Diagnosis of dual human immunodeficiency virus types 1 & 2 infections in a resouce-limited setting

Background: The presence of dual HlV-l/HIV-2 infection in Ghana and the different drug requirements for the treatment of HlV-1 and HIV-2 presents difficulties for the treatment of dual infections with both viruses.Objectives: To determine the prevalence of the dual sero-positive profile in treatment naive patients at a principal ART Clinic in Accra, Ghana and to investigate if rapid screening assays could be useful for diagnosis.Design: A cross-sectional study.Setting: A principal antiretroviral treatment centre in Accra, Ghana.Subjects: Three hundred and twenty eight antiretroviral treatment naive patients.Results: A total of 12 (3.7%) of patients seen were dual seropositive. There was a slight tendency of dual seropositive females being older than their HIV-l counterparts (p=0.088, CI=-l 0.833 to 0.753). Eight of the 12 of the dual seropositives were reactive for Genie II and were considered as possibly infected with both HIV-I and HIV-2. Seven (87.5%) of Genie II dual seropositives had strong intensities (> 1+) on both HIV-2 specific bands (sgp105 and gp36) on Innolia. CD4 counts were not significantly different in dual seropositives as compared to HIV-1 infected patients.Conclusions: Dual HIV-l/HIV-2 seropositives (and possibly infections) may be common especially in older women. The Genie II will be useful as a supplemental rapid test for rapid and accurate differentiation of HIV-l and HIV-2 antibodies at treatment centres

Congenital rubella syndrome in Iran

BACKGROUND: Congenital rubella syndrome (CRS) can be prevented with appropriate vaccination programs. The prevalence rates of rubella and CRS in Iran are unknown; therefore, the risk of exposure in pregnant women is not clear. The prevalence of CRS in the pre-vaccine period can be estimated by evaluating the proportion of children in the population with sensorineural hearing loss attributable to rubella. METHODS: This was a case-control study to estimate prevalence of CRS in Tehran (Iran) by evaluating the proportion of children with sensorineural hearing loss attributable to rubella. The study used rubella antibody titer as an indicator, and compared the prevalence of rubella antibody between children with and without sensorineural hearing loss. Using these findings, the proportion of cases of sensorineural hearing loss attributable to rubella was estimated. RESULTS: A total of 225 children aged 1 to 4 years were entered into the study (113 cases and 112 controls). There was a significant difference between cases and controls with regard to rubella antibody seropositivity (19.5% vs. 8.9%, respectively, odds ratio = 2.47, 95% CI = 1.04–5.97). The proportion of sensorineural hearing loss cases attributable to rubella was found to be 12%, corresponding to a CRS prevalence of 0.2/1000. CONCLUSION: The prevalence of CRS was approximately 0.2/1000 before rubella vaccination in Iran, Moreover; the results suggest that implementation of appropriate rubella vaccination programs could potentially prevent about 12% of cases of sensorineural hearing loss in Iranian children. This data could potentially be used as baseline data, which in conjunction with an appropriate method, to establish a surveillance system for rubella vaccination in Iran. An appropriate surveillance system is needed, because the introduction of a rubella vaccine without epidemiological data and an adequate monitoring program could result in the shifting of rubella cases to higher ages, and increasing the incidence of CRS

Virological Characterization of Dual HIV-1/HIV-2 Seropositivity and Infections in Southern Ghana.

SUMMARY BACKGROUND: Dual HIV-1/HIV-2 seropositivity (dual seropositivity) is common in West African countries including Ghana. The diagnosis of dual HIV-1/HIV-2 infections is however complicated as HIV-2 DNA is more often not detected in dual seropositive individuals. OBJECTIVES: To detect the presence of HIV-1 and HIV-2 pro-viral DNA in dual seropositives and to determine the correlation between HIV-2 antibody titers and presence of HIV-2 DNA. The growth kinetics of HIV-1 and HIV-2 in vitro were also determined using plasma and lymphocyte cultures. DESIGN: Cross-sectional study SETTING: Urban and semi-rural HIV/AIDS clinics PARTICIPANTS: 13 dual HIV-1/HIV-2 seropositives from Agomanya and Accra RESULTS: HIV-1 DNA was detected in uncultured peripheral blood mononuclear cells of all 13 patients but HIV-2 DNA in 4 (30.8%). HIV-2 antibody titres were not useful in determining the presence or absence of HIV-2 DNA (P=0.28, Mann-Whitney U test). HIV-2 specific antibody was detected in 12 of the 13 dual seropositives by peptide-inhibition, the only patient with an Innolia gp36 band rating of 1+ was shown not to be reactive. HIV-2 grew efficiently in the presence or HIV-1 in vitro. CONCLUSION: HIV-2 DNA may not be detected in all dual seropositives thus not all of such patients may need drugs effective against HIV-2. Peptide based assays will be useful for correctly diagnosing dual seropositivity. Since HIV-2 may grow efficiently in the presence of HIV-1 and no commercial HIV-2 HIV RNA tests are available, dual seropositives on HAART need to be monitored to determine if a lack of immune restoration may correspond to an efficient suppression of HIV-1 RNA levels