Jean-Jacques Lefrère

Carriage of GB Virus C/Hepatitis G Virus RNA Is Associated with a Slower Immunologic, Virologic, and Clinical Progression of Human Immunodeficiency Virus Disease in Coinfected Persons

The prevalence of GB virus C (GBV-C) infection is high in human immunodeficiency virus (HIV)-infected persons. However, the long-term consequences of coinfection are unknown. HIV-positive persons with a well-defined duration of infection were screened on the basis of their GBV-C/hepatitis G virus (HGV) RNA status and studied. GBV-C/HGV viremia was observed in 23, who carried the virus over a mean of 7.7 years. All parameters (survival, CDC stage B/C, HIV RNA load, CD4 T cell count) showed significant differences in terms of the cumulative progression rate between persons positive and negative for GBV-C/HGV RNA. When GBV-C/HGV RNA-positive and -unexposed subjects were matched by age, sex, baseline HIV RNA load, and baseline CD4 T cell count, HIV disease progression appeared worse in GBV-C/HGV RNA-negative subjects. The carriage of GBV-C/HGV RNA is associated with a slower progression of HIV disease in coinfected persons.

Improvement of Hepatitis C Virus (HCV) Genotype Determination with the New Version of the INNO-LiPA HCV Assay

ABSTRACT Hepatitis C virus (HCV) isolates have been classified into six main genotypes. Genotyping methods, and especially the widely used line probe assay (LiPA), are frequently based on the 5′-untranslated region (5′UTR). However, this region is not appropriate for discriminating HCV strains at the subtype level and for distinguishing many genotype 6 samples from genotype 1. We investigated the capacity of a novel LiPA (Versant HCV Genotype 2.0 assay) based on the simultaneous detection of 5′UTR and Core regions for genotypes 1 and 6 to provide correct HCV genotypes (characterized with a phylogenetic analysis) in a set of HCV strains mainly encountered in Western countries. The improvement was assessed by comparing the results to those obtained with the previous version of the assay. Of the 135 tested samples, 64.7% were concordant for genotype group and subtype with sequencing reference results using the Versant HCV Genotype 2.0 assay versus 37.5% with the previous version. The yield was mainly related to a better characterization of genotype 1, since the accuracy, tested in 62 genotype 1 samples, increased from 45.2% with the first version to 96.8% with the new one. However, this new version necessitates a specific PCR and could no longer be used after 5′UTR PCR used for current HCV infection diagnosis. Moreover, the information provided by 5′UTR hybridization is not reliable for correctly identifying the diversity within genotypes 2 and 4. Thus, the Versant HCV Genotype 2.0 assay remains a useful tool for clinical practice when only the discrimination between major HCV genotypes is necessary.

Blood safety in Sub-Saharan Africa: a multi-factorial problem

Although the World Health Organization (WHO) has set targets for safe blood by 2012, Sub‐Saharan Africa remains confronted with multi‐factorial issues that compromise blood safety in most countries of the region. Some of these include the development and implementation of national policies for transfusion, the recruitment of voluntary and unpaid donors, proper screening of collected blood as well as a strategy for its rational use in a setting already plagued by a high prevalence of blood‐borne agents, poverty, and sometimes organizational deficits. Furthermore, the organization of hemovigilance, as well as quality systems that could monitor transfusion practices is lacking in these settings. There is no funding and global improvement of blood safety has to be cheap to be feasible. Specific solutions for the African continent need to be developed and implemented. This paper examines the current status and difficulties of blood safety in Africa and reviews available data on transfusion medicine in the region.

Comparison of Hepatitis C Virus NS5b and 5′ Noncoding Gene Sequencing Methods in a Multicenter Study

ABSTRACT A national evaluation study was performed in 11 specialized laboratories with the objective of assessing their capacities to genotype hepatitis C virus (HCV) and define the applicability of a given genotyping method. The panel consisted of 14 samples positive for HCV RNA of different genotypes (including 3 samples with two different artificially mixed genotypes) and 1 HCV-negative sample. Seventeen sets of data were gathered from the 11 participating laboratories. The sensitivities ranged from 64.3 to 100% and from 42.7 to 85.7% for the methods that used sequencing of the NS5b region and the 5′ noncoding (5′ NC) region, respectively. When the data for the artificially mixed samples were excluded, NS5b genotyping gave correct results for 80% of the samples, 1.7% of the samples were misclassified, and 18.3% of the samples had false-negative results. By 5′ NC-region genotyping methods, 58.3% of the results were correct, 29.7% were incomplete, 8.3% were misclassifications, 1.2% were false positive, and 2.4% were false negative. Only two procedures based on NS5b sequencing correctly identified one of the three samples with mixtures of genotypes; the other methods identified the genotype corresponding to the strain with the highest viral load in the sample. Our results suggest that HCV 5′ NC-region genotyping methods give sufficient information for clinical purposes, in which the determination of the subtype is not essential, and that NS5b genotyping methods are more reliable for subtype determination, which is required in epidemiological studies.

Prevalence of GB virus type C/hepatitis G virus RNA and of anti-E2 in individuals at high or low risk for blood-borne or sexually transmitted viruses: evidence of sexual and parenteral transmission.

BACKGROUND: The first epidemiologic evidence of GB virus type C (GBV‐C)/hepatitis G virus (HGV) infection showed a high prevalence of asymptomatic carriers in blood donors and in populations at risk for blood‐borne viruses. However, by using only viral RNA polymerase chain reaction, those studies underestimated the true spread of GBV‐C/HGV infection. The combined detection of GBV‐C/HGV RNA and of anti‐E2 (which reflects recovery from infection) is necessary to define accurately the prevalence of GBV‐C/HGV.

B19 parvovirus DNA in solvent/detergent-treated anti-haemophilia concentrates

A transfusional B19 parvovirus infection may have severe consequences in immunocompromised hosts. The presence of B19 DNA was investigated with a polymerase chain reaction (PCR) assay in 30 batches of solvent/detergent-treated clotting factor concentrates (12 batches of factor VIII, 16 batches of factor IX, 1 batch of factor VII, and 1 batch of PPSB). B19 DNA was detected in 6 (20%) batches, including 3 factor VIII and 3 factor IX concentrates. Because of the frequency of B19 DNA in batches of clotting factors, measures to prevent transfusional risk of B19 infection via these blood products are justified, especially in recipients immunocompromised by HIV infection.

Advances in Human B19 Erythrovirus Biology

ABSTRACT Since its discovery, human parvovirus B19 (B19V), now termed erythrovirus, has been associated with many clinical situations (neurological and myocardium infections, persistent B19V DNAemia) in addition to the prototype clinical manifestations, i.e., erythema infectiosum and erythroblastopenia crisis. In 2002, the use of new molecular tools led to the characterization of three different genotypes of human B19 erythrovirus. Although the genomic organization is conserved, the geographic distribution of the different genotypes varies worldwide, and the nucleotidic divergences can impact the molecular diagnosis of B19 virus infection. The cell cycle of the virus remains partially unresolved; however, recent studies have shed light on the mechanism of cell entry and the interactions of B19V proteins with apoptosis pathways.

Seroprevalence of human herpes virus 8 antibody in populations at high or low risk of transfusion, graft, or sexual transmission of viruses

BACKGROUND: The routes of transmission of human herpes virus 8 (HHV‐8) remain unclear. In particular, HHV‐8 transmission by blood components and organ transplantation is still debated and raises public health issues. The objective of this study was to determine the prevalence of anti‐HHV‐8 in selected populations of persons or patients with or without risk factors for the transmission of viral infections, in order to determine the routes of HHV‐8 transmission.

The Risk of Disease Progression Is Determined during the First Year of Human Immunodeficiency Virus Type 1 Infection

A cohort of 103 human immunodeficiency virus type 1 (HIV-1)-infected persons with well-defined dates of seroconversion were studied to determine whether baseline plasma HIV RNA loads 6-12 months after seroconversion have prognostic value. Baseline plasma virus loads had predictive value for the disease-free survival rate and for the survival rate. The level of baseline HIV RNA also had a strong negative predictive value for the CD4+ T cell count during the fifth year of infection: A baseline load >5 log was predictive of a CD4+ T cell count <500/mm3 5 years after infection. Baseline HIV RNA load was a CD4+ T cell-independent predictor of progression to death. The major finding was that the disease outcome for HIV-1-infected persons is already determined during the first year of infection.

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