Mean Viral Load Research Articles

The impact of COVID-19 epidemic phase and changes in mean viral loads: implications for SARS-CoV-2 testing strategies

The sensitivity of SARS-CoV-2 diagnostic tests is inherently linked to viral load. We explored whether average viral loads changed at a population level in Queensland, Australia during the early phase of the pandemic. RT-PCR threshold cycle (CT) values, a crude marker for viral load, were compared for samples collected in February/March-2020 to those collected in April/May-2020, noting that the major public health interventions began in late-March 2020. Positive detections peaked mid-March, which coincided with the highest detection numbers and lowest CT values. However, this changed from April where the later CT samples (CT > 30) predominated. Overall, in February/March 29% (267/922) of samples had CT values >30 cycles compared to 88% (559/636) in April/May. Our study shows that SARS-CoV-2 viral loads in patients may vary at a population level over time. This needs considering when assessing suitability of diagnostic methods, particularly when methods in question are known to have reduced sensitivity.

Real-World Outcomes of Aggressive B-Cell Non-Hodgkin Lymphoma in People Living with HIV (PLWH) Treated in Australia: An Australasian Lymphoma Alliance Study

BackgroundModern antiretroviral therapy (ART) has reduced HIV associated morbidity and mortality, and allowed a similar treatment approach of aggressive lymphomas in PLWH to that of their HIV negative counterparts. Australia is an ethnically diverse country with a low HIV prevalence and an excellent population-wide ART coverage and adherence in PLWH. We aimed to describe the real-world Australian experience in managing PLWH diagnosed with diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma (BL), and compare our treatment approach and outcomes against international data.MethodsThis was a retrospective, multicenter study conducted by the Australasian Lymphoma Alliance across 6 centers in 5 states. HIV positive patients with biopsy proven BL and DLBCL, diagnosed between 1st January 2009 and 31st December 2019 were identified through each institution's database. Baseline patient and disease characteristics, treatment exposure and outcomes were extracted from hospital medical records. Descriptive statistics, and survival analyses were performed as appropriate.Results44 patients (24 DLBCL, 20 BL) were included in the analysis. The median age was 52 years (range 32-78). The median follow-up was 1.8 years (range 0.1-13.1). 36 (82%) patients presented with advanced stage (III-IV) disease. 28 (64%) were defined as high-risk based on disease specific IPI scoring systems. The mean CD4 count was 334 cells/μL at diagnosis and 10 (23%) patients had a CD4 count of <100 cells/μL. 23 (52%) had a HIV viral load <50 copies/ml. 12 (27%) were diagnosed with HIV at the time of lymphoma diagnosis (Mean CD4 count 191 cells/μL, mean viral load 665,612 copies/ml). 41 (93%) patients received chemotherapy with curative intent and 39 (88%) received Rituximab. 37 (84%) were given concurrent ART and chemo(immuno)therapy. 11 (55%) of BL patients were treated with CODOX-M/IVAC or HyperCVAD followed by 6 (30%) with Da-EPOCH. 14 (58%) of DLBCL patients received CHOP-based therapy with 11 (45%) receiving more intensive regimens (Da-EPOCH, HyperCVAD or CODOX-M/IVAC). In the whole cohort, median number of chemotherapy cycles delivered was 6, 6, 4 and 3 for CHOP, Da-EPOCH, CODOX-M/IVAC and HyperCVAD respectively. CR rates after first-line curative intent therapy were 75% and 83% in BL and DLBCL respectively. All treatment response assessments were made by positron emission tomography. Grade 3-4 toxicity was significant higher in patients receiving intensive chemotherapy (77% vs 29%, p=0.015). Total treatment related mortality was 5% (2 died of bacterial sepsis). The 2-year OS was 77% (95% CI 61-88); 67% for BL (95% CI 46-88) and 81% for DLBCL (95% CI 53-90)]. 2-year PFS was 67% for BL (95% CI 40-83) and 77% for DLBCL (95% CI 53-89). An initial drop of mean CD4 count post treatment was observed (334 to 214 cells/μL), followed by a rise after 6 and 12 months (290 and 431 cells/μL respectively) (fig 1). At 6 months post chemotherapy, 83% of patients had a HIV viral load of <50 copies/ml with 40% and 83% achieving a CD4 count of >350 cells/μL and >200 cells/μL respectively.ConclusionsA significant proportion of PLWH still present with aggressive lymphoma as an AIDS-defining event prior to HIV diagnosis, despite high levels of health education and healthcare availability. Our results appear equivalent to those for non-HIV patients with acceptable toxicity. Current Australian practice favors treating aggressive lymphomas in PLWH similarly to the HIV negative population, with the addition of concurrent ART. CD4+ T-cell-related immune reconstitution appears to recover within 6 months post-therapy. The OS of this cohort appears similar to the HIV negative population and published cohort studies (Coutinho AIDS 2013, Evens Blood 2019, Alderuccio Blood Adv 2021). [Display omitted] DisclosuresHamad: Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Cheah: Beigene: Consultancy, Honoraria, Other: advisory; Celgene: Research Funding; AstraZeneca: Consultancy, Honoraria, Other: advisory; Loxo/Lilly: Consultancy, Honoraria, Other: advisory; TG Therapeutics: Consultancy, Honoraria, Other: advisory; AbbVie: Research Funding; Roche: Consultancy, Honoraria, Other: advisory and travel expenses, Research Funding; Janssen: Consultancy, Honoraria, Other: advisory; MSD: Consultancy, Honoraria, Other: advisory, Research Funding; Gilead: Consultancy, Honoraria, Other: advisory; Ascentage pharma: Consultancy, Honoraria, Other: advisory. Ku: Genor Biopharma: Consultancy; Antegene: Consultancy; Roche: Consultancy.

Evaluating maternal characteristics and DNA polymerase chain reaction birth testing of neonates born with HIV in a KwaZulu-Natal referral hospital – missed opportunities?

Background. Congenital HIV infection has declined in South Africa with an expanded programme to decrease perinatal HIV transmission. Understanding the challenges within this programme can identify opportunities for improvements. There is an opportunity with birth HIV DNA polymerase chain reaction testing to expedite very early treatment of neonates born with HIV in referral hospitals. Objectives. This study was aimed at describing the characteristics of mothers of neonates born with HIV as well as the evaluation of the access and availability of birth HIV DNA PCR results within a referral hospital. Method. This study was a retrospective chart review of all documented neonates born with HIV delivered between 1 January 2017 and 30 June 2019 at King Edward VIII Hospital, Durban, KwaZulu-Natal. The birth HIV DNA PCR results provided through institutional programmes were analysed, and the clinical characteristics of mothers of neonates born with HIV were described. Results. Review of hospital-based records, during the 30-month study period, identified 6 902 (40.02% of 17 243 total live births) birth HIV DNA PCR tests having been done. During the sample period, documented positive, rejected or indeterminate results were analysed. These results indicated only 37 (0.54%) of known HIV-exposed neonates who were tested, to have a documented positive birth HIV DNA PCR result. Fifty-nine neonates had either indeterminate or rejected results. Negative HIV DNA PCR results could not be verified. Analysis of the mothers of neonates with documented HIV-positive results indicated high mean viral loads of these mothers (52 343 copies/mL) and most were diagnosed in the current pregnancy or at delivery. Conclusion. Review of the characteristics of mothers of neonates born with HIV within a public referral hospital reiterates that late HIV diagnosis is common in this high-risk group. Birth HIV DNA PCR results may fail to adequately identify all positive neonates timeously for very early initiation of antiretroviral treatment.

Development and verification of a test rig for inactivation of bacteria and (corona-) viruses by UVC air disinfection systems

Abstract The ongoing coronavirus pandemic spreads through airborne transmission and is therefore difficult to contain. However, coronaviruses are highly sensitive to UVC, so UVC air disinfection systems should be able to inactivate the virus. Unfortunately, so far there are only few possibilities to test the reduction of airborne viruses or other pathogens. A special test rig, which mainly consisted of a nebulizer and an airflow system, was developed to determine the antiviral and antibacterial efficiency of UVC air disinfection systems. In the assessment of such an UVC air disinfection system with nebulized Staphylococcus carnosus and a sampling period of 30 minutes, a mean bactericidal reduction of 3.70 log10 (99.98 %) was determined. For antiviral irradiation of the coronavirus surrogate phi6 a mean viral load reduction of 1.18 log10 (93.40 %) was observed after a sampling period of 10 minutes. Therefore, mobile UVC air disinfection systems could be applied in hospitals, retirement and nursing homes.

S3398 Glecaprevir/Pibrentasvir Is an Effective Treatment for Patients Receiving HCV Positive Liver Transplants

Introduction: Liver transplantation (LT) from HCV positive donors has become an option to expand a limited donor pool with the advent of Direct-Acting Antiviral therapy (DAA). Current guidelines for post-LT Hepatitis C treatment includes Glecaprevir/Pibrentasvir (Mavyret). Our study focuses on Glecaprevir/Pibrentasvir’s efficacy in achieving a Sustained Virological Response (SVR) and undetectable Viral Load (VL) in HCV Donor (D+)/Recipient (R-) transplanted patients. Methods: We performed a retrospective cohort review of 13 HCV D+/R- patients who underwent LT at our institution from January 2019 to November 2020. Patient demographics, co-morbidities, liver cirrhosis etiology, HCV VL and genotype was recorded. Patients received a standard 12 weeks of Glecaprevir/Pibrentasvir initiated at the time of VL detection on post-op day 3. Other data included post-LT complications, mortality, graft rejection, time to achieve undetectable VL, and liver function tests at first and last clinic visits post-LT. Results: Our cohort consisted of 13 HCV D+/R- patients; 92% male, 62% white, 12 orthotopic liver transplants, and 1 simultaneous liver kidney transplant with an average age 58 +/- 11, BMI of 30 +/- 6 and MELD-Na 27 +/- 8. Liver cirrhosis etiology included NASH (50%), Alcohol (33%), NASH/Alcohol (8%) and other (9%). HCV genotypes at the time of VL detection included 1a (54%), 2 (8%), and 3 (31%). All patients completed treatment and 92% (n = 12) achieved SVR at 12 weeks. Mean VL detected within the first week post-LT was 10.7 million +/- 9.7 million and mean undetectable VL was achieved within 34 +/- 21 days. Mean ALT and AST at the first clinic visit during the first three to five weeks of Glecaprevir/Pibrentasvir initiation was 27.8 +/- 17.8 and 22.2 +/- 12.6 respectively and mean ALT and AST at the last clinic visit 7-17 months post-LT following Glecaprevir/Pibrentasvir completion was 17.8 +/- 9.3 and 24.1 +/- 24.3 respectively. Following treatment, one patient had graft rejection and one patient mortality was noted due to events following post-operative complications. Conclusion: Patients treated with Glecaprevir/Pibrentasvir following LT from HCV positive donors had overall excellent graft survival with most patients achieving SVR at 12 weeks and maintaining undetectable VL post-transplantation without significant elevations in liver function tests during treatment and after completion. Glecaprevir/Pibrentasvir is an effective treatment for patients receiving LT from HCV positive donors.Table 1.: HCV D+/R- transplanted patients receiving Glecaprevir/Pibrentasvir. CKD = Chronic Kidney Disease CAD = Coronary Artery Disease HCC = Hepatocellular Carcinoma LT = Liver Transplant AKI = Acute Kidney Injury LFT = Liver Function Tests Data represented as averages and mean +/- standard deviation.

Viral and bacterial factors of mother-to-child transmission of hepatitis B virus.

Hepatitis B virus (HBV) infection is the tenth leading cause of death worldwide. Mother-to-child transmission of HBV occurring mainly at delivery remains one of the most common routes of infection in developing countries. One of the main challenges concerning HBV in Africa is to implement a prevention policy aiming at interrupting the cycle of pseudo-vertical transmission of this infection. The aim of this study was to assess the implication of certain bacterial and viral factors in mother-to-child transmission of HBV. This prospective study was conducted on 165 pregnant women carriers of HBV surface antigen (HBsAg) and their 169 newborns who attended care at the Gynecology Department of the University Hospital of Cocody. Serological, molecular, and bacteriological analyses were performed on blood samples and vaginal secretions. Mean viral load (VL) was 4.5±1.3log10 IU/ml, while mean HBsAg titres were 3.5±0.9log10 IU/ml. HBV DNA was found in vaginal secretions in 13.3% of mothers and in the blood of 10.3% of the newborns. Six bacterial species were identified in the vaginal discharge of pregnant women during labour before delivery. Staphylococcus aureus and Enterococcus faecalis were the most frequent species found in 23.0% and 13.9% of cases. Mothers positive for vaginal HBV DNA displayed higher plasma HBV DNA loads than negative mothers (6.2±1.6log10 IU/ml vs. 4.3±1.0log10 IU/ml, p<.0001). In conclusion, our study showed that presence of HBV DNA in vaginal secretions and the presence of S.aureus could play a role in mother-to-child transmission of HBV. HBV DNA detection in vaginal discharge represents a promising biomarker to identify newborns at risk of perinatal persistent infection.

Hepatitis A Outbreaks and Environmental Circulation of Genotype IA Strains in the São Paulo City, 2017-2018.

Hepatitis A virus (HAV) is the major cause of enterically transmitted infectious hepatitis. Between 2016 and 2017, the number of confirmed cases of hepatitis A virus (HAV) increased from 64 to 786 in São Paulo affecting mainly adults aged between 18 and 39years (80%) and males (88%). To support epidemiological surveillance, the present study monitored the presence of HAV in urban sewage samples collected bimonthly for 1year (November 2017-November 2018) in the central region of the city, where most of cases were detected. Sewage samples were concentrated by polyethylene glycol precipitation and HAV RNA was quantified by RT-qPCR. Nucleotide sequencing targeting the VP1/2A junction region was carried out to genotype the HAV strains. HAV was detected in 76.9% (40/52) of the samples, with a geometric mean viral load of 5.09 × 104 (± SD 4.51 × 105) genome copies (GC/L) (Mauá Street) and 5.27 × 104 (± SD 1.26 × 106) GC/L (Prestes Maia Avenue). Of the 40 positive samples, 8 were typed as HAV subgenotype IA [100% nucleotide (nt) identity with HAV strain VRD_521_2016]. Highest homology was obtained with sequences from European countries (Italy, Spain) and Israel, all of which had reported recent HAV outbreaks associated with men who have sex with men. Our results highlight that wastewater surveillance is a useful tool to support investigating HAV outbreaks in the community, including circulating genotypes.

Determination of Intestinal Viral Loads and Distribution of Bovine Viral Diarrhea Virus, Classical Swine Fever Virus, and Peste Des Petits Ruminants Virus: A Pilot Study.

The aim of this pilot study was to determine viral loads and distribution over the total length, at short distances, and in the separate layers of the intestine of virus-infected animals for future inactivation studies. Two calves, two pigs, and two goats were infected with bovine viral diarrhoea virus (BVDV), classical swine fever virus (CSFV), and peste des petits ruminants virus (PPRV), respectively. Homogenously distributed maximum BVDV viral loads were detected in the ileum of both calves, with a mean titer of 6.0 log10 TCID50-eq/g. The viral loads in colon and caecum were not distributed homogenously. In one pig, evenly distributed CSFV mean viral loads of 4.5 and 4.2 log10 TCID50-eq/g were found in the small and large intestines, respectively. Mucosa, submucosa, and muscular layer/serosa showed mean viral loads of 5.3, 3.4, and 4.0 log10 TCID50-eq/g, respectively. Homogenous distribution of PPRV was shown in the ileum of both goats, with a mean viral load of 4.6 log10 TCID50-eq/g. Mean mucosa, submucosa, and muscular layer/serosa viral loads were 3.5, 2.8, and 1.7 log10 TCID50-eq/g, respectively. This pilot study provides essential data for setting up inactivation experiments with intestines derived from experimentally infected animals, in which the level and the homogeneous distribution of intestinal viral loads are required.

Burden of HIV, Tuberculosis Infection and Risk Factors amongst Inmates of Correctional Institutions in Port Harcourt Nigeria

Aims: Burden of infectious diseases in correctional institutions constitutes a public health concern due to the confined nature and congestion of the prisons. This study aimed at surveying Burden of HIV, Tuberculosis Infection and Risk factors amongst inmates of Correctional Institutions in Port Harcourt Nigeria&#x0D; Study Design: The study was descriptive, comprising both males and females. A total of 178 inmates constituted the study population&#x0D; Place and Duration of Study: Port Harcourt Maximum Prisons, Creek Road and the Juvenile Remand Home, Borokiri, Port Harcourt, Nigeria, between the months of May to December 2019.&#x0D; Methodology: Two millilitres of blood was collected from each participant after receiving their informed consent. The blood was dispensed into EDTA anti-coagulant bottles and used for serological investigations of HIV 1&amp;2, and TB. Samples positive for TB was confirmed using the GeneXpert Molecular technique while HIV 1&amp;2 were confirmed using Real-Time PCR and their Viral Loads determined.&#x0D; Results: The overall prevalence of HIV and MTB in the study population were: HIV 1 &amp; 2 (3.9%) and Tuberculosis (0.6%) The Mean Viral Loads of positive samples were HIV 1&amp;2 (479.3 copies/ml); and High MTB was detected. The most significant risk factors identified are as follows:, inmates with tattoos on their bodies (c2=83.6, p&lt;0.0001), took part in blood initiation ceremonies (c2=110.1, p&lt;0.0001), have exchanged needles/sharp objects (c2=2.2, p&gt;0.0001), have tribal marks (c2=58.4, p&lt;0.0001), received blood (c2=151.1, p&lt;0.0001). Majority of the inmates have had sex before, 159(89.3%) [89(56.0%) had multiple sex partners up to 3 and above, 32(20.1%) had 2 partners while 38(23.9%) said they were single sex partners (c2=37.1, p&lt;0.0001)]. On condom use, 90(50.6%) of the inmates do not use condom while 88(49.4%) admitted they use condoms. 7(3.9%) of the inmates have indulged in anal sex (c2=151.1, p&lt;0.0001). 6(3.4%) had history of family drug use while 23(12.9%) have used drugs prior to imprisonment&#x0D; Conclusion: The prevalence of HIV among inmates in this study is quite high and remains a public health problem while that of Mycobacterium tuberculosis (MTB) though appearing relatively low still remains a public health risk. The risk factors amongst inmates of Correctional Institutions in Port Harcourt Nigeria have been identified in this study. The high HIV 1 &amp; 2 prevalence with MTB prevalence with high viral load results indicates poor health conditions which if not contained can spread to other inmates. This requires prompt interventions and treatment among the correctional inmates.

SARS-CoV-2: Viral Loads of Exhaled Breath and Oronasopharyngeal Specimens in Hospitalized Patients with COVID-19

BackgroundSARS-CoV-2 seems mainly transmissible via respiratory droplets. We compared the time-dependent SARS-CoV-2 viral load in serial pharyngeal swab with exhaled breath (EB) samples of hospitalized COVID-19 patients. MethodsIn this prospective proof of concept study, we examined hospitalized patients who initially tested positive for SARS-CoV-2. Paired oronasopharyngeal swab and EB specimens were taken at different days of hospitalization. EB collection was performed through a simple, noninvasive method using an electret air filter-based device. SARS-CoV-2 RNA detection was determined with real-time quantitative reverse transcription polymerase chain reaction. ResultsOf 187 serial samples from 15 hospitalized patients, 87/87 oronasopharyngeal swabs and 70/100 EB specimens tested positive. Comparing the number of SARS-CoV-2 copies, the viral load of the oronasopharyngeal swabs was significantly higher (CI 99%, P<<0,001) than for EB samples. The mean viral load per swab was 7.97 × 106 (1.65 × 102-1.4 × 108), whereas EB samples showed 2.47 × 103 (7.19 × 101-2.94 × 104) copies per 20 times exhaling. Viral loads of paired oronasopharyngeal swab and EB samples showed no correlation. ConclusionsAssessing the infectiousness of COVID-19 patients merely through pharyngeal swabs might not be accurate. Exhaled breath could represent a more suitable matrix for evaluating infectiousness and might allow screening for superspreader individuals and widespread variants such as Delta.

Abstract 64: The Prevalence of Hepatocellular Carcinoma in HIV-Infection: Results of Large-Scale Liver Ultrasound Screening Program in HIV-Infected Nigerians

Abstract Purpose: In Nigeria, over 3 million people are infected with HIV (prevalence rates 6.1-8.0%). Rates of co-infection with HBV and HCV among HIV-infected are common ranging from 9-12.3% (HBV) and 6-20% (HCV). Given the high burden of HIV/HBV co-infection, it is hypothesized that there are high rates of HCC among HIV-infected individuals in Nigeria. This abstract describes the pattern of liver diseases detected by abdominal ultrasound, including abnormalities suggestive of HCC, from a screening program. Methods: In this cross-sectional study, all consenting adults (&amp;gt;18) HIV-infected subjects underwent an abdominal ultrasound using the N2 full Digital Ultrasound and completed a structured questionnaire. Ultrasonography findings were recorded. Basic descriptive statistics was performed. Results: Two thousand seven hundred and twenty-seven subjects were enrolled into the program [1950 (71.5%) females; mean age 46.40±10.15 years]. All subjects were receiving antiretroviral therapy (ART). The majority of study subjects (2149, 78.8%) had a normal liver ultrasound scan. The most common liver abnormality was hepatomegaly, seen in 298 (10.9%) of the study subjects. One hundred and nine (4.0%) had a diffusely hyper-echogenic liver, suggestive of fatty liver. Seventy-two (2.6%) had a hypo-echogenic liver with starry sky appearance, suggestive of active inflammation. Thirty-eight (1.4%) of the study subjects had features consistent with liver cirrhosis. Liver nodules or solid masses were seen in 4 (0.01%) of the study subjects. Mean HIV viral load was significantly higher among those with hepatomegaly compared to those with a normal scan (log103.74 vs.log105.21 p=0.015). Conclusion: The prevalence of HCC among HIV-infected was extremely low 4(0.01%). This is reassuring given the relatively large number of subjects screened and high prevalence of other risk factors for HCC in this population. An effect of ART on reducing incidence of HCC in this population is surmised, however, requires further exploration in long-term follow up studies. Citation Format: Pantong Davwar, Nyam David, Emuobor Odeghe, Duguru Mary, Claudia Hawkins, Ganiyat Oyeleke, Edith Okeke, Lesi Olufunmilayo, Lewis Roberts, Atiene Sagay, Lifang Hou, Robert Murphy, Godwin Imade. The Prevalence of Hepatocellular Carcinoma in HIV-Infection: Results of Large-Scale Liver Ultrasound Screening Program in HIV-Infected Nigerians [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 64.

Diagnostic Accuracy of SARS-CoV-2 Rapid Antigen Detection Testing in Symptomatic and Asymptomatic Children in the Clinical Setting.

ABSTRACTAntigen-based rapid diagnostic tests (RDTs) are used in children despite the lack of data. We evaluated the diagnostic performance of the Panbio-COVID-19 Ag Rapid Test Device (P-RDT) in children. Symptomatic and asymptomatic participants 0 to 16 years old had two nasopharyngeal swabs (NPS) for both reverse transcription-PCR (RT-PCR) and P-RDT. A total of 822 participants completed the study, of which 533 (64.9%) were symptomatic. Among the 119 (14.5%) RT-PCR-positive patients, the P-RDT sensitivity was 0.66 (95% confidence interval [CI] 0.57 to 0.74). Mean viral load (VL) was higher among P-RDT-positive patients than negative ones (P < 0.001). Sensitivity was 0.91 in specimens with VL of >1.0E6 IU/ml (95% CI 0.83 to 0.99) and decreased to 0.75 (95% CI 0.66 to 0.83) for specimens >1.0E3 IU/ml. Among symptomatic participants, the P-RDT displayed a sensitivity of 0.73 (95% CI 0.64 to 0.82), which peaked at 1.00 at 2 days post-onset of symptoms (DPOS) (95% CI 1.00 to 1.00), then decreased to 0.56 (95% CI 0.23 to 0.88) at 5 DPOS. There was a trend toward lower P-RDT sensitivity in symptomatic children <12 years (0.62 [95% CI 0.45 to 0.78]) versus ≥12 years (0.80 [95% CI 0.69 to 0.91]; P = 0.09). In asymptomatic participants, the P-RDT displayed a sensitivity of 0.43 (95% CI 0.26 to 0.61). Specificity was 1.00 in symptomatic and asymptomatic children (95% CI 0.99 to 1.00). The overall 73% and 43% sensitivities of P-RDT in symptomatic and asymptomatic children, respectively, was below the 80% cutoff recommended by the World Health Organization. We observed a correlation between VL and P-RDT sensitivity, as well as variation of sensitivity according to DPOS, a major determinant of VL. These data highlight the limitations of RDTs in children, with the potential exception in early symptomatic children ≥12yrs.

Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines

BackgroundInformation is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions.MethodsWe conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase–polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100%×(1−hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation.ResultsSARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7).ConclusionsAuthorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.)

Observation of varicella zoster virus-induced acute retinal necrosis: viral load detection and visual outcome.

To observe the changes of viral load in aqueous humour samples and visual outcomes in varicella zoster virus (VZV)-induced acute retinal necrosis (ARN). Observational retrospective study. Medical records and viral load measured by real-time quantitative polymerase chain reaction (qPCR) of 20 eyes with VZV-induced ARN were reviewed. The mean viral load at presentation was 5.7 × 107 ± 9.7 × 107 copies/mL. An initial plateau phase for viral load lasting up to 2 weeks occurred in most eyes (18 eyes, 90%). In the following logarithmic reduction phase, the mean slope of the decline in viral load was -0.103 ± 0.029 log/day, and the expected time for half reduction of the initial viral load was 3.2 ± 1.0 days. At the end of the first 8-week's antiviral treatment, the viral load was below detection threshold in all 20 eyes (100.0%). The mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 1.1 ± 0.7 (Snellen equivalent 20/250) to 0.7 ± 0.6 (Snellen equivalent 20/100) after a follow-up of 8.6 ± 2.0 months. Thirteen of the 20 eyes (65.0%) suffered retinal detachment and underwent vitrectomy. The initial viral load was the independent predictive factor of logMAR BCVA at the last follow-up (β = 0.745, P < 0.001). The observation of viral load changes by qPCR was useful for better monitoring of therapeutic efficacy and deciding needed antiviral duration in VZV-induced ARN patients.

Development, Assessment, and Outcomes of a Community-Based Model of Antiretroviral Care in Western Kenya Through a Cluster-Randomized Control Trial.

To develop and assess an alternative care model using community-based groups for people living with HIV and facilitate by lay personnel. Geographic locations in the Academic Model Providing Access to Healthcare Kitale clinic catchment were randomized to standard of care versus a community-based care group (ART Co-op). Adults stable on antiretroviral therapy and virally suppressed were eligible. Research Assistant-led ART Co-ops met in the community every 3 months. Participants were seen in the HIV clinic only if referred. CD4 count and viral load were measured in clinic at enrollment and after 12 months. Retention, viral suppression, and clinic utilization were compared between groups using χ2, Fisher exact, and Wilcoxon rank sum tests. At 12 months, there were no significant differences in mean CD4 count or viral load suppression. There was a significant difference in patient retention in assigned study group between the intervention and control group (81.6% vs 98.6%; P < 0.001), with a number of intervention patients withdrawing because of stigma, relocation, pregnancy, and work conflicts. All participants, however, were retained in an HIV care program for the study duration. The median number of clinic visits was lower for the intervention group than that for the control group (0 vs 3; P < 0.001). Individuals retained in a community-based HIV care model had clinical outcomes equivalent to those receiving clinic-based care. This innovative model of HIV care addresses the problems of insufficient health care personnel and patient retention barriers, including time, distance, and cost to attend clinic, and has the potential for wider implementation.

Association of blood groups with hepatitis C viremia.

Hepatitis C virus remained a public health problem with approximately half of the patients untreated and undiagnosed. Chronic HCV is a leading cause of cirrhosis, fibrosis, hepatocellular carcinoma and other hepatic morbidities. Active HCV has a prevalence rate of about 1% (71 million). By July, 2019, 10 million population of Pakistan was declared to have active HCV infection. According to World Health Organization, 23,720 people died of hepatitis-related complexities in Pakistan in 2016. Individuals with certain types of ABO blood groups were more susceptible to diverse kinds of infections. For instance, blood types A and AB predisposed individuals to severe malaria, while type O conferred resistance to the many of the protozoan agent.This study was designed to explore the association of hepatitis C viremia to blood groups, Rh factors, age and gender distribution among Pakistani population. Total 246 participants were screened for HCV in Taqwa diagnostics laboratory, Multan and 200 were found positive. They were divided into 4 groups on the basis of their age. First group included patients ranging from 17 to 25 (52), second, third and fourth group included patients from 26 to 34 (92), 35 to 43 (42) and 44 to above (14) respectively. Confirmed Hepatitis C patients were subjected to analysis of blood group, Rh factor and viral load. Results demonstrated that patients having ‘O’ blood group (60.37%) were reported for high viral load than any of the other blood groups in the patients of Southern Punjab, Pakistan. Furthermore, Rh-negative factor (26.42) was associated with high viral load than that of the Rh-positive factor (73.58). Disclosure practiced that age group (26–34) was reported for the high viral load than that of the any other group of this study. Females were more aggressively affected by HCV Viremia than male because the mean viral load among the females was higher than that of the males. Greater social awareness and gender-sensitive healthcare is necessary to improve the experiences of patients with HCV.

Chronic viral HBeAg-negative hepatitis B: Epidemiological, clinical and biochemical characteristics in an outpatient descriptive cohort in Burkina Faso

IntroductionOur study aimed to describe epidemiological and diagnostic features in an outpatient's cohort with chronic HBeAg-negative hepatitis B. Patients and methodsA cross-sectional descriptive study with a retrospective data collection was implemented from January 2004 to April 2016 in the hepato-gastroenterology department of the University Teaching Hospital Yalgado Ouédraogo (CHU-YO) in Burkina Faso. ResultsOverall 325 HBeAg negative patients met the inclusion criteria. The sex ratio was 1.5 and the mean age 38.7 years. The most frequent circumstance of diagnosis was the health check-up (54.5%). The mean HBsAg concentration and viral load were 7861.6 IU/mL and 32 237.20 IU/mL, respectively. Low or moderate inflammatory activity was found in 44% and 24% of patients, respectively at the liver biopsy; 32% presented a portal fibrosis with some septa (F2). 43.9% and 41.6% had low (A1) or moderate (A2) inflammatory activity, respectively at the hepatic fibrosis blood test, while 59.1% and 20.4% had low (F1) or moderate (F2) fibrosis stage, respectively. Of the five biochemical and virological profiles among the untreated patients, the profile 1 represented 67.2% of the sample. ConclusionThe proportions of negative HBeAg in chronic hepatitis B patients are increasing in Burkina Faso. Most of the patients have a high viral load, a low to moderate inflammatory activity or fibrosis stage.

HIV Treatment Outcomes in Rural Georgia Using Telemedicine.

BackgroundThe increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model.MethodsWe conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics.ResultsThree hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm3) than that of the F2F group (596.3 cells/mm3; P < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 104 and –1 to 0.24 × 104, respectively (P = 1.00).ConclusionsTM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted.

Parvovirus B19 DNA detectable in hearts of patients with dilated cardiomyopathy, but absent or inactive in blood.

AimsParvovirus B19 (B19V) is often assumed to be a cause of dilated cardiomyopathy (DCM), based on the quantification of B19V DNA in endomyocardial biopsies (EMB). Whether the presence of B19V DNA correlates with active infection is still debated. Application of the enzyme endonuclease to blood samples results in degradation of B19V DNA remnants but leaves viral particles intact, which enables differentiation between active and past infection. In this study, the susceptibility to degradation by endonuclease of B19V DNA in blood was compared between DCM patients and a control group of recent B19V infections.Methods and resultsTwenty blood samples from 20 adult patients with DCM, who previously tested positive for B19V DNA in EMB and/or blood, were tested with B19V PCR before and after application of endonuclease to the samples. Six blood samples tested positive for B19V DNA with a mean viral load of 2.3 × 104 IU/mL. In five samples, B19V DNA became undetectable after endonuclease (100% load reduction); in one sample DNA load showed a 23% log load reduction (viral load before endonuclease: 9.1 × 104 IU/mL; after: 6.5 × 103 IU/mL). Presence of cardiac inflammation did not differ between patients with B19V DNAemia (1/4) and patients without B19V DNAemia (6/14) ( P value = 1.0). In all 18 control samples of proven recent B19V infections, DNA remained detectable after application of endonuclease, showing only a mean log load reduction of 2.3% (mean viral load before endonuclease: 8.1 × 1011 IU/mL; after: 8.0 × 1011 IU/mL). Load reduction differed significantly between the DCM group and the control group; indicating the presence of intact viral particles in the control group with proven active infection and the presence of DNA remnants in the DCM group (P value = 0.000).ConclusionDuring recent B19V infection, viral DNA levels in blood were unaffected by endonuclease. In contrast, B19V DNA in blood in patients with DCM became undetectable or strongly reduced after application of endonuclease. Circulating viral DNA in this subset of patients with presumed parvovirus‐associated DCM does not consist of intact viral particles. Viral replicative activity cannot be assumed from demonstrating B19V DNA in cardiac tissue or in blood in DCM patients.

Investigation of nasopharyngeal viral load at discharge in patients with COVID-19

This study aimed to assess the nasopharyngeal viral load at discharge or time of discontinued isolation in coronavirus 2019 (COVID-19) patients admitted to our hospital and discharged under the current symptom-based criteria in Japan.Patients diagnosed with COVID-19 by reverse transcription polymerase chain reaction and hospitalized at Toyama University Hospital were included in the analysis. Nasopharyngeal viral load was measured when symptom-based criteria for discharge or end of isolation in the accommodations were met, and examined the relationship between viral load and days after onset or age. From the perspective of virus isolation limit, the amount of infectious viral load was defined at 50 copies/μL by nasopharyngeal sample.Thirty-three patients with laboratory-confirmed COVID-19 were included in the analysis, after excluding critical and fatal cases. Mean nasopharyngeal viral load at discharge or end of isolation was 1.90 log-copies/μL, and 64% of patients were discharged with over 50 copies/μL. No correlation was apparent between age and viral load at discharge, and viral load remained relatively high at discharge or end of isolation in all age groups.Although attempts at infectious virus isolation are necessary, infection control precautions even after discharge or discontinued isolation in accommodations may be needed, as the date of onset mostly depended on self-reporting by patients.