Factors associated with the continuum of care of HIV infected patients in Belgium

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Decision tree for accurate infection timing in individuals newly diagnosed with HIV-1 infection

Background: There is today no gold standard method to accurately define the time passed since infection at HIV diagnosis. Infection timing and incidence measurement is however essential to better monitor the dynamics of local epidemics and the effect of prevention initiatives. Methods: Three methods for infection timing were evaluated using 237 serial samples from documented seroconversions and 566 cross sectional samples from newly diagnosed patients: identification of antibodies against the HIV p31 protein in INNO-LIA, SediaTM BED CEIA and SediaTM LAg-Avidity EIA. A multi-assay decision tree for infection timing was developed. Results: Clear differences in recency window between BED CEIA, LAg-Avidity EIA and p31 antibody presence were observed with a switch from recent to long term infection a median of 169.5, 108.0 and 64.5 days after collection of the pre-seroconversion sample respectively. BED showed high reliability for identification of long term infections while LAg-Avidity is highly accurate for identification of recent infections. Using BED as initial assay to identify the long term infections and LAg-Avidity as a confirmatory assay for those classified as recent infection by BED, explores the strengths of both while reduces the workload. The short recency window of p31 antibodies allows to discriminate very early from early infections based on this marker. BED recent infection results not confirmed by LAg-Avidity are considered to reflect a period more distant from the infection time. False recency predictions in this group can be minimized by elimination of patients with a CD4 count of less than 100 cells/mm3 or without no p31 antibodies. For 566 cross sectional sample the outcome of the decision tree confirmed the infection timing based on the results of all 3 markers but reduced the overall cost from 13.2 USD to 5.2 USD per sample. Conclusions: A step-wise multi assay decision tree allows accurate timing of the HIV infection at diagnosis at affordable effort and cost and can be an important new tool in studies analyzing the dynamics of local epidemics or the effects of prevention strategies

Transmitted drug resistance, selection of resistance mutations and moderate antiretroviral efficacy in HIV-2: Analysis of the HIV-2 Belgium and Luxembourg database

BACKGROUND: Guidelines established for the treatment of HIV-1 infection and genotype interpretation do not apply for HIV-2. Data about antiretroviral (ARV) drug efficacy and resistance mutations is scarce. METHODS: Clinical data about HIV-2 infected patients in Belgium and Luxembourg were collected and the effect of ARV therapy on plasma viral load and CD4 counts were analysed. Viral RNA encoding for protease (PR) and reverse transcriptase (RT) from ARV-naive and treated patients were sequenced. RESULTS: Sixty-five HIV-2 infected patients were included in this cohort. Twenty patients were treated with 25 different ARV combinations in a total of 34 regimens and six months after the start of ARV therapy, only one third achieved viral load suppression. All of these successful regimens bar one contained protease inhibitors (PIs). Mean CD4 gains in the group of viral load suppressors and the group of patients treated with PI-containing regimens were respectively significantly higher than in the group of non-suppressors and the group of PI-sparing regimens. The most frequent mutations selected under therapy (compared to HIV-2 ROD) were V71I, L90M and I89V within PR. Within RT, they were M184V, Q151M, V111I and K65R. All of these mutations, except K65R and M184V, were also found in variable proportions in ARV-naive patients. CONCLUSION: Despite a high rate of ARV treatment failure, better virological and immunological results were achieved with PI-containing regimens. The analysis of polymorphic positions and HIV-2 specific mutations selected during therapy showed for the first time that transmission of drug resistant viruses has occurred in Belgium and Luxembourg. The high heterogeneity in ARV combinations reflects a lack of guidelines for the treatment of HIV-2 infection

De l'utilité ou non de la sérologie infectieuse: morceaux choisis.

Serology testing allows the determination of immunity against different infecting organisms via the dosage of IgG. When the direct detection of a pathogen is not possible, detection of specific IgM antibodies or antigens may also help to diagnose an acute infection. This article describes the usefulness of serological testing for the diagnosis or the follow-up of some infectious pathologies: Lyme disease, sexually transmitted diseases (STD) and Epstein-Barr virus (EBV). Serological diagnosis of Lyme disease is difficult. Results must always be interpreted in correlation with clinical symptoms: on the one hand, the presence of antibodies could be correlated either with a recent or a past infection; and on the other hand, sensitivity of Lyme serology is low in the early stages. Concerning STD, the direct detection of the pathogen must be preferred for Herpes simplex, Chlamydia, mycoplasma and gonorrhoea infections. For detection of HIV, HCV, HBV and syphilis, serological testing is the method of choice. The diagnosis of infectious mononucleosis is based on the detection of specific EBV IgM antibodies and should be preferred to the detection of heterophilic antibodies such as Paul and Bunnel test. EBV reactivation are very rare in immunocompetent patients, but can occur in immunocompromised, particularly transplanted patients and can lead to a lymphoproliferative disorder. Surveillance of these patients can be followed with the monitoring of EBV viral load. Serological testing in this case is generally not useful.English AbstractJournal ArticleSCOPUS: sh.jinfo:eu-repo/semantics/publishe

De l’utilité de la sérologie infectieuse: morceaux choisis

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Infection congénitale à cytomégalovirus :Amélioration des techniques diagnostiques sérologiques de l’infection maternelle et étude de marqueurs virologiques maternels de transmission materno-fœtale

L’infection congénitale à cytomégalovirus (CMV) représente l’infection congénitale la plus fréquente et est la cause principale de retard mental acquis et de déficience auditive neurosensorielle d’origine infectieuse chez le nouveau-né. Le risque de transmission au fœtus en cas de primo-infection maternelle est de 30 à 40%, et d’environ 1.4% chez les femmes séropositives pour le CMV avant la grossesse. L’analyse de la littérature montre que de nombreuses questions subsistent dans le domaine du CMV congénital. Le screening sérologique des femmes enceintes n’est pas systématique, entre autres à cause des difficultés fréquentes d’interprétation sérologique et des possibilités limitées de prévention et de traitement de l’infection fœtale. L’amélioration du diagnostic sérologique de l’infection à CMV est donc une étape importante dans la prise en charge des femmes enceintes. Dans la première partie de notre travail, nous avons montré les bonnes performances des tests automatisés LIAISON®CMV IgG II, LIAISON®CMV IgM II and LIAISON®CMV IgG Avidity II tant en prospectif sur des échantillons de routine que sur des sérums sélectionnés avec date de primo-infection connue. Ces nouveaux tests sont donc utiles pour le diagnostic de la primo-infection à CMV et la détermination du statut immunitaire, avec l’avantage d’une automatisation complète. Cependant, dans 18% des cas, la mesure de l’avidité des IgG se situe dans une zone intermédiaire ne permettant pas de dater l’infection. Dans la deuxième partie de ce travail, nous avons évalué les capacités des immunoblots Mikrogen recomLine CMV IgG and IgG Avidity à dater une infection primaire en utilisant des sérums pour lesquels la date de primo-infection à CMV est précisément connue, et montré que ces tests donnent une interprétation correcte dans 83.1%, un résultat incorrect dans 4.5% et un résultat non concluant dans 12.4% des cas. En particulier, la combinaison des tests Mikrogen montre une meilleure sensibilité à diagnostiquer une infection <14 semaines comparé au test VIDAS IgG Avidity (85.96% vs 76.92%). Sur un second panel d’échantillons avec une avidité des IgG VIDAS intermédiaire, ces nouveaux tests ont apporté une information complémentaire quant à la datation de la primo-infection dans 79% (70/89) des cas. L’impact clinique direct est prometteur :une analyse préliminaire sur 10 femmes enceintes de moins de 14 semaines d’âge gestationnel avec une sérologie difficile à interpréter, montre que ces tests ont permis d’éviter une amniocentèse chez 5 d’entre elles.Enfin, lorsqu’un diagnostic de primo-infection maternelle à CMV est posé ou suspecté chez une femme enceinte, nous manquons de marqueurs prédictifs de transmission materno-fœtale non invasifs pour la grossesse. Dans la troisième partie de notre travail, sur une cohorte de 150 femmes enceintes présentant une primo-infection, nous avons montré que la présence de CMV dans le sang et les urines maternelles est corrélée avec la transmission verticale et que la charge virale urinaire est plus élevée chez les femmes transmetteuses. Ces marqueurs virologiques peuvent être utiles dans l’évaluation du risque de transmission en cas de primo-infection maternelle mais nécessitent des études sur de plus larges cohortes afin de confirmer ces résultats et d’établir un seuil quantitatif.Doctorat en Sciences biomédicales et pharmaceutiques (Médecine)info:eu-repo/semantics/nonPublishe

Evaluation of Liaison Toxoplasma IgG and IgM: comparison with VIDIA and Architect assays

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Fulminant myocarditis with dramatic response to corticoids.

A 47-year-old healthy man developed acute fulminant coxsackie BI myocarditis with cardiogenic shock and extreme elevation of NT-pro-BNP (82585 pg/ml). He had a dramatic and rapid improvement within the following days after administration of corticoids on top of dobutamine and classic treatment.Case ReportsJournal Articleinfo:eu-repo/semantics/publishe

Evaluation of the Bio-Rad Geenius HIV-1/2 test as a confirmatory assay

Objectives: We have evaluated the recently Conformité Européenne (CE)-marked Bio-Rad Geenius human immunodeficiency virus (HIV)1/2 as a rapid and simple alternative to western blot for confirmation of HIV screening results. Methods: A total of 160 serum samples were tested: 44 HIV-1 reactive samples by a fourth-generation Murex HIV Ag/Ab and/or Vidas HIV Duo Ultra, five HIV-2 reactive samples, 15 HIV-1 non-B subtype samples and 11 confirmed HIV-1 early seroconversion samples, 72 nonreactive samples, eight indeterminate samples by MP HIV BLOT 2.2 confirmed negative after follow-up and five low-reactive samples by enzyme immunoassay (EIA) negative by MP HIV BLOT 2.2. The samples were tested according to the manufacturer's guidelines. Results: The overall sensitivity for Bio-Rad Geenius HIV1/2 assay was 92%. Five out of 11 early seroconversion samples were tested positive, four negative and two indeterminate. All HIV-1 non-B subtype samples were tested positive. Two out of the five HIV-2 reactive samples were tested positive HIV-2, two positive HIV-2 with HIV-1 cross-reaction and one HIV positive untypable. After excluding early seroconversion samples, the sensitivity of Bio-Rad Geenius HIV1/2 assay reached 100%. Overall specificity was 96%. All HIV negative serums by fourth-generation EIA were tested negative. All five low-reactive samples by EIA, negative by HIV BLOT 2.2 were tested negative by Bio-Rad Geenius HIV1/2. Two out of the eight indeterminate samples by MP HIV BLOT 2.2 that were confirmed negative after follow-up were tested indeterminate and one invalid, the other five were negative. After excluding these last 13 samples, the specificity of Bio-Rad Geenius HIV1/2 assay reached 100%. In comparison with MP HIV BLOT 2.2, the Bio-Rad Geenius HIV1/2 assay was markedly time saving, allowed full traceability, automatic reading and interpretation. Conclusions: The Bio-Rad Geenius HIV1/2 confirmatory system represents a reliable alternative to other confirmatory assays in HIV testing algorithms and provides clear improvement in quality management. © 2014 Elsevier B.V.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Evaluation of Liaison Biotrin Parvovirus B19 kits for antibodies IgG and IgM detection

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