Human leukocyte antigen B*57 does not fully explain hepatitis C clearance in HIV controllers

ObjectiveHIV controllers demonstrate high rates of spontaneous clearance of hepatitis C virus (HCV) infection. The objective of this study was to evaluate the role of human leukocyte antigen (HLA) B*57 and other genetic polymorphisms on HCV clearance in HIV controllers.DesignThis is a prospective cohort study.MethodsPatients in the Study of the Consequences of Protease Inhibitor Era (SCOPE) were tested for anti-HCV using enzyme immunoassay (EIA3) and HCV RNA using discriminatory HCV transcription-mediated amplification assay (Norvatis). We compared the proportion of HIV controllers and noncontrollers demonstrating HCV clearance and fitted multivariable Poisson regression models with robust standard errors to estimate adjusted prevalence ratios (APRs) and assessed genetic and immunologic predictors of HCV clearance.ResultsOf 279 HIV/HCV seropositive individuals, 48 were HIV controllers. HIV controllers compared to HIV noncontrollers, were significantly more likely to have HLA B*57 (33 vs. 10%, P < 0.01). In multivariate analyses, adjusting for HLAB57, IL28B genotype, age, sex and race/ethnicity, HCV clearance was significantly more likely in HIV controllers than HIV noncontrollers [APR 1.78; 95% confidence interval (CI) 1.06-3.0; P = 0.03]. HLA B*57 did not explain the increased proportion of HCV clearance in HIV controllers, but IL28B CC genotype was independently associated with spontaneous HCV clearance (APR 2.76; 95% CI 1.85-4.11; P < 0.001).ConclusionAlthough enriched in HIV controllers, HLA B*57 does not explain the increased HCV clearance. Further identification of host immunologic or genetic factors that contribute to control of HIV and HCV may support the development of novel treatments for and effective vaccines against both viruses

Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015

<div><p>Background</p><p>Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing.</p><p>Methods</p><p>The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks.</p><p>Results</p><p>165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine.</p><p>Conclusions</p><p>The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere.</p></div

Contact tracing results from the Duport Road EVD outbreak, November–December, 2015.

<p>This table displays the summary information for the 168 contacts monitored in response to the Duport Road EVD outbreak.</p

Contact status by day of monitoring, Duport Road EVD outbreak, Montserrado County, November–December 2015.

<p>Contact status by day of monitoring, Duport Road EVD outbreak, Montserrado County, November–December 2015.</p

Montserrado County EVD contact tracing structure and information flow for Duport Road outbreak, November–December, 2015.

<p>Montserrado County EVD contact tracing structure and information flow for Duport Road outbreak, November–December, 2015.</p

Contacts by risk status, Duport Road EVD outbreak, Montserrado County, November–December 2015.

<p>*Includes two pediatric patient contacts who died during the monitoring period due to underlying illnesses.</p

Contact tracing components, challenges, and solutions from the Duport Road EVD outbreak, November–December, 2015.

<p>Contact tracing components, challenges, and solutions from the Duport Road EVD outbreak, November–December, 2015.</p

Key recommendations from the contact tracing activities of the Duport Road EVD outbreak, Montserrado County, November–December 2015.

<p>Key recommendations from the contact tracing activities of the Duport Road EVD outbreak, Montserrado County, November–December 2015.</p

Sample contact tracing dashboard (de-identified) used in the Duport Road EVD outbreak, Montserrado County, November–December 2015.

<p>Sample contact tracing dashboard (de-identified) used in the Duport Road EVD outbreak, Montserrado County, November–December 2015.</p