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PubMed2001

The role of viral load determination for the management of human immunodeficiency virus, hepatitis B virus and hepatitis C virus infection.

During the last 5 years, considerable scientific and financial efforts have been made in the development of quantitative nucleic acid detection technology. For detection of human immunodeficiency virus (HIV), quantitative culture is time consuming, cumbersome and requires appropriate laboratory safety equipment. Quantitative determination of p24 antigen by enzyme immunoassay is of limited value due to its relatively poor sensitivity. Therefore, quantitative determination of viral load using nucleic acid amplification techniques is the most accurate, prognostic marker for HIV type 1 infection, independently of the CD4+ cell count. Hepatitis B virus (HBV) is not cultivable in vitro. Serological assays allow an accurate diagnosis and follow-up of acute or chronic infection. Quantification of HBV DNA is used for the monitoring of antiviral therapy, determination of infectivity and for resolution of unclear serological profiles, e.g. isolated anti-HBc reactivity, as well as for patients in which HBV mutants are suspected. Hepatitis C virus (HCV) can only be detected by molecular based assays because no cell culture system, which permits a reliable isolation of clinical specimens, is currently available. Furthermore, early diagnosis and follow-up of infection cannot be achieved with antibody serology. The prognostic relevance of quantitative HCV RNA determination is of limited value for the long-term prognosis of chronic hepatitis C. However, viral load may predict the outcome of antiviral therapy. Genetic diversity is another challenge for HCV RNA quantification.

HIV Infections↗
PubMed2006

[Human immunodeficiency virus, hepatitis C virus and hepatitis B viruses in patients with sickle-cell disease in Togo].

CONTEXT: The clinical features of sickle cell disease (SCD) are vaso-occlusive and/or hemolytic crises which treatment may require blood transfusions. OBJECTIVE: This study aimed to determine the prevalence of HIV, Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) infections in a population of SCD patients. METHODS: All the samples were analyzed by Elisa technique. We studied 119 sera for HIV using Elisa and a confirmation test in case of positive Elisa. We screened 91 sera for HCV and 119 sera for HBV. RESULTS: The prevalence was 5.04% for HIV, 6.5% for HCV and 20.2% for HBs Ag. Homozygous (SS) patients were more infected than compound heterozygous patients SC, (p < 0.02). 24.6% of the children (0 to 15 years of age) were infected as well as adults (35.5%). The Relative Risk to be contaminated was 7.14 for HIV, 4.29 for HCV and 5.43 for HBV in transfused compared to non transfused SCD patients. CONCLUSIONS: This high infectious risk in SCD patients should lead us to elaborate a better strategy to increase the safety of blood transfusion in Togo.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Quantification of viral load: clinical relevance for human immunodeficiency virus, hepatitis B virus and hepatitis C virus infection.

Quantitative determination of viral load using nucleic acid amplification techniques represents the most accurate prognostic marker for human immunodeficiency virus type 1 (HIV-1) infection, independently of CD4+ cell count. Overall, the different methods for HIV-1 RNA determination (RT-PCR, nucleic acid sequence-based amplification, branched DNA) show a good reproducibility (0.5 log), however for low copy numbers and in HIV-1-infected children the variability may exceed 0.7 log. In non-HIV-1 subtype B infections the copy number is underestimated. While serology permits an accurate follow-up of hepatitis B virus (HBV) infection, HBV DNA quantification is used for monitoring of antiviral therapy, determination of infectiosity and in combination with serological markers for the resolution of unusual profiles, i.e. isolated anti-HBc reactivity. The prognostic relevance of hepatitis C virus (HCV) RNA determination is of limited value for the long-term prognosis of chronic hepatitis C, however the viral load may predict the outcome of antiviral therapy. Genetic diversity represents a challenge for HCV RNA quantification.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Differential seroprevalences of hepatitis C virus, hepatitis B virus and human immunodeficiency virus among intravenous drug users, commercial sex workers and patients with sexually transmitted diseases in Chiang Mai, Thailand.

To elucidate the differences in the mode of transmission of three blood-borne viruses, hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV), under comparable conditions of study, we analyzed the prevalences of anti-HCV antibodies (anti-HCV), anti-HBV core antibodies (anti-HBc), HBV surface antigen (HBsAg) and anti-HIV antibodies (anti-HIV) in different risk populations in Chiang Mai, Thailand, where the prevalence of HIV infection is high. The subjects consisted of 98 intravenous drug users (IVDU), 100 commercial sex workers (CSW) and 50 male patients with sexually transmitted diseases (STD). In IVDU the prevalence of anti-HCV was the highest (85%), followed by anti-HBc (77%) and anti-HIV (46%), whereas in CSW and STD the prevalence of anti-HCV was 2 and 0%, respectively, that of anti-HBc 69 and 64%, respectively, and that of anti-HIV 11 and 14%, respectively. The prevalence of anti-HBc minus that of HBsAg, representing horizontal transmission of HBV, was similar for IVDU (63%), CSW (58%) and STD (64%). Thus, HCV is mainly transmitted by blood contact, HIV primarily by blood contact rather than by sexual contact, and HBV equally readily by blood or sexual contact. These findings were supported by the results of logistic regression analysis.

Journal Article↗
PubMed2003

Occupational exposures to human immunodeficiency virus, hepatitis B virus, and hepatitis C virus: risk, prevention, and management.

Current data indicate that the risk for transmitting bloodborne pathogens in dental health care settings is low. Pre-exposure hepatitis B vaccination and the use of standard precautions to prevent exposure to blood are the most effective strategies for preventing DHCP from occupational infection with HIV, HBV or HCV. Each dental health care facility should develop a comprehensive written program for preventing and managing occupational exposures to blood that: (1) describes the types of blood exposures that may place DHCP at risk for infection; (2) outlines procedures for promptly reporting and evaluating such exposures; and (3) identifies a health care professional who is qualified to provide counseling and perform all medical evaluations and procedures in accordance with the most current USPHS recommendations. Finally, resources should be available that permit rapid access to clinical care, testing, counseling, and PEP for exposed DHCP and the testing and counseling of source patients.

Anti-HIV Agents↗
PubMedDate not supplied

Hepatitis B virus, hepatitis non-A, non-B virus and hepatitis delta virus in lyophilized antihemophilic factor: relative sensitivity to heat.

Lyophilized plasma derivatives are more stable to heat than when they are in the liquid state. Commercial Factor VIII (antihemophilic factor) was seeded with a measured quantity of hepatitis B virus. The contaminated material was then lyophilized and subjected to heat of 60 degrees C for 30 hr. Chimpanzees were inoculated with the heat-treated antihemophilic factor or sham-treated antihemophilic factor that had been held at 4 degrees C. Surprisingly, hepatitis B virus survived the heating procedure with no apparent loss in titer: the incubation period to appearance of HBsAg was that expected for the challenge dose of virus. Even more surprising, one chimpanzee (the recipient of the unheated antihemophilic factor) also developed non-A, non-B hepatitis and two chimpanzees (recipients of the heated antihemophilic factor) also developed delta hepatitis. Neither of these agents was a contaminant of the hepatitis B virus challenge pool, since the purity of this hepatitis B virus pool was established previously in chimpanzees. Thus, both a non-A, non-B agent and the delta agent apparently contaminated the commercial antihemophilic factor. This is the first direct evidence for contamination of antihemophilic factor with the delta agent and confirms previous seroepidemiologic evidence for its presence in pooled plasma derivatives. Subsequent inactivation studies were performed with antihemophilic factor experimentally contaminated with the Hutchinson strain of non-A, non-B hepatitis virus. In these studies, heating at 60 degrees C for 30 hr in the dry state rendered antihemophilic factor free of detectable non-A, non-B hepatitis virus.

Animals↗
PubMed1989

Cytoplasmic antigen in hepatocytes of chimpanzees infected with non-A, non-B hepatitis virus or hepatitis delta virus: relationship to interferon.

We previously described a cytoplasmic antigen, detected by monoclonal antibodies, in hepatocytes of chimpanzees experimentally infected with the parenterally transmitted form of non-A, non-B hepatitis virus or with the hepatitis delta virus. The expression of this antigen appears to be a host-specified response to infection with these two hepatitis viruses but not with hepatitis A virus, hepatitis B virus or enterically transmitted non-A, non-B hepatitis virus. To determine whether this antigen, found in parallel with the hepatocyte cytoplasmic structures described previously, is associated with interferon, as suggested by others, we studied by immunofluorescence liver biopsies from chimpanzees treated with an interferon inducer or exogenous interferon for the presence of the antigen. In two hepatitis B virus carrier chimpanzees and one normal chimpanzee treated with the interferon inducer polyinosinic-polyribocytidylic acid-poly-l-lysine carboxymethylcellulose, the antigen became detectable in hepatocytes within 2 weeks of initiation of the treatment, remained detectable throughout the treatment and disappeared within 4 weeks after treatment was terminated. Electron microscopy revealed that the biopsies positive for the antigen exhibited the hepatocyte cytoplasmic changes; convoluted membranes and microtubular aggregates, identical to those described originally for chimpanzees infected with non-A, non-B hepatitis virus. The antigen was not detected in any of the biopsies from a control chimpanzee that received only the carboxymethylcellulose used to stabilize the interferon inducer. In addition, liver biopsies obtained from a hepatitis B virus carrier chimpanzee during treatment with exogenous human leukocyte interferon were found to be positive for the antigen as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Seroprevalence survey of Egyptian tourism workers for hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and Treponema pallidum infections: association of hepatitis C virus infections with specific regions of Egypt.

Blood samples from 740 Egyptian Nationals working in the tourism industry at two sites in the South Sinai governorate were screened for markers of infection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and Treponema pallidum. Study subjects included 467 individuals from a rural seashore tourist village and 273 persons at two hotels in a well-established resort town. Subjects' ages ranged from 15 to 70 years; 99.3% were male. The prevalence of serologic markers for currently asymptomatic or past HBV infection alone was 20.7% (n = 153), of markers for past or chronic HCV infection alone was 7.4% (n = 55), and of markers for both HBV and HCV was 6.9% (n = 51). Of the 204 individuals positive for anti-HBV core antibody, 12 (5.9%) were also positive for hepatitis B surface antigen. Two individuals (0.3%) had a serologic market suggestive of an active syphilitic infection. No subject was found to be HIV-seropositive. History of prior injections and number of injections were associated with infection with HCV. Primary residence in the Nile delta and valley areas where schistosomiasis is highly endemic, was also a statistically significant risk factor for HCV, but not HBV infection.

Adolescent↗
PubMed1993

Prevalence of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among dialysis patients. The Italian Multicentric Study on Nosocomial and Occupational Risk of Blood-Borne Infections in Dialysis.

In April 1991, a cross-sectional study of HIV, HBV and HCV markers among dialysis patients was carried out in 19 Italian units in order to evaluate the spread of these bloodborne infections among patients and to evaluate the potential risk for staff who care for them. A total of 2,180 patients were eligible and all consented to be tested. Of the 1,347 patients who had not been given hepatitis B vaccine, 67.9% had at least one marker of HBV infection; of these 9.2% were HBsAg carriers; conversely, the rates were 7.6 and 0.4%, respectively, among the 833 vaccinated patients. Antibodies against HCV were found in 501 patients (23%) by EIA C100-3; of these, 270 were tested by RIBA-100: 246 (91%) were reactive and 11 (4.1%) indeterminate. Five patients resulted anti-HIV positive [0.22%, 95% CI (Poisson distribution): 0.07-0.53] by EIA and Western blot techniques. Length of time on dialysis seems to correlate with higher prevalence of HBV and HCV infection markers, but (not) HIV. Overall, 608 (28%) patients were a potential source of infections for other patients and staff. This emphasizes the need for stricter adherence to infection control, barrier precautions and preventive behaviours with all patients.

Adolescent↗
PubMed1999

Etiology of sporadic acute viral hepatitis in Taiwan: the role of hepatitis C virus, hepatitis E virus and GB virus-C/hepatitis G virus in an endemic area of hepatitis A and B.

The etiology of sporadic acute hepatitis was studied in 334 consecutive patients from Taiwan (237 men and 97 women, aged 16-81 years), with emphasis on the role of hepatitis C virus (HCV), hepatitis E virus (HEV), and GB virus-C/hepatitis G virus (GBV-C/HGV) in acute non-A, non-B (NANB) hepatitis and in HBsAg carriers with superimposed acute hepatitis. According to the conventional diagnostic criteria, there were 12 cases (3.6%) of acute hepatitis A, 17 cases (5.1%) of acute hepatitis B, 128 cases (38.3%) of acute NANB hepatitis, and 177 cases (53.0%) of acute hepatitis in HBsAg carriers (those who were HBsAg positive but IgM anti-HBc negative). Among 128 cases of acute NANB hepatitis, 70 (54.7%) had acute hepatitis C (HCV RNA positive), 5 (3.9%) had acute hepatitis E (IgM anti-HEV positive), and the other 53 (41.4%) were presumably acute hepatitis non-A-E. The prevalence of acute hepatitis A, B, E, and non-A-E showed no significant sex difference, whereas acute hepatitis C was significantly more prevalent in females. The prevalence of acute hepatitis A and B decreased and that of acute hepatitis C increased significantly with increasing age. In contrast, acute hepatitis E and non-A-E showed no significant age predominance. Of 177 HBsAg carriers with acute hepatitis, 64 (36.1%) demonstrated non-B hepatotropic virus superinfection, with HCV being the most common (60.9%), followed by hepatitis D, E, and A viruses, and the other 55 (31.1%) and 58 (32.8%) were presumed to have acute exacerbation of chronic hepatitis B or superimposed acute hepatitis non-A-E, respectively. Serum GBV-C/HGV RNA was detected in 3-4% of acute hepatitis non-A-E cases, suggesting its limited role in these cases.

Acute Disease↗
PubMed2000

Approaches of the diagnosis of hepatitis viruses.

Hepatitis virus infection occurs in close to a billion people worldwide at some point in their lifetimes. Hepatitis B and C viruses together account for infections in half a billion people and are considered the most carcinogenic of any known biological agent. The diagnostic approaches to detect hepatitis viruses are discussed.

Clinical Protocols↗
PubMed1999

Molecular methods of measurement of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection: implications for occupational health practice.

Over the past decade, several molecular techniques for the detection of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) have been developed that have implications for occupational health practice. This review describes the techniques used for qualitative and quantitative detection of the viral genome, and briefly explains nucleic acid sequencing and analysis of phylogenetic trees. The review also discusses the current and potential uses of these techniques in investigations of transmission of bloodborne viruses by patient to worker and worker to patient, in the management of occupational exposure to blood, in research, and in the development of guidance and policy on infected healthcare workers who perform procedures prone to exposure.

DNA, Viral↗
PubMed1992

Correlation of hepatitis B virus, hepatitis D virus and human immunodeficiency virus type I infection markers in hepatitis B surface antigen positive haemophiliacs and patients without haemophilia with clinical and histopathological outcome of hepatitis.

The hepatitis D virus (HDV) infection plays a major role in severe liver damage caused by hepatitis. To establish the prevalence of HDV infection in haemophilic patients and patients without haemophilia, 87 patients with chronic hepatitis B virus (HBV) infection were examined for serological evidence of delta hepatitis. In addition HBV, HDV and human immunodeficiency virus type 1 (HIV) infection markers were compared to clinical and histopathological outcome of hepatitis. Out of 46 haemophiliacs 30 (65%) were anti-HD-seropositive; 10 out of 30 anti-HD-positive patients (33%) had pathological liver function tests compared to 2 out of 16 anti-HD-negative haemophiliacs (13%). The rate of HIV infection did not differ between the HDV infected and the non-HDV infected individuals with haemophilia (17/27 anti-HD-positive patients versus 12/16 anti-HD-negative patients). Two haemophilic anti-HD-positive patients underwent liver biopsy, in both cases hepatitis D antigen (HDAg) was detected in the biopsies. Only 2 out of 41 patients without haemophilia were anti-HD-positive. Both had pathological liver function tests; chronic active hepatitis and cirrhosis, respectively, were diagnosed and HDAg was found in the liver biopsies. Out of 39 anti-HD-seronegative patients without haemophilia, 26 (67%) were hepatitis B e antigen positive; in the sera of 20 patients (51%) HBV-DNA was demonstrated, but only 6 patients (15%) had pathological liver function tests. In conclusion a high seroprevalence of HDV infection was found in haemophilic patients treated with non-pasteurized commercial clotting factor concentrates. An endemic spreading of HDV infection in patients without haemophilia with chronic HBV infection could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Blood-borne viral infection in hemodialysis units: special reference to hepatitis B virus, hepatitis C virus and human T-lymphotropic virus type 1].

Hemodialysis patients are one of the high risk groups for blood-borne viral infection due to their need of blood transfusions for renal anemia. In addition, the hemodialysis procedure itself is a risk factor for blood-borne viral infection. Therefore, prevention of blood-borne infection in hemodialysis units is highly important. I would like to introduce our previous studies on hepatitis B virus, hepatitis C virus and human T-lymphotropic virus type 1 infection in hemodialysis units in Fukuoka, Japan. In these studies, both anti-HCV positive rates and anti-HTLV 1 positive rates were significantly higher in patients having received blood transfusion than those not having received, and increased with the duration of hemodialysis therapy. In contrast, the positive rate of HBs-antigen did not differ with experiencing or not experiencing blood transfusion, nor did it increase with the duration of hemodialysis therapy. These findings suggest that infectious control of hepatitis B virus such as isolation of carriers and screening of blood donors may be effective for the prevention of blood-borne viral infection among hemodialysis patients.

HTLV-I Infections↗
PubMed2004

A visual DNA chip for simultaneous detection of hepatitis B virus, hepatitis C virus and human immunodeficiency virus type-1.

For the simultaneously visual detection of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus type-1 (HIV-1), a qualitative DNA chip method, combining multiplex and nested polymerase chain reaction (PCR) with arrayed anchored primer PCR and a biotin-avidin alkaline phosphatase (Av-AP) indicator system, was developed. After pretreatment of infected blood samples and reverse transcription of the RNA virus genome, PCR was performed in a single tube by using the outer primer pairs. Second round nested multiplex PCR was performed on the DNA chip, on which the primers array had already been prepared. During the arrayed anchored multiplex PCR, 5[N-(N-biotinylaminocaproyl)-epsilon-3-aminoallyl]-2-deoxy-uridine-5-triphosphate (biotin-11-dUTP) was incorporated into the extended DNA chains in order to bind avidin alkaline phosphatase via avidin and biotin. To produce purple precipitates on the chips, the enzyme substrate 5-bromo-4-chloro-3-indolyl phosphate (BCIP) was used in conjunction with the enhancer, nitro blue tetrazolium (NBT). Blood samples containing the three viruses were tested using this DNA chip and about 1 pg of specific viral DNA fragments were detected on the chip wells after nested PCR.

Colorimetry↗
PubMed2003

High throughput screening of 16 million serologically negative blood donors for hepatitis B virus, hepatitis C virus and human immunodeficiency virus type-1 by nucleic acid amplification testing with specific and sensitive multiplex reagent in Japan.

Nationwide nucleic acid amplification testing (NAT) for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus type 1 (HIV-1) of blood donated voluntarily after serological screening was implemented on July 1st 1999 for transfusion and plasma fractionation by the Japanese Red Cross blood transfusion services. From February 1st 2000, HBV, HCV and HIV-1 NAT screening of pools of 50 negative serologically screened donated blood was started and the results were reported within 1 day after blood donation. Systems were established for rapid shipment, electronic communication, automated specimen preparation, pooling and automated amplification and detection. At present, NAT screening is carried out within 1 day after donation. This report describes the blood screening system by NAT and the results obtained from over 16 million blood samples using simultaneous screening for HBV, HCV and HIV-1 with multiplex reagent. Between February 1, 2000 and December 31, 2002, 16012175 serologically negative units were tested by NAT. 308 units with Hepatitis B virus DNA (HBV DNA) were detected. The sensitivity of 50 pool NAT screening with input volume of 0.2 ml is significantly higher than that of highly sensitive HBsAg testing. 46 cases with HCV RNA and six cases with HIV-1 RNA were detected. These cases were not detected by HCV antibody and HIV-1 antibody screening. The false positive rate was 0.18%. The NAT system was developed from serological screening test negative non-remunerated voluntary donations. We supply blood products to medical organizations after screening by NAT for HBV, HCV and HIV-1 for transfusion and source plasma for fractionation. This is the first automated integrated system for prevention of transfusion transmitted HBV, HCV and HIV-1 infections, by NAT screening.

Antibodies, Viral↗
PubMed1998

No-fault compensation for transfusion-associated hepatitis B virus, hepatitis C virus, and HIV infection: Italian law and the Tuscan experience.

BACKGROUND: On February 25, 1992, in Italy, a law (Number 210; referred to as 210/1992) was promulgated providing economic indemnity for persons infected with hepatitis B virus, hepatitis C virus, and HIV via transfusion or the administration of hemoderivatives. STUDY DESIGN AND METHODS: The requests for compensation presented in the central Italian region of Tuscany from the time of the law's promulgation through December 31, 1996, were analyzed. These requests are surveyed by medical commissions in the regional military hospitals, which must compile a report of the completed assessments, formulate a decision concerning verified illnesses, and express an opinion on the existence of a relationship of causality between the damaging event and the impairment or death of the subjects. RESULTS: Out of 428 requests for indemnity, 372 have been granted and 56 denied. Posttransfusion infections (286 cases) were clearly more prevalent than those due to hemoderivatives (141 cases). Cases of hepatitis, particularly type C, constitute the great majority of the infections for which indemnity was sought, while cases of HIV infection are scarce and in sharp decrease in the data from 1995 and 1996. CONCLUSIONS: Italian Law 210/1992 has been recognized as providing a benefit to persons infected medically, but its efficiency is greatly obstructed by a lack of documentation regarding transfusions performed in the past.

Female↗