Towards Targeted Screening for Acute HIV Infections in British Columbia

Background: Our objective was to describe the characteristics of acute and established HIV infections diagnosedin the Canadian province of British Columbia. Province-wide HIV testing and surveillance data were analyzed toinform recommendations for targeted use of screening algorithms to detect acute HIV infections.Methods: Acute HIV infection was defined as a confirmed reactive HIV p24 antigen test (or HIV nucleic acid test), anon-reactive or reactive HIV EIA screening test and a non-reactive or indeterminate Western Blot. Characteristics ofunique individuals were identified from the British Columbia HIV/AIDS Surveillance System. Primary drug resistanceand HIV subtypes were identified by analyzing HIV pol sequences from residual sera from newly infectedindividuals.Results: From February 2006 to October 2008, 61 individuals met the acute HIV infection case definition,representing 6.2% of the 987 newly diagnosed HIV infections during the analysis period. Acute HIV infection caseswere more likely to be men who have sex with men (crude OR 1.71; 95% CI 1.01-2.89], to have had a documentedprevious negative HIV test result (crude OR 2.89; 95% CI 1.52-5.51), and to have reported a reason for testing dueto suspected seroconversion symptoms (crude OR 5.16; 95% CI 2.88-9.23). HIV subtypes and rates of transmitteddrug resistance across all classes of drugs were similar in persons with both acute and established HIV infections.Conclusions: Targeted screening to detect acute HIV infection is a logical public health response to the HIVepidemic. Our findings suggest that acute HIV infection screening strategies, in our setting, are helpful for earlydiagnosis in men who have sex with men, in persons with seroconversion symptoms and in previously negativerepeat testers

Vaginose bacteriana, história obstétrica e antecedentes sexuais como fatores preditivos para o trabalho de parto pré-termo : um estudo caso-controle /

Orientador: Flávio de Queiroz Telles FilhoCo-orientadores: Newton Sérgio de Carvalho e Aníbal FaúndesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa: Curitiba, 2005Inclui bibliografia e anexo

Detection of Early Sero-Conversion HIV Infection Using the INSTITM HIV-1 Antibody Point-of-Care Test

We compared the INSTITM HIV-1 Antibody Point-of-Care (POC) Test to laboratory-based tests for detection of early sero-conversion (i.e. acute) HIV infections. Fifty-three (53) individuals with early HIV infection, (i.e. 3rd generation anti-HIV EIA non-reactive or reactive, HIV-1 Western Blot non-reactive or indeterminate and HIV-1 p24 antigen reactive) were tested by INSTITM. The INSTITM test was reactive for 34/49 (sensitivity 69.4%; 95% confidence interval 54.6-81.8%) early-infected individuals whose laboratory-based 3rd generation HIV EIA test was reactive. Four (4) were non-reactive by both the laboratory-based EIA and INSTITM tests, but were p24 antigen reactive. The INSTITM POC test performs well compared with other POC tests for the detection of early sero-conversion HIV infection, but it may miss 20% to 30% of those detected by laboratory-based 3rd generation anti-HIV tests. Both POC and laboratory-based anti-HIV tests will fail to detect a proportion of infected individuals in the first weeks after infection

Modeling Control Strategies of Respiratory Pathogens

Contact network epidemiology can provide quantitative input even before pathogen is fully characterized

Stable hepatitis C virus RNA detection by RT-PCR during four days storage

BACKGROUND: Suboptimal specimen processing and storage conditions of samples which contain hepatitis C virus (HCV) RNA may result in a decline of HCV RNA concentration or false-negative results in the detection of HCV RNA in serum. We evaluated the stability of HCV RNA in serum and clotted blood samples stored at room temperature or at 4°C for 4 days with the aim of optimizing the standard procedures of processing and storage of samples. METHODS: Blood from five HCV RNA positive patients was collected in tubes with and without separator gel, centrifuged 1 or 6 hours after collection. Samples were then left 6, 24, 48, 72 or 96 h at room temperature (21.5 – 25.4°C) or at 4°C before determining their HCV RNA level using the COBAS AMPLICOR HCV MONITOR Test, vs 2.0 (Roche Diagnostic Systems). RESULTS: The logarithm of the HCV RNA level measurements remained within a 0.3 value of the means for 4 days at both temperatures (room temperature or 4°C). CONCLUSIONS: We conclude that blood samples may be collected and aliquoted within 6 h of collection and can be stored at 4°C for 72 hours as proposed by the manufacturer without significant differences in measured HCV RNA level. Our results indicate that lapses in this scheme may still yield reliable results

Hepatitis C cross-genotype immunity and implications for vaccine development.

While about a quarter of individuals clear their primary hepatitis C (HCV) infections spontaneously, clearance (spontaneous or treatment-induced) does not confer sterilizing immunity against a future infection. Since successful treatment does not prevent future infections either, an effective vaccine is highly desirable in preventing HCV (re)infection. However, development of an effective vaccine has been complicated by the diversity of HCV genotypes, and complexities in HCV immunological responses. Smaller studies on humans and chimpanzees reported seemingly opposing results regarding cross-neutralizing antibodies. We report a lack of cross-genotype immunity in the largest cohort of people to date. In the adjusted Cox proportional hazards model, reinfection with a heterologous HCV genotype (adjusted Hazard Ratio [aHR]: 0.45, 95% CI: 0.25-0.84) was associated with a 55% lower likelihood of re-clearance. Among those who cleared their first infection spontaneously, the likelihood of re-clearance was 49% lower (aHR: 0.51, 95% CI: 0.27-0.94) when reinfected with a heterologous HCV genotype. These findings indicate that immunity against a particular HCV genotype does not offer expanded immunity to protect against subsequent infections with a different HCV genotype. A prophylactic HCV vaccine boosted with multiple HCV genotype may offer a broader and more effective protection

Characteristics of gay, bisexual and other men who have sex with men with multiple diagnoses of infectious syphilis in British Columbia, Canada, 2005-2014

Background: Infectious syphilis has increased substantially over the past decade. Targeting limited public health resources toward subpopulations with multiple reinfections may have a large impact in reducing onward transmission within a community. Methods: A chart review was conducted for individuals with 4 or more infectious syphilis diagnoses between 2005 and 2014 (the top 1% of all syphilis diagnoses in British Columbia, Canada). We characterized the sociodemographics, partner notification outcomes and social network. Results: Between 2005 and 2014, there were 30 individuals with 4 or more syphilis diagnoses, accounting for 139 diagnoses. All were men who have sex with men and 29 (96%) were human immunodeficiency virus–positive. Of the 139 diagnoses, 65% occurred in the early latent stage of infection, 22% in the secondary stage, and 14% in the primary stage. The median number of sexual partners per diagnosis was 5 (range, 1–50). Among the 838 partners reported, 79% were notifiable, 53% were notified, and 23% were reported to be tested or treated. Sexual network mapping showed that almost half of the members of this group could be linked to one another either directly or indirectly via partners over 10 years. Social network mapping demonstrated high connectivity, with 4 venues associated with almost two thirds of the study population. Conclusions: The connectivity and recurrent diagnoses in this study population suggest potential benefits of targeted interventions to individuals with multiple diagnoses and their partners. Our study highlights the need for enhanced care, increased syphilis testing frequency, and exploring alternative preventative methods among individuals with syphilis rediagnoses to reduce syphilis incidence

Fungaemia due to Cryptococcus laurentii and a review of non- neoformans cryptococcaemia

Cryptococcus laurentii is one of several non- neoformans cryptococci that have rarely been associated with human infection. The spectrum of clinical infection due to non- neoformans species ranges from skin lesions to fungaemia. Most cases of non- neoformans fungaemia have been noso-comially acquired and have been associated with indwelling intravascular catheters and neutropenia. Limited data on in vitro susceptibilities of non- neoformans cryptococci show these species to be more resistant to fluconazole and flucytosine than most Cr. neoformans. Two such cases are presented here. Zusammenfassung . Cryptococcus laurentii ist eine von mehreren nicht- neofomans-Cryptococcus -Arten, die selten mit Krankheiten am Menschen in Zusammenhang gebracht werden. Das Spektrum durch Nicht- neoformans -Arten bedingter klinischer Infektionen reicht von HautlÄsionen bis zur FungÄmie. Die Mehrzahl der FÄlle von nicht- neoformans -FungÄmie waren nosokomial bedingt und mit intravasalen Dauerkathetern und Neutropenie assoziiert. Die wenigen Daten Über In-vitro-SuszeptibilitÄt von Non- neoformans -Arten fÜr Fluconazol und Flucytosin sprechen dafÜr, daß diese Arten resistenter als die meisten Cr. neoformans-StÄmme sind. Zwei solcher FÄlle werden vorgestellt.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72398/1/j.1439-0507.1998.tb00338.x.pd