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Roy Choudhury A, Hoad VC, Seed C, Bentley P. Is dual testing for hepatitis C necessary? Modelling the risk of removing hepatitis C antibody testing for Australian blood donations. Vox Sang 2023; 118:480-487. [PMID: 37183505 PMCID: PMC10952898 DOI: 10.1111/vox.13430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Parallel testing of blood donations for hepatitis C virus (HCV) antibody and HCV RNA by nucleic acid testing (NAT) has been standard practice in Australia since 2000. Meanwhile, NAT technologies have improved, and HCV has become a curable disease. This has resulted in a significant reduction in the risk and clinical consequences of HCV transmission through transfusion. This study aimed to estimate the residual risk (RR) under various testing options to determine the optimal testing strategy. MATERIALS AND METHODS A developed deterministic model calculated the RR of HCV transmission for four testing strategies. A low, mid and high estimate of the RR was calculated for each. The testing strategies modelled were as follows: universal dual testing, targeted dual testing for higher risk groups (first-time donors or transfusible component donations) and universal NAT only. RESULTS The mid estimate of the RR was 1 in 151 million for universal dual testing, 1 in 111 million for targeted dual testing of first-time donors, 1 in 151 million for targeted dual testing for transfusible component donations and 1 in 66 million for universal NAT only. For all testing strategies, all estimates were considerably less than 1 in 1 million. CONCLUSION Antibody testing in addition to NAT does not materially change the risk profile. Even conservative estimates for the cessation of anti-HCV predict an HCV transmission risk substantially below 1 in 1 million. Therefore, given that it is not contributing to blood safety in Australia but consuming resources, anti-HCV testing can safely be discontinued.
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Affiliation(s)
- Avijoy Roy Choudhury
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
| | | | - Clive Seed
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
| | - Peter Bentley
- UWA Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia
- Australian Red Cross LifebloodPerthWestern AustraliaAustralia
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2
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van den Berg K, Murphy EL, Louw VJ, Maartens G, Hughes SD. Motivations for blood donation by HIV-positive individuals on antiretrovirals in South Africa: A qualitative study. Transfus Med 2023. [PMID: 36799902 PMCID: PMC10403373 DOI: 10.1111/tme.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We performed a mixed-methods study to explore the motivations associated with blood donation by donors with known, but undisclosed HIV-positive status and ARV use (HIV+/ARV+), seeking potential strategies to reduce such donations and mitigate risk for blood recipients. Here, we report predominantly the qualitative component. BACKGROUND A safe and sustainable blood supply is dependent in part, on effective pre-donation donor assessment. We previously described failure by HIV+/ARV+ blood donors to disclose their status. Such donations may lead to transfusion-transmitted HIV. METHODS The social ecological model provided the conceptual framework for this study. Previously identified HIV+/ARV+ donors were invited to complete a survey (including a validated stigma scale) and qualitative interview, which underwent inductive and deductive thematic analysis. RESULTS We uncovered two primary motivational paths to HIV+/ARV+ blood donations: privacy and altruism. The latter included a motivation not previously reported in the literature: donating specifically for other people living with HIV (PLWH). The other primary factor was a lack of privacy. These accounts often included donors encountering donation opportunities when accompanied by people to whom they had not and did not plan to disclose their HIV status. Most were highly confident their donations would be identified as HIV-positive and discarded. CONCLUSION We demonstrated a complex interaction between individual, social, cultural, and structural/policy factors in blood donations by PLWH who take ARV. Recommendations to limit HIV + ARV+ donations include: (1) Targeted communication strategies to increase knowledge among PLWH of their deferral from blood donation-without increasing stigma, and (2) development of procedures to assist those who feel unable to opt-out of donation due to privacy concerns.
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Affiliation(s)
- Karin van den Berg
- Medical Division, South African National Blood Service, Roodepoort, South Africa.,Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Haematology, University of the Free State, Bloemfontein, South Africa
| | - Edward L Murphy
- Department of Laboratory Medicine, University of California, San Franciscco, San Francisco, California, USA.,Department of Epidemiology/Biostatistics, University of California, San Franciscco, San Francisco, California, USA.,Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
| | - Vernon J Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shana D Hughes
- Epidemiology and Bioinformatics Core, Vitalant Research Institute, San Francisco, California, USA
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3
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Modeling the Risk of HIV Transfusion Transmission. J Acquir Immune Defic Syndr 2023; 92:173-179. [PMID: 36219691 DOI: 10.1097/qai.0000000000003115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/19/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Blood donations are routinely screened for HIV to prevent an infectious unit from being released to the blood supply. Despite improvements to blood screening assays, donations from infected donors remain undetectable during the window period (WP), when the virus has not yet replicated above the lower limit of detection (LOD) of a screening assay. To aid in the quantitative risk assessments of WP donations, a dose-response model describing the probability of transfusion-transmission of HIV over a range of viral RNA copies was developed. METHODS An exponential model was chosen based on data fit and parsimony. A data set from a HIV challenge study using a nonhuman primate model and another data set from reported human blood transfusions associated with HIV infected donors were separately fit to the model to generate parameter estimates. A Bayesian framework using No-U-Turn Sampling (NUTS) and Monte Carlo simulations was performed to generate posterior distributions quantifying uncertainty in parameter estimation and model predictions. RESULTS The parameters of the exponential model for both nonhuman primate and human data were estimated with a mean (95% credible intervals) of 2.70 × 10 -2 (7.74 × 10 -3 , 6.06 × 10 -2 ) and 7.56 × 10 -4 (3.68 × 10 -4 , 1.31 × 10 -3 ), respectively. The predicted ID 50 for the animal and human models was 26 (12, 90) and 918 (529, 1886) RNA copies transfused, respectively. CONCLUSION This dose-response model can be used in a quantitative framework to estimate the probability of transfusion-transmission of HIV through WP donations. These models can be especially informative when assessing risk from blood components with low viral load.
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van Drimmelen H, Lelie N. Early Dynamics of Hepatitis B Virus (HBV)-DNA and Surface Antigen (HBsAg) in Ramp-Up Phase of Viremia: Implications for Performance Evaluation of Blood Screening Assays. Viruses 2022; 14:v14091942. [PMID: 36146748 PMCID: PMC9503664 DOI: 10.3390/v14091942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
The Common Specifications/EU 2017/746 regulation for market approval of class D in vitro diagnostic devices (IVDs) intended for detection of blood borne viruses requires testing of the International Standard and 10–30 seroconversion panels to demonstrate ‘state of the art’ assay performance. We examined whether these requirements for performance evaluation are reasonable for HBV-DNA and HBsAg assays. For this purpose, we quantified HBsAg and HBV-DNA (genotype A) in the ramp-up phase of five seroconversion panels and demonstrated a remarkably parallel increase in the Log concentration of both analytes over time. Testing of seroconversion panels by three nucleic acid amplification technology (NAT) methods in multiple replicates and probit analysis with sufficient critical samples from all five panels taken together showed detection limits in copies/mL that were comparable to those on a HBV-DNA genotype A standard dilution panel. This indicates that the viral doubling time in the ramp-up phase is equal above and below the quantification limit of the viral load assay. The geometric mean HBsAg (PRISM) cutoff crossing point was 20 days later than the 50% NAT (Ultrio Plus) conversion point equivalent to 1500 (range: 1100–2200) and 4.8 (CI: 3.7–6.4) HBV-DNA copies/mL, respectively. Analytical sensitivity data of different NAT assay versions obtained over a decade demonstrated that the detection limit on the International Standard is not representative of all genotyped reference samples. From our detailed mathematical analysis, we conclude that HBV-DNA and HBsAg standard dilution series are functionally equivalent to seroconversion panels. A general requirement of a 95% detection limit ≤100 HBV-DNA copies/mL for different viral genotypes would be a better-defined regulation for EU market approval of NAT blood screening assays than the testing of multiple seroconversion panels to claim ‘state of the art’ performance.
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Affiliation(s)
- Harry van Drimmelen
- Biologicals Quality Control (BioQControl), De Droogmakerij 31h, 1851LX Heiloo, The Netherlands
| | - Nico Lelie
- Biologicals Quality Control (BioQControl), De Droogmakerij 31h, 1851LX Heiloo, The Netherlands
- Lelie Research, Parkstraat 2, 1811DK Alkmaar, The Netherlands
- Correspondence:
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5
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Mechanism of Viral Suppression among HIV Elite Controllers and Long-Term Nonprogressors in Nigeria and South Africa. Viruses 2022; 14:v14061270. [PMID: 35746741 PMCID: PMC9228396 DOI: 10.3390/v14061270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/30/2022] Open
Abstract
A subgroup among people living with HIV (PLHIV) experience viral suppression, sometimes to an undetectable level in the blood and/or are able to maintain a healthy CD4+ T-cell count without the influence of antiretroviral (ARV) therapy. One out of three hundred PLHIV fall into this category, and a large sample of this group can be found in areas with a high prevalence of HIV infection such as Nigeria and South Africa. Understanding the mechanism underpinning the nonprogressive phenotype in this subgroup may provide insights into the control of the global HIV epidemic. This work provides mechanisms of the elite control and nonprogressive phenotype among PLHIV in Nigeria and South Africa and identifies research gaps that will contribute to a better understanding on HIV controllers among PLHIV.
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MicroRNA let-7 and viral infections: focus on mechanisms of action. Cell Mol Biol Lett 2022; 27:14. [PMID: 35164678 PMCID: PMC8853298 DOI: 10.1186/s11658-022-00317-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
MicroRNAs (miRNAs) are fundamental post-transcriptional modulators of several critical cellular processes, a number of which are involved in host defense mechanisms. In particular, miRNA let-7 functions as an essential regulator of the function and differentiation of both innate and adaptive immune cells. Let-7 is involved in several human diseases, including cancer and viral infections. Several viral infections have found ways to dysregulate the expression of miRNAs. Extracellular vesicles (EV) are membrane-bound lipid structures released from many types of human cells that can transport proteins, lipids, mRNAs, and miRNAs, including let-7. After their release, EVs are taken up by the recipient cells and their contents released into the cytoplasm. Let-7-loaded EVs have been suggested to affect cellular pathways and biological targets in the recipient cells, and can modulate viral replication, the host antiviral response, and the action of cancer-related viruses. In the present review, we summarize the available knowledge concerning the expression of let-7 family members, functions, target genes, and mechanistic involvement in viral pathogenesis and host defense. This may provide insight into the development of new therapeutic strategies to manage viral infections.
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7
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Lelie N, van Drimmelen H. Accuracy of quantitative HIV-1 RNA test methods at 1000 copies/mL and the potential impact of differences in assay calibration on therapy monitoring of patients. J Med Virol 2020; 92:3246-3253. [PMID: 32285945 DOI: 10.1002/jmv.25877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/11/2020] [Indexed: 11/09/2022]
Abstract
The World Health Organization (WHO) recommends the clinical use of a human immunodeficiency virus 1 (HIV-1) viral load (VL) threshold level of 1000 copies (cp)/mL in patients on antiretroviral therapy (ART) to distinguish between viral control (VL < 1000 cp/mL) and viral failure or poor adherence (VL > 1000 cp/mL). The accuracy of five quantitative HIV-1 RNA assays at this level was compared by replicate testing (n = 24) of 1000 cp/mL samples prepared from the Viral Quality Control (VQC) HIV-1 subtype B standard, which is in use for validation of nucleic acid testing methods since 1995. Until 2004 the VL assays reported geometric mean (95% confidence interval [CI]) values ranging between 449 (188-1067) and 3162 (3057-2367) cp/mL when using the Siemens bDNA 3.0 assay as reference method for an assigned value of 1000 (962-1038) cp/mL. In 2018, the following values (95% CI) were found by 24 replicate tests in each of the VL assays on the 1000 cp/mL samples: Abbott RealTime 1084 (784-1572), BioMerieux EasyQ 1110 (533-2230), Roche CAP/CTM 1277 (892-1828), Hologic Aptima 1616 (1324-1973), and Cepheid GeneXpert 2502 (1713-3655) cp/mL. Calibration studies involving three consecutive WHO replacement standards showed a significant drift in the amount of RNA copies per International Unit overtime. Heat inactivation of HIV-1 standards was found to cause a destandardizing effect. Our study underlines the limitations in HIV-1 RNA assay calibration based on frequently replaced WHO international standards. It is therefore proposed that clinicians interpret the recommended 1000 cp/mL alert level in therapy monitoring with an inaccuracy range of 500 to 2000 cp/mL.
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Affiliation(s)
- Nico Lelie
- Lelie Research, Alkmaar, The Netherlands
- Biologicals Quality Control (BioQControl), Heiloo, The Netherlands
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Coleman C, Lelie N, Rademeyer R, van Drimmelen H, van den Berg K, Vermeulen M. Comparison of two nucleic acid amplification technology systems for detection of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus. Transfusion 2020; 60:2929-2937. [PMID: 33064884 PMCID: PMC10936959 DOI: 10.1111/trf.16137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic in South Africa while hepatitis C virus (HCV) infection is rare. Two nucleic acid amplification technology platforms, the Procleix Ultrio Elite assay on the Panther instrument (Elite) and the cobas MPX assay on the cobas 6800 or 8800 system (MPX), are used worldwide. In 2015 these were evaluated in South African context. STUDY DESIGN AND METHODS The sensitivity of HIV, HBV, and HCV was evaluated using reference panels and 2-fold dilutions of 51 positive plasma samples tested in 12 to 24 replicates. The 95% and 50% lower limits of detection (LOD) were estimated by probit analysis and window period (WP) risk days by the Weusten model. Specificity was established by testing 3646 blood donations individually and instrument performance by evaluating all runs. RESULTS Specificity was 99.94% for MPX and 99.97% for Elite. The following 95% LODs (95% confidence intervals [CIs]) were estimated for MPX and Elite, respectively: HBV, 17.8 (10.9-33.9) and 47.9 (29.1-92.4) cp/mL; HCV, 21.9 (15.3-34.6) and 13.8 (8.9-24.0) cp/mL; and HIV, 8.3 (5.5-14.7) and 10.4 (6.9-18.2) cp/mL. On SA HBV and HIV dilution panels, relative sensitivity (range) of MPX was 3.20 (1.26-6.50) and 1.42 (0.26-2.72) fold higher than Elite. Downtime on cobas 6800 was 26 hours vs 6.6 hours on Panther (P < .001). We estimated infectious WPs for HBV, HCV, and HIV-1 at 13.8, 1.8, and 2.6 days for Elite and 10.3, 2.1, and 2.4 days for MPX. CONCLUSION Although MPX was significantly more sensitive for HBV, Elite was implemented due to instrument reliability during evaluation.
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Affiliation(s)
- Charl Coleman
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | - Nico Lelie
- Lelie Research, Parkstraat 2, 1811DK Alkmaar
| | - Ronel Rademeyer
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | | | - Karin van den Berg
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
| | - Marion Vermeulen
- South African National Blood Service, 2 Constantia Boulevard, Constantia Kloof Ext 22, Roodepoort, 1709, ZA
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Vermeulen M, Chowdhury D, Swanevelder R, Grebe E, Brambilla D, Jentsch U, Busch M, Van Zyl G, Murphy EL. HIV incidence in South African blood donors from 2012 to 2016: a comparison of estimation methods. Vox Sang 2020; 116:71-80. [PMID: 32762088 DOI: 10.1111/vox.12987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Measuring incidence is important for monitoring and maintaining the safety of the blood supply. Blood collected from repeat-donors has provided the opportunity to follow blood donors over time and has been used to estimate the incidence of viral infections. These incidence estimates have been extrapolated to first-time donors using the ratio of NAT yield cases in first-time versus repeat-donors. We describe a model to estimate incidence in first-time donors using the limiting antigen (LAg) avidity assay and compare its results with those from established models. METHODS HIV-positive first-time donations were tested for recency using the LAg assay. Three models were compared; incidence estimated for (1) first-time donors using LAg avidity, (2) first-time and repeat-donors separately using the NAT yield window period (WP) model and (3) repeat-donors using the incidence/WP model. RESULTS HIV incidence in first-time donors was estimated at 3·32 (CI 3·11, 3·55) and 3·81 (CI 3·07, 4·73) per 1000 PY using the LAg assay and NAT yield WP models, respectively. Incidence in repeat-donors was between 2·0- and 2·5-fold lower than in first-time donors estimated at 1·56 (CI 1·37, 1·77) and 1·94 (CI 1·86-2·01) per 1000 PY using the NAT yield/WP and incidence/WP models, respectively. CONCLUSION Testing HIV-positive donations using the LAg assay provides a reliable method to estimate incidence in first-time donors for countries that collect the majority of blood from first-time donors and do not screen with NAT.
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Affiliation(s)
- Marion Vermeulen
- The South African National Blood Service, Roodepoort, South Africa
| | | | | | - Eduard Grebe
- Vitalant Research Institute, San Francisco, CA, USA
| | | | - Ute Jentsch
- The South African National Blood Service, Roodepoort, South Africa
| | | | - Gert Van Zyl
- Stellenbosch University, Cape Town, South Africa
| | - Edward L Murphy
- Vitalant Research Institute, San Francisco, CA, USA.,University of California San Francisco, San Francisco, CA, USA
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10
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Lanteri MC, Santa-Maria F, Laughhunn A, Girard YA, Picard-Maureau M, Payrat JM, Irsch J, Stassinopoulos A, Bringmann P. Inactivation of a broad spectrum of viruses and parasites by photochemical treatment of plasma and platelets using amotosalen and ultraviolet A light. Transfusion 2020; 60:1319-1331. [PMID: 32333396 PMCID: PMC7317863 DOI: 10.1111/trf.15807] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The INTERCEPT Blood System pathogen reduction technology (PRT), which uses amotosalen and ultraviolet A light treatment (amotosalen/UV-PRT), inactivates pathogens in plasma and platelet components (PCs). This review summarizes data describing the inactivation efficacy of amotosalen/UVA-PRT for a broad spectrum of viruses and parasites. METHODS Twenty-five enveloped viruses, six nonenveloped viruses (NEVs), and four parasites species were evaluated for sensitivity to amotosalen/UVA-PRT. Pathogens were spiked into plasma and PC at high titers. Samples were collected before and after PRT and assessed for infectivity with cell cultures or animal models. Log reduction factors (LRFs) were defined as the difference in infectious titers before and after amotosalen/UV-PRT. RESULTS LRFs of ≥4.0 log were reported for 19 pathogens in plasma (range, ≥4.0 to ≥7.6), 28 pathogens in PC in platelet additive solution (PC-PAS; ≥4.1-≥7.8), and 14 pathogens in PC in 100% plasma (PC-100%; (≥4.3->8.4). Twenty-five enveloped viruses and two NEVs were sensitive to amotosalen/UV-PRT; LRF ranged from >2.9 to ≥7.6 in plasma, 2.4 or greater to greater than 6.9 in PC-PAS and >3.5 to >6.5 in PC-100%. Infectious titers for four parasites were reduced by >4.0 log in all PC and plasma (≥4.9 to >8.4). CONCLUSION Amotosalen/UVA-PRT demonstrated effective infectious titer reduction for a broad spectrum of viruses and parasites. This confirms the capacity of this system to reduce the risk of viral and parasitic transfusion-transmitted infections by plasma and PCs in various geographies.
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Affiliation(s)
- Marion C Lanteri
- Department of Scientific Affairs, Cerus Corporation, Concord, California, USA
| | | | - Andrew Laughhunn
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | - Yvette A Girard
- Department of Microbiology, Cerus Corporation, Concord, California, USA
| | | | - Jean-Marc Payrat
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | - Johannes Irsch
- Department of Scientific Affairs, Cerus Europe BV, Amersfoort, The Netherlands
| | | | - Peter Bringmann
- Department of Microbiology, Cerus Corporation, Concord, California, USA
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11
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Lelie N, Vermeulen M, van Drimmelen H, Coleman C, Bruhn R, Reddy R, Busch M, Kleinman S. Direct comparison of three residual risk models for hepatitis B virus window period infections using updated input parameters. Vox Sang 2020; 115:133-145. [PMID: 31960480 DOI: 10.1111/vox.12889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/21/2019] [Accepted: 12/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Comparison of two models for estimating residual transfusion transmission risk by NAT screened window period (WP) donations in South African repeat donors gave identical results for HIV but not for HBV. In order to understand discrepant HBV modelling outcomes, the values of input parameters in three HBV WP risk models were reviewed and subsequently applied to the same South African screening data generated by HBsAg PRISM and two NAT assays (Ultrio and Ultrio Plus). Two of the models were also compared using individual donation (ID)-NAT screening data from different geographical regions. METHODS Values of input parameters were derived from two published data sources and used in three risk models [(1) the incidence rate-WP risk day equivalent model, (2) the NAT yield WP ratio model and (3) the anti-HBc-negative HBsAg yield period ratio model] and subsequently applied to the same ID-NAT screening data. RESULTS The HBV WP transmission risk in South African repeat donations during a one-year Ultrio Plus NAT screening period was estimated as 22, 43 and 17 per million, respectively, for the three models, as compared to 56, 117 and 48 per million for HBsAg PRISM screening. The approximate two-fold higher estimate calculated with the NAT yield WP ratio model was corroborated in repeat donations from three of four regions in a multi-regional study. When another set of model input values (with shorter viraemia periods and a higher proportion of acute occult infections) was applied to the South African screening data, the relative difference in risk estimates between the three models became smaller. CONCLUSIONS Window period risk modelling for HBV is more complex than for HIV. Multiple factors affect the modelling outcomes. These include the values used for the length of transient HBsAg and HBV-DNA-positive phases, the proportion of acute occult and vaccine breakthrough infections and the assumption of random appearance of donors throughout the entire acute resolving infection phase. A substantial proportion of HBV WP NAT yields have very low viral load and lack donor follow-up data calling into question their definitive classification into the early acute (infectious) replication stage. Since these possible WP NAT yields most highly impact the NAT yield WP ratio model, we recommend relying on the more conservative estimates of the incidence rate-WP risk day equivalent model.
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Affiliation(s)
- Nico Lelie
- Lelie Research, Alkmaar, The Netherlands
| | - Marion Vermeulen
- South African National Blood Service (SANBS), Roodepoort, South Africa
| | | | - Charl Coleman
- South African National Blood Service (SANBS), Roodepoort, South Africa
| | - Roberta Bruhn
- Vitalant Research Institute (previously Blood Systems Research Institute), San Francisco, CA, USA
| | - Ravi Reddy
- South African National Blood Service (SANBS), Roodepoort, South Africa
| | - Michael Busch
- Vitalant Research Institute (previously Blood Systems Research Institute), San Francisco, CA, USA
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12
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Sykes W, Van den Berg K, Jacobs G, Jauregui A, Roubinian N, Wiesner L, Maartens G, Swanevelder R, Custer B, Busch M, Jentsch U, Murphy EL, Vermeulen M. Discovery of False Elite Controllers: HIV Antibody-Positive RNA-Negative Blood Donors Found To Be on Antiretroviral Therapy. J Infect Dis 2019; 220:643-647. [PMID: 30950501 PMCID: PMC6639597 DOI: 10.1093/infdis/jiz145] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increase in potential HIV elite controllers (EC) and anecdotal reports of antiretroviral therapy (ART) use among South African blood donors led us to verify EC status. METHODS Stored plasma samples from potential EC were tested for ART drugs. Demographic and temporal associations were examined using multivariable logistic regression. RESULTS Of 226 potential EC, 150 (66.4%) had detectable ART with increasing prevalence by year (OR = 7.57 for 2016 vs 2010, 95% confidence interval, 1.96-32.17). DISCUSSION False presumptive EC status due to undisclosed ART represents a growing proportion of potential EC donors in South Africa coincident with the country's ART rollout.
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Affiliation(s)
- Wendy Sykes
- South African National Blood Service, Durban, South Africa,Correspondence: W. Sykes, BTech, South African National Blood Service, 10 Eden Road, Pinetown 3610, South Africa ()
| | | | - Genevieve Jacobs
- South African National Blood Service, Johannesburg, South Africa
| | | | | | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | | | | | | | - Ute Jentsch
- South African National Blood Service, Johannesburg, South Africa
| | - Edward L Murphy
- Vitalant Research Institute, San Francisco, CA,University of California, San Francisco, CA
| | - Marion Vermeulen
- South African National Blood Service, Johannesburg, South Africa
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13
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Development and validation of plasma miRNA biomarker signature panel for the detection of early HIV-1 infection. EBioMedicine 2019; 43:307-316. [PMID: 31005516 PMCID: PMC6557912 DOI: 10.1016/j.ebiom.2019.04.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/27/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Accurate laboratory diagnosis of HIV is essential to reduce the risk of HIV-positive individuals transmitting HIV-1 infection. The goal of this study was to identify and assess a panel of host derived plasma miRNAs that could to serve as a prognostic and predictive biomarker to detect early/acute HIV-1 infection. Methods A total of 372 microRNAs were analyzed in nine plasma samples from HIV-1 infected individuals in the early phase of infection and three healthy controls using the miRNA PCR-array. Seventeen microRNAs were selected and validated in 80 plasma samples from HIV-1 infected individuals in the early phase of infection (20 each of eclipse stage, RNA+ stage, Ag + stage, and Ag + Ab+ stage of HIV-1 patients) and 25 healthy controls. Using the validation study results a plasma miRNA panel was developed and evaluated to detect early/acute HIV-1 infection in 49 blinded samples. Finding We identified an miRNA panel (PeHIV-1) containing four differentially expressed miRNAs (miR-16-5p, miR-20b-5p, miR-195-5p, and miR-223-3p) that could distinguish early HIV-1 infection from healthy controls with high AUC (1·000[1·00–1·00]), sensitivity (100%), and specificity (100%).We also found that miR-223-3p demonstrates 100% sensitivity and specificity (AUC 1·00[1·00–1·00]) and could distinguish eclipse stage of HIV-1 infection from healthy controls. To detect eclipse stage of HIV-1 infection we also developed a four-miRNA based (miR-16-5p, miR-206, let-7 g-3p, and miR-181c-3p) panel (PE) with AUC 0·999 (0·995–1·000), 100% sensitivity and 95·8% specificity. Interpretation The miRNA panel, PeHIV-1 is a potential biomarker for detecting early/acute stage of HIV-1infection and could help initiate early antiretroviral treatment, thus preventing the spread of HIV-1 infection.
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Vermeulen M, Lelie N, Coleman C, Sykes W, Jacobs G, Swanevelder R, Busch M, van Zyl G, Grebe E, Welte A, Reddy R. Assessment of HIV transfusion transmission risk in South Africa: a 10-year analysis following implementation of individual donation nucleic acid amplification technology testing and donor demographics eligibility changes. Transfusion 2019; 59:267-276. [PMID: 30265757 PMCID: PMC10419327 DOI: 10.1111/trf.14959] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk. STUDY DESIGN AND METHODS In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations. RESULTS The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%. CONCLUSION ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.
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Affiliation(s)
- Marion Vermeulen
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
| | - Nico Lelie
- Lelie Research, Parkstraat 2, 1811DK, Alkmaar
| | - Charl Coleman
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
| | - Wendy Sykes
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
| | - Genevieve Jacobs
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
| | - Ronel Swanevelder
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
| | - Michael Busch
- Blood Systems Research Institute, 270 Masonic Avenue, San Francisco, California, USA
| | - Gert van Zyl
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Francie van Zijl Drive, Parow, 7500, South Africa
- National Health Laboratory Service, Tygerberg Business Unit, Francie van Zijl Drive, Parow, 7500, South Africa
| | - Eduard Grebe
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Francie van Zijl Drive, Parow, 7500, South Africa
| | - Alex Welte
- Division of Medical Virology, Stellenbosch University, Faculty of Medicine and Health Sciences, Francie van Zijl Drive, Parow, 7500, South Africa
| | - Ravi Reddy
- The South African National Blood Service, 1 Constantia Boulevard, Constantia kloof, Roodepoort, South Africa
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McCullough J, Alter HJ, Ness PM. Interpretation of pathogen load in relationship to infectivity and pathogen reduction efficacy. Transfusion 2018; 59:1132-1146. [PMID: 30592305 DOI: 10.1111/trf.15103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 01/12/2023]
Affiliation(s)
| | - Harvey J Alter
- Department of Transfusion Medicine, NIH Clinical Center, Bethesda, Maryland
| | - Paul M Ness
- Departments of Pathology and Medicine, Johns Hopkins University, Baltimore, Maryland
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Moura Vieira PC, Lamarão LM, de Miranda Corrêa AS, de Almeida NCC, Hermes de Castro RB, Palmeira MK, Burbano RR. Performance of mini-pool nucleic acid testing by studying diluted HIV NAT yield samples in a blood center of Brazil. Transfus Apher Sci 2018; 57:670-671. [DOI: 10.1016/j.transci.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
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17
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Strategies for screening cord blood for a public cord blood bank in high HIV prevalence regions. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2018; 3:e9. [PMID: 30263133 PMCID: PMC6152491 DOI: 10.1017/gheg.2018.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 02/08/2023]
Abstract
assay suggest that it could be used for the routine screening of CB units in conjunction with currently recommended maternal screening to reduce the risk of transplant transmissible infection.
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Key Words
- ART, anti-retroviral therapy
- Africa
- CMV, cytomegalovirus
- DNA, deoxyribonucleic acid
- ELISA, enzyme-linked immunosorbent assay
- EPI, Expanded Programme of Immunisation
- FDA, Food and Drug Administration
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV
- HIV, human immunodeficiency virus
- HLA, human leukocyte antigen
- HSCT, haematopoietic stem cell transplantation
- MTCT, mother-to-child transmission
- NAT, nucleic acid test
- PCR, polymerase chain reaction
- PMTCT, prevention of mother-to-child transmission
- RNA, ribonucleic acid
- SABMR, South African Bone Marrow Registry
- SANBS, South African National Blood Service
- TNC, total nucleated cell
- UCB, umbilical cord blood
- WMDA, World Marrow Donor Association
- cord blood
- stem cell
- transplantation
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Laperche S, Tiberghien P, Roche-Longin C, Pillonel J. Fifteen years of Nucleic Acid Testing in France: Results and lessons. Transfus Clin Biol 2017; 24:182-188. [PMID: 28709845 DOI: 10.1016/j.tracli.2017.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
Of the 40 million donations screened with Nucleic acid testing (NAT) between July 2001 and December 2015 in France, 20 HIV-positive, 13 HCV-positive and 17 HBV (HBV-NAT was initiated in 2005 and extended to the whole country in 2010) donations were discarded thanks to NAT. The main benefit in terms of discarded donations is related to HBV with a yield of 0.88 per million donations, which is 12.5 and 1.8 times higher than for HCV and HIV respectively. The main risk factor found in these donors during the post donation interview was having sex with men for males (n=11, all repeat blood donors), having a partner HCV positive (n=6) or at-risk partner (originated from endemic area or HBV positive) for HBV (n=8) for HIV, HCV and HBV, respectively. Although the mean viral load was high for HIV (5.6 log copies/mL) and HCV (7 log IU/mL), HBV cases show low level of DNA (1.8 log IU/mL) demonstrating the need of a highly sensitive NAT assay. Overall, the clinical benefit for recipients remains those related to the prevention of HIV contaminations since HCV avoided transmissions are extremely rare (only one case in the last 5 years thanks to NAT) and the potential infectivity of HBV-NAT only positive cases is questionable due to the low level of HBV DNA and the presence of anti-HBs in more than a half of DNA positive/HBsAg and anti-HBc negative donors.
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Affiliation(s)
- S Laperche
- Institut national de la transfusion sanguine, département d'études des agents transmissibles par le sang, centre national de référence risques infectieux transfusionnels, 6, rue Alexandre-Cabanel, 75015 Paris, France.
| | - P Tiberghien
- Établissement français de sang, 20, avenue du Stade-de-France, 93218 Saint-Denis, France
| | - C Roche-Longin
- Centre de transfusion sanguine des armées, 1, rue lieutenant Raoul-Battany, 92140 Clamart, France
| | - J Pillonel
- Département des maladies infectieuses, santé publique France, 12, rue du Val-d'Osne, 94410 Saint-Maurice, France
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19
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Weusten J, van Drimmelen H, Vermeulen M, Lelie N. A mathematical model for estimating residual transmission risk of occult hepatitis B virus infection with different blood safety scenarios. Transfusion 2017; 57:841-849. [DOI: 10.1111/trf.14050] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/06/2016] [Accepted: 12/18/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Jos Weusten
- Philips Handheld Diagnostics; Eindhoven the Netherlands
| | | | | | - Nico Lelie
- Biologicals Quality Control; Rijswijk the Netherlands
- Lelie Research; Paris France
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20
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Gu WM, Hu Y, Hu WZ, Xu B. Dynamic changes in biomarkers in acute human immunodeficiency virus infections: a case report. BMC Res Notes 2017; 10:65. [PMID: 28126023 PMCID: PMC5270311 DOI: 10.1186/s13104-017-2392-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background The highest incidence of human immunodeficiency virus infection in China is among men who have sex with men. This case report aims to describe the dynamic changes in biomarkers in an acute human immunodeficiency virus infection of a Han Chinese man who has sex with men, and to illustrate the possibility of using these biomarkers for the early detection of human immunodeficiency virus infection in Chinese hospital settings. Case presentation The 25-year-old Han Chinese male patient presented himself with an 8-day history of symptoms and signs of upper respiratory viral infections to a sexually transmitted infection clinic of a hospital setting in Shanghai. The viral load of human immunodeficiency virus, p24 antigen–antibody complex, and lymphocyte subsets of blood samples were repeatedly measured over the next 39 days. The human immunodeficiency virus from serum was genotyped. This patient was diagnosed as a human immunodeficiency virus infection, and the viral genotype was CRF 01_AE. The onset of the symptoms and signs was 12 days after his last reported unprotected intercourse with a human immunodeficiency virus -infected man. The patient had detectable levels of p24 antigen at his first visit, 20 days after infection, and the HIV viral load was at the highest point (8 × 106 copies/ml). A low concentration of antibody to HIV was observed in the patient’s serum 10 days after his 1st visit (30 days after infection). The confirmation of human immunodeficiency virus infection by Western blot assays was made at day 20 after his 1st visit (40 days after infection). Conclusions Symptoms of acute human immunodeficiency virus infection are non-specific. Specific laboratory markers appear shortly after HIV infections. The first biomarker detected from serum is the viral RNA and p24 antigen, followed by HIV-specific antibody. The results suggest that there are urgent needs for both human immunodeficiency virus antigen and antibody testing in routine medical practice, and that human immunodeficiency virus RNA testing should be recommended to detect early infection. Ethics approval was obtained from the Ethics Board of the Shanghai Dermatology Hospital.
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Affiliation(s)
- Wei-Ming Gu
- Shanghai Dermatology Hospital, Shanghai, 200050, China.
| | - Yi Hu
- School of Public Health, Fudan University, Shanghai, 200032, China
| | - Wei-Zhong Hu
- Shanghai Dermatology Hospital, Shanghai, 200050, China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, 200032, China
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21
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Vermeulen M, Lelie N. The current status of nucleic acid amplification technology in transfusion-transmitted infectious disease testing. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M. Vermeulen
- The South African National Blood Service; Johannesburg South Africa
| | - N. Lelie
- Lelie Research; Paris France
- Biologicals Quality Control; Rijswijk The Netherlands
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22
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[Human immunodeficiency virus: position of Blood Working Group of the Federal Ministry of Health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:1351-70. [PMID: 26487384 DOI: 10.1007/s00103-015-2255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Human Immunodeficiency Virus (HIV). Transfus Med Hemother 2016; 43:203-22. [PMID: 27403093 PMCID: PMC4924471 DOI: 10.1159/000445852] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022] Open
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24
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Grabarczyk P, Koppelman M, Boland F, Sauleda S, Fabra C, Cambie G, Kopacz A, O'Riordan K, van Drimmelen H, O'Riordan J, Lelie N. Inclusion of human immunodeficiency virus Type 2 (HIV-2) in a multiplex transcription-mediated amplification assay does not affect detection of HIV-1 and hepatitis B and C virus genotypes: a multicenter performance evaluation study. Transfusion 2015; 55:2246-55. [PMID: 26103564 DOI: 10.1111/trf.13193] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/21/2015] [Accepted: 03/01/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Ultrio Elite assay (Hologic/Grifols) runs on the Panther blood screening system and is comparable to the Ultrio Plus assay apart from the addition of oligonucleotides for human immunodeficiency virus Type 2 (HIV-2) detection. In this multicenter evaluation study the analytical sensitivity and genotype detection efficiency of the two assay versions were compared. STUDY DESIGN AND METHODS The analytical sensitivity and genotype detection efficiency were analyzed by replicate (18-303) testing of 27 hepatitis B virus (HBV), hepatitis C virus (HCV), HIV-1, and HIV-2 standard dilution panels calibrated in international units (IUs) and copies/mL. A wider range of subgenotypes was tested at 25 copies/mL. Specificity was evaluated in 30,756 donor samples. RESULTS The 95% lower limits of detection (LODs) in Ultrio Elite assay on WHO standards were 4.6, 7.3, 23.5, and 23.3 IU/mL for HBV, HCV, HIV-1, and HIV-2, respectively, and ranged from 13 to 44, 7 to 23, 6 to 15, and 9 copies/mL on genotype panels of the respective viruses. Comparable LODs had been previously found on the same panels with the Ultrio Plus assay. The specificity was 99.95% on initial test and 100% in the repeat test algorithm. CONCLUSION The change in the oligonucleotide design of the Ultrio Elite assay to enable HIV-2 detection has not affected the analytical sensitivity for the other viruses regardless of the genotype. Genotype reference panels are instrumental to compare the sensitivity of nucleic acid test assay versions and could serve as an alternative to seroconversion panels.
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Affiliation(s)
- Piotr Grabarczyk
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | | | - Fiona Boland
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | | | | | - Aneta Kopacz
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
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25
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Tamási B, Marschalkó M, Kárpáti S. [Skin symptoms associated with human immunodeficiency virus infection]. Orv Hetil 2015; 156:10-8. [PMID: 25544049 DOI: 10.1556/oh.2015.30077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The recently observed accelerated increase of human immunodeficiency virus infection in Hungary poses a major public concern for the healthcare system. Given the effective only but not the curative therapy, prevention should be emphasized. Current statistics estimate that about 50% of the infected persons are not aware of their human immunodeficiency virus-positivity. Thus, early diagnosis of the infection by serological screening and timely recognition of the disease-associated symptoms are crucial. The authors' intention is to facilitate early infection detection with this review on human immunodeficiency virus-associated skin symptoms, and highlight the significance of human immunodeficiency virus care in the everyday medical practice.
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Affiliation(s)
- Béla Tamási
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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26
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El Ekiaby M, Moftah F, Goubran H, van Drimmelen H, LaPerche S, Kleinman S, Busch M, Lelie N. Viremia levels in hepatitis C infection among Egyptian blood donors and implications for transmission risk with different screening scenarios. Transfusion 2015; 55:1186-94. [PMID: 25766141 DOI: 10.1111/trf.13061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Knowledge about the viral load (VL) distributions in different stages of hepatitis C virus (HCV) infection is essential to compare the efficacy of serologic screening and nucleic acid testing (NAT) in preventing transfusion transmission risk. We studied HCV-RNA levels in Egyptian blood donors in the preseroconversion window period (WP) and in later anti-HCV-positive stages of infection. STUDY DESIGN AND METHODS Subsets of individual-donation (ID)-NAT and anti-HCV-yield samples from a screening study among 119,756 donors were tested for VL by quantitative polymerase chain reaction (qPCR). Low viremia levels below the quantification limit of qPCR were determined by probit analysis using the proportion of reactive results on replicate NATs. Poisson distribution statistics were used to estimate transmission risk in different stages of HCV infection based on 50% minimum infectious doses (MID50 ) of 3.2 (1-10) and 316 (100-1000) virions in the absence and presence of anti-HCV, respectively. RESULTS Rates of total HCV infections and WP-NAT-yield donations in two Egyptian blood centers varied between 2.6% to 4.5% and 1:3100 to 1:9500, respectively. VLs ranged from 82 to 3 × 10(7) copies/mL in WP and from fewer than 1600 to 1.6 × 10(6) copies/mL in anti-HCV-positive carrier donations. Only two (1.1%) of 175 donors with probable resolved infection had detectable RNA on replicate testing (estimated VLs of 0.5 and 1.8 copies/mL). This translates to an estimated transmission risk of 0.028% if ID-NAT-nonreactive, anti-HCV-positive donations would be used for RBC transfusions. CONCLUSION Almost 99% of anti-HCV-reactive donations without detectable HCV-RNA on initial ID-NAT screening had eradicated the virus from the circulation, while 1% had extremely low VLs and are likely not infectious. The incremental safety offered by serologic testing of ID-NAT-screened blood seems minimal.
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Affiliation(s)
| | | | | | | | | | - Steve Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Busch
- Blood Systems Research Institute, San Francisco, California
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Shyamala V. Nucleic Acid Technology (NAT) testing for blood screening: impact of individual donation and Mini Pool - NAT testing on analytical sensitivity, screening sensitivity and clinical sensitivity. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/voxs.12106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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28
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Vermeulen M, van Drimmelen H, Coleman C, Mitchel J, Reddy R, Lelie N. A mathematical approach to estimate the efficacy of individual-donation and minipool nucleic acid amplification test options in preventing transmission risk by window period and occult hepatitis B virus infections. Transfusion 2014; 54:2496-504. [PMID: 24749834 DOI: 10.1111/trf.12657] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Sensitivity data from a head-to-head comparison study in South Africa were used to compare the efficacy of the Ultrio Plus assay in individual-donation (ID) and minipool (MP)4 and MP8 formats with that of TaqScreen MP6 in preventing hepatitis B virus (HBV) transmission risk. STUDY DESIGN AND METHODS The replicate nucleic acid test (NAT) results on 106 HBV NAT (Ultrio)-yield samples and 29 HBV DNA (Ultrio)-negative, hepatitis B surface antigen (HBsAg)-positive samples were used to determine the viral load in copies/mL against the Eurohep HBV standard by probit analysis. Random viral load distributions were established in 32 pre-HBsAg window period (WP), 15 post-HBsAg WP, and 56 occult HBV infection (OBI) donations. Regression analysis of log viral load and Poisson distribution statistics of infectious HBV particles in blood components was used to predict infectivity and efficacy of NAT options in removing HBV transmission risk. RESULTS For red blood cell transfusions (20 mL of plasma), the modeling predicted an Ultrio Plus ID-NAT efficacy of 68 and 83% in removing WP and (antibody to hepatitis B surface antigen-negative) OBI transmission risk, respectively, compared to 52 and 49% by TaqScreen MP6. For 200 mL of fresh-frozen plasma the estimated efficacy levels by these ID- and MP6-NAT options reduced to 57 and 44% for WP and to 67 and 34% for OBI donations, respectively. CONCLUSION The efficacy of the currently available commercial NAT systems in reducing HBV transmission risk is mainly driven by the pool size and the transfusion plasma volume. The modeled OBI transmission risk and NAT efficacy levels were in line with those recently reported in three lookback studies and give more insight in the incremental safety provided by HBsAg and antibody to hepatitis B core antigen testing of ID-NAT screened blood.
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Affiliation(s)
- Marion Vermeulen
- South African National Blood Service (SANBS), Johannesburg, South Africa
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Kleinman S, Busch MP, Murphy EL, Shan H, Ness P, Glynn SA. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2013; 54:942-55. [PMID: 24188564 DOI: 10.1111/trf.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. STUDY DESIGN AND METHODS The domestic component involves four blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa, which involve US and in-country investigators. RESULTS REDS-III is using two major methods to address key research priorities in blood banking and transfusion medicine. First, there will be numerous analyses of large "core" databases; the international programs have each constructed a donor and donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Second, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that either are in progress or are scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization, transfusion outcomes, noninfectious transfusion risks, human immunodeficiency virus-related safety issues (particularly in the international programs), emerging infectious agents, blood component quality, donor health and safety, and other donor issues. CONCLUSIONS It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the United States as well as to help assure a safe and available blood supply in the United States and in international locations.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada
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30
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Bruhn R, Lelie N, Custer B, Busch M, Kleinman S. Prevalence of human immunodeficiency virus RNA and antibody in first-time, lapsed, and repeat blood donations across five international regions and relative efficacy of alternative screening scenarios. Transfusion 2013; 53:2399-412. [DOI: 10.1111/trf.12299] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Nico Lelie
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Brian Custer
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Michael Busch
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Steven Kleinman
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
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Vermeulen M, Coleman C, Mitchel J, Reddy R, van Drimmelen H, Ficket T, Lelie N. Sensitivity of individual-donation and minipool nucleic acid amplification test options in detecting window period and occult hepatitis B virus infections. Transfusion 2013; 53:2459-66. [PMID: 23621791 DOI: 10.1111/trf.12218] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 03/10/2013] [Accepted: 03/12/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several comparison studies showed that the Ultrio assay (Novartis Diagnostics) used in individual-donation nucleic acid amplification testing (ID-NAT) format was as sensitive as the TaqScreen assay (Roche) on minipools of six donations (MP6), but the sensitivity of HBV DNA detection has been improved in the new Ultrio Plus version of the assay. A head-to-head comparison study was designed to compare the clinical sensitivity of the Ultrio and Ultrio Plus assay in ID, MP4, and MP8 formats using TaqScreen MP6 as a reference assay. STUDY DESIGN AND METHODS Plasma samples of 107 hepatitis B surface antigen (HBsAg)-negative, HBV ID-NAT (Ultrio) positive-yield samples and 29 HBV DNA-negative, HBsAg-positive samples were used for comparison of NAT options in replicate testing of dilutions. Viral loads and relative sensitivities were determined by probit analysis against the Eurohep standard. RESULTS Ultrio Plus detected a significantly (p < 0.00001) higher proportion of replicate assays on HBV NAT yields (77%) than Ultrio ID (62%) and TaqScreen MP6 (47%), whereas Ultrio Plus MP4 and MP8 detected 53 and 41%, respectively. On HBsAg-yield samples missed by Ultrio screening, the reactivity rate increased significantly (p < 0.0001) from 23% in Ultrio to 65% in Ultrio Plus and further to 72% (p = 0.10) in the TaqScreen assay. The overall improvement factor of the analytical sensitivity offered by the target enhancer reagent in the Ultrio Plus assay was 2.5 (2.0-3.1)-fold on the Ultrio yield samples, but 43 (11-350)-fold on the HBsAg yields. In ID-NAT format the analytical sensitivity of TaqScreen relative to Ultrio Plus was 2.0 (1.0-4.2), 0.9 (0.7-1.3), and 1.6 (0.9-3.0) on the Eurohep standard, HBV NAT-, and HBsAg-yield samples respectively. CONCLUSION The clinical sensitivity of the currently available commercial NAT methods is mainly driven by the pool size.
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Affiliation(s)
- Marion Vermeulen
- South African National Blood Service (SANBS), Johannesburg, South Africa; Biologicals Quality Control, DDL Laboratories, Rijswijk, the Netherlands; Creative Testing Solutions (CTS), Tampa, Florida; Lelie Research, Paris, France
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