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Thorman J, Björkman P, Sasinovich S, Tesfaye F, Mulleta D, Medstrand P, Reepalu A. Performance of Galectin-9 for identification of HIV viremia in adults receiving antiretroviral therapy in a resource-limited setting. J Acquir Immune Defic Syndr 2023:00126334-990000000-00214. [PMID: 36961948 DOI: 10.1097/qai.0000000000003196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
BACKGROUND Targeted viral load (VL) testing has been proposed for antiretroviral treatment (ART) monitoring in resource-limited settings. In this study, we have investigated the performance of the host biomarker Galectin-9 (Gal-9), alone and in combination with interferon-γ-inducible protein 10 (IP-10), in identifying individuals at increased likelihood of viremia during ART. SETTING Cohort of HIV positive adults receiving ART at Ethiopian health centers. METHODS We included participants with detectable viremia (VL ≥150 copies/ml) 12 months after starting ART and sex-matched non-viremic controls. Performance to identify individuals with VL ≥1000 copies/ml was determined for Gal-9 and the Gal-9/IP-10 combination respectively, using receiver operating characteristics (ROC) analysis. RESULTS Among 191 participants (50.3% women), 46 (24.1%) had VL ≥1000 copies/ml, 23 (12.0%) 150-999 copies/ml and 122 (63.9%) <150 copies/ml. Gal-9 and VL were positively correlated (rs=0.451, p<0.001). Sensitivity and specificity for Gal-9 to identify individuals with VL ≥1000 copies/ml was 91.3% (95% CI, 79.2-97.6) and 54.5% (95% CI, 46.0-62.8) respectively. The area under the ROC curve for Gal-9 was 0.810 (95% CI, 0.745-0.875), which was similar to that of the combination of Gal-9 and IP-10 [0.849 (95% CI, 0.792-0.905)]. Assuming 10% prevalence of VL ≥1000 copies/ml, using Gal-9 for targeted VL testing instead of universal VL testing would reduce the number of VL tests from ten to five to identify one viremic individual, with misclassification in 1/10 viremic individuals. CONCLUSION Gal-9 is a potential screening marker for targeted VL monitoring in ART recipients. Further studies are needed to determine optimal threshold levels.
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Affiliation(s)
- Johannes Thorman
- Clinical Infection Medicine, Dept. of Translational Medicine, Lund University, Malmö, Sweden
- Internship/Residency Unit, Skåne University Hospital, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Dept. of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | | | - Fregenet Tesfaye
- Clinical Infection Medicine, Dept. of Translational Medicine, Lund University, Malmö, Sweden
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daba Mulleta
- Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Patrik Medstrand
- Clinical Virology, Dept. of Translational Medicine, Lund University, Malmö, Sweden
| | - Anton Reepalu
- Clinical Infection Medicine, Dept. of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Gobena D, Kebede Gudina E, Yilma D, Girma T, Gebre G, Gelanew T, Abdissa A, Mulleta D, Sarbessa T, Asefa H, Woldie M, Shumi G, Kenate B, Kroidl A, Wieser A, Eshetu B, Degfie TT, Mekonnen Z. Escalating spread of SARS-CoV-2 infection after school reopening among students in hotspot districts of Oromia Region in Ethiopia: Longitudinal study. PLoS One 2023; 18:e0280801. [PMID: 36735689 PMCID: PMC9897530 DOI: 10.1371/journal.pone.0280801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 pandemic caused by extended variants of SARS-CoV-2 has infected more than 350 million people, resulting in over 5.5 million deaths globally. However, the actual burden of the pandemic in Africa, particularly among children, remains largely unknown. We aimed to assess the seroepidemiological changes of SARS-CoV-2 infection after school reopening among school children in Oromia, Ethiopia. METHODS A prospective cohort study involving students aged 10 years and older were used. A serological survey was performed twice, at school reopening in December 2020 and four months later in April 2021. Participants were selected from 60 schools located in 15 COVID-19 hotspot districts in Oromia Region. Serology tests were performed by Elecsys anti-SARS-CoV-2 nucleocapsid assay. Data were collected using CSentry CSProData Entry 7.2.1 and exported to STATA version 14.2 for data cleaning and analysis. RESULTS A total of 1884 students were recruited at baseline, and 1271 completed the follow-up. SARS-CoV-2 seroprevalence almost doubled in four months from 25.7% at baseline to 46.3% in the second round, with a corresponding seroincidence of 1910 per 100,000 person-week. Seroincidence was found to be higher among secondary school students (grade 9-12) compared to primary school students (grade 4-8) (RR = 1.6, 95% CI 1.21-2.22) and among those with large family size (> = 5) than those with a family size of <3 (RR = 2.1, 95% CI 1.09-4.17). The increase in SARS-CoV-2 seroprevalence among the students corresponded with Ethiopia's second wave of the COVID-19 outbreak. CONCLUSION SARS-CoV-2 seroprevalence among students in hotspot districts of the Oromia Region was high even at baseline and almost doubled within four months of school recommencement. The high seroincidence coincided with the second wave of the COVID-19 outbreak in Ethiopia, indicating a possible contribution to school opening for the new outbreak wave.
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Affiliation(s)
- Dabesa Gobena
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | | | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Getu Gebre
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Daba Mulleta
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Tarekegn Sarbessa
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Henok Asefa
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Gemechu Shumi
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Birhanu Kenate
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tizta Tilahun Degfie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
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Mulleta D, Jaleta F, Banti H, Bekele B, Abebe W, Tadesse H, Eshetu L, Zewdu A, Botore A, Tadesse L, Debela T. The Impact of Laboratory Quality Management System Implementation on Quality Laboratory Service Delivery in Health Center Laboratories of Oromia Region, Ethiopia. PLMI 2021. [DOI: 10.2147/plmi.s314656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tesfaye F, Sturegård E, Walles J, Winqvist N, Balcha TT, Karlson S, Mulleta D, Isberg PE, Jansson M, Björkman P. Alternative biomarkers for classification of latent tuberculosis infection status in pregnant women with borderline Quantiferon plus results. Tuberculosis (Edinb) 2020; 124:101984. [PMID: 32829076 DOI: 10.1016/j.tube.2020.101984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 01/29/2023]
Abstract
Borderline interferon-gamma (IFN-γ) results (near the cut-off level 0.35 IU/ml) occur in QuantiFERON (QFT) assays. We investigated the performance of alternative biomarkers for classification of latent tuberculosis infection (LTBI) status in pregnant women with borderline QFT IFN-γ responses. Pregnant women (n = 96) were identified from a cohort study in Ethiopia, based on QFT-Plus IFN-γ results (QFT-low: <0.20 IU/ml, n = 33; QFT-borderline: 0.20-0.70 IU/ml, n = 31; QFT-high: >0.70 IU/ml, n = 32), including 12 HIV-positive individuals in each group and with 20 HIV-negative non-pregnant women from the same cohort with QFT IFN-γ <0.20 IU/ml as controls. Concentrations of 8 markers (IL-1ra, IL-6, IL-8, IP-10, MCP-1, MCP-2, osteopontin and resistin) were measured in whole blood QFT supernatants, stimulated separately with TB1 and TB2 antigens. K-nearest neighbor analysis (KNN) was used to classify participants with regard to likelihood of LTBI. Concentrations of MCP-2, IP-10 and IL-1ra were higher in QFT-borderline compared to QFT-low participants in both antigen stimulations (p < 0.001). KNN classification indicated high likelihood of LTBI in 13/31 (42%) women with QFT-borderline IFN-γ results. MCP-2, IP-10 and IL-1ra expressed in whole blood after TB antigen stimulation may be considered as alternative biomarkers for classification of LTBI status in pregnant women with borderline QFT IFN-γ results.
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Affiliation(s)
- Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Erik Sturegård
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Clinical Microbiology, Division of Laboratory Medicine, Lund, Sweden
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Tolera Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sara Karlson
- Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Daba Mulleta
- Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Per-Erik Isberg
- Department of Statistics, School of Economics and Management, Lund University, Lund, Sweden
| | - Marianne Jansson
- Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skane University Hospital, Malmö, Sweden
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Olsson O, Björkman P, Jansson M, Balcha TT, Mulleta D, Yeba H, Valfridsson C, Carlsson F, Skogmar S. Plasma Profiles of Inflammatory Markers Associated With Active Tuberculosis in Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Positive Individuals. Open Forum Infect Dis 2019; 6:ofz015. [PMID: 30800697 PMCID: PMC6379652 DOI: 10.1093/ofid/ofz015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/21/2019] [Indexed: 01/29/2023] Open
Abstract
Background Diagnosis of tuberculosis (TB) in human immunodeficiency virus (HIV)-coinfected individuals is challenging. We hypothesized that combinations of inflammatory markers could facilitate identification of active TB in HIV-positive individuals. Methods Participants were HIV-positive, treatment-naive adults systematically investigated for TB at Ethiopian health centers. Plasma samples from 130 subjects with TB (HIV+/TB+) and 130 subjects without TB (HIV+/TB−) were tested for concentration of the following markers: CCL5, C-reactive protein (CRP), interleukin (IL)-6, IL12-p70, IL-18, IL-27, interferon-γ-induced protein-10 (IP-10), procalcitonin (PCT), and soluble urokinase-type plasminogen activator receptor (suPAR). Analyzed markers were then assessed, either individually or in combination, with regard to infection status, CD4 cell count, and HIV ribonucleic acid (RNA) levels. Results The HIV+/TB+ subjects had higher levels of all markers, except IL12p70, compared with HIV+/TB− subjects. The CRP showed the best performance for TB identification (median 27.9 vs 1.8 mg/L for HIV+/TB+ and HIV+/TB−, respectively; area under the curve [AUC]: 0.80). Performance was increased when CRP was combined with suPAR analysis (AUC, 0.83 [0.93 for subjects with CD4 cell count <200 cells/mm3]). Irrespective of TB status, IP-10 concentrations correlated with HIV RNA levels, and both IP-10 and IL-18 were inversely correlated to CD4 cell counts. Conclusions Although CRP showed the best single marker discriminatory potential, combining CRP and suPAR analyses increased performance for TB identification.
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Affiliation(s)
- Oskar Olsson
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
| | - Marianne Jansson
- Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Sweden
| | - Taye Tolera Balcha
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | | | - Christine Valfridsson
- Department of Experimental Medical Science, Section for Immunology, Lund University, Sweden
| | - Fredric Carlsson
- Department of Experimental Medical Science, Section for Immunology, Lund University, Sweden.,Department of Biology, Section for Molecular Cell Biology, Lund University, Sweden
| | - Sten Skogmar
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
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