Nosocomial hepatitis C virus infection in a renal transplantation center

AbstractNosocomial hepatitis C virus (HCV) infections were recorded in the renal transplantation unit of the university hospital. There were cases of acute HCV infection with aggressive clinical courses diagnosed from a positive HCV RNA test in the early post-transplantation period and which remained anti-HCV negative. Their anti-HCV seronegativity was attributed to them having acquired HCV under intense immunosuppressive therapy and suggested that the aggressive clinical course could be due to the deficient immune response resulting in an inability to limit viral replication. There were also donors diagnosed as having acute HCV infection in the early post-operative period. Genotyping and sequence analysis for HCV were performed on the isolates of eight of these patients who were consecutively transplanted and of three donors whose recipients were infected with HCV prior to transplantation, and who acquired acute HCV infection after transplantation. Of the eight recipients in the first group three were genotype 1a, three were genotype 1b, one wasgenotype 3a, and the last one was genotype 4 according to Simmond's classification. Of the three donor-recipient couples both the HCV isolates from one couple were genotyped as 1b and the phylogenetic analysis indicated that the patients were infected with a common variant of HCV, but the genotypesof HCV isolates from the other couples were different. Recipients were genotype 1b and the donors were genotype 1a in these couples. Genotype results of the first group and donor-recipient couples, and sequence analysis of genotype 1b and 1a isolates, showed that the source of infection was not a unique strain and there were multiple breaks in universal precautions while managing these patients

Major decline of hepatitis C virus incidence rate over two decades in a cohort of drug users

Injecting drug users (DU) are at high risk for hepatitis C virus (HCV) and HIV infections. To examine the prevalence and incidence of these infections over a 20-year period (1985–005), the authors evaluated 1276 DU from the Amsterdam Cohort Studies who had been tested prospectively for HIV infection and retrospectively for HCV infection. To compare HCV and HIV incidences, a smooth trend was assumed for both curves over calendar time. Risk factors for HCV seroconversion were determined using Poisson regression. Among ever-injecting DU, the prevalence of HCV antibodies was 84.5% at study entry, and 30.9% were co-infected with HIV. Their yearly HCV incidence dropped from 27.5/100 person years (PY) in the 1980s to 2/100 PY in recent years. In multivariate analyses, ever-injecting DU who currently injected and borrowed needles were at increased risk of HCV seroconversion (incidence rate ratio 29.9, 95% CI 12.6, 70.9) compared to ever-injecting DU who did not currently inject. The risk of HCV seroconversion decreased over calendar time. The HCV incidence in ever-injecting DU was on average 4.4 times the HIV incidence, a pattern seen over the entire study period. The simultaneous decline of both HCV and HIV incidence probably results from reduced risk behavior at the population level

Intraocular pressure and aqueous humor flow during a euglycemic-hyperinsulinemic clamp in patients with type 1 diabetes and microvascular complications

<p>Abstract</p> <p>Background</p> <p>Microvascular complications, including retinopathy and nephropathy are seen with type 1 diabetes. It is unknown whether functional changes in aqueous humor flow or intraocular pressure (IOP) develop in parallel with these complications. This study was designed to test the hypothesis that clinical markers of microvascular complications coexist with the alteration in aqueous humor flow and IOP.</p> <p>Methods</p> <p>Ten patients with type 1 diabetes and ten healthy age- and weight-matched controls were studied. Aqueous flow was measured by fluorophotometry during a hyperinsulinemic-euglycemic clamp (insulin 2 mU/kg/min). Intraocular pressure was measured by tonometry at -10, 90 and 240 minutes from the start of the clamp, and outflow facility was measured by tonography at 240 minutes.</p> <p>Results</p> <p>During conditions of identical glucose and insulin concentrations, mean aqueous flow was lower by 0.58 μl/min in the diabetes group compared to controls (2.58 ± 0.65 versus 3.16 ± 0.66 μl/min, respectively, mean ± SD, p = 0.07) but statistical significance was not reached. Before the clamp, IOP was higher in the diabetes group (22.6 ± 3.0 mm Hg) than in the control group (19.3 ± 1.8 mm Hg, p = 0.01) but at 90 minutes into the clamp, and for the remainder of the study, IOP was reduced in the diabetes group to the level of the control group. Ocular pulse amplitude and outflow facility were not different between groups. Systolic blood pressure was significantly higher in the diabetes group, but diastolic and mean arterial pressures were not different.</p> <p>Conclusions</p> <p>We conclude that compared to healthy participants, patients with type 1 diabetes having microalbuminuria and retinopathy have higher IOPs that are normalized by hyperinsulinemia. During the clamp, a reduction in aqueous flow was not statistically significant.</p

Diagnosis of hepatitis C virus (HCV) infection and laboratory monitoring of its therapy

WOS: 000169298100012PubMed ID: 11397664Background: Just after the identification and characterization of hepatitis C virus (HCV) in 1989, tests for the detection of HCV antibodies or HCV RNA in serum were developed. The enzyme-linked immunosorbent assays (ELISAs) and confirmatory/supplemental analytical antibody tests were improved in sensitivity and specificity with the development of further generations of these assays. Application of molecular tests for detecting, quantifying, and characterization of the infecting virus became very important in management of HCV infection. Objectives and study design: This review summarizes the assays developed for the diagnosis and management of HCV infection. Strategies for the diagnosis and monitoring with the advantages and disadvantages of the assays based on the setting and goal are discussed according to data in the literature and our experience. Results: Specific laboratory diagnostic tests for hepatitis C virus infection may be discussed under two titles: (i) Serological antibody tests which detect anti-HCV in serum or plasma; (ii) Molecular tests which detect HCV RNA genome, investigate viral load, and determine the characteristics of the genome. Strategies in different laboratory settings which screen populations with different HCV prevalences vary. Conclusions: Anti-HCV positive result in a low-risk setting such as blood banks should be confirmed with an analytical antibody test. Then a HCV RNA test should be performed on serum of the person with a positive or indeterminate confirmatory test result. On the contrary, anti-HCV positive test result in high-risk population or a situation where HCV infection is suspected, it is likely to be true positive and confirmation with HCV RNA test will be significant. Quantitative HCV RNA test and genotyping should be performed if therapy is considered. (C) 2001 Elsevier Science B.V. All rights reserved

Evaluation of the agreement of results obtained from ABI PRISM 7000 and 7700 sequencers in the quantification of hepatitis B virus DNA [Hepatit B virus DNA kantitasyonunda ABI Prism 7000 ile 7700 sekans saptama cihazlarinin sonuçlarinin birbiri ile uygunlugunun araştirilmasi]

PubMed ID: 16128028There are different methods and systems for quantification of HBV-DNA in clinical virology laboratories. The aim of this study was to evaluate the agreement of the polymerase chain reaction (PCR) protocol with ABI Prism 7000 instrument (PE Biosystems) which was designed and optimised for ABI Prism 7700 (PE Biosystems). Serum samples obtained from 168 chronic hepatitis B patients were treated with "High Pure Viral Nucleic Acid Kit" (Roche Applied Science, USA), and MagnaPure LC isolation station (Roche Applied Science, Germany) was used for HBV-DNA isolation. Real time PCR procedure which amplifies pre-S gene of HBV genome was performed. Amplification and detection steps of all samples were performed with ABI Prism 7700 and 7000 Sequence Detection Systems. Among 168 samples, results of 124 serum samples were found to be in dynamic ranges of the tests. The results of these 124 samples obtained from ABI 7000 and ABI 7700 were concordant. Among the rest of 44 samples; one yielded higher than 1010 copies/mL with two of the systems; six samples gave results higher than 1010 copies/mL only with 7700; thirty samples were found negative with both of the systems; seven samples were positive (320-1220 copies/mL) with 7000 but negative with 7700. As a result this PCR protocol can be used in ABI 7000 system according to viral quality control (VQC) results. However, since the results of samples with HBV-DNA less than 1×106 copy/ml were discordant with the results obtained by ABI 7700 system, it can be concluded that different systems must not be used for the management and monitoring of the same patient

Low-dose intramuscular hepatitis B vaccination in medical students: 4-year follow-up

WOS: 000178702500010PubMed ID: 12382091Background: This is a report on the results of immunization of medical students with Low-dose hepatitis B (HB) vaccine prior to starting clinical practice and evaluation of the efficacy of this vaccination scheme. Materials and Methods: Low-dose (2 mug) recombinant HB vaccine was administered intramuscularly (im) at months 0, 1, 2 and 12 to 105 volunteers who were HB surface antigen (HBsAg) and anti-HB core antigen (HBc) negative. Additional doses were administered after the third dose to the vaccinees with anti-HBs titers below 10 IU/l. Results: Protective anti-HBs levels (above 10 IU/l) were obtained in 73.3%, 95.6%, 100% and 92.8% of vaccinees with geometric mean titers of 91, 61.6, 3,662 and 367 IU/l at months 3, 12, 13 and 44 months, respectively. Conclusion: Long-term effective protection against HB could be obtained in medical students with this scheme. Low-dose HB im vaccination can be utilized as a cost-saving vaccination strategy

Serological Markers of Hepatitis-B In Hospital Staff

SYMP ON PROGRESS IN HEPATITIS B IMMUNIZATION -- MAY 03-05, 1989 -- PALAIS CONGRES, PARIS, FRANCEWOS: A1990BQ74Q00125INSERM, WHO, MINIST SANTE FRANCE, MINIST EDUC NATL JEUNESSE & SPORTS FRANCE, MINIST COOPERAT & DEV FRANC