Christiane Gerard

Delayed massive immune hemolysis mediated by minor ABO incompatibility after allogeneic peripheral blood progenitor cell transplantation

BACKGROUND: Bone marrow transplantation with minor ABO incompatibility may be followed by moderate delayed hemolysis of the recipients red cells by donor‐derived ABO antibodies. This reaction may be more severe after transplantation of peripheral blood progenitor cells (PBPCs).

Treatment of acute hepatitis C with interferon alpha-2b: early initiation of treatment is the most effective predictive factor of sustained viral response

Aim : To evaluate the efficacy of early interferon α‐2b in non‐post‐transfusion acute hepatitis C virus: a prospective study with historical comparison.

Hepatitis C virus genotype 5 in southern Belgium: Epidemiological characteristics and response to therapy

Data are scarce on patients infected with hepatitis C virus of genotype 5, due to the low prevalence of this genotype around the world. To better define the characteristics of these patients, we reviewed the files of 16 genotype 5 patients. Mean age was 38 ± 14. All patients were of European origin. Most of them (75%) had been contaminated by transfusion within a short time period (between 1980 and 1991). There were no intravenous drug addicts. Seven patients received treatment. One patient did not respond to interferon (IFN) monotherapy. Of four patients treated with IFN and ribavirin, three became sustained viral responders. Two patients treated with pegylated IFN and ribavirin became sustained viral responders. In our region, genotype 5 patients seem to have been contaminated within a relatively short time period. Treatment with IFN or pegylated IFN and ribavirin gave a high rate (83%) of sustained viral responses.

Epidemiological profiles of human immunodeficiency virus and hepatitis C virus infections in Malian women: Risk factors and relevance of disparities.

AIM To document the epidemiologic patterns and risk factors of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections in Mali in order to develop prevention means for both diseases. METHODS Two prospective studies were conducted in Bamako in 2009 among 1000 pregnant women (i.e., young women) who consulted six reference health centers, and in 2010, among 231 older women who attended general practice in two hospitals. Antibody tests and molecular analysis (performed only for HCV) were used to quantify the frequencies of both infections. The data were collected from patients recruited through a questionnaire. Transmission risk factors of both diseases were identified by univariate and multivariate analysis. RESULTS HCV seroprevalence was 0.2% for young and 6.5% for older women. HIV prevalence was similar in both populations (4.1% vs 6.1%). In older women, the analysis of risk factors highlighted an association between HCV infection and episodes of hospitalization (P < 0.01). The study did not show an association between HIV infection and the variables such as hospitalization, transfusion, tattoo, dental care, and endoscopy. A significant decrease of HIV seroprevalence was detected in young women who used condoms for contraception more than for other purposes (P < 0.01). By contrast, HIV seroprevalence was significantly increased in young women using condoms mainly to prevent sexual infections rather than for contraception (P < 0.01). No HCV/HIV coinfection was detected in our study. CONCLUSION Risk factors and epidemiologic data of HIV and HCV as well as the absence of co-infection strongly suggest epidemiological disparities between these diseases.

Hepatitis C virus transmission following invasive medical procedures

D S, Hepatitis C represents a major public health problem due to its prevalence and high incidence of chronic disease. Until now, most reported cases of hepatitis C infection have been associated with intravenous drug abuse or administration of untested blood products; many fewer cases have resulted from sexual or vertical transmission. In 40% of patients, however, the mode of viral transmission remains unknown. For some of these, a nosocomial origin has been suggested [1–3], with particular attention paid to transmission by gastrointestinal endoscopy [4–6]. However, the number of reported cases of patient-to-patient transmission associated with invasive medical procedures (IMPs) remains very low. Between 1994 and 1997, we diagnosed 20 cases of acute, icteric hepatitis C, nine of which were attributable to invasive medical procedures. Although sequencing or genotyping were not carried out to confirm the identity of the viral strains involved, we were convinced of a causal relationship by a series of chronological, clinical, biological and viral events (Table 1). Furthermore, these nine cases were subsequently traced to errors in disinfection procedures. Prior to IMP, all nine patients had normal levels of transaminases; none of them had ever received blood products or used intravenous drugs, and all sexual partners were seronegative for the C virus. The IMPs, which involved various medical specialities, were performed in several medical centres. Icteric hepatitis appeared an average of 50 days (range 32–91) after the procedure. The presence of viral HCV-RNA was confirmed by polymerase chain reaction (PCR) in all cases. Four of the nine patients were seropositive at the time of icterus, whilst five others converted to seropositivity within 4.5 months. Clinical evolution to chronic hepatitis was observed in four patients (patients 1, 3, 5 and 8), whilst in three patients (patients 2, 7 and 9), the hepatitis spontaneously resolved (with sustained biochemical resolution and undetectable serum hepatitis C virus RNA 32, 12 and 24 months, respectively, after the end of icterus). Two patients (patients 4 and 6), who were treated early after the resolution of icterus with interferon a-2b (5 million units day for 2 months), had apparent cure (normal transaminase levels and negative PCR 6 months after the end of treatment). LETTER TO THE EDITOR

Prevalence of HIV and HCV infections in two populations of Malian women and serological assays performances.

AIM To estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections in women in Mali and to evaluate the performance of serological assays. METHODS Two prospective studies were conducted in 2009 and 2010 in Mali. They concerned first, 1000 pregnant women attending six reference health centers in Bamako (Malian capital) between May 26 and June 16, 2009; and secondly, 231 women over 50 years who consulted general practitioners of two hospitals in Bamako between October 25 and December 24, 2010. Blood samples were collected and kept frozen in good condition before analysis. All samples depicted as positive using HIV/HCV enzyme immuno-assay screening assays were submitted to confirmation analysis. Molecular markers of HCV were characterized. RESULTS The seroprevalence of HIV and HCV in the population of pregnant women was 4.1% and 0.2% respectively. Among older women the seroprevalence was higher and similar for HIV and HCV (6.1% vs 6.5%). The anti-HIV prevalence was not different in young and older women (4.1% vs 6.1%). In contrast, the anti-HCV prevalence was higher in older compared to younger women (6.5% vs 0.2%, P < 0.01). Of 2 pregnant women who were HCV seropositive, only one was polymerase chain reaction (PCR) reactive and infected by genotype 2, with a viral load of 1600 IU/mL. Regarding older women who were HCV seropositive, 13 out of 15 were PCR reactive, infected by genotype 1 or 2. Globally HCV genotype 2 was predominant. The positive predictive value (PPV) measured with VIKIA HIV test in young women was 100% therefore significantly higher than the 87.5% measured in older women (P < 0.05). Conversely, the PPV measured with Monolisa HCV assay in older women was 88.2% and higher than the 14.3% measured in younger women (P < 0.01). CONCLUSION Whereas HIV prevalence was similar in both subpopulations HCV was more frequent among older women (P < 0.01). The PPV of screening assays varied with the age of the subjects.

Simultaneous passenger lymphocyte syndrome and multiple alloimmunization against donor's blood group antigens after liver transplantation

If ‘passenger lymphocyte syndrome’ (PLS) is a well‐recognized complication in ABO‐mismatched solid organ transplantation, the coexistence of this reaction with recipients alloimmunization against multiple antigens expressed on the residual red blood cells in the graft is less common and unpredictable.

Rh D foeto-maternal alloimmunization prophylaxis with anti-D immunoglobulins reviewed in the era of foetal RHD genotyping.

Abstract In Belgium, prevention of anti-D immunization is currently based on systematic postnatal prophylaxis associated with targeted antenatal injection in high-risk situations of foeto-maternal haemorrhage. The failures of prevention are mainly due to the non-respect of established guidelines for RhIG prophylaxis, and to spontaneous undetected foetal-maternal haemorrhages without any obvious cause during the third trimester of pregnancy. In order to reduce the rate of residual post-pregnancy anti-D immunization, several countries decided to associate the classical prophylaxis to a routine antenatal anti-D prophylaxis (RAADP) during the 28th or 29th week of gestation. Since a few years, the foetal RHD genotyping in maternal plasma enables us to limit the antenatal prophylaxis only to those D- women carrying a D+ foetus. This paper deals with: the advantages of an antenatal prevention in the light of non-invasive foetal RHD genotyping, the rules rendering prevention protocols efficient whatever the algorithm applied, and the recommended immuno-haematology follow-up of women who received RhIG.

Combination of Serological Markers to Predict the Presence or Absence of Viremia in HCV-Seropositive Blood Donors

Firstand second-generation anti-HCY screening assays have significantly contributed to the decline of posttransfusion hepatitis C (PTH-C) to a point where nosocomial transmission and iatrogenic procedures are currently being discussed as a possible remaining cause of hepatitis C in hospitalized patients [1]. This is excellent news for recipients but blood banks also have a responsibility towards their donors. Inthis regard the question ofinfectivity and its long-term consequences for HCY-seropositive donors begs for an answer. HCY-RNA assay by the polymerase chain reaction (PCR) is useful for the detection of viremia as a measure ofinfectivity [2]. However, PCR technology is still too complex and too costly for routine use in blood banks. Investigators have attempted to circumvent this difficulty by studying the predictive value ofmarkers readily available in blood banks for indirect detection of HCY viremia [3-5]. Several have noted an association between HCYRNA and abnormal alanine aminotransferase (ALT) levels [6], increased optical density (00) signals in anti-HCY screening tests [7], or the presence of complete antibody profiles in so-called supplemental assays [8]. Recent reports have documented an association between serum HCYRNA and HCY core IgM (lgM anti-HCc), and HCY core IgG antibodies (IgG anti-HCc) inpatients with chronic liver disease [9-11]. The aim of our study was to assess the predictive value, alone or incombination, ofanti-HCY seropositivity by thirdgeneration EIA (HCY EIA-3), the HCY antibody pattern by HCY supplemental EIA (HCY SA), HCY core IgG, HCY core IgM, and ALT as indirect markers of viremia ina cohort (n =131) of Belgian blood donors deferred from donating blood due to HCY seropositivity and/or elevated ALT.