Journal of Clinical Virology

Editorial Board

2012-06-01

A dilemma in management of an unwell infant: Short term mortality vs. long term morbidity

Kathy K. Li, Andrew Powls, Marylouisa Holton, Celia Aitken — 2012-03-16

Baby E was delivered by Caesarean section at 28 weeks for decreased foetal movements and intra-uterine growth restriction (IUGR). He had low platelets (22×109/L) and his head was more growth restricted than his body. He remained thrombocytopenic after a week and cranial ultrasound scan (USS) revealed cerebral calcification. Other abnormalities at birth included ambiguous genitalia and patent ductus arteriosus (PDA).

Detection of hepatitis C virus RNA in dried blood spots

2012-03-15

Abstract: Background: An estimated 130–170million people worldwide are chronically infected with HCV. In Europe the highest prevalence of HCV infections is in the IDU population. As traditional HCV screening relies on the detection of HCV antibody or HCV RNA in blood, screening in high-risk groups such as IDU is difficult due to poor venous access caused by damaged veins.Objectives: In this study DBS was evaluated as an alternative sample type to blood for the detection of HCV RNA.Study design: The endpoint detection limit, inter-assay and intra-assay variability of the method were determined. The DBS method was compared to our routine frontline assay using a panel of paired DBS and blood samples. The effect of different storage temperatures and length of storage time on the stability of HCV RNA in DBS was also assessed.Results: The endpoint detection limit of the method based on results from mock DBS was 250IU/ml. The method was shown to be precise and robust. The sensitivity and specificity of the method was found to be 100% and 95.8%, respectively. No significant variation in the stability of HCV RNA in DBS over a 1year period at a range of different temperatures was observed.Conclusions: A sensitive and stable method was developed for the detection of HCV RNA in DBS. Screening high-risk populations using DBS as a sample type may improve uptake of HCV testing by increasing opportunity for patients to be tested and consequently increasing access to treatment.

Increase of HCV RNA concentration during hemodialysis treatment in patients with chronic hepatitis C

2012-03-09

Abstract: Background: In hemodialysis (HD) patients, a decrease of serum HCV RNA concentration during HD has been reported.Objectives: To evaluate the effect of two different extracorporeal blood treatments, HD and hemodiafiltration (HDF), on HCV RNA concentration under standardized conditions.Study design: Eleven chronic HD patients with chronic hepatitis C (CHC) and thirty-three non-uremic patients with CHC as controls were studied. Blood samples were collected at baseline (t=0min), 30min (t=30), and 180min (t=180) after start of HD or HDF. HCV RNA concentrations were determined by a real-time PCR assay. Values obtained 30min and 180min after start of HD or HDF were adjusted according to the ultrafiltration-induced hemoconcentration.Results: Baseline HCV RNA concentrations were found to be similar in dialysis patients and controls (2.9E+06 vs. 5.8E+06IU/ml). After adjustment for hemoconcentration, no significant differences of HCV RNA concentrations were observed when HD versus HDF treatments and blood samples collected pre versus those collected post membrane were compared. Adjusted HCV RNA concentrations increased by 13% (not significant) at 30min and by 56% (p<0.001) at 180min after start of HD or HDF. Inhibitory effects on PCR through heparin and uremic toxins could be excluded.Conclusions: In contrast to recent publications, a significant increase of serum HCV RNA within 180min after start of HD or HDF was observed. Changes in serum HCV RNA concentration are independent from HD and HDF procedures, dialysis membrane, heparin concentration, and uremic toxins.

Quantitative determination of IgM antibodies reduces the pitfalls in the serodiagnosis of tick-borne encephalitis

K. Stiasny, J.H. Aberle, V. Chmelik, U. Karrer, H. Holzmann, F.X. Heinz — 2012-03-15

Abstract: Background: Tick-borne encephalitis (TBE) is the most important arbovirus disease in parts of Europe and Asia. Its laboratory diagnosis depends on the detection of specific IgM antibodies which can be impeded by (1) long-time persistence of IgM antibodies after infection, (2) vaccine-induced IgM antibodies, and (3) cross-reactive IgM antibodies from other flavivirus infections.Objectives: To assess the extent of interference factors in the serodiagnosis of TBE that might lead to the false positive assignment of a recent infection.Study design: We quantified TBE virus-specific IgM and IgG antibodies in sera collected at different time points from cohorts of (1) 61 TBE patients, (2) 131 TBE vaccinees, and (3) 42 patients with recent dengue or West Nile virus infections.Results: All of the TBE patients were IgM- and IgG-positive upon hospitalization and 87% of acute TBE sera had IgM antibody titers of >500 Arbitrary Units (AU). These titers rapidly declined and only 16% of TBE patients had low IgM titers ≥9months after infection. Vaccine-induced as well as flavivirus cross-reactive IgM antibodies were rarely detectable and of low titer.Conclusions: Most of the potential problems of TBE serodiagnosis can be resolved by the quantification of IgM antibodies in a single serum sample taken upon hospitalization. High IgM values (>500AU in our assay) are indicative of a recent infection. Lower IgM values, however, may require the analysis of a follow-up sample and/or a specific neutralization assay to exclude the possibilities of IgM persistence, vaccine-induced IgM antibodies or heterologous flavivirus infections.

Urine viral load and correlation with disease severity in infants with congenital or postnatal cytomegalovirus infection

2012-03-16

Abstract: Background: A correlation between cytomegalovirus (CMV) load in urine and severity of disease in congenitally infected infants has previously been reported. CMV load in postnatally infected infants has not been studied before.Objective: To investigate CMV load in urine of infants with postnatal or congenital infection and correlate this with clinical symptoms of CMV disease and cerebral abnormalities.Study design: Infants admitted to our NICU between July 2000 and February 2010, and diagnosed with congenital or postnatal CMV infection were included. Clinical symptoms of CMV infection, cranial ultrasonography (cUS) and magnetic resonance imaging (MRI) findings were evaluated. CMV urine loads of postnatally infected infants were analyzed and compared with CMV urine loads of congenitally infected infants.Results: Seventeen infants with congenital CMV infection and 45 infants with postnatal CMV infection were included. Thirteen/17 (76%) congenitally infected infants had clinical symptoms of CMV infection at birth and 11/17 (65%) had cerebral abnormalities diagnosed by neuro-imaging. None of the four asymptomatic infants had cerebral abnormalities. Of the postnatally infected infants 43/45 (96%) did not develop any clinical symptoms of CMV infection, but in 23/45 (51%) cerebral abnormalities such as lenticulostriate vasculopathy and germinolytic cysts were identified. The median CMV load in postnatally infected infants was significantly lower than in congenitally infected infants (1.0×105copies/ml versus 8.5×106copies/ml, p<0.001, respectively).Conclusions: CMV load in urine is significantly lower in infants with postnatal CMV infection than in infants with congenital CMV infection irrespective of clinical symptoms of CMV infection or cerebral abnormalities.

Importance of the cytomegalovirus seropositive recipient as a contributor to disease burden after solid organ transplantation

Vincent C. Emery, Kevin Asher, Cristina de Juan Sanjuan — 2012-03-23

Abstract: Background: The incidence of cytomegalovirus (CMV) syndrome/disease after adult solid organ transplantation in the era effective antiviral therapy has not been fully assessed.Objective: To determines the incidence of CMV syndrome/disease after solid organ transplantation in the UK.Study design: A retrospective analysis of 1807 solid organ transplants from 12 UK solid organ transplant centres representing 32.7% of all transplant activity occurring in the UK between 1/04/2004 and 31/03/2006. Patients were categorised into those experiencing an episode of symptomatic CMV infection after transplant or those who remained free of symptoms. All patients were followed up for 2 years for the occurrence of CMV syndrome/disease.Results: The majority of the transplant centres used valganciclovir prophylaxis in the high risk D+R− patients (91.6%) whereas management of the lower risk D+R+ and D−R+ patients was more variable with deployment of both prophylactic and pre-emptive strategies in ∼50% of centres. CMV syndrome/disease occurred in 20.5% of the D+R− patients representing 55 cases whereas the incidence was only 8.1% and 9% in the D+R+ and D−R+ group, respectively (p<0.001 compared to the D+R− group), but representing a further 58 cases of CMV syndrome/disease. CMV viraemia in the D+R− group was associated with a high probability (65%) of CMV syndrome/disease in renal transplant recipients whereas this was less apparent in the intermediate risk groups.Conclusions: CMV syndrome/disease remains an important healthcare burden after solid organ transplantation with the intermediate risk groups contributing similar numbers of cases as the high risk group.

Detection and quantification of influenza C virus in pediatric respiratory specimens by real-time PCR and comparison with infectious viral counts

2012-03-09

Abstract: Background: The epidemiological and clinical impacts of influenza C virus infection may have been underestimated by conventional viral culture screening alone.Objective: To evaluate a newly developed real-time polymerase chain reaction (PCR) assay as a tool for diagnosing influenza C virus infection.Study design: The primers and probe for real-time PCR were designed to amplify the conserved region of the nucleoprotein gene based on the aligned sequences of nine isolates from 1967 to 2010. Respiratory specimens from children collected between January 2010 and August 2010 were examined for the presence of influenza C virus by cell culture and real-time PCR. Specimens that were positive for the virus using real-time PCR were further examined using an infectivity assay with embryonated hen's eggs.Results: Of the 1203 specimens examined, 34 (2.8%) tested positive for the influenza C virus by cell culture and 51 (4.2%) tested positive by real-time PCR. The mean viral load and infectivity titer in specimens that tested positive using cell culture were 3.97×108copies/ml and 5.43×105EID50/ml, respectively, and those in specimens that were negative using cell culture were 2.18×106copies/ml and 3.67×102EID50/ml, respectively. In the clinical specimens with viral loads less than 105copies/ml, it was not possible to isolate the virus using embryonated hen's eggs. The copy number-to-EID50 ratio of the clinical specimens was much higher, ranging from 32 to 278,000, than those of culture fluid, ranging from 2.3 to 13.5.Conclusion: The real-time PCR assay described here can be used as a sensitive method for diagnosing influenza C virus infection.

Influenza in the immediate post-pandemic era: A comparison with seasonal and pandemic influenza in hospitalized patients

2012-03-09

Abstract: Background: Comparative data on severity and treatment of seasonal, pandemic and post-pandemic influenza virus infections are scarce.Objectives: To systematically analyze characteristics of hospitalized patients with influenza in the post-pandemic period compared to seasonal and pandemic influenza.Study design: Clinical and virological data of patients hospitalized in a tertiary referral hospital with post-pandemic influenza (2010–2011) were compared with those during seasonal influenza epidemics (2007–2009) and the influenza A(H1N1)pdm09 pandemic (2009–2010).Results: 82 patients were admitted during the post-pandemic period, compared to 85 during the pandemic and 60 during seasonal influenza epidemics. No differences were observed in the occurrence of complicated illness and the need for intensive care. However, radiographic pneumonia was significantly more often diagnosed in patients with influenza A(H1N1)pdm09 compared to patients with seasonal influenza A (25% versus 71% in pandemic, p=0.004, and 55% in post-pandemic, p=0.047). Oseltamivir was more frequently prescribed in post-pandemic and pandemic patients compared to previous influenza seasons (48.9% resp. 76.5% versus 6.5%, p<0.0001). During the post-pandemic period, patients with influenza B were significantly less often treated with oseltamivir compared to patients with influenza A (27.0% versus 48.9%, p=0.043), although the course of illness in patients with influenza B was comparable with influenza A. No upsurge of oseltamivir resistance was observed.Conclusions: In our center, severity of illness was comparable for all influenza seasons, although more radiographic pneumonia was diagnosed in patients with influenza A(H1N1)pdm09. Despite the increased use of oseltamivir, no increase in oseltamivir resistance was detected.

Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy

2012-03-21

Abstract: Background: Natural history of HPV infection is altered in HIV positive women, with increased risk of cervical dysplasia. Limited data are available about the influence of HPV genotypes and HPV multiple infections on cervical disease in HIV positive women.Objectives: We determined HPV genotype prevalence in cervical samples from 553 HIV-infected women attending the gynaecological service at “L. Spallanzani” Hospital. Association of HPV multiple infections with cervical abnormalities was investigated.Study design: MY09/MY11 consensus primers were used to detect HPV-DNA; HPV typing was performed by RFLP. A commercial array based kit was used to define unresolved RFLP patterns.Results: HPV was detected in 244/553 (44.1%) patients, correlating with low CD4 counts (p<0.001) and age (p=0.001). Multiple HPV types were observed in 44.4% of cases, more frequently involving HR than LR HPV (OR=12.8, p<0.00001). Multiple HPV infections were associated with low CD4 counts (OR=3.8 in CD4<200 vs CD4≥500cells/mm3). Dyskaryosis was associated with decreased CD4 counts (≥500 vs 200–499 vs <200cells/mm3, χ2 for trend, p=0.001) and with HPV types multiplicity (1 vs 2–3 vs ≥4, χ2 for trend, p<0.00001). Notably, in 3 H-SIL cases only LR types were detected (HPV62, n=2; HPV81, n=1).Conclusions: Multiple HPV infections, often involving HR types, are frequent in HIV-infected women. Association between multiple HPV infection, low CD4 count and cytological abnormalities supports the interplay of virological and immunological factors in cervical cancer pathogenesis. Assessment of multiple HPV infections might gain importance in cervical cancer screening, particularly in patients with predisposing factors like immuno-suppression.

Brush-based self-sampling in combination with GP5+/6+-PCR-based hrHPV testing: High concordance with physician-taken cervical scrapes for HPV genotyping and detection of high-grade CIN

2012-03-26

Abstract: Background: Studies have shown that self-sampling for hrHPV testing (HPV self-sampling) is highly acceptable to women, increases screening participation rate, and may therefore further reduce cervical cancer incidence. However, it is important to clinically validate HPV self-sampling procedures for screening purposes.Objectives: Clinical validation of combined brush-based self-sampling with GP5+/6+-PCR EIA for primary cervical screening. In addition, HPV type-specific agreement between sample types and acceptability of brush-based self-sampling were evaluated.Study design: 135 women referred for colposcopy took a self-sample at home prior to vaginal- and cervical sampling by a gynaecologist. All women were biopsied for histology. HPV testing was done by GP5+/6+-PCR EIA, with genotyping by reverse line blotting (RLB). Acceptability of sampling methods was measured with a questionnaire.Results: In this outpatient population, hrHPV test results showed good concordance between self-samples and physician-taken cervical scrapes (86%, k=0.70), with sensitivities and specificities for CIN2+ that did not differ significantly (93% and 51%, 91% and 51%, respectively (P=1.0)). The clinical sensitivity of brush-based self-sampling combined with GP5+/6+-PCR EIA hrHPV testing for detection of CIN2+ was non-inferior to that of hrHPV testing on physician-taken cervical samples (P=0.018). In addition, hrHPV genotyping results were highly concordant between sample types, with almost perfect agreement for HPV16 (k=0.81) and HPV18 (k=0.92). Finally, 91% of participants described brush-based self-sampling as easy-to-use.Conclusions: Brush-based self-sampling in combination with GP5+/6+-PCR EIA hrHPV testing is acceptable to women and valid for assessing the risk of CIN2+ in comparison to hrHPV testing on physician-taken scrapes. In addition, there was high concordance of HPV genotyping results. Therefore, this HPV self-sampling procedure may be considered for use in routine cervical screening.

Low risk of hepatitis E virus reactivation after haematopoietic stem cell transplantation

2012-03-19

Abstract: Background: Hepatitis E virus (HEV) is an emerging cause of acute hepatitis in industrialized countries. HEV infection can evolve to chronic hepatitis in immunocompromised patients. Additionally, HEV reactivation after haematopoietic stem cell transplantation has been reported.Objective: To assess the prevalence of anti-HEV antibodies in patients who underwent haematopoietic stem cell transplantation in south-western France and the risk of HEV reactivation after transplantation.Study design: We have investigated the prevalence of anti-HEV antibodies in 88 patients who underwent allogenic or autologous haematopoietic stem cell transplantation with two anti-HEV IgG assays and have evaluated the risk of HEV reactivation in pretransplant seropositive patients by testing for HEV RNA in blood samples collected after stem cell transplantation.Results: While only 11 patients (12.5%) tested positive for anti-HEV IgG with the Adaltis assay, 32 patients (36.4%) tested positive for anti-HEV IgG with the Wantai assay before transplantation. Three anti-HEV IgG positive patients were also anti-HEV IgM positive. Plasma HEV RNA was negative in all the patients before transplantation. We looked for HEV reactivation in pretransplant seropositive patients by testing 89 blood samples for HEV RNA 1, 3 and 6months after transplantation. We detected no reactivation. Similarly, we detected no HEV RNA in pretransplant seronegative patients after transplantation.Conclusion: Despite strong immunosuppression, the risk of HEV reactivation after stem cell transplantation appears to be very low.

Human parechoviruses are frequently detected in stool of healthy Finnish children

2012-03-09

Abstract: Background: Human parechoviruses (HPeVs) are common viruses mainly infecting young children. Most infections are mild, but HPeV3 causes severe CNS infections in new-born infants.Objectives: The aim was to study the epidemiology of HPeVs in Finnish general population in the period 1996–2007, with special emphasis on the different types circulating in Finland.Study design: A total of 2236 stool specimens were collected from 200 healthy Finnish children in a prospective birth cohort study, most before the age of 2 years. Samples were tested for the presence of HPeV RNA using a specific RT-PCR. The genotype of HPeV was determined by sequencing the VP1 genomic region.Results: HPeV RNA was detected in 144 (6.4%) specimens from 78 (39%) children. The dominant type was HPeV1 (93% of the type-identified 105 samples), although types 3 and 6 were also identified. HPeV was found sequentially in more than one sample in 43 infections lasting up to 93 days. The positive findings were distributed equally in young ages and declined towards the age of 2 years. Infections clustered around the autumn months with no obvious change between years. No significant differences were seen between boys and girls.Conclusions: HPeV is a common virus infecting Finnish children under 2 years of age. HPeVs circulate throughout the year with clear accumulation on autumn, also seen in individual years over the 11-year study period. The virus deserves increased attention and should be included in the test panel of clinical virus laboratories.

Increased frequency of rotavirus G3P[8] and G12P[8] in Argentina during 2008–2009: Whole-genome characterization of emerging G12P[8] strains

2012-03-14

Abstract: Background: Group A rotaviruses are the leading cause of non-bacterial severe diarrhea disease in infants and young children. In humans, the most common genotypes are G1–G4 and G9. Recently, G12 strains have been sporadically reported in several countries, including Argentina, Brazil and Paraguay.Objectives: To analyze rotavirus strain diversity in Argentina during 2008–2009 and to describe the whole genome-based classification of emerging G12P[8] strains detected in our country.Study design: Rotavirus positive-samples (n=544) were collected from Argentinean children during 2008–2009, as a part of the National Surveillance Network for Viral Diarrheas. Specimens were genotyped by reverse transcription-polymerase chain reaction (RT-PCR) followed by nested-multiplex PCR. Sequencing of 11 genome segments was performed in 3 randomly selected G12P[8] strains.Results: G9P[8] was the most frequent strain in 2008, but in 2009 G3P[8] and G12P[8] were the most frequent strains in different geographical regions of the country. The novel emerging G12P[8] strains presented the following combination of genes: G12-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 (i.e. genotype1, Wa-like strains). The phylogenetic analysis of the VP7 gene of the G12P[8] strains grouped them within lineage III. Previously reported Argentinean G12P[9] strains presented genes from genotype 3 (AU-1-like strains) with a VP7 gene from lineage II.Conclusions: The emergence of G12P[8] rotaviruses was due to the introduction of a new strain, rather than to a reassortment of the G12P[9] strains previously circulating in our country. This study assesses the temporal and geographical changes in genotypes prevalence as well as the periodic emergence of unusual G genotypes.

Laboratory diagnosis, molecular characteristics, epidemiological and clinical features of an outbreak of measles in a low incidence population in Australia

2012-03-29

Abstract: Background: Prompt and accurate laboratory diagnosis of measles is essential for case detection, outbreak management and ongoing surveillance in low incidence countries. Several disease markers are employed for diagnosis and are important to determine epidemiological and molecular characteristics for future control measures.Objectives: To report different disease markers, genotypes and epidemiology of a measles outbreak in Australia, a low incidence country.Study design: A retrospective descriptive study of the clinical and epidemiological features and laboratory diagnosis in 16 confirmed measles cases using measles serum IgM/IgG, antigen detection (IFA), viral RNA detection by real-time PCR and genotyping results for respiratory and urine specimens processed in one reference laboratory.Results: Of the 16 confirmed measles cases, 11 were young adults aged between 20–35 years and 15 were not age-appropriately vaccinated. The most common genotype detected was D9 (11/16), followed by D4 (1/16) and D8 (1/16). Two imported cases were from the Philippines (D4) and Italy (D9). Of six disease markers, respiratory swab PCR and serum IgM gave the highest percentage (100%) of positive samples for confirmed cases followed by urine PCR (90.9%), serum PCR (66.6%), urine IFA (54.5%) and respiratory IFA (46.2%).Conclusions: Measles should be considered in the differential diagnosis of a presentation with fever and rash, even in countries in the elimination phase of measles control. Genotyping is a powerful molecular-epidemiological tool to assist low incidence countries towards eradication goals. Improving vaccination coverage remains essential, particularly in young adults and travellers.

New natural variants of hepatitis B virus among Amerindians from Argentina with mainly occult infections

2012-03-23

Abstract: Background: Hepatitis B virus infection is frequent among Amerindians. In Argentina HBV genotypes A, B, C, D, E, F and H were described in different populations, while some cases of occult hepatitis B infection (OBI) were reported in human immunodeficiency virus (HIV) coinfected patients.Objective: To determine the prevalence, genetic diversity of HBV and to analyze the deduced amino acid sequence of both S and viral polymerase (P) genes among Amerindians of Argentina.Study design: A cross-sectional study including 561 individuals belonging to distinct ethnic groups, the Mbyá-guaraní (MG), the Kolla (K), the Sagua-Huarpe (SH) and the Wichi (W) was performed.Results: The prevalence of HBsAg was 1.7% and 1.4% for the MG and SH, respectively, while anti-HBc was detected in all communities. HBV DNA of S/P and preCore-Core genomic regions were amplified by nested polymerase chain reaction in 59 reactive samples for anti-HBc total Ig and/or HBsAg. Of them, thirteen exhibited detectable HBV DNA, eleven of which were identified as OBI. Genotype F was predominant in the MG community with co-circulation of subgenotypes F4, F1b, A2 and D3, while subgenotype C2 prevailed within the SH community. All cases exhibited the polymorphism rtL217R within the RT domain associated to resistance to adefovir. Mutations rtD206E and rtV207I associated with lamivudine resistance were found in two MG and three SH respectively. Other new substitutions were described within the P sequence.Conclusions: This study shows for the first time the predominance of OBI, HBV subgenotypes and natural variants in Amerindians from Argentina.

Evaluation of a 4th generation rapid HIV test for earlier and reliable detection of HIV infection in pregnancy

Vani Chetty, Dhayendre Moodley, Anil Chuturgoon — 2012-03-23

Abstract: Background: Currently used 3rd generation rapid HIV-tests in resource-limited settings do not detect acute HIV-infections (AHI). They are known to detect HIV-infections after or late in the “window period”. Detecting incident-HIV infections early in pregnancy increases opportunities for initiating antiretroviral prophylaxis to prevent mother-to-child transmission of HIV.Objectives: We evaluated the Determine® HIV1/2 Ag/Ab Combo Rapid Test (Combo RT), a 4th generation test against two 3rd generation tests (SENSA-HIV1/2/0 Tri-line, SD-Bioline) for early detection of HIV-infection in pregnancy.Study design: In a cohort study, plasma samples from 32 pregnant women who seroconverted at a subsequent antenatal visit (incident-infection), samples from 189 women who tested HIV positive at baseline (established-infections) and samples from 32 women remaining HIV-seronegative at a subsequent antenatal visit were tested with 3rd generation (antibody detection only) and 4th generation (antibody/antigen detection) rapid HIV tests. The HIV-1 NucliSENSEasyQ® v2.0 PCR test was used to quantify HIV-viral copies in women with incident HIV-infections.Results: Eighteen of 32 (56.3%) women (incident-infections) had detectable viral copies (baseline); 16 (88.9%) were antibody reactive with the Combo RT. None of the 32 specimens were reactive on the antigen component of the Combo RT. The sensitivity and specificity of the Combo RT in detecting HIV infections prior to seroconversion is 59.4% (95%CI 40.6–76.3) and 96.9% (95%CI 83.8–99.9) respectively. The Combo RT detected 94.0% of all HIV-infections if used as a screening test (baseline) compared to 85.5% detected by 3rd generation tests.Conclusions: The Combo RT does not identify AHI but is superior to 3rd generation tests in detecting HIV antibody responses.

Prevalence, genotype diversity and determinants of anal HPV infection in HIV-uninfected men having sex with men

2012-03-14

Abstract: Background: Anal human papillomavirus (HPV) infection is very common in men having sex with men (MSM), but the available data on its burden and characteristics mainly concern HIV-infected individuals.Objectives: This study aimed to assess the prevalence, spectrum of genotypes, and determinants of the anal HPV infection in metropolitan HIV-1 uninfected MSM.Study design: A cohort of 258 MSM (median age 32 years, IQR 26–39) enrolled at an STI Clinic was screened for anal HPV infection using a highly sensitive PCR-based genotyping method. Medical history and behavioral data were collected.Results: Overall, 74.8% of the MSM were HPV-positive, with 56.2% of the participants being infected by high-risk (HR) types. A multiple infection was detected in 65.3% of the HPV-positive MSM, with up to 10 different HPV types detected in the same sample. A broad spectrum of infecting HPV types was observed, with 36 different types found overall and HPV16 representing the most common type (17.8%). The lifetime and recent number of sexual partners as well as having receptive anal sex were significantly associated with the anal HPV infection, confirming the role of sexual behavior in risk of HPV infection. However, neither younger age at first intercourse nor inconsistent use of condom was significantly associated with the infection.Conclusions: The present findings highlight the need to create a more significant awareness about the risk of anal HPV infection among HIV-uninfected MSM and warrant the investigation of possible anal intraepithelial lesions, particularly in view of the increasing anal cancer incidence in high-risk populations.

An unusual human papillomavirus type 82 detection in laryngeal squamous cell carcinoma: Case report and review of literature

2012-04-05

Abstract: Squamous cell carcinoma (SCC) of the larynx is extremely rare in adolescent or younger adult and typically has an aggressive nature. The mechanism of laryngeal oncogenesis is complex and little is known about the role of human papillomaviruses (HPVs) in SCC in young age. HPV infection may occur during birth or latter by oro-genital contact. Most HPV genotypes detected were HPV 6, 11, 16, 18, 33 and 51. Herein, we report a case of invasive laryngeal SCC expressing an HPV 82 in an 18 year-old man with a history of unexplored severe acute dysphonia that started in early childhood.

Emergence of cytomegalovirus resistance to foscarnet in a patient receiving foscarnet salvage therapy for multidrug-resistant HIV infection

2012-03-09

Abstract: Foscarnet (FOS) is a pyrophosphate analogue that inhibits both cytomegalovirus (CMV) and human immunodeficiency virus (HIV) replication. We describe herein the emergence of CMV resistance to FOS in a 54-year-old man receiving FOS salvage therapy because of multidrug-resistant HIV-1 infection. Oral valganciclovir (VGCV) treatment allowed subsequently the improvement of FOS-resistant CMV infection.

Circulation of genotype 4 hepatitis E virus in Europe: First autochthonous hepatitis E infection in France

2012-03-14

Abstract: Background: Human HEV infections reported in Europe without previous travel to endemic regions are linked to exposure to genotype 3 Hepatitis E virus (HEV).Genotype 3 is widely distributed through human cases and zoonotic reservoir. The geographical distribution of genotype 4 is limited to Asian countries.Objectives: The first human case of autochthonous genotype 4 hepatitis E infectionwasreported in France.Study design: The HEV infection was described in an immunosuppressed patient, presenting an acute myeloblastic leukemia. Investigation of the case was performed on detection of HEV markers in the patient and in the environment.Results: Hepatitis E infection was diagnosed on the basis of HEV RNA viremia, and detection of anti-HEV IgM. The prognostic of leukemia was favorable and HEV was cleared without relapsing. HEV isolate was classified into genotype 4.Conclusions: The recent characterization of genotype 4 HEV through swine surveillance in Europe and the description of the first human case in France open interesting questions about the circulation of this genotype: health risks in human population, transmission patterns, and zoonotic reservoir.

Transmission of HBV infection from mothers HBsAg positive to infants need to more attention

Seyed Moayed Alavian — 2012-03-14

I read with interest the recently published article by Papaevangelou et al. in your journal. The study was designed to find risk factors for HBV transmission from HBsAg positive mothers to their infants. The authors detected HBV-viremia in 19/80 (23.8%) babies born to viremic mothers and 8/29 (27.6%, p=0.682) of these babies were born to mothers with undetectable HBV-DNA. Mothers of viremic newborns did not have significantly higher perinatal mean HBV-DNA levels when compared with those of non-viremic newborns (2.61 versus 2.17log10 copies/mL, p=0.719). The p-value was not significant. However, according to a review of the literature and guidelines, this result appears odd. It may be related to other transmission risk factors such as; maternal age, parity and multiparity in their study group. Differentiating between inactive carrier status and chronic hepatitis B-HBeAg infection is required before any conclusion can be reached. The data is to be recommended in regard to the ALT and the comparison between groups with normal and abnormal ALT. I think that in this regard, there is no relationship between HBV viral load and the risk of transmission in this study cannot therefore, be generalized to all pregnant women who are HBsAg positive in the community. Some of the results lack reliability due to the low sample size in the HBeAg positive group.

Perinatal HBV viremia in newborns of HBsAg(+) mothers is a transient phenomenon that does not necessarily imply HBV infection transmission

Vassiliki Papaevangelou — 2012-04-05

We read with interest Dr Alavian's letter in reference to our recently published study. The study was designed to examine the incidence of perinatal hepatitis B (HBV) viremia in newborns of HBsAg(+) predominantly HBeAg(−) mothers. As previously shown and confirmed by our study HBV viremia during the perinatal period may be a transient phenomenon. Most importantly, since none of the 27 newborns with perinatal viremia were HbsAg(+) we do not suggest that detection of low HBV-DNA at birth necessarily signifies maternal to infant HBV transmission. This detectable low levels of HBV viremia can be due to contamination with maternally derived HBV-infected PBMCs. Alternatively one could postulate that by providing passive–active immunoprophylaxis HBV infection is aborted. Moreover, as previously shown by others, perinatal HBV viremia has been associated with hepatitis B vaccine failure. Therefore this observed transient viremia may be clinically relevant.

ESCV Membership

2012-06-01