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J Pillonel

Publications and source records attributed to J Pillonel.

At least 19 recordsLinked to original sources
PubMed2006

[Modes of hepatitis C virus transmission: methodological approaches].

Since the mid-1990s, hepatitis C virus (HCV) transmission through blood transfusion has become very rare in western countries. Better understanding of the current modes of transmission is needed. However, risk factors have been mainly estimated on prevalent HCV infections. In this paper we describe the methods of the main case-control studies and their contribution to the knowledge on modes of HCV transmission. We also report the results of a case-control study of incident HCV infections recently carried out in France which confirms the continuing major role of IV drug use and suggests that transmission related to invasive care remained a potential source of new HCV infection between 1995 and 2001.

Adult↗
PubMed2005

[Evaluation of the organization of pre and post transfusion screening of viral infection markers in blood recipients in France in 2001].

In France, data collection related to blood recipient's viral infectious disease markers pre and post-transfusion is a legal requirement for hospitals. Our study aimed to evaluate the actual modalities of this extensive screening in 2001, six years after the Ministry of health issued recommendations. A questionnaire was sent to the haemovigilance correspondents in hospitals having transfused labile blood products (LBP) in 2001. A total of 1463 hospitals having transfused 85% of LBP in France responded. 82.4% of hospitals have written guidelines for pre-transfusion screening of viral markers, mainly for HIV and hepatitis C. A frozen repository storage is held by 23.9% of hospitals with storage durations between 1 to 40 years. 84% of hospitals have written guidelines for post-transfusion screening. The test prescriptions are mostly done by physicians from clinical services and they include in more than 80% of cases, HIV and HCV markers. Only 12% of hospitals recontact the patient in case of a no show. Even though 77.5% of responding hospitals have labile blood products recipients follow up processes, their effectiveness remains quite low, only 16% of recipients having test results available at the hospital.

Alanine Transaminase↗
PubMed2005

[Epidemiological surveillance of blood donors and residual risk of blood-borne infections in France, 2001 to 2003].

The national surveillance of French blood donors is performed by the Institut de Veille Sanitaire and the National Reference Center for Hepatitis B and C in transfusion in collaboration with the Etablissement Français du Sang and the Army blood center. The main objectives of this surveillance are to evaluate trends in prevalence and incidence rates of blood-borne infections in the blood donor population, to identify routes of contamination and to assess residual risk. This exhaustive surveillance also contributes to evaluate the blood donor selection and the impact of measures taken to prevent infections in the general population. The analyse of the database of all blood donations obtained from 2001 to 2003 has shown that prevalence rates were stable in the study period (0.60 per 10(4) donors for HIV, 8.0 per 10(4) donors for HCV, 1.8 per 10(4) first-time donors for HBs Ag and 0.56 per 10(4) donors for HTLV), The incidence rate of HIV and HBV (1 per 10(5) person-years) was three-times higher than for HCV (0.35 per 10(5) person-years) and eleven times higher than for HTLV (0.09 per 10(5) person-years). At least, the residual risk of transfusion-transmitted viral infections is very low: 1/3,150,000 donations for HIV, 1/10,000,000 donations for HCV and 1/640,000 donations for HBV. The yield of Nucleic Acid Testing (NAT) is limited since only 2 donations for HIV and 3 for HCV which were negative for antibodies were discarded thank to the NAT.

Animals↗
PubMed2005

Trends in risk of transfusion-transmitted viral infections (HIV, HCV, HBV) in France between 1992 and 2003 and impact of nucleic acid testing (NAT).

Monitoring trends in residual risk of transfusion-transmitted viral infections is important to assess improvements in blood safety and to adapt the risk reduction policies. These trends were analysed in France over 4 periods of 3 years (1992-1994, 1995-1997, 1998-2000 and 2001-2003). The 2001-2003 estimates were compared to the results of HIV-1 and HCV NAT implemented on all blood donations in July 2001. Due to improvements in donor recruitment and selection, continuing progress in screening assays, and preventive measures taken in the community to control infections, a significant decrease was observed in residual risks for HIV, HCV and HBV between 1992 and 2003. The residual risk is currently extremely low: for the 2001-2003 period, this risk was estimated at 1 in 3.15 million donations for HIV, at 1 in 10 million for HCV and at 1 in 640,000 for HBV. Of the 6.14 million donations screened with NAT between July 2001 and December 2003 in France, 2 HIV-positive and 3 HCV-positive donations were discarded thanks to NAT, representing a yield of 1 in 3.07 million for HIV and 1 in 2.05 million for HCV. These results show the limited benefit of NAT and suggest that its cost-effectiveness is poor.

Blood Transfusion↗
PubMed2004

[Trends in residual risk of transfusion-transmitted viral infections (HIV, HCV, HBV) in France between 1992 and 2002 and impact of viral genome screening (Nucleic Acid Testing)].

BACKGROUND: Monitoring trends in residual risk of transfusion-transmitted viral infections is important to assess improvements in blood safety. These trends were analysed over nine overlapping periods of 3 years from 1992 to 2002. The 2000-2002 estimates were compared to the results of HIV-1 and HCV NAT implemented on all blood donations in July 2001. METHOD: As risk is mainly associated with the window period, residual risks were estimated by multiplying incidence rates by the durations of the window periods. For the first seven periods, incidence rates were calculated from data collected by the blood centres belonging to the Transfusion-Transmissible Agents Working Group which collect more than 50% of blood donations in France, and for the two last periods, on the overall blood supply. RESULTS: On the 2000-2002 period, residual risks without NAT were estimated at 1 in 1,400,000 for HIV, at 1 in 1,000,000 for HCV and at 1 in 400,000 for HBV. With minipool NAT, the residual risk become nearly two times lower for HIV (1 in 2.5 million donations) and seven times lower for HCV (1 in 6.65 million donations). For HIV, of the 4.9 million donations screened with NAT between July 2001 and June 2003, two were remote thanks to the NAT, which is consistent with the NAT expected yield. Concerning HCV, one out of the four WP predicted cases was detected with NAT. Without NAT, the overall residual risk for the three viruses combined (HIV, HCV, HBV) decreased from 1 in 65,000 to 1 in 235,000 donations between 1992 and 2002. Since the implementation of NAT, the current overall residual risk is 1 in 325,000 donations (28% less than without NAT). CONCLUSION: NAT results confirm the validity of residual risk estimates given by the model, and the limited benefit of genomic screening due to the very low level of residual risk at the time of its implementation.

DNA, Viral↗
PubMed2004

[Evaluation of pre- and post-transfusion serological screening in France in 2001].

Screening of labile blood products recipients for HIV and HCV has been performed in France since a government recommendation was issued in 1996. It has been designed to get transfusion related contamination of recipients through pre- and post-transfusion serological tests. Since then, residual risk has decreased dramatically and it was suspected that recommendations might sometimes be ignored. A nationwide survey has been done to measure the real screening rate and its cost efficacy ratio. In addition accuracy of tracability and recipients mortality has also been evaluated. A random sample of 1115 labile blood products among all the 1203 378 distributed during first semester of 2001 in France has been drawn. They have been matched with test results obtained in hospital files. Tracability has been considered accurate if name, surname and birth date of recipients were exactly the same both in hospital file and in the file of the Etablissement Français du Sang. A total of 1092 hospital files has been retrieved. Pre transfusion HIV and HCV tests have been performed in 58.5 % of cases, 95 % CI [55.6-61.5], and post-transfusion tests in 30.5 % [28.5-35.5] of cases. Only 19.5% [16.6-22.6] of recipients, not known to be dead 6 months after transfusion, have had both pre and post-transfusion tests. No HIV or HCV contamination has been notified by the Haemovigilance network during the same period. Accuracy rate of tracability was 96.25% [94.9-97.3]. Furthermore 35.8% [33-38.7] of recipients were found dead within 6 months after transfusion. A logistic regression analysis showed that the hospital area, the hospital size (more than 300 beds) and the annual amount of blood bags transfused in it (less than 5000) were factors independently associated with having a full pre and post-transfusion screening. Currently, the screening program may detect 0.14 cases of HIV and 0.05 HCV transfusion related contamination of recipient every year. The total cost of this program is about 20 million euro and the cost per case exceeds 110 million euro. The program will be of no use in case of an emerging transmitable disease. This program does not comply to any evaluation criteria of screening programs and its cost efficacy ratio is very poor.

Blood Donors↗
PubMed2004

Preliminary results from the new HIV surveillance system in France.

In addition to AIDS surveillance, data on HIV infection are necessary to better follow the dynamics of the epidemic. We report the first results of France's mandatory anonymous HIV notification system, which is linked to a virological surveillance of recent HIV infections and of circulating HIV types, groups and subtypes. HIV notifications are initiated by microbiologists who create an anonymous code of patient's identity. Clinicians complete the notification form with epidemiological and clinical data. Notifications are sent to the local health authorities and passed to the Institut de Veille Sanitaire (InVS). Laboratories voluntarily send sera from newly diagnosed HIV infected persons on dried blood spots to the national HIV reference laboratory where an immunoassay for recent infection (< or = 6 months) and a serotyping assay for the determination of group and subtype are done. The virological results are then merged at the InVS with the information from the mandatory reporting. Of the first 1301 new HIV diagnoses reported in 2003, 43% were in women, and overall, 53% were in heterosexuals, of whom 47% were of sub-Saharan African origin. MSM accounted for 36% of male notifications. A dried blood spot was available for 64% of new HIV diagnoses. Evidence of recent infection was found for 38%, ranging from 22% in IDUs to 58% in MSM. Twenty-six percent of infections in sub-Saharan migrants were recent infections. HIV-1 accounted for 98% of all notifications: 48% of these were non-B subtypes. The first results of the HIV notification system indicate that heterosexual transmission is the predominant mode of transmission and that persons originating from sub-Saharan Africa are particularly affected. Over half of infections shown to be recently acquired were in MSM; this may indicate an increased HIV incidence in this population.

Adult↗
PubMed2003

[Application of molecular biology to blood transfusion safety: the nucleic acid testing].

Nucleic Acid Testing (NAT) for HIV-1 and HCV has been introduced in France and became mandatory for all homologous blood donations since July 1st 2001 in addition to serology screening. Previously, a feasibility study led to the selection of 2 technologies : a TMA based assay (Chiron) uses the Procleix HIV-/HCV assay on pools of 8 samples and a PCR based assay from BioMérieux-Roche which is a combination of an RNA extraction system (NucliSens, BioMérieux) with a fully automated system for nucleic acid amplification and detection (Cobas Amplicor, Roche). This system uses the Cobas Ampliscreen HCV test v.2.0 and the The Cobas Ampliscreen HIV test v1.5, on 24 sample pools. Pooling was required because single-donation testing is not yet feasible, as a result of the limitations in automation available for all current NAT technologies. The two technologies were easily implemented and showed nearly the same detection limit for HCV RNA and HIV-1 RNA. During a one-year period, from July 1st 2001 to June 30, 2002, out of the 2.5 million donations tested, the NAT yield resulted in one HIV-1 RNA positive-antibody negative donation and one HCV RNA positive-antibody negative donation. Two HIV NAT positive-antibody negative donations were missed by minipool NAT because a very low viral load. Moreover, the NAT implementation did not impact on blood component availability, including platelet concentrates.

Blood Transfusion↗
PubMed2001

[Impact of the exclusion of donors who have stayed in the United Kingdom on the residual risk of HIV transmission by blood transfusion].

BACKGROUND: One of the measures aimed at reducing the risk of transmission of the agent responsible for the new variant of Creutzfeldt-Jakob disease was to exclude blood donors having stayed in the United Kingdom between 1980 and 1996. The objective of the study was to estimate the impact on the residual risk of HIV transmission of recruiting extra first-time donors to replace donors having stayed in the United Kingdom. METHODS: The residual risk of HIV transmission due to donations made during the window period was estimated in all donations made in France during the 3-year period 1996-1998 by a linear combination of residual risks in repeat donors and first-time donors. In repeat donors, the estimate is based on the incidence rate of HIV in this population and in first-time donors on the "detuned assay" method. Seven simulations of the impact on the residual risk were made using various percentages of donors which would be excluded (from -5% to -35%). RESULTS: In all donations made in France during the 1996-1998 period, the residual risk of HIV transmission was estimated at 0.70 per million donations, which represents five to six donations made during the window period. If all the donors who had stayed in the United Kingdom were excluded from the donation (35%) and replaced by first-time donors, the residual risk of HIV transmission would be increased from 0.70 to 0.86 per million donations. This increase of 24% would represent one or two extra cases of post-transfusion HIV infection over a 3-year period. CONCLUSION: The results of this study show that the exclusion of a large number of blood donors, replaced by first-time donors, would have a low but quantifiable impact on the residual risk of HIV transmission. This increase of risk was one of the factors that led to the decision of not excluding donors having stayed in the United Kingdom between 1980 and 1996.

Blood Donors↗
PubMed2000

[Screening for markers of infections transmitted by transfusions in the blood collected in France from 1996 to 1998].

From 1996 to 1998, a decrease in positive donation rates has been observed for HIV, HCV and HBs Ag in first-time donors, while these rates remained stable for HTLV. In repeat donors, the same decrease was observed for HCV and HBs Ag while the rates remained stable for HIV. No HTLV-positive donations from repeat donors were noted in 1998. About half of the HIV-positive repeat donors were regular donors (less than two years between the two donations), as well as 88% of HBV-infected repeat donors. Inversely, only 20% of HCV-positive repeat donors were regular donors. Anti-HBc antibodies have been found in 20% of HIV-infected donors, in 22% of HCV-infected donors, and were associated with HBs Ag in 99% of the cases. Elevated ALT was observed in 47% of donors with anti-HCV and in 10% of donors with HBs Ag. The major risk factors are at-risk sexual behavior for HIV and use of intravenous drugs and nosocomial infections for HCV. Being a native of an endemic country has been found to be the major risk for HBV. The major HTLV risk factor was directly or indirectly linked to the Caribbean area.

Biomarkers↗
PubMed2000

GB virus type C/HGV markers in HCV RNA-positive French blood donors: correlation with HCV genotypes and risk factors.

BACKGROUND: Exposure to GB virus type C/HGV (GBV-C/HGV) could be determined by detection either of RNA by RT-PCR or of antibodies of the envelope protein E2. STUDY DESIGN AND METHODS: The aim of the study was to determine the proportion of the GBV-C/HGV markers of infection in a blood donor population infected with HCV and to identify GBV-C/HGV routes of transmission that are associated with HCV genotypes and risk factors. RESULTS: Among 306 HCV RNA-positive blood donors, the proportion of GBV-C/HGV RNA-positive donors and anti-E2-positive donors was 19.3 percent (95% CI = 15.0-24.2%) and 42.1 percent (95% CI = 36.6-47.9%), respectively. Exposure to GBV-C/HGV (RNA or anti-E2) was significantly associated with the risk factor of IV drug use. There was a trend toward association with HCV subtypes 1a and 3a, probably because these HCV subtypes are the most frequent in IV drug users. No correlation was observed between ALT elevation and the presence of GBV-C/HGV RNA. CONCLUSION: In persons with HCV infection, IV drug use seems to be a major route of GBV-C/HGV transmission. Precautions taken to avoid HCV infection will probably also decrease GBV-C/HGV transmission.

Biomarkers↗
PubMed2000

Record-linkage between two anonymous databases for a capture-recapture estimation of underreporting of AIDS cases: France 1990-1993. The Clinical Epidemiology Group from Centres d'Information et de Soins de l'Immunodéficience Humaine.

OBJECTIVE: To estimate the completeness of the French mandatory AIDS surveillance system (Declaration Obligatoire DO) over the 1990-1993 period using a capture-recapture approach, by matching the mandatory reports with the AIDS cases present in the French Hospital Database on HIV infection (FHDH). METHODS: An anonymous record-linkage algorithm was developed to identify those cases common to both anonymous surveillance systems. The linkage was based on sex, date of birth, and infection risk group, all strictly matched, and on the dates of AIDS diagnosis and of death, the places of diagnosis and residence, and the AIDS-defining diseases at diagnosis. The total number of AIDS cases and completeness of both surveillance systems were estimated using a capture-recapture approach, assuming independence of the ascertainment sources. RESULTS: The completeness of the mandatory reporting was estimated at 83.6% (95% CI: 82.9-84.3), and that of the FHDH at 47.6% (95% CI: 46.9-48.3) for the surveillance of AIDS cases diagnosed among adults in France between 1990 and 1993. The completeness of the system based on FHDH increased over the study period as more hospitals joined the project, while the completeness of the DO surveillance system remained stable. CONCLUSION: This approach was useful in estimating the underreporting of AIDS cases in France. Regularly performed, it will allow the impact of underreporting to be monitored over time.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Hepatitis C virus: routes of infection and genotypes in a cohort of anti-HCV-positive French blood donors.

BACKGROUND: We evaluated and analysed risk factors of HCV-infected blood donors according to HCV genotypes in order to improve the transfusion policy and safety of blood supply. MATERIALS AND METHODS: HCV-RNA was analysed in sera from 518 anti-HCV-positive blood donors, who were invited to medical consultation and interview as to risk factors by means of an extensive questionnaire. HCV genotyping was done on all samples positive for HCV-RNA. RESULTS: Of the 518 sera, 399 (77%) were HCV-RNA positive, and 394 of 399 HCV genotypes were identified. Major genotypes were 1b (34.3%), 3a (24%), 1a (19.5%) and 2 (11.4%). Of the donors, 289 (55.8%) were interviewed regarding their risk behaviour: 27% were former intravenous drug users (IVDUs), 26% had been transfused, 8% had a history of invasive diagnostic procedures, and 13% a history of surgery. Among the 224 interviewed donors, genotypes 1a and 3a were mainly associated with IVDU (51 and 45% respectively) and genotype 1b, with transfusion and nosocomial infections (40 and 25%, respectively). CONCLUSION: In this population of anti-HCV-positive blood donors, nosocomial infection may be a route of HCV spread, but the main risk factor remains IVDU, particularly in young men. The transfusion policy will improve if predonation interviews of such young men are done with a specific and sensitive questionnaire.

Adult↗
PubMed1998

[Prevalence of HIV, HTLV, and hepatitis B and C viruses in blood donors in France, 1992-1996].

The prevalence of HIV, HTLV, HBV and HCV infections has been calculated by age and sex of blood donors and not, as generally done, according to the number of donations. This study has been conducted on the basis of two surveys. The first one collected information about the sex and age of the seropositive donors. A second survey, begun in 1992, collected information about the demographic characteristics of blood donors. This population has a higher male to female sex ratio (1:2 versus 1:0) and is younger than the general population. Thus, the prevalence of these viral infections has been determined according to sex, age and type of donors (first-time or repeat) from 1992 to 1996 and the trends have been analysed. The main results are the following: a decreasing prevalence of HIV in first-time donors from 1992 to 1996, more marked in men than in women and in the 18-29 year age group than in the other age groups; a slighter decrease in prevalence of HBV and HCV in first-time donors from 1992 to 1996 with no difference in this decrease between sex and age groups. HBs Ag prevalence in first-time donors was twice as high in men than in women and was highest in donors aged from 40 to 49 years in both sexes. Prevalence of antibodies to HCV in first-time donors was comparable in both sexes but varied greatly with age. In men, a peak was observed in the 30-39 age group and in women, the highest prevalence was seen in the 50-65 age group.

Adult↗