Prolonged antibody-negative HCV viremia in a US blood donor with apparent HCV transmission to a recipient.
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Adult↗
Biomedical subjects
S L Stramer
Publications and source records attributed to S L Stramer.
Nucleic acid testing for transfusion-transmissible agents.
Pooled nucleic acid testing for HIV and hepatitis C virus (HCV) has been successfully implemented in the United States. Reactive rates for nucleic acid testing (NAT) are comparable to those for serological testing. The combined yield for HIV and HCV RNA confirmed-positive, seronegative donations for the 1st year of testing has been 62 HCV NAT-reactive donations among more than 16.3 million screened (1:263,000) and four HIV NAT-reactive, p24 antigen-negative donations among greater than 12.6 million screened (1:13,150,000). The observed yield of NAT confirmed-positive donations is compatible with estimates derived from window-period projections and recent measurements of incidence. Of the HCV NAT-reactive donations identified, one has not sero-converted over a 300-day period. The predominant recent risk factor identified for HCV NAT-reactive donors is intravenous drug use.
Blood Transfusion↗
Risk of hepatitis and retroviral infections among blood donors and introduction of nucleic acid testing (NAT).
Blood donors represent a carefully selected population of individuals. In particular, they have reduced prevalence and incidence rates for hepatitis and retroviral markers when compared to the general population. Serological testing of all donations further decreases the risk of collecting an infectious blood unit to negligible levels. Nevertheless, a significant fraction of this residual risk will be eliminated by the introduction of nucleic acid testing for viral genomic material in donor samples. This testing, which has already reached the initial phases of implementation, will be performed on pooled samples, at least in the first instance.
Blood Donors↗
New testing strategy to detect early HIV-1 infection for use in incidence estimates and for clinical and prevention purposes.
CONTEXT: Differentiating individuals with early human immunodeficiency virus 1 (HIV-1) infection from those infected for longer periods is difficult but important for estimating HIV incidence and for purposes of clinical care and prevention. OBJECTIVE: To develop and validate a serologic testing algorithm in which HIV-1-positive persons with reactive test results on a sensitive HIV-1 enzyme immunoassay (EIA) but nonreactive results on a less sensitive (LS) EIA are identified as having early infection. DESIGN: Diagnostic test and testing strategy development, validation, and application. Specimens were tested with both a sensitive HIV-1 EIA (3A11 assay) and a less sensitive modification of the same EIA (3A11-LS assay). SETTINGS AND PARTICIPANTS: For assay development: 104 persons seroconverting to HIV-1 comprising 38 plasma donors, 18 patients of a sexually transmitted disease clinic in Trinidad, and 48 participants in the San Francisco Men's Health Study (SFMHS); 268 men without the acquired immunodeficiency syndrome (AIDS) in the SFMHS who had been infected for at least 2.5 years; and 207 persons with clinical AIDS; for testing strategy validation: 488 men in the SFMHS from 1985 through 1990 and 1275449 repeat blood donors at 3 American Red Cross blood centers from 1993 through 1995; and for HIV-1 incidence estimates: 2717910 first-time blood donors. We retrospectively identified persons eligible for a study of early infection. MAIN OUTCOME MEASURE: Ability to identify early HIV infection. RESULTS: Estimated mean time from being 3A11 reactive/3A11-LS nonreactive to being 3A11 reactive/3A11-LS reactive was 129 days (95% confidence interval [CI], 109-149 days) [corrected]. Our testing strategy accurately diagnosed 95% of persons with early infection; however, 0.4% (1/268) of men with established infection and 2% (5/207) of persons with late-stage AIDS were misdiagnosed as having early HIV-1 infection. Average yearly incidence estimates in SFMHS subjects were 1.5% per year vs observed average incidence of 1.4 per 100 person-years. Incidence in repeat blood donors using the sensitive/less sensitive assay testing strategy was 2.95 per 100000 per year (95% CI, 1.14-6.53/100000) vs observed incidence of 2.60 per 100000 person-years (95% CI, 1.49-4.21/100000). Overall incidence in first-time blood donors was 7.18 per 100000 per year (95% CI, 4.51-11.20/100000) and did not change statistically significantly between 1993 and 1996. Use of the sensitive/less sensitive testing strategy alone would have identified all 17 persons with antibodies to HIV-1 eligible for a study of early HIV-1 infection and would have increased enrollment. CONCLUSIONS: The sensitive/less sensitive testing strategy provides accurate diagnosis of early HIV-1 infection, provides accurate estimates of HIV-1 incidence, can facilitate clinical studies of early HIV-1 infection, and provides information on HIV-1 infection duration for care planning.
AIDS Serodiagnosis↗
Identification and characterization of an HIV-2 antibody-positive blood donor in the United States.
BACKGROUND: As of June 1, 1992, the Food and Drug Administration recommended that all donated blood be screened for antibodies specific to HIV-2. Despite broad serologic surveillance, only two cases of HIV-2 infection had been detected among potential blood and plasma donors since the implementation of the test. CASE REPORT: The identification of a third HIV-2 antibody-positive blood donor is reported. The first-time donor was identified by routine screening procedures as anti-HIV-1/HIV-2-reactive, and that status was confirmed by licensed HIV-1 Western blot. Concurrent whole-virus lysate enzyme immunoassay and Western blot for HIV-2 were strongly positive, but the possibility of HIV-1 cross-reactivity could not be eliminated. The donor was notified, counseled, and deferred from future donation. He subsequently enrolled in a Centers for Disease Control and Prevention-sponsored epidemiologic study of HIV-positive former donors. When it was revealed during the standardized interview that he was a native of an HIV-2-endemic region, follow-up samples were submitted to the Centers for Disease Control and Prevention. Investigational HIV-1 and HIV-2 peptide enzyme immunoassays indicated that this infection was due to HIV-2 only. CONCLUSION: Enzyme immunoassays for antibodies to synthetic peptides of HIV-1 and HIV-2 may be useful in differentiating the two viruses in individuals with ambiguous Western blot results and risk factors for HIV-2 infection.
Adult↗
Comparison of saliva and serum for human immunodeficiency virus type 1 antibody testing in Uganda using a rapid recombinant assay.
The accuracy and acceptability of saliva human immunodeficiency virus type 1 (HIV-1) antibody testing were compared with serum testing in a study of paired specimens from HIV-1-seropositive and HIV-1-seronegative Ugandan adults attending a clinic for sexually transmitted diseases. Saliva collection was performed with the Omni-sal device (Saliva Diagnostic Systems, Vancouver, Wash.), and antibody testing was performed by a rapid filter paper assay (Test-Pack; Abbott Laboratories, Abbott Park, Ill.). Relative to serum testing, the sensitivity of saliva testing was 95% (195 of 205) and the specificity was 99% (295 of 297). The sensitivity of saliva testing was higher for patients with elevated levels of beta-2 microglobulin in sera and greater numbers of HIV-1-related symptoms. Pre- and poststudy interviews indicated that saliva testing did not foster inordinate fears of saliva exposure. The development of saliva tests that are inexpensive and do not require electricity is needed.
Adult↗
Early detection of antibody to human immunodeficiency virus type 1 by using an antigen conjugate immunoassay correlates with the presence of immunoglobulin M antibody.
Sequential plasma samples obtained from 16 individuals who seroconverted were tested for the presence of antibody to human immunodeficiency virus type 1 (HIV-1) by an antigen conjugate enzyme immunoassay (EIA) and a conventional antibody conjugate assay. In 11 of these individuals, the antigen conjugate assay detected antibody to HIV-1 2 to 11 days (mean, 5.5 days) earlier than the antibody conjugate assay. In 11 individuals, HIV-1 p24 antigen was detected a median of 6.5 days (range, 3 to 14 days) prior to positivity by the antigen conjugate EIA. Using class-specific probes, we determined the profiles of immunoglobulin M (IgM), IgG, and IgA antibodies for each individual and correlated these profiles with the EIA signals from both assays. In general, the appearance of IgM exhibited a peak at about 1 week postseroconversion, which was followed by gradually declining levels. Absorbance levels for IgG antibody, however, rose steadily and reached a plateau after 3 to 5 weeks. The levels of IgA were generally low and variable. In contrast to the progressive increase in EIA absorbance observed by the antibody conjugate assay, the antigen conjugate assay displayed a rapid early rise in absorbance which generally coincided with the transient expression of IgM antibody. The subsequent gradual increase coincided with rising levels of IgG. Because the configuration of the antigen conjugate EIA allows for an increased sensitivity for IgM compared with that for other classes of immunoglobulins, these results suggest that earlier detection of antibody to HIV-1 is due to the detection of IgM antibody during the early phase of seroconversion.
Biomarkers↗
Absence of HIV infection in blood donors with indeterminate western blot tests for antibody to HIV-1.
To determine whether apparently healthy persons who have had repeatedly reactive enzyme immunoassays and an indeterminate Western blot assay for antibody to the human immunodeficiency virus type 1 (HIV-1) are infected with HIV-1 or HIV-2, we studied 99 such volunteer blood donors in a low-risk area of the country. The subjects were interviewed about HIV risk factors. Coded blood specimens were tested again for HIV-1 antibody (by two different enzyme immunoassays, a Western blot assay and a radioimmunoprecipitation assay) and for HIV-2 antibody by enzyme immunoassay, for HIV-1 by the serum antigen test, for HIV-1 by culture, for human T-cell leukemia virus Type I or II antibody by enzyme immunoassay, and for sequences of HIV DNA by the polymerase chain reaction. Of the 99 blood donors, 98 reported no risk factors for HIV-1 infection; 1 donor had used intravenous drugs. After a median of 14 months (range, 1 to 30) from the time of the initial test, 65 subjects (66 percent) were still repeatedly reactive for HIV-1 antibody on at least one immunoassay. In 91 subjects (92 percent) the Western blot results were still indeterminate, whereas in 8 they were negative. No donor met the criteria for a positive Western blot assay for HIV-1, and none had evidence of HIV-1 or HIV-2 infection on culture or by any other test. We conclude that persons at low risk for HIV infection who have persistent indeterminate HIV-1 Western blots are rarely if ever infected with HIV-1 or HIV-2.
Adult↗
Recovery of hepatitis A virus from a water supply responsible for a common source outbreak of hepatitis A.
An outbreak of hepatitis A occurred in a north Georgia trailer park served by a private well. Of 18 residents who were serosusceptible to hepatitis A virus (HAV), 16 (89%) developed hepatitis A. Well water samples were collected 3 months after illness onset in the index case and 28 days after illness onset in the last trailer park resident. Hepatitis A virus antigen (HAVAg) was detected in the samples by enzyme immunoassay from three of the five cell lines following two 30-day passages and from a fourth cell line following a third passage of 21 days.
Adult↗
Markers of HIV infection prior to IgG antibody seropositivity.
During a 1-year period of study at two plasma collection centers, 7 of 35,000 plasma donors seroconverted to the human immunodeficiency virus (HIV) and had stored plasma samples that predated or antedated the seroconversion period. From each donor, three to eight plasma samples that had been collected at 2- to 7-day intervals were tested for IgG and IgM antibodies to HIV with enzyme immunoassays, Western blot testing, and radioimmunoprecipitation assays. The presence of an HIV viremic phase was demonstrated by the infectivity of plasma on normal, phytohemagglutinin-stimulated peripheral blood mononuclear cells and by the detection of HIV antigen. In 5 of these donors, HIV antigen was detected prior to or simultaneously with IgG to HIV; these HIV-antigen-positive samples overlapped an IgM immune response. The disappearance of detectable HIV antigen, and to a lesser extent plasma infectivity, was concurrent with the development of an IgG immune response. Although the improved sensitivity of a recombinant DNA-derived anti-HIV screening assay shortened the "window period" between initial HIV infection and antibody detection, HIV antigen and plasma HIV viremia were the only markers of HIV infection for several days in 2 donors. These results demonstrate that HIV plasma viremia and antigenemia occur prior to seroconversion in healthy plasma donors.
Adult↗
Septage treatments to reduce the numbers of bacteria and polioviruses.
Disposal of the pumped contents of septic tanks (septage) represents a possible means of dissemination of enteric pathogens including viruses, since persistence of enteroviruses in septic tank sludge for greater than 100 days has been demonstrated. The risk of exposure to potentially infectious agents can be reduced by disinfecting septages before their disposal. Of the septage disinfectants examined (technical and analytical grade glutaraldehyde, hydrogen peroxide, heat treatments, and a combination of heat and hydrogen peroxide), the treatment including hydrogen peroxide (5 mg, plus 0.33 mg of trichloroacetic acid, per ml of septage) and 55 degrees C killed virtually all the bacteria in septage within 1 h, whereas 55 degrees C alone inactivated inoculated polioviruses within 30 min. Virus was the most sensitive to heat, whereas fecal coliforms appeared to be the most sensitive to all chemical treatments. The responses of fecal streptococci and virus to both grades of glutaraldehyde (each at 1 mg/ml) were similar. Virus was more resistant than either fecal streptococci or total bacteria to low concentrations of hydrogen peroxide (1 to 5 mg/ml); however, virus and fecal streptococci were more labile than total bacteria to the highest peroxide concentration (10 mg/ml) examined. It is possible that the treatment combining heat and hydrogen peroxide was the most effective in reducing the concentrations of all bacteria, because catalase and peroxidases as well as other enzymes were heat inactivated, although catalase seems the most likely cause of damage. However, this most effective treatment does not appear to be practical for on-site use as performed, so further work on septage disinfection is recommended.
Bacteria↗
Improved growth of Thermus aquaticus on cellular lysates.
Studies on the thermophilic bacterium Thermus aquaticus have demonstrated the ability of this organism to exist on its own cell lysates. The use of 0.1% tryptone, and 0.1% yeast extract and a mineral salts lysate medium increased growth 9-to 44-fold over the above medium without cell lysates. It has also been established in this study that, due to the high growth temperature of T. aquaticus, its metabolic activities are greatly accelerated resulting in early cell destruction. Therefore, bacterial lysates from which other cells could derive nutrients and/or growth factors would constantly be available in the environment immediately around the organism to aid the growth of cells in natural as well as man-made thermal environments.
Culture Media↗
Presumptive identification of Klebsiella pneumoniae on m-FC medium.
Klebsiella pneumoniae is a human and animal pathogen frequently encountered in the environment. The membrane-filtration method utilizing m-FC medium for the detection of fecal coliforms yields a colony type easily distinguishable as K. pneumoniae. These colonies appear as atypical light blue, nucleated, mucoid colonies differing considerably from the typical dark blue fecal coliform colonies.
Culture Media↗
Sensitivity and specificity of human T-lymphotropic virus (HTLV) types I and II polymerase chain reaction and several serologic assays in screening a population with a high prevalence of HTLV-II.
BACKGROUND: Since 1988, all blood donations in the United States have been screened for antibodies to human T-lymphotropic virus type I (HTLV-I). However, the sensitivity of current serologic tests for the detection of HTLV type II (HTLV-II) antibodies and the diagnostic utility of direct tests for HTLV-I and -II using polymerase chain reaction (PCR) are poorly defined. STUDY DESIGN AND METHODS: Five hundred sixty-nine HTLV-I- or -II-seropositive and 687 age- and sex-matched seronegative samples from a high-risk population at an inner-city emergency department were selected. All samples were tested with four HTLV enzyme immunoassays (EIAs), one Western blot assay and one type-specific Western blot assay, one HTLV type-specific EIA, and a research HTLV-I/II PCR kit. RESULTS: Sensitivity of the various EIAs ranged from 95.1 to 99.5 percent, and specificity ranged from 97.2 to 99.4 percent. PCR performed in duplicate without selective retesting had lower sensitivity (85.1 %) and specificity (88.0%). However, PCR detected 20 (3.2%) HTLV-I-positive and 47 (7.5%) HTLV-II-positive samples among the 627 samples that were negative in all EIAs. The type-specific EIA and PCR assay had the highest rate of concordance in classifying samples as either HTLV-I or II, with the type-specific EIA and type-specific Western blot having the next highest rates of concordance. CONCLUSION: In this sample set from a population at high risk for HTLV-II, screening with HTLV-I/II PCR had lower sensitivity and specificity than that with EIAs. However, 4.1 to 10.8 percent of samples were PCR positive but seronegative for HTLV-I or -II, and their true infection status remains undetermined.
Adult↗