Anne-Marie Couroucé

Efficacy of HCV core antigen detection during the preseroconversion period.

BACKGROUND: The purpose of this study was to compare the performances of HCV core antigen (HCV Ag) testing with HCV RNA detection during the preseroconversion period.

Trends in residual risk of transfusion-transmitted viral infections in France between 1992 and 2000

BACKGROUND : Monitoring trends in residual risks of transfusion‐transmitted viral infections (HIV, HTLV, HBV, and HCV) is important to assess improvements in blood safety. In France, theses trends were analyzed between 1992 and 2000.

Anti‐hepatitis C virus (anti‐HCV) seroconversion in patients undergoing hemodialysis: comparison of second‐ and third‐generation anti‐HCV assays

BACKGROUND: The results obtained in sequential specimens from recently infected subjects generally provide the best means of comparing the sensitivity of assays.

Increasing diversity of Hiv-1m serotypes in French blood donors over a 10-year period (1985–1995)

Objective:Phylogenetic analysis of gene sequences of HIV-1 has led to the classification of isolates into a major group (M) of viruses, itself divided into subtypes (A to I), and a minor group (O) of rare isolates. Subtype B viruses are the most prevalent in Western countries but little is known about the dynamics of diffusion of the other subtypes in these regions. The prevalence of B subtypes and non-B subtypes in French blood donors between 1985 and 1995 was evaluated. Methods:A retrospective study was conducted in 490 blood donors, identified as positive for antibody to HIV-1, by twelve French blood banks between 1985 and 1995. Serological subtyping was performed with a subtype-specific enzyme immunoassay, the reliability for genotyping of which has been demonstrated previously. Results:Of 450 typable samples, 48 (10.7%) were non-B subtypes. Non-B reactive samples were found in all of the regions. An increasing prevalence of individuals infected by non-B viruses was observed, from approximately 4% in the early period to more than 20% in 1994–1995 (P = 0.0004). Non-B viruses did not appear to be restricted to patients with direct or indirect epidemiological links to non-European populations. Conclusion:We observed an increasing diversity of HIV-1 strains in the population of blood donors residing in France. This stresses the necessity to broaden the surveillance of HIV-1 diversity in order to improve measures to prevent HIV-1 infections.

Outbreak of hepatitis C virus infection in a hemodialysis unit: potential transmission by the hemodialysis machine?

OBJECTIVE To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit. DESIGN A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit. SETTING A hemodialysis unit treating an average of 90 patients. PATIENTS A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient. RESULTS HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit. CONCLUSIONS The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.

Randomised placebo-controlled trial of recombinant interleukin-2 in chronic uraemic patients who are non-responders to hepatitis B vaccine

Natural interleukin-2 at low dose has been reported to overcome the non-responsiveness of patients with chronic uraemia to hepatitis B vaccine. Therefore, we revaccinated 52 previous such non-responders (24 on maintenance dialysis) with 20 micrograms of recombinant preS2-containing hepatitis B vaccine with human recombinant interleukin-2 (1 MU) or placebo (randomly allocated). Seroconversion rates (74 vs 80%, respectively) and proportion of patients who elicited anti-HBs titres of 10 mlU/mL or more (56 vs 68%) were similar in both groups. Our results do not confirm local injection of interleukin-2 as an effective immunoadjuvant to hepatitis B vaccine in uraemic patients.

Seroepidemiology of HTLV-I/II in universal screening of blood donations in France.

ObjectiveTo evaluate the serological and epidemiological characteristics of HTLV-I/ll-positive Wood donors in continental France during the first 6 months of universal screening of blood donations (n = 1 816927). MethodA collaborative investigation of all confirmed anti-HTLV-I/II-positive samples reported by blood transfusion centres was performed. Seventy-three out of 77 reported samples were retested at two reference laboratories. Epidemiological data on risk factors were compiled. ResultsOf the 73 retested samples, 66 were confirmed to be HTLV-I-positive and one to be HTLV-II-positive; six samples were designated false-positive, mainly because of non-specific reactivity to recombinant gp21 in Western blot. The overall prevalence of HTLV-I/II in continental France is 0.039 per thousand. The main risk factor identified for HTLV-I infection was directly (origin) or indirectly (heterosexual contact) linked to endemicity in the Caribbean. The cost per case of avoided contamination in the 6-month period of this study was 1.36 million French francs. ConclusionSixty-two per cent of HTLV-I/II-infected blood donations would not have been discarded through the previous targeted HTLV screening or through other mandatory tests, including anti-hepatitis B core. To avoid false-positive results, we propose a new algorithm of diagnosis.

AUTOIMMUNE HAEMOLYTIC ANAEMIA REVEALED BY HUMAN PARVOVIRUS LINKED ERYTHROBLASTOPENIA

SIR,-Human parvovirus (HPV) infection can induce transient and intense erythroblastopenia in patients with haemolytic anaemia. This has been reported in the context of homozygous sickle cell disease, hereditary spherocytosis, and homozygous 0 thalassaemia, for example, but not, as far as we know, in autoimmune haemolytic anaemia. A 12-year-old boy was admitted to 1’Hopital Saint-Louis on Jan 7 1985, with fever and anaemia. He had a malformation of the left pulmonary artery (detected at age 4), and jaundice in August, 1984, had resolved spontaneously. The fever was associated with vomiting, abdominal pain, and conjunctival subicterus. The child was very pale and has an enlarged liver and spleen. There were no enlarged lymph nodes and no signs of meningitis; nor did he have a rash nor haemorrhage. He was anaemic (figure). The anaemia was macrocorpuscular, non-regenerative, and without schizocytes or spherocytes. Neutrophil, lymphocyte, and platelet counts were also low. His non-conjugated bilirubin level was 13 imol/1 (conjugated 2 mol/1). A bone marrow smear (Jan 8) revealed erythroblastopenia (3%) with normal granulocytic maturation (60%); megakaryocytes were present but rare and there were no abnormal cells. The pancytopenia and erythroblastic marrow prompted immunological and viral investigations which revealed recent HPV infection (anti-HPV positive on counter immunoelectrophoresis

Frequency and prognostic importance of thrombocytopenia in symptom-free HIV-infected individuals: a 5-year prospective study.

The exact frequency of HIV-associated thrombocytopenia (TCP), defined as platelet count <150 ± 109/1, was studied in 435 symptom-free HIV-seropositive individuals. At the baseline control, 23 (5.5%) had TCP. TCP individuals had a significantly lower mean CD4 lymphocyte count than the non-TCP individuals. During a mean follow-up of 30 months, 79 out of the 435 individuals (18%) had TCP at least once. During the study period, only 1% of our patients had a platelet count <50 ± 109/1. TCP was more frequent in intravenous drug users than in other risk groups. A spontaneous normalization of platelet count was observed in more than 50% of TCP individuals.

Six cases of hereditary spherocytosis revealed by human parvovirus infection

Summary Recent research has shown that the human parvovirus is a causative agent of aplastic crisis in hereditary haemolytic anaemias. We report six cases—four children and two adults—of hereditary spherocytosis revealed by aplastic crisis due to human parvovirus infection.