Confirming the presence of HTLV-1 infection and the absence of HTLV-2 in blood donors from Arequipa, Peru

Epidemiological studies conducted in Peru disclosed HTLV-1 to be prevalent in different ethnic groups, and found HTLV-2 in some Amazonian Indians and in men who have sex with men. No data concerning HTLV-1/2 infection in blood donors from Arequipa, a highlands region in southern Peru, is available. We searched for the presence of HTLV-1 and HTLV-2 antibodies in 2,732 serum samples obtained from blood donors from this geographic area. HTLV-1/2-specific antibodies were detected using an enzyme-linked immunosorbent assay (ELISA) and were confirmed by Western blot (WB). Reactive sera had their blood bags discarded from donation, and the demographic characteristics of the donors were analyzed. Thirty-five sera (1.2%) were HTLV seroreactive by ELISA, and 25 were confirmed HTLV-1-positive by WB. One serum disclosed HTLV-positivity, and the remaining nine serum samples showed indeterminate results by WB; three of which had an HTLV-1 indeterminate Gag profile. The median age of HTLV-positive individuals was 34.6 years; 27 were male and eight were female. All individuals were from southern Peru: 27 from Arequipa, five from Puno, and three from Cuzco. HTLV co-positivity with hepatitis B (five sera) and syphilis (one serum) were detected. Previous transfusion and tattooing were observed in two and one individuals, respectively. No serum was positive for HTLV/HIV co-infection. This study confirmed, for the first time, HTLV-1 infection and the absence of HTLV-2 infection in blood donors from Arequipa, Peru and suggests vertical transmission as the major route of HTLV-1 transmission and acquisition in this geographic region.Estudos epidemiológicos conduzidos no Peru apontam a infecção por HTLV-1 como prevalente em diferentes grupos étnicos e por HTLV-2 restrita a alguns índios da região Amazônica e a homens que fazem sexo com homens. Não existem dados sobre a infecção por HTLV-1/2 em doadores de sangue de Arequipa, região montanhosa do sul do Peru. Portanto, o presente estudo pesquisou anticorpos anti-HTLV-1 e HTLV-2 em 2.732 doadores de sangue desta região geográfica. Foram utilizados na triagem sorológica os testes imunoenzimáticos (ELISA) e para confirmação dos resultados o Western Blot (WB). Soros reagentes no ELISA tiveram suas bolsas de sangue descartadas. Os resultados obtidos foram analisados de acordo com características demográficas dos indivíduos. Trinta e cinco soros (1,2%) resultaram HTLV-1/2 reagentes no ELISA, 25 confirmaram infecção por HTLV-1 no WB. Um soro resultou HTLV positivo e os nove soros restantes resultaram em padrão indeterminado no WB: três com perfil HTLV-1 Gag indeterminado. A média de idade dos indivíduos HTLV positivos foi de 34,6 anos; 27 do gênero masculino e oito do gênero feminino. Todos eram da região sul do país: 27 de Arequipa, cinco de Puno e três de Cuzco. Foi detectada co-positividade HTLV com hepatite B (cinco soros) e sífilis (um soro). Nenhum soro resultou positivo para a co-infecção HIV/HTLV. Havia dois indivíduos com transfusão prévia e um com tatuagem. Este trabalho confirma pela primeira vez infecção por HTLV-1 e ausência de infecção por HTLV-2 em doadores de sangue de Arequipa, sul do Peru e sugere que a transmissão vertical seja a principal via de transmissão/aquisição de HTLV-1 nesta região geográfica

Desempenho de testes sorológicos para o diagnóstico de infecção por HTLV em população de alto-risco de São Paulo, Brasil

Testing problems in diagnosing human T-lymphotropic virus (HTLV) infection, mostly HTLV-II, have been documented in HIV/AIDS patients. Since December 1998, the Immunology Department of Instituto Adolfo Lutz (IAL) offers HTLV-I/II serology to Public Health Units that attend HTLV high-risk individuals. Two thousand, three hundred and twelve serum samples: 1,393 from AIDS Reference Centers (Group I), and 919 from HTLV out-patient clinics (Group II) were sent to IAL for HTLV-I/II antibodies detection. The majority of them were screened by two enzyme immunoassays (EIAs), and confirmed by Western Blot (WB 2.4, Genelabs). Seven different EIA kits were employed during the period, and according to WB results, the best performance was obtained by EIAs that contain HTLV-I and HTLV-II viral lysates and rgp21 as antigens. Neither 1st and 2nd, nor 3rd generation EIA kits were 100% sensitive in detecting truly HTLV-I/II reactive samples. HTLV-I and HTLV-II prevalence rates of 3.3% and 2.5% were detected in Group I, and of 9.6% and 3.6% in Group II, respectively. High percentages of HTLV-seroindeterminate WB sera were detected in both Groups. The algorithm testing to be employed in HTLV high-risk population from São Paulo, Brazil, needs the use of two EIA kits of different formats and compounds as screening, and because of high seroindeterminate WB, may be another confirmatory assay.Problemas nos testes diagnósticos de infecção pelos vírus linfotrópicos de células T humanas (HTLV), principalmente HTLV-II, têm sido observados em pacientes com HIV/Aids. Desde Dezembro de 1998, a Seção de Imunologia do Instituto Adolfo Lutz (IAL) oferece a sorologia para HTLV-I/II para Serviços de Saúde Pública que atendem populações consideradas de risco para esta infecção. Duas mil trezentas e doze amostras de soro: 1.393 de Centros de Referência em Aids (Grupo I) e 919 de Clínicas de Especialidade em HTLV (Grupo II) foram encaminhadas para o IAL para a pesquisa de anticorpos anti-HTLV-I/II. A maioria delas foram testadas por dois ensaios imunoenzimáticos (EIAs) e confirmadas por Western Blot (WB 2.4, Genelabs). Sete kits diferentes de EIAs foram empregados durante o período e de acordo com os resultados do WB a melhor performance foi obtida com os EIAs que continham lisado viral dos HTLV-I e -II e a rgp21 como antígenos. Nenhum kit de EIA de 1ª, 2ª ou 3ª geração foi 100% sensível para detectar todas as amostras verdadeiramente HTLV-I/II reagentes. A prevalência de HTLV-I e HTLV-II, respectivamente, foi de 3,3% e 2,5% no Grupo I e de 9,6% e 3,6% no Grupo II. Em ambos os Grupos, foram detectadas altas percentagens de soros com padrão indeterminado no WB. O algoritmo de testes sorológicos para ser usado em população de alto risco para HTLV de São Paulo, Brasil, necessita de dois kits EIAs de princípios e composição diferentes para a triagem sorológica e, pelo elevado número de WB indeterminado, talvez de um outro teste confirmatório

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Human Herpesvirus type 8 (HHV-8): Study of target segments of the HHV-8 genoma in blood, saliva and urine of HIV/aids infected patients with or without Kaposi's Sarcoma

Desde a descoberta do herpes vírus humano tipo 8 (HHV-8) como o agente etiológico do sarcoma de Kaposi (SK) nas suas diferentes formas clínico-epidemiológicas, vários estudos vêm sendo conduzidos com o intuito de determinar as vias de transmissão desse vírus em populações endêmicas e de risco epidemiológico. Em regiões endêmicas, a transmissão viral foi relacionada à transmissão horizontal de mães para filhos e entre irmãos e a sexual principalmente, nos casos de SK/aids. Com o objetivo de determinar segmentos do genoma viral em fluídos biológicos e consequentemente seu potencial infectante foi conduzido o presente trabalho. Foram avaliados quanto à presença de segmentos localizados em posições estratégicas do genoma do HHV-8 em sangue, saliva e urina de 76 pacientes com SK/aids, 19 pacientes com HIV/aids, 4 casos de SK clássico e 11 indivíduos sadios (HIV-soronegativos, sem SK). Foram utilizadas as técnicas de PCR "nested" para as ORF K1, ORF 25, ORF 26, ORF K8.1 e ORF 73 em DNA extraído de material de biópsia de lesão de SK (controle positivo), células do sangue periférico, saliva e urina. Os resultados de PCR positivo para o HHV-8 foram analisados quanto a variáveis epidemiológicas, clínicas e laboratoriais. Foram consideradas como variáveis: sexo, cor, origem étnica, tempo de infecção por HIV e de acompanhamento do SK, terapia ARV e para SK, contagem de células CD4+ e sorologia para o HHV-8 (IFI-LANA e IFI-Lítico). Os testes estatísticos de regressão logística e de razão de chances foram usados para detectar as associações estatisticamente significantes entre as PCRs positivas e as variáveis estudadas nos grupos SK/aids e HIV/aids. Os subtipos do HHV-8 foram também determinados pela técnica de PCR-RFLP da ORF K1 (VR1). Os resultados obtidos mostraram a detecção de DNA/HHV-8 em 80,2% do material de biópsia, 69,7% no sangue, 59,2% na saliva e 21,0% na urina de pacientes com SK/aids. No grupo HIV/aids, a PCR para o HHV-8 resultou positiva em 47,4% dos casos no sangue e em 26,3% na saliva e urina. Já no grupo SK clássico 100% das biópsias e salivas resultaram PCR positiva, 67% do sangue e 33% das urinas. A avaliação sorológica revelou 73,3% de reatividade para IFI-LANA e 85,3% para a IFI-Lítico no grupo SK/aids, enquanto o grupo HIV/aids mostrou reatividade de 15,8% para IFI-LANA e 47,4% para IFI-Lítico; todos os pacientes apresentaram resultados reagentes nas duas sorologias para o HHV-8 no grupo de SK clássico. No grupo controle sadio não houve reatividade na sorologia para o HHV-8, com exceção de um caso, que mostrou ser reagente na IFI-LANA. Foi possível realizar a subtipagem do HHV-8 em amostras de 69 pacientes, sendo detectadas 27 cepas do subtipo A, 13 do subtipo B, 28 do subtipo C e 1 do subtipo E. Após as análises estatísticas foi verificado que as PCRs que identificam as regiões ORF 26, ORF K8.1 e ORF 73 foram as que apresentaram melhor desempenho na identificação de DNA/HHV-8. Houve associação entre a reatividade de IFI-Lítico e a presença do vírus no sangue periférico, assim como a reatividade para IFI-LANA e a detecção de DNA/HHV-8 na saliva. Houve uma tendência dos subtipos B e C de HHV-8 serem detectados em pacientes com infecção profunda ou disseminada de SK. Estes resultados sugerem que a boca pode ser um sítio de latência da infecção por HHV-8 e confirmam a atuação de sangue, saliva e urina como fluídos potencialmente infectantes.Since the discovery of the human herpesvirus 8 (HHV-8) as the etiological agent of Kaposis sarcoma (KS), several studies have been conducted in order to determine routes of virus transmission, mostly in endemic and at risk populations. The main of the present study was to determine target segments of the HHV-8 genoma and consequently infected bodily fluids. DNA sequences of ORF K1, ORF 25, ORF 26, ORF K8.1 and ORF 73 strategically localized in viral genoma were searched using nested PCR techniques in KS lesions (positive control), blood, saliva, and urine from 76 KS/aids patients, 19 HIV/aids patients, 4 classic KS patients, and among 11 healthy individuals (HIV-1 seronegative, without KS). HHV-8 subtypes were determined by PCR-RFLP of the ORF K1 (VR1), and HHV-8 antibodies by IFA-LANA and IFA-Lytic assays. The results obtained were analyzed according to epidemiological, clinical and laboratorial data, and the c2 test, logistic regression and odds ratio were applied to identify statistical association among variables in KS/aids and HIV/aids groups. The results obtained showed HHV-8 DNA in 80.2% of biopsies, 69.7% of blood, 59.2% of saliva, and 21% of urines from KS/aids group. Among HIV/aids patients, 47.4% resulted PCR positive in blood, 26.3% in saliva and urine. In classic KS cases, all biopsies and saliva resulted PCR positive, 67% in blood, and 33% in urine. The serology in KS/aids group showed 73.3% frequency of anti-latent antibodies, and 85.3% frequency of anti-lytic antibodies, while in HIV/aids group the frequencies were 15.8% and 47.4%, respectively. All classic KS cases resulted HHV-8 seroposite, while all individuals from control group resulted HHV-8 seronegative. Molecular characterization of 69 HHV-8 strains disclosed: 27 of subtype A, 13 of subtype B, 28 of subtype C, and 1 of subtype E. The ORF 26, ORF K8.1 and ORF 73 were the best segments for identifying HHV-8 DNA in bodily fluids. It was observed an association between antibodies to lytic antigens and the presence of HHV-8 in blood, and antibodies to latent antigens and the detection of HHV8 DNA in saliva of KS/aids patients. Indeed, HHV-8 subtypes B and C were detected mostly in disseminated KS cases. Taken together, the results obtained suggest that the mouth could be one site of HHV-8 latency, and confirm that blood, saliva and urine were potentially infectious bodily fluids

A Comparative Study of the Frequency of Antibody and Titers Against Human Herpesvirus 8 Latent and Lytic Antigens in ""At-Risk"" Individuals and Among Patients With Kaposi`s Sarcoma

Differences in the prevalence of human herpesvirus 8 (HHV-8) and Kaposi`s sarcoma (KS) have been described, depending on the study population and their geographic origin. A cross-sectional study aimed at detecting the frequency and titers of antibodies against HHV-8 latent and lytic antigens in serum samples from individuals with different risk-factors for HHV-8 infection, as well as predictive marker identification in patients with KS, was conducted. Serum samples were collected from seven groups of individuals: 75 patients with AIDS-KS, 5 with classic KS, 16 with African KS, 495 with HIV/AIDS, 805 patients with chronic kidney disease, 683 handicapped individuals, and 757 health care workers. Samples were evaluated for the presence and titers of HHV-8-specific antibodies to latent and lytic antigens using ""in house"" immunofluorescence assays. The results were analyzed by the Chi-square, Fisher`s exact test, Kruskal-Wallis and/or Mann-Whitney U-tests. The frequencies of HHV-8 antibodies were as follows: 87.5-100% in patients with KS, 20.4% in patients with HIV/AIDS, 18% in patients with chronic kidney disease, 1.6% in handicapped individuals, and 1.1% in health care workers. A greater number of samples were antibody positive to lytic antigens. Elevated titers of antibodies to latent and lytic antigens, mostly among patients with KS, were detected. Using established serological assays, different ""at-risk"" populations for HHV-8 infection/disease were detected in this geographic area, confirming HIV/AIDS and identifying patients with chronic kidney disease as high-risk groups. It is suggested that a longitudinal evaluation of antibody titers in patients with chronic kidney disease be undertaken to confirm their predictive value in the development of KS. J. Med. Virol. 81: 1292-1297, 2009. (C) 2009 Wiley-Liss, Inc.Adele Caterino-de-Araujo (CNPq Fellowship)[PD 304372/2006-4]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)FAPESP Fundacao de Amparo a Pesquisa de Sao Paulo[98/13313-5]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Instituto Adolfo LutzInstituto Adolfo Lutz[35/99]Instituto Adolfo LutzInstituto Adolfo Lutz[22/04

Human herpesvirus-8 (HHV-8) antibodies in women from São Paulo, Brazil: association with behavioral factors and Kaposi's sarcoma

BACKGROUND: With the spread of AIDS, many HIV-infected women have been diagnosed with Kaposi's sarcoma (KS), especially in Africa. Since the discovery of a novel herpesvirus as the causative agent of KS (human herpesvirus 8 - HHV-8) several seroepidemiological studies have been conducted to identify groups at risk for KS. The risk for women in Brazil has not been studied. MATERIALS AND METHODS: We searched for HHV-8 antibodies in sera obtained from a bank made up of samples from 3 groups of individuals: Group I: 163 HIV-1-infected women attended at an ambulatory clinic in 1994; Group II: 108 children born to HIV-1-infected mothers from 1990 to 1992, their antibodies reflected maternal infection, and Group III: 630 HIV-1-seronegative, healthy women. In-house immunofluorescence and Western-Blot assays based on the BCBL-1 cell line were used to detect anti-latent and anti-lytic HHV-8 antibodies. RESULTS: Group I had an overall frequency of antibodies of 8.6%, with a 1.2% frequency of anti-latent antibodies and an 8.0% frequency of anti-lytic antibodies. Similar results were detected in Group II, i.e., no cases with anti-latent antibodies and a 7.4% frequency of anti-lytic antibodies. In contrast, prevalences of 1.1% anti-latent antibodies and 0.3% anti-lytic antibodies were observed in Group III. CONCLUSIONS: The epidemiologic pattern of HHV-8 in women from São Paulo varies according to behavioral factors, with emphasis on the sexual and blood routes of virus transmission/acquisition. Although HHV-8 anti-lytic antibodies were found in HIV-1-infected women, no case of KS was detected. Protective factors against KS are probably related to gender and/or to antiretroviral therapies introduced in Brazil since 1994

Human herpesvirus-8 (HHV-8) antibodies in women from São Paulo, Brazil: association with behavioral factors and Kaposi's sarcoma

BACKGROUND: With the spread of AIDS, many HIV-infected women have been diagnosed with Kaposi's sarcoma (KS), especially in Africa. Since the discovery of a novel herpesvirus as the causative agent of KS (human herpesvirus 8 - HHV-8) several seroepidemiological studies have been conducted to identify groups at risk for KS. The risk for women in Brazil has not been studied. MATERIALS AND METHODS: We searched for HHV-8 antibodies in sera obtained from a bank made up of samples from 3 groups of individuals: Group I: 163 HIV-1-infected women attended at an ambulatory clinic in 1994; Group II: 108 children born to HIV-1-infected mothers from 1990 to 1992, their antibodies reflected maternal infection, and Group III: 630 HIV-1-seronegative, healthy women. In-house immunofluorescence and Western-Blot assays based on the BCBL-1 cell line were used to detect anti-latent and anti-lytic HHV-8 antibodies. RESULTS: Group I had an overall frequency of antibodies of 8.6%, with a 1.2% frequency of anti-latent antibodies and an 8.0% frequency of anti-lytic antibodies. Similar results were detected in Group II, i.e., no cases with anti-latent antibodies and a 7.4% frequency of anti-lytic antibodies. In contrast, prevalences of 1.1% anti-latent antibodies and 0.3% anti-lytic antibodies were observed in Group III. CONCLUSIONS: The epidemiologic pattern of HHV-8 in women from São Paulo varies according to behavioral factors, with emphasis on the sexual and blood routes of virus transmission/acquisition. Although HHV-8 anti-lytic antibodies were found in HIV-1-infected women, no case of KS was detected. Protective factors against KS are probably related to gender and/or to antiretroviral therapies introduced in Brazil since 1994