantitative HBV DNA by real time polymerase chain reaction (PCR) (QIAGEN-Germany) with 3.8 IU/mL detection limit was estimated for blood units with negative serum anti-HBs and also for 32 whose anti-HBs serum titers were > 1000 IU/L. Also, 265 recipients were included, 34 of whom were followed up for 3-6 mo. Recipients were investigated for ALT and AST, HBV serological markers: HBsAg (ETI-MAK-4, Dia Sorin-Italy), anti-HBc, quantitative detection of anti-HBs and HBV-DNA. 525/3167 (16.6%) of blood units were positive for total anti-HBc, 64% of those were anti-HBs positive. Confirmation by ARCHITECT anti-HBc assay were carried out for 498/525 anti-HBc positive samples, where 451 (90.6%) confirmed positive. Reactivity for anti-HBc was considered confirmed only if two positive results were obtained for each sample, giving an overall prevalence of 451/3167 (14.2%) for total anti-HBc. HBV DNA was quantified by real time PCR in 52/303 (17.2%) of anti-HBc positive blood donors (viral load range: 5 to 3.5 x 10(5) IU/mL) with a median of 200 IU/mL (mean: 1.8 x 10(4) ± 5.1 x 10(4) IU/mL). Anti-HBc was the only marker in 68.6% of donors. Univariate and multivariate logistic analysis for identifying risk factors associated with anti-HBc and HBV-DNA positivity among blood donors showed that age above thirty and marriage were the most significant risk factors for prediction of anti-HBc positivity with AOR 1.8 (1.4-2.4) and 1.4 (1.0-1.9) respectively. Other risk factors as gender, history of blood transfusion, diabetes mellitus, frequent injections, tattooing, previous surgery, hospitalization, Bilharziasis or positive family history of HBV or HCV infections were not found to be associated with positive anti-HBc antibodies. Among anti-HBc positive blood donors, age below thirty was the most significant risk factor for prediction of HBV-DNA positivity with AOR 3.8 (1.8-7.9). According to HBV-DNA concentration, positive samples were divided in two groups; group one with HBV-DNA ≥ 200 IU/mL (n = 27) and group two with HBV-DNA < 200 IU/mL (n = 26). No significant difference was detected between both groups as regards mean age, gender, liver enzymes or HBV markers. Serological profiles of all followed up blood recipients showed that, all were negative for the studied HBV markers. Also, HBV DNA was not detected among studied recipients, none developed post-transfusion hepatitis (PTH) and the clinical outcome was good. OBI is prevalent among blood donors. Nucleic acid amplification/HBV anti core screening should be considered for high risk recipients to eliminate risk of unsafe blood donation.

A prospective study for prevalence and/or development of transfusion-transmitted infections in multiply transfused thalassemia major patients

Objective:To evaluate the rate of seropositivity to hepatitis B and C and Human Immunodeficiency Virus (HIV) infections among children with β-thalassemia major receiving multiple transfusions in Ahmedabad, India, compared with healthy controls.Materials and Methods:The study was performed during January 2007 to January 2009 on multi-transfused children suffering with β-thalassemia major registered in the Prathama Blood Centre, Ahmedabad; Jeevandeep hospital, Ahmedabad; and Red Cross Blood Centre, Ahmedabad, and investigated for the prevalence and development of transfusion-transmitted infections. Hepatitis B surface Antigen (HBsAg), anti-Hepatitis C Virus (HCV) Antibodies (Ab), and HIV Ab were checked using a fourth-generation Enzyme-Linked Immunosorbent Assay (ELISA). Positive tests were confirmed by western blots. Healthy blood donors were used for the control group.Results:Hepatitis B surface antigen, anti-HCV Ab, and HIV Ab were positive in one of 96 (1.04%; 95% Confidence Interval (CI) = 0.17–1.3), 24 of 96 (25%; 95% CI = 11.4–14.2), and one of 96 (1.04%; 95% CI = 0.12–1.3), respectively. The rate of anti-HCV Ab was significantly higher in multi-transfused children suffering with β-thalassemia major. In thalassemia patients, the rate of positive anti-HCV Ab was significantly higher than that for positive HBsAg (P<0.001) and HIV Ab (P<0.001).Conclusion:It is concluded that HCV is the current major problem in multi-transfused children with thalassemia major and more careful pretransfusion screening of blood for anti-HCV must be introduced in blood centers.

Zero risk tolerance costs lives: loss of transplantable organs due to human immunodeficiency virus nucleic acid testing of potential donors

Patients' deaths due to the organ donor shortage make it imperative that every suitable organ be transplanted. False-positive results of tests for infection with the human immunodeficiency virus (HIV) result in lost organs. A survey of US organ procurement organizations collected the numbers of donors and ruled-out potential donors who had a positive result on an HIV test from January 1,2006, to October 31, 2008. Sixty-two percent of US organ procurement organizations participated. Of the 12397 donor/nondonor cases, 56 (0.45%) had an initial positive result on an HIV antibody or HIV nucleic acid test, and only 8 (14.3%) of those were confirmed positive. Of the false-positive results, 50% were from HIV antibody tests and 50% were from HIV nucleic acid tests. Organs are a scarce, finite, and perishable resource. Use of HIV antibody testing has produced a remarkably safe track record of avoiding HIV transmission, with 22 years of nonoccurrence between transmissions. Because false positives occur with any test, including the HIV Ab test, adding nucleic acid testing to the standard donor testing panel doubles the number of false-positive HIV test results and thus the number of medically suitable donors lost. The required HIV antibody test is 99.99% effective in preventing transmission of the HIV virus. Adding the HIV nucleic acid test to routine organ donor screening could result in as many as 761 to 1551 unnecessary deaths of patients between HIV transmission events because medically suitable organs are wasted.

Zero Risk Tolerance Costs Lives: Loss of Transplantable Organs Due to Human Immunodeficiency Virus Nucleic Acid Testing of Potential Donors

Patients' deaths due to the organ donor shortage make it imperative that every suitable organ be transplanted. False-positive results of tests for infection with the human immunodeficiency virus (HIV) result in lost organs. A survey of US organ procurement organizations collected the numbers of donors and ruled-out potential donors who had a positive result on an HIV test from January 1,2006, to October 31, 2008. Sixty-two percent of US organ procurement organizations participated. Of the 12397 donor/nondonor cases, 56 (0.45%) had an initial positive result on an HIV antibody or HIV nucleic acid test, and only 8 (14.3%) of those were confirmed positive. Of the false-positive results, 50% were from HIV antibody tests and 50% were from HIV nucleic acid tests. Organs are a scarce, finite, and perishable resource. Use of HIV antibody testing has produced a remarkably safe track record of avoiding HIV transmission, with 22 years of nonoccurrence between transmissions. Because false positives occur with any test, including the HIV Ab test, adding nucleic acid testing to the standard donor testing panel doubles the number of false-positive HIV test results and thus the number of medically suitable donors lost. The required HIV antibody test is 99.99% effective in preventing transmission of the HIV virus. Adding the HIV nucleic acid test to routine organ donor screening could result in as many as 761 to 1551 unnecessary deaths of patients between HIV transmission events because medically suitable organs are wasted.

Reduction of the risk of transfusion‐transmitted human immunodeficiency virus (HIV) infection by using an HIV antigen/antibody combination assay in blood donation screening in Cameroon

Improving blood safety without introducing nucleic acid testing in blood screening may be possible using antigen/antibody (Ag/Ab) combination assays, especially in resource-poor countries. To evaluate the potential reduction of human immunodeficiency virus (HIV)-transmitted infection using such an assay, a study was carried out aimed to compare the routine strategy for blood screening (S1), combining a rapid test (Determine HIV-1/-2, Inverness) and an enzyme immunoassay (human HIV-1/-2, Human Diagnostic) with an HIV Ag/Ab assay (S2, Genscreen ULTRA HIV Ag-Ab, Bio-Rad) in 2000 blood donations tested in Cameroon. Western blot and HIV RNA polymerase chain reaction were used to confirm the infection in reactive donors, and genotype was determined in HIV RNA-positive samples. Of the 2000 donors, 3.1% were positive with S1 and 4.3% with S2. Of the 97 samples positive with S1 and/or S2 tested for confirmation, 54.7% were positive, 38.1% indeterminate, and 7.2% negative. There were significant differences between S1 and S2 in terms of sensitivity (S1, 79.2%; S2, 100%), irrespective of the genotype, and in specificity (S1, 99.0; S2, 98.3%). The most frequent genotype (49%) was CRF02_AG. A testing strategy using Genscreen ULTRA HIV Ag/Ab could prevent 55 HIV transmissions per 10,000 donations. However, this would be at a cost of discarding 170 per 10,000 negative donations that would test false positive, showing that the implementation of new techniques in blood screening need an optimization before routine use. Using confirmatory assays, HIV Ab prevalence in blood donors in Cameroon was estimated at 2.65%.

Force Protection and Infectious Risk Mitigation From Suicide Bombers

Pedestrian suicide bombers (SB) pose an infectious threat to United States (U.S.) forces. The objective of this study is to evaluate the use of rapid human immunodeficiency virus (HIV) antibody assays under contaminated field conditions and develop plans to mitigate the infectious threat. Twenty-six commercially available rapid HIV antibody assays were contaminated with environmental substances. Half of the tests were conducted with HIV-1 antibody (Ab) positive controls and half with HIV Ab negative controls. There were no test failures. Using statistical approximations to evaluate the plausibility of a zero failure rate, the upper 95% confidence limit for the occurrence of a test failure by chance is at most 10.8%. These results suggest the test's success is less likely because of chance and further studies should be conducted for validation. Regardless of the methodology, it is important to develop plans to mitigate infectious risks from pedestrian suicide bombers.

Clinicoepidemiological Characteristics of HIV‐Infected Immigrants Attended at a Tropical Medicine Referral Unit

Migration is a growing phenomenon with a well-known impact in infectious diseases epidemiology. Currently, immigrants represent almost 10% of the Spanish population. The majority come from countries where the prevalence of chronic viral illnesses is higher than in Spain. To describe clinicoepidemiological features of human immunodeficiency virus (HIV)-infected immigrants attending our Unit and to compare differential characteristics depending on geographical origin, information from all new immigrants from January 1997 to December 2006 was collected. noninterventional retrospective chart review. We screened 1,609 patients of whom 77 (4.8%) were HIV antibody (Ab) positive. Of these, 80% were sub-Saharan Africans (SSAFR) and 20% were South-Central Americans (SCA). HIV prevalence was higher in SSAFR (5.6% vs 3.2%; p= 0.04). Overall, of those who were HIV Ab positive, 70% were male (median age 30 years), 59% heterosexuals, 9% hepatitis C virus coinfected, 8.6% hepatitis B virus coinfected, and 34% showed a positive tuberculin skin test. Median CD4 cell count was 263 cells/microL, median HIV-ribonucleic acid viral load 4.6 Log/mL, and 48% had a late diagnosis [acquired immunodeficiency syndrome (AIDS)-defining illness or <200 CD4 microL at the time of diagnosis]. Only 68% of patients for whom antiretroviral therapy was indicated actually started therapy and 22% were lost to follow-up just after diagnosis. SCA had lower CD4 cell counts (26 vs 168 cells/microL; p= 0.016), higher viral loads (5.3 vs 4.8 Log; p= 0.001), and were more likely to have an AIDS-defining illness (53% vs 21%; p= 0.04) compared to SSAFR. Tuberculin skin test reactivity was more common among SSAFR versus SCA [adjusted by CD4 count, odds ratio (OR) 6.3 and 95% confidence interval (CI): 0.65-60.5]. The main risk factor for late diagnosis was geographical origin: OR 4.6 (95% CI: 1.11-19.3) (SCA vs SSAFR; adjusted by the interval between the date of arrival in Spain and the date of HIV diagnosis). Almost half the HIV-infected immigrants were diagnosed in late stages. Patients were frequently lost to follow-up, and a significant minority did not start highly active antiretroviral therapy when indicated. SCA seem to have more severe immunosuppression at the time of diagnosis than SSAFR. Early voluntary routine HIV screening should be promoted.