Daniel Candotti

Molecular and serological characterization of hepatitis B virus in deferred Ghanaian blood donors with and without elevated alanine aminotransferase.

Summary.  Candidate blood donors in Ghana are frequent carriers of hepatitis B virus (HBV). A comparative study of 117 donor samples including 46 with alanine aminotransferase (ALT) ≥ 60 IU/L and 71 with ≤40 IU/L level was undertaken. S and the basic core promoter‐precore regions (BCP/PC) sequencing was used to identify genotypes and variants relevant to HBV natural history, respectively. Age, viral load, HBe status were correlated with molecular data. HBV genotype E (87%) was dominant with little genotypes A (10%) and D (3%). Comparing individuals with or without liver disease, an association between liver disease and older age (P = 0.004) and higher viral load (P = 0.002) whether as a whole population or only genotype E was found. Compared with a commercial assay, BCP/PC sequencing had lower sensitivity to detect mixtures of wild‐type and variant viruses but detected BCP deletions. BCP 1762/1764 variants were positively correlated with older age (P < 0.0001) and elevated ALT levels (P = 0.01). PC 1896 stop codon was marginally correlated with viral load (P = 0.09). HBV genotype E infection natural history appears different from genotypes B and C prevalent in Asia. Donors with liver disease being older, with higher viral load and higher BCP variant proportion may be at higher risk of cirrhosis and hepatocellular carcinoma

Evaluation of a transcription‐mediated amplification‐based HCV and HIV‐1 RNA duplex assay for screening individual blood donations: a comparison with a minipool testing system

BACKGROUND : NAT was introduced for HCV RNA in 1999 to screen blood donations and improve the safety of the blood supply.

Predonation testing of potential blood donors in resource-restricted settings

Clark and coworkers caution against adopting predonation screening practices lest they be inexpertly applied or delay a move toward nationalized blood transfusion services. Indeed, under the guidance of WHO-led programs, many countries in Sub-Saharan Africa, such as Uganda, have made significant strides toward establishing sustainable volunteer blood donor programs. I cannot help but wonder, however, whether the two programs have to be mutually exclusive. In Fall 2003, I had the honor of serving the CDC in assessing the status of blood transfusion in Tanzania in anticipation of the current administration announcing the PEPFAR (President’s Emergency Package for AIDS Relief) package that includes

Maternal-fetal transmission of human parvovirus B19 genotype 3.

42 million to help 14 emerging countries establish blood transfusion services. A visit to the public hospital that serves nearly 2 million people in Dar Es Salaam revealed a blood bank that had few units on its shelves, and they were all directed donor units. At present, plans are under way to establish four zonal transfusion centers, which should greatly relieve the dearth of available safe blood. I also had the opportunity to visit a mission hospital in a remote area of Tanzania that had neither electricity nor refrigeration (http://www.iambi.org/). The hospital had implemented rapid screening (Determine HIV-1 and -2, Abbott Laboratories, Abbott Park, IL) and observed that 11 percent of prospective blood donors were HIV-seropositive. It took 15 hours to travel approximately 250 miles from Dar Es Salaam because most of the roads were not paved and many crossed over dry stream beds. In the rainy season, the hospital is inaccessible by any convenient route. Even if the zonal centers were fully stocked in the near future, the needs of the majority of the country’s population would not be addressed, because most citizens live in rural regions. During my travels, I passed many signs for “Money Maker” irrigation pumps, a simple

Lack of correlation between hepatitis B surface antigen and hepatitis B virus DNA levels in blood donors.

50 stair-stepper device that allows subsistence farmers to become cash crop farmers. The developers of this technology, ApproTEC, have been so successful that there is a Harvard Business School case study describing their contributions. Simply put, ApproTEC, with its advocacy for providing simple and appropriate technology into the hands of users in resource-limited setting, has had greater and more sustainable impact on the East African economy than many more expensive and well-intentioned international relief programs. By analogy, organizations like PATH (Program for Appropriate Technology in Healthcare), have helped develop extremely sensitive, yet simple, blood screening strips for HIV that approach the sensitivity of Western blot tests, yet do not require refrigeration, extensive training, or other equipment. Because there are parallel needs, I would encourage international aid programs to support both the establishment of national transfusion services and innovative programs, such as those of J.-P. Allain, MD, MBA, and colleagues, that fill a much-needed niche. We should not let the perfect be the enemy of the good. Jed B. Gorlin, MD Memorial Blood Centers Minneapolis, Minnesota 55404 e-mail: jed@mbc.org

Multiplex real-time quantitative RT-PCR assay for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1.

Plasma samples obtained at delivery from 885 pregnant Ghanaian women were tested for human parvovirus B19 DNA and B19-specific antibodies. Maternal-fetal transmission was evaluated by testing paired maternal plasma and umbilical cord blood samples, as well as newborn whole-blood samples when they were available. The B19 DNA seroprevalence rate in women was 1.8% (94% had genotype 3 strains), and the immunoglobulin G (IgG) seroprevalence rate in women was 81%. Two of 3 cases of primary maternal B19 infection resulted in fetal transmission. Coexistence of B19 DNA and B19-specific IgG (persistence) was detected in 13 women (1.5%), but no transmission of the virus was observed. Contrary to the situation in pregnant women with primary B19 infection and high viral loads, pregnant women with low viral loads and B19-specific IgG do not appear to be vertically infectious.

Identification and genetic diversity of two human parvovirus B19 genotype 3 subtypes

The shortage of human blood and organs has led to increased interest in animal substitutes. In both transplantation and transfusion, the greatest roadblock to the use of animal tissues is the expression of xenoantigens. A major xenoantigen in pigs is linear B (Gal α 1-3Gal β 14GlcNAc-R), a cross-reactive, B-like antigen expressed on red blood cells (RBCs) and other tissues that is recognized by naturally occurring antibodies present in human serum. 1,2