Feasibility of prevention of perinatal HIV infection by nevirapine in rural areas of the northeast Democratic Republic of Congo, 2002-2004

The HIV NET 012 protocol for prevention of perinatal transmission of HIV, a single-dose of nevirapine given to the mother during labor and one given to the newborn, has been adopted by several developing countries. The implementation of this protocol may be difficult in African rural regions and must be evaluated. The study was carried out at the Oicha General Hospital, Democratic Republic of Congo. HIV-infected women with a gestational age > or =36 weeks were offered participation in the study during a prenatal visit. Among the 5,016 women tested during prenatal attendance from December 2002 to December 2004, 94 (1.9%, 95% confidence interval [CI]: 1.5-2.3%) were HIV-infected. Among these women, 59 (62.8%; 95% CI: 53.0-72.6%) received nevirapine and 35 (37.2%; 95% CI: 27.4-47.0%) did not receive nevirapine prophylaxis. Twenty-six (27.7%) of these women arrived fully dilated and 9 (9.5%) were not given the drug by the midwives. Among the 59 HIV-infected pregnant women who received nevirapine before delivery, 33 (55.9%, 95% CI: 43.2-68.6%) received the drug at the start of uterine contractions and 24 (40.7%; 95% CI: 28.2-53.2%) did not receive nevirapine within the recommended time before delivery. Two women (3.4%) received nevirapine, but this was not written in the logbook. Overall, among the 101 newborns, all children received a single-dose nevirapine: 48 (47.5%; 95% CI: 37.8-57.2%) of the 101 newborns received nevirapine in the 24-72 hr following birth and 52 (51.5%; 95% CI: 41.8-61.2%) just after birth when their mother did not receive nevirapine. Even for a protocol as simple as HIV prophylaxis with a single-dose nevirapine, the application in African rural areas encounters field difficulties. Further simplified procedures and health care re-organization are still needed to guarantee a full Prevention of Mother to Child Transmission coverage for every HIV pregnant woman in Africa.

[Production of monoclonal antibodies specific for the ABO blood group and rhesus D antigens]

We report, in this work, the techniques to obtain four monoclonal antibodies specific of erythrocytes antigens. Three of this antibodies, react with the ABO Blood Groupe System (A,B and AB), are produced by three mouse hybridomas (M18-2F11, M18-4F6 et M19-45D6), obtained by fusion of Sp2/0 mouse myeloma cell with spleen cell of balb/c mice immunized with human red blood cells and selected on selectif medium (Hypoxanthin, Aminoptérin, Thymidin) (HAT) and cloned by four limiting dilutions. Where as the fourth, it is an human monoclonal antibodies against Rhesus (D) produced by heterohybridomas, realized by fusion of X63 mouse myeloma cell with human B lymphocytes, from actively immunized persons by D antigen, that are purified and transformed by Epstein-Barr virus (EBV), and selected on selectif medium (HAT), presence of ouabain and then cloned by four limiting dilutions. The specificity of the antibodies produced, has been determined by direct hemagglutinin for the mouse monoclonal antibodies and artificial for the human anti-D. The determination of isotype the heavy and light chains is released by the technique immunoenzymatique (ELISA) and immunofixation has shown that mouse monoclonal antibodies belong to class IgM kappa, and human monoclonal antibodies anti-D belong to class IgG lambda.

Prevalence of hepatitis G virus in a haemodialysis unit

BACKGROUND

Recently, a novel blood-borne virus has been identified and named hepatitis G virus. Transfusion is the main route of transmission. It is known that patients on maintenance dialysis are more susceptible to infections with parenterally-transmitted viruses than the general population. The aim of the present study was to determine the prevalence of hepatitis G infection in a Belgian dialysis unit.

METHODS

The entire population of our dialysis unit (82 patients) was tested for the presence of hepatitis G virus (HGV) by reverse transcriptase polymerase chain reaction. History of transfusion or renal transplantation, coinfections with hepatitis B and C viruses, and serum aminotransferase levels were also tested.

RESULTS

Thirteen patients (16%) were found positive for HGV-RNA. Among these patients, 69.2% were infected by the G virus alone, 15.4% were coinfected with B virus, and 15.4% with C virus. All but one patient had a history of transfusion. Ten of the thirteen infected patients (77%) had normal aminotransferase (< 30 UI/l). Three patients had elevated aminotransferase levels (23%); one was coinfected with B virus, one with C virus, and the last one had a diabetes-induced fatty liver infiltration. No liver biopsies were performed.

CONCLUSIONS

It is concluded that infection with G virus is common among dialyzed patients. This high rate of infection could be related to previous transfusions, but may as well be due to nosocomial transmission. In our series, at least one patient has been contaminated by another road than transplantation or transfusion. Finally, it does not appear clearly that chronic infection with hepatitis G virus induces liver disease, as defined by elevated aminotransferase level.

Hemovigilance: clinical tolerance of solvent-detergent treated plasma

OBJECTIVE

This study was conducted to assess retrospectively the clinical tolerance of SD treated plasma and to compare it to other labile blood products (red blood cell and platelet concentrates).

METHODS

Adverse events (AEs) related to the use of blood products at the Blood Transfusion Center (BTC) are routinely collected through a formalised system of hemovigilance. All AEs reported are entered into a safety data base which was used for the study. All AEs reported during a one-year period to the BTC were retrospectively re-assessed and descriptive statistics calculated.

RESULTS

5064 units of SD treated plasma were transfused to 894 recipients during the study period at the occasion of 1553 transfusions. No AE associated to SD treatment plasma was reported during that period. In contrast, during the same period, 485 AEs associated with the use of red blood cell concentrates (RBCC) were reported in 251 patients at the occasion of 262 transfusions. 2.1% (251/11,748) of the patients transfused with RBCC experienced one or more AEs. The incidence of AEs per unit transfused was 1.3% (485/37,332), and 2.4% (485/20,460) of RBCC transfusions were associated with one or more AEs. 142 AEs associated with the use of platelet concentrate (PC) were observed in 69 patients at the occasion of 73 transfusions. 4.2% (69/1645) of patients transfused with PC experienced one or more AEs. The incidence of AEs per unit transfused was 1.1% (142/12,772), and 2.8% (142/5034) of PC transfusions were associated with one or more AEs. All reported AEs were classified and non serious. The most frequently observed AEs were fever, chills and rashes which accounted for roughly 64% of all reported AEs.

CONCLUSION

As for the overall clinical tolerance of red cell and platelet concentrates, the results of this study are in complete agreement with the published literature. The study also confirms the extremely good tolerability of SD treated plasma in comparison with other labile blood products.

Prestorage leukocyte reduction with in-line filtration of whole blood: evaluation of red cells and plasma storage

OBJECTIVES

Prestorage filtration of blood components appears to be an effective method to reduce leukocyte-induced adverse reactions and other complications. To determine whether it is better to filter whole blood before component separation, we compared the efficiency of in-line filtration of whole blood with that of postseparation filtration.

METHODS

Blood was collected from normal, healthy donors into either regular triple-bag containers or into whole-blood integral-filter container systems. We then compared the in vitro storage values of leukocyte-depleted red blood cell concentrates (RBCC) kept at 4 degrees C, and plasma frozen for 1 year with nonfiltered blood components as control.

RESULTS

All counts of white blood cells after filtration were < 1 x 10(6) per unit. For almost all storage parameters no significant differences were found between leukocyte-reduced RBCC and control units. The plasma fibrinopeptide A values below 30 ng/ml prior to freezing indicate that filtration does not activate the coagulation factors. Furthermore, the filtration did not influence either the biological values or the coagulation factors of plasma units.

CONCLUSIONS

Whole blood filtration prior to component preparation seems to offer a useful alternative technique for obtaining leukocyte-reduced RBCC and plasma.

Multi-center European evaluation of HIV testing on serum and saliva samples

OBJECTIVE

to evaluate the reliability of HIV antibody testing on saliva.

DESIGN

matched serum and saliva samples were collected from both seronegative (n = 344) and seropositive (n = 125) individuals in five European countries. Duplicate saliva samples collected with Omni-Sal devices provided by Saliva Diagnostic System (SDS) were pooled before analysis.

METHODS

all samples were analyzed by Recombinant HIV1 EIA Cambridge Bioscience and 2nd generation Abbott HIV 1&2 1A80. EIA procedures were adapted for saliva testing by modification of sample dilution and/or cut-off calculation. All saliva recording positive and/or doubtful EIA results were further analyzed by Western blot as a confirmatory method.

RESULTS

EIA results obtained from sera analysis from both seropositives and seronegatives allowed for calculation of the tests' sensitivity (HIV1 Biotech: 99.2%-100%; Abbott: 100%) and specificity (both tests 100%). In the series of 125 saliva samples collected from seropositives, the EIA results were as follows: with Biotech (3 negative, 3 in the grey-zone and 119 reactive) and with Abbott (1 negative, 1 in the grey-zone and 123 reactive). One saliva sample found negative by both EIA tests, although fulfilling HIV1 WB criteria of positivity, was collected from an HIV2 infected person. Out of 125 saliva samples collected from seropositives, 121 produced positive Western Blot profiles, 4 were indeterminate and 1 was found negative whereas 125/125 sera were found positive.

CONCLUSION

the reliability of HIV testing of saliva is dependent on the sensitivity of EIA tests and on the criteria used for the interpretation of Western blot tests as well. Although saliva testing offers numerous advantages for epidemiological purposes, it should not be recommended for diagnosis.

Production of stable human-mouse hybridomas secreting monoclonal antibodies against Rh D and c antigens

Peripheral blood lymphocytes from donors immunized against Rh antigens were fused with mouse myelomas and heteromyelomas in order to obtain human-mouse hybridomas secreting antibodies specific for these antigens. Three cell lines secreting anti-D IgG and two secreting anti-c IgM were stabilized and produced immunoglobulins for several months. These human monoclonal antibodies were evaluated as reagents for Rh phenotyping. Their complementary activity towards weak D and partial D antigens is examined.

[HIV infection in women. Psychological and somatic obstacle]

We consider the word "impediment" in the meaning of what compels someone, makes someone feel uncomfortable. What are the consequences/implications of seropositivity for the woman in her sexual life, in her motherhood and how does she then cope with it? The following clinical observations account for the suffering induced by seropositivity and the diversity of the processes spontaneously set by HIV-infected women in their sexual life. To answer that suffering, the commonly used psychotherapeutical approach is a palliative one.

The provision of safe blood--policy issues in the prevention of human immunodeficiency virus transmission

The AIDS epidemic has focused attention on the constraints and deficiencies present in many blood transfusion services in the developing world. We discuss a variety of options for reducing transfusion-related HIV transmission, and suggest how new transfusion strategies may be implemented. We show that a transfusion service cannot rely solely on the screening of donor blood for anti-HIV antibodies and that a more comprehensive approach is needed. Important components of this approach include donor selection and improved clinical practice, in which blood and blood products are prescribed only when really necessary.

Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda

BACKGROUND

Although transmission of human immunodeficiency virus type 1 (HIV-1) from mother to infant has been well documented during pregnancy and delivery, little is known about the possible transmission of HIV-1 during the postnatal period.

METHODS

We conducted a prospective cohort study in Kigali, Rwanda, of 212 mother-infant pairs who were seronegative for HIV-1 at delivery. All the infants were breast-fed. The subjects were followed at three-month intervals, with Western blot assays for antibodies to HIV-1 and testing of mononuclear cells by a double polymerase chain reaction (PCR) using three sets of primers. To evaluate potential risk factors, each mother who seroconverted was matched with three seronegative control women.

RESULTS

After a mean follow-up of 16.6 months, 16 of the 212 mothers became seropositive for HIV-1. Of their 16 infants, 9 became seropositive. One infant was excluded from the analysis because of a positive test by PCR on the blood sample obtained at birth. Postnatal seroconversion to HIV-1 occurred in four of the five infants born to the mothers who seroconverted during the first 3 months post partum, and in four infants of the 10 mothers who seroconverted between month 4 and month 21. In all cases, the infant seroconverted during the same three-month period as the mother. The main risk factor for maternal seroconversion was being single.

CONCLUSIONS

HIV-1 infection can be transmitted from mothers to infants during the postnatal period. Colostrum and breast milk may be efficient routes for the transmission of HIV-1 from recently infected mothers to their infants.

Characterization of a neuraminidase from Corynebacterium aquaticum responsible for Th polyagglutination

Th polyagglutinability is characterized by the agglutination of the red blood cells (RBC) by Arachis hypogaea, Medicago disciformis, Vicia cretica but, in contrast to the T phenomenon, not by Glycine max (Glycine soja). Because Th transformation of RBC has been obtained in vitro, the mechanism of Th polyagglutinability expression has been studied and reproduced experimentally. An enzyme with neuraminidase specificity has been isolated from the culture supernatant of Corynebacterium aquaticum, and further characterized (MW = 55,600 kDa, pH = 5.5, Km = 0.138 microM, Kcat = 0.22 micrograms). Reversely, Th transformation of RBC could be obtained by using other neuraminidases but in very mild conditions of hydrolysis. From our results, it can be concluded that by the release of less than 20 micrograms of sialic acid per 10(10) RBC, Th reactivity can be induced whereas hydrolysis of greater amounts of sialic acid (greater than 20 micrograms/10(10) RBC) give the classical T polyagglutinability.