Audit of Antenatal Testing of Sexually Transmissible Infections and Blood Borne Viruses at Western Australian Hospitals

In August 2007, the Western Australian Department of Health (DOH) released updated recommendations for testing of sexually transmissible infections (STI) and blood-borne viruses (BBV) in antenates. Prior to this, the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG) antenatal testing recommendations had been accepted practice in most antenatal settings. The RANZCOG recommends that testing for HIV, syphilis, hepatitis B and C be offered at the first antenatal visit. The DOH recommends that in addition, chlamydia testing be offered. We conducted a baseline audit of antenatal STI/BBV testing in women who delivered at selected public hospitals before the DOH recommendations. We examined the medical records of 200 women who had delivered before 1st July 2007 from each of the sevenWAhospitals included in the audit. STI and BBV testing information and demographic data were collected. Of the 1,409 women included, 1,205 (86%) were non-Aboriginal and 200 (14%) were Aboriginal. High proportions of women had been tested for HIV (76%), syphilis (86%), hepatitis C (87%) and hepatitis B (88%). Overall, 72% of women had undergone STI/BBV testing in accordance with RANZCOG recommendations. However, chlamydia testing was evident in only 18% of records. STI/BBV prevalence ranged from 3.9% (CI 1.5– 6.3%) for chlamydia, to 1.7% (CI 1–2.4%) for hepatitis C, 0.7% (CI 0.3–1.2) for hepatitis B and 0.6% (CI 0.2–1) for syphilis. Prior to the DOH recommendations, nearly three-quarters of antenates had undergone STI/BBV testing in accordance with RANZCOG recommendations, but less than one fifth had been tested for chlamydia. The DOH recommendations will be further promoted with the assistance of hospitals and other stakeholders. A future audit will be conducted to determine the proportion of women tested according to the DOH recommendations. The hand book from this conference is available for download Published in 2008 by the Australasian Society for HIV Medicine Inc © Australasian Society for HIV Medicine Inc 2008 ISBN: 978-1-920773-59-

High prevalence of antibodies to human herpesvirus 8 in relatives of patients with classic Kaposi's sarcoma from Sardinia

A survey for antibodies to a recombinant small viral capsid antigen (sVCA) of human herpesvirus type 8 (HHV‐8) was conducted in Sardinia, one of the world's highest incidence areas for classic Kaposi's sarcoma (KS). Prevalence of antibodies to HHV‐8 sVCA was greatest in patients with KS (95%), followed by family members (39%) and a Sardinian control population age‐ and sex‐matched to the relatives (11%). Within families, prevalence of antibodies was about equal among spouses, children, and siblings of KS patients, a finding that raises the possibilities of intrafamilial person‐to‐person or vertical transmission. Antibodies were detected 2–3 times more frequently in males than in females. The data show that prevalence of antibodies to HHV‐8 sVCA correlates with the distribution of classic KS in a high‐ incidence area. Clustering of seroprevalence within some families suggests the presence of familial risk factors for active HHV‐8 infection

Sensitivity of Five Rapid HIV Tests on Oral Fluid or Finger-Stick Whole Blood: A Real-Time Comparison in a Healthcare Setting

BACKGROUND: Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV) antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. METHODS AND FINDINGS: 200 adults with documented HIV-1 (n=194) or HIV-2 infection (n=6) were prospectively screened with five HIV rapid tests using either oral fluid (OF) or finger-stick whole blood (FSB). The OraQuick Advance rapid HIV1/2 was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2, Determine HIV 1-2, Determine HIV-1/2 Ag/Ab Combo and INSTI HIV-1/HIV-2. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3%) and most were on antiretroviral therapy (68.5%). Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001). OraQuick was less sensitive on OF than on FSB (p=0.008). Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level<200 cp/ml was significantly associated with a false-negative result (p=0.009). When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI) were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p=0.04; 100%, p=0.004; and 100%, p=0.02, respectively). CONCLUSION: When evaluated in a healthcare setting, rapid HIV tests were less sensitive on oral fluid than on finger-stick whole blood and less sensitive on finger-stick whole blood than on serum

Failure of A Novel, Rapid Antigen and Antibody Combination Test to Detect Antigen-Positive HIV Infection in African Adults with Early HIV Infection

BACKGROUND: Acute HIV infection (prior to antibody seroconversion) represents a high-risk window for HIV transmission. Development of a test to detect acute infection at the point-of-care is urgent. METHODS: Volunteers enrolled in a prospective study of HIV incidence in four African cities, Kigali in Rwanda and Ndola, Kitwe and Lusaka in Zambia, were tested regularly for HIV by rapid antibody test and p24 antigen ELISA. Five subgroups of samples were also tested by the Determine Ag/Ab Combo test 1) Antigen positive, antibody negative (acute infection); 2) Antigen positive, antibody positive; 3) Antigen negative, antibody positive; 4) Antigen negative, antibody negative; and 5) Antigen false positive, antibody negative (HIV uninfected). A sixth group included serial dilutions from a p24 antigen-positive control sample. Combo test results were reported as antigen positive, antibody positive, or both. RESULTS: Of 34 group 1 samples with VL between 5x105 and >1.5x107 copies/mL (median 3.5x106), 1 (2.9%) was detected by the Combo antigen component, 7 (20.6%) others were positive by the Combo antibody component. No group 2 samples were antigen positive by the Combo test (0/18). Sensitivity of the Combo antigen test was therefore 1.9% (1/52, 95% CI 0.0, 9.9). One false positive Combo antibody result (1/30, 3.3%) was observed in group 4. No false-positive Combo antigen results were observed. The Combo antigen test was positive in group 6 at concentrations of 80 pg/mL, faintly positive at 40 and 20 pg/mL, and negative thereafter. The p24 ELISA antigen test remained positive at 5 pg/mL. CONCLUSIONS: Although the antibody component of the Combo test detected antibodies to HIV earlier than the comparison antibody tests used, less than 2% of the cases of antigen-positive HIV infection were detected by the Combo antigen component. The development of a rapid point-of-care test to diagnose acute HIV infection remains an urgent goal

Reconstruction of the historic time course of blood‐borne virus contamination of clotting factor concentrates, 1974–1992

Factor VIII and IX clotting factor concentrates manufactured from pooled plasma have been identified as potent sources of virus infection in persons with hemophilia (PWHs) in the 1970s and 1980s. To investigate the range and diversity of viruses over this period, we analysed 24 clotting factor concentrates for several blood‐borne viruses. Nucleic acid was extracted from 14 commercially produced clotting factors and 10 from nonremunerated donors, preserved in lyophilized form (expiry dates: 1974–1992). Clotting factors were tested by commercial and in‐house quantitative PCRs for blood‐borne viruses hepatitis A, B, C and E viruses (HAV, HBV, HCV, HEV), HIV‐ types 1/2, parvoviruses B19V and PARV4, and human pegiviruses types 1 and 2 (HPgV‐1,‐2). HCV and HPgV‐1 were the most frequently detected viruses (both 14/24 tested) primarily in commercial clotting factors, with frequently extremely high viral loads in the late 1970s–1985 and a diverse range of HCV genotypes. Detection frequencies sharply declined following introduction of virus inactivation. HIV‐1, HBV, and HAV were less frequently detected (3/24, 1/24, and 1/24 respectively); none were positive for HEV. Contrastingly, B19V and PARV4 were detected throughout the study period, even after introduction of dry heat treatment, consistent with ongoing documented transmission to PWHs into the early 1990s. While hemophilia treatment is now largely based on recombinant factor VIII/IX in the UK and elsewhere, the comprehensive screen of historical plasma‐derived clotting factors reveals extensive exposure of PWHs to blood‐borne viruses throughout 1970s‐early 1990s, and the epidemiological and manufacturing parameters that influenced clotting factor contamination

Correlation of heavy metals and theirs impact to epidemiological survey in the miners blood donors and other human population

Introduction: Miners who are blood donors, and work in mines for lead-zinc ores are constantly exposed to heavy metals (lead, zinc and cadmium) and this aspect is expected to increase or decrease many hematological parameters. Aim of the Study: The concentration of lead, zinc and cadmium was studied in exposed blood donors and non-exposed blood donors (control group). Knowing the structure of various heavy metals, all of the analysis was carried out to examine the impact of these heavy metals on the occurrence and severity of certain epidemiological diseases and hematological parameters on the miners who are blood donors. Material and Methods: In this research 120 miners were included who were blood donors (mining for lead and zinc) from the Republic of Macedonia and a control group of 30 participants that included blood donors not directly exposed to heavy metals, while living in the immediate vicinity of the lead and zinc mine. In this research biochemical analysis (inductively coupled plasma spectrometry (ICP) one of the most sensitive analytical techniques for the determination of elements in biological materials was applied and the basic haematological parameters were determined. Results: The observation of increased blood lead level on blood donors in the exposed group (mean = 0.089 mg/l) and 20% on blood donors in the control group (mean = 0066), increased blood zinc level in the exposed (mean = 1391) and in the control group (mean = 1074), increased blood cadmium level in 62% of exposed (mean = 0007) and in 50% of the control group (mean = 0006); If the normal BLL (blood lead level) is 0.04–0.07 mg/l, we concluded that all male blood donors in the exposed group had above normal BLL. In the control group 20% of male blood donors had above normal BLL; if the normal BZL (blood zinc level) is 0.1 mg/l, we concluded that all male blood donors exposed in the control group had above normal BZL. If the normal BCL is 0.005 mg/l, we concluded that 62% of the male blood donors in the exposed group had above normal BCL. In the control group 50% of male blood donors had above normal BCL; The blood lead, zinc and cadmium level will rise during exposure at work. forty eight percent of miners (exposed group) had an exposure period of 20 years, 29% between 10 and 20 years and the remaining 23% an exposure period under 10 years. Results showed negative correlation between the number of red blood cells and hemoglobin and blood levels of heavy metals; positive correlation between the number of leukocytes and blood heavy metals levels. Epidemiological survey showed that nearly all workers complained of headache. While 25 of 70 miners who were blood donors (with long exposure) were found to be suffering from various diseases such as asthma, respiratory tract, irritation and watering of eyes. Conclusion: The research confirms that the increased content of heavy metals in blood donors affects the concept of professional risk that involves probability that as a result of exposure of workers to certain harmful agents in the work environment negative effects are manifested on their health. The change of some haematological parameters in the blood donors, results in the emergence of certain diseases with complex etiologies and risks to their health

Prevention from transfusion transmissive diseases in the regional center for transfusion medicine in Stip, Republic of Macedonia for the period 2009-2010

Introduction: Blood transfusion is a transplantation of fluid tissue or an introduction of human biological material that needs to survive in the donor organism and to play important biological functions. During the blood and blood products transfusion, it is possible to transmit many transfusion transmissive diseases, which increases the need of securing safe blood transfusion. Objective: To present the procedures and measures taken in order to prevent the transmission of transfusion transmissive diseases in the blood and blood products donors at the Clinical Hospital in Stip. Materials and methods: Each blood unit was mandatory tested for HBSAG, anti- HCV, anti-HIV and Treponema pallidum antibodies at the Regional center for transfusion medicine. The testing was done with the ELISA technique by using the Dade Berhing BEP 200 instrument and the tests from Siemens and Ortho for anti-HCV. The confirmation tests were done at the Institute of Transfusion Medicine in the capital Skopje. Results: In total, 6067 blood samples were tested. The presence of HBAGS was detected in 81 sample (1.33%), anti-HCV in 19 (0.313%), anti-HIV in one (0,016%) and Treponema pallidum antibodies in 5 samples (0.082%). Discussion and conclusion: In order to achieve high level of security of the transfusion blood and blood products it is essential to use highly specific and sensitive tests, modern equipment, well trained health personnel and sufficient financial resources allocated specifically for that aim