Sensitivity of Five Rapid HIV Tests on Oral Fluid or Finger-Stick Whole Blood: A Real-Time Comparison in a Healthcare Setting

BACKGROUND: Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV) antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. METHODS AND FINDINGS: 200 adults with documented HIV-1 (n=194) or HIV-2 infection (n=6) were prospectively screened with five HIV rapid tests using either oral fluid (OF) or finger-stick whole blood (FSB). The OraQuick Advance rapid HIV1/2 was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2, Determine HIV 1-2, Determine HIV-1/2 Ag/Ab Combo and INSTI HIV-1/HIV-2. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3%) and most were on antiretroviral therapy (68.5%). Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001). OraQuick was less sensitive on OF than on FSB (p=0.008). Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level<200 cp/ml was significantly associated with a false-negative result (p=0.009). When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI) were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p=0.04; 100%, p=0.004; and 100%, p=0.02, respectively). CONCLUSION: When evaluated in a healthcare setting, rapid HIV tests were less sensitive on oral fluid than on finger-stick whole blood and less sensitive on finger-stick whole blood than on serum

The evolution of bluetongue virus: genetic and phenotypic diversity of field strains

Bluetongue virus (BTV), the aetiological agent of bluetongue (BT), is a small (about 70 nm in diameter) icosahedral virus with a genome composed of ten linear segments of double-stranded RNA (dsRNA), which is packaged within an icosahedral nucleocapsid composed of seven structural proteins. The BTV genome evolves rapidly via genetic drift, reassortment of genome segments (genetic shift) and intragenic recombination. This evolution, and random fixation of quasispecies variants during transmission of BTV between susceptible animals and vectors appear to be the main mechanism leading to the observed genetic diversity amongst BTV field strains. The individual BTV gene segments evolve independently of one another by genetic drift in a host-specific fashion, generating quasispecies populations in both ruminant and insect hosts. Reassortment of BTV genes is responsible for genetic shift among strains of BTV, and has been demonstrated after infection of either the ruminant host or insect vector with different strains or serotypes of BTV. Intragenetic recombination, whereby mosaic genes are generated from the “splicing” together of homologous genes from different ancestral viral strains, has been demonstrated for BTV. The genetic variation of BTV is likely responsible for differences in the virulence and other phenotypic properties of individual field strains of the virus

Bluetongue in Europe and the role of wildlife in the epidemiology of disease

The article reviews a current bluetongue (BT) epidemiological situation in Europe, BT restricted zones and the role of wild ungulates as a reservoir for bluetongue virus (BTV) and its transmission. BT has been eradicated from central and northern Europe, however it is still circulating in some regions of southern and south-eastern Europe. According to the recent information of the Directo-riate General for Health and Consumer Affairs (DG SANCO) disease caused by BTV1 was spreading at the beginning of 2014 in Corsica (France). Moreover, four BTV1 cases were noticed in the west Spain (Cáceres province), 59 BTV4 outbreaks in south Spain (Andalusia), 10 in the region of Algarve in Portugal and about 200 outbreaks of BTV4 in Greece (Peloponesse and Evros regions). On 4th July the first outbreak of BTV4 was also confirmed at the south Bulgarian border and by 5th September 2014 disease was noticed in 21 of 28 administrative districts of Bulgaria. In August 2014 the BTV4 disease was reported in south-east of Romania and as for 8th September 184 outbreaks of BT were confirmed in 17 counties of this country. As of 3 September 2014 in Europe there has been fourteen BT-affected zones, in different regions of Italy, Spain, Portugal, Cyprus, Malta, France (Corsica), Greece, Bulgaria and Romania. Most species of wild ruminants and camelids are susceptible to BTV infection, although frequently asymptomatically. Wild sheep, bighorn and mouflon, are susceptible to BTV infection and can develop fatal clinical disease, as do domestic sheep. Experimental or natural infection of antelope, wapiti, musk, ox, bison, yak, white-tailed deer and African buffalo also produced clinical disease, whereas blesbock, mountain gazelle, roe deer, red deer and Eurasian elk did not show clinical sign after natural or experimental infection and infection was recognized by the presence of BTV viral RNA or specific antibodies. The wildlife due to the long-term carrier state may act as a reservoir for BTV and play an important role in its transmission

Evaluation of commercial ELISA kits for the detection of antibodies against bluetongue virus

The aim of this study was to estimate the diagnostic value of different commercially available ELISA kits for the detection of bluetongue virus (BTV) antibodies in infected and vaccinated animals. The relative specificity of ELISA kits was evaluated using a panel of sera originating from healthy cattle, never vaccinated nor exposed to BTV. All ELISA kits applied had a high relative specificity (99.3 - 100%). The relative sensitivity of ELISA kits assessed using a panel of sera collected from BTV infected cattle was also high and similar for all the kits (97.3 - 100%). However, the relative sensitivity evaluated on the basis of testing vaccinated animals was different: the highest sensitivity was found for Ingenasa, PrioCHECK and ID VET ELISAs (96.5 - 98.3%). Slightly lower sensitivity was calculated for Pourquier and LSI kits (82.8% and 85.4%, respectively) and much lower sensitivity was found for VMRD ELISA kit (69.5%). The repeatability of BTV ELISA kits was expressed as a coefficient of variation (CV) of results of sera tested 5 times in the same day and in different days by the period of 2 months, by the same person, in the same conditions, and by using the same equipment. The CVs of sera tested in all ELISA kits ranged from 6.1 to 9.8% and were below 10% threshold adopted as a maximum for the acceptable repeatability of the method. In conclusion, it can be stated that the applied ELISA kits can be a valuable diagnostic tool for the serological monitoring studies in the BTV contaminated premises. All the methods are very specific and sensitive when testing BTV infected animals. Nevertheless, the Ingenasa and PrioCHECK can be the most useful in sero-surveillance of livestock following vaccination

Bluetongue vaccines in Europe

The article reviews the history, present status and the future of BT vaccines in Europe. So far, an attenuated (modified live viruses, MLV) and inactivated virus vaccines against BT were developed and used in the field. Moreover, the virus-like particles (VLPs) produced from recombinant baculovirus, and live recombinant vaccinia or canarypox virus-vectored vaccines were tested in the laboratory. The main aims of BT vaccination strategy are: to prevent clinical disease, to reduce the spread of the BTV in the environment and to protect movement of susceptible animals between affected and free zones. Actually, all of the most recent European BT vaccination campaigns have used exclusively inactivated vaccines. The use of inactivated vaccines avoid risk associated with the use of live-attenuated vaccines, such as reversion to virulence, reassortment of genes with field strain, teratogenicity and insufficient attenuation leading to clinical disease. The mass vaccinations of all susceptible animals are the most efficient veterinary method to fight against BT and successful control of disease. The vaccination of livestock has had a major role in reducing BTV circulation and even in eradicating the virus from most areas of Europe

Serological survey for RHD antibodies in rabbits from two types of rabbit breeding farms

Seroprevalence studies of RHDV antibodies in domestic rabbits were conducted between 2008-2014. A total of 12,169 sera from the provinces of central, southern and south-east Poland, including 7,570 samples collected from mixed-breed rabbits reared in smallholder farms and nearly 4,600 sera taken mainly from unvaccinated rabbits kept in industrial farms, were examined using ELISA tests. Additionally, cross-reactivity of selected tested and control archival sera using both classic RHDV and RHDVa antigens was determined by HI assay. The overall seroprevalence was 13.3%. In rabbits with unkown history of immunisation or RHD infection which came from small farms, RHDV antibodies were detected in 6.1% ranging between 1.0% to 17.2% of animals. In rabbits of the same group, but with a declared vaccination status, or confirmed exposure to an infectious virus, or coming from exposed females, the seroprevalence ranged from 83% to 100%. Among unvaccinated meat rabbits aged 71 to 90 days from industrial farms, low (1.85%, 4.17%, 11%), medium (34%, 54%) or high rates (98.7%) of seropositivity were detected. The seroconversion recorded in adult vaccinated females from industrial farms was 70% and 95%. Generally, the antibody levels examined by ELISAs and HI were comparable. However, a number of sera from the rabbits from small farms, as well as archival sera, showed clear differences. Several-fold differences in antibody titers, evidenced mainly in the postoutbreak sera, indictaed the contact of animals with RHDVa antigen. The overall results of the survey revealed a great proportion of seronegative rabbits potentially highly susceptible to RHD infection. In combination with the emergence of a novel pathogenic RHD virus type (RHDV2), it poses a severe risk of a next wave of fatal disease cases spreading in the native population of domestic rabbits, especially in farms with a traditional system of husbandry

Identification of Polish RHDVa subtype strains based on the analysis of a highly variable part VP60 gene

In order to determine the genetic variability of Polish RHD virus strains and to confirm the presence of genetic variant (RHDVa) subtype the partial nucleotide sequences of capsid protein gene, including two highly variable regions C and E, were examined. Phylogenetic analyses of 15 viral strains obtained over 18 years revealed the presence of three genetic groups. The oldest RHDV strains exhibit very close amino acid sequence similarity (98-99%) to the German FRG89 reference strain and most of European strains of the same period, as well as Chinese isolate from 1984. The HA-negative strains and isolates with variable reactivity in the HA test belong to the second subgroup and exhibit an intermediate level of variability (about 3%) in the analysed VP60 gene fragment. The most genetically variable strains (6-7%) clustered to RHDVa subtype. The analysis of nucleotides and amino acid sequences demonstrated three pairs of well conserved RHDV strains, isolated over 3, 6 and 10-year period