HIV infection in England and Wales: a changing pattern

SUMMARYOf 32983 specimens from 307 sources in England and Wales tested in the Virus Reference Laboratory for anti-HIV between 1984 and 1987, 6491 (20%) were positive. Ninety-five per cent of the positive subjects were male and 44% of them were from three London genito-urinary medicine clinics. In 1987 the numbers of newly diagnosed HIV infections decreased in homosexual men and haemophiliacs and increased in injecting drug abusers; 148/119 (12%) of all the positive findings in 1987 were in females. Between 1984 and 1987 the proportion of anti-HIV positive individuals who were asymptomatic fell by nearly 10% and the proportion with AIDS/ARC rose by nearly 10%. Of the requests leading to positive results 1280 (20%) were recognized as duplicates of previous positive results, while for 34 % of the requests no clinical information was provided. These deficiencies in the data compromise HIV surveillance based on diagnostic testing, and supplementary bias-free data are needed.

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The Laboratory Diagnosis of HIV Infections

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2005/515063 ◽

2005 ◽

Vol 16 (1) ◽

pp. 26-30 ◽

Cited By ~ 18

Author(s):

Margaret Fearon

Keyword(s):

Point Of Care ◽

Diagnostic Testing ◽

Clinical Information ◽

Hiv Infections ◽

Laboratory Diagnosis ◽

The United States ◽

Specific Information ◽

Antibody Testing ◽

Diagnostic Laboratory ◽

Laboratory Results

HIV diagnostic testing has come a long way since its inception in the early 1980s. Current enzyme immunoassays are sensitive enough to detect antibody as early as one to two weeks after infection. A variety of other assays are essential to confirm positive antibody screens (Western blot, polymerase chain reaction [PCR]), provide an adjunct to antibody testing (p24 antigen, PCR), or provide additional information for the clinician treating HIV-positive patients (qualitative and quantitative PCR, and genotyping). Most diagnostic laboratories have complex testing algorithms to ensure accuracy of results and optimal use of laboratory resources. The choice of assays is guided by the initial screening results and the clinical information provided by the physician; both are integral to the laboratory's ability to provide an accurate laboratory diagnosis. Laboratories should also provide specific information on specimen collection, storage and transport so that specimen integrity is not compromised, thereby preserving the accuracy of laboratory results. Point of Care tests have become increasingly popular in the United States and some places in Canada over the past several years. These tests provide rapid, on-site HIV results in a format that is relatively easy for clinic staff to perform. However, the performance of these tests requires adherence to good laboratory quality control practices, as well as the backup of a licensed diagnostic laboratory to provide confirmation and resolution of positive or indeterminate results. Laboratory quality assurance programs and the participation in HIV proficiency testing programs are essential to ensure that diagnostic laboratories provide accurate, timely and clinically relevant laboratory results.

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Abstract 16136: Underutilization of Appropriate Testing for Transthyretin Amyloidosis Despite Suspicious Clinical & Echocardiographic Findings

Circulation ◽

10.1161/circ.142.suppl_3.16136 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Katelyn Young ◽

Kinjal Banerjee ◽

Maulin Patel ◽

Sangeeta Prabhakar Bhat ◽

Colin Reynolds ◽

...

Keyword(s):

Genetic Testing ◽

Cardiac Amyloidosis ◽

Chart Review ◽

Diagnostic Testing ◽

Wild Type ◽

Transthyretin Amyloidosis ◽

Highly Sensitive ◽

Amyloid Light Chain ◽

Positive Results ◽

Echocardiographic Findings

Introduction: Both hereditary (hATTR) and wild-type (wtATTR) transthyretin amyloidosis are under-recognized causes of cardiomyopathy (CM) and heart failure. Certain findings on Transthoracic Echocardiography (TTE) and cardiac Magnetic Resonance Imaging (cMRI) are suggestive but not diagnostic of ATTR. Although biopsy historically has been the gold standard for diagnosis, patients can be diagnosed with the highly sensitive and specific technetium-99m pyrophosphate scan (Tc-99m PYP). Genetic testing is recommended to confirm hATTR in patients diagnosed with ATTR cardiac amyloidosis. Despite growing awareness of this condition, many cases remain undiagnosed. This study evaluated if patients with TTEs concerning for infiltrative CM received appropriate diagnostic testing for ATTR-CM. Methods: Our echocardiography registry was queried from January 2011 to March 2020 for patients with our echo lab’s embedded infiltrative CM code. Data on demographics, comorbidities, TTE variables, cMRI results, PYP scans, genetic testing and biopsy results were retrieved from electronic medical records. Thorough manual chart review excluded other causes of CM. Data was expressed as mean ± SD and n (%). Results: We retrieved 510 patients (mean age 64 ± 16 years; 43% female) with TTEs suspicious for infiltrative CM revealing a mean interventricular septal diameter (IVSd) of 1.6 ± 0.3 cm. Only 67 (13%) patients underwent cMRI with 11 (16%) suggestive of cardiac amyloidosis. Of the patients with suspicious TTEs, 16 (3.1%) had PYP scans and 24 (4.7%) had tissue biopsy, with positive results in 7 (44%) and 11 (46%), respectively. Genetic testing in 31 (6%) patients revealed known hATTR mutations in 2 (6.5%) patients. Cardiac amyloidosis was diagnosed in 23 (4.5%) with 11 ATTR (2 hATTR), 5 amyloid light chain, and 7 unknown subtype. Conclusion: Despite clinical and TTE findings suspicious for ATTR-CM, many patients did not undergo appropriate confirmatory testing (see Figure 1).

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Prevalence of hepatitis-C viral infection among opioid dependent injectable drug users: a study conducted at regional hospital drug de-addiction and treatment centre, Solan, Himachal Pradesh, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202879 ◽

2020 ◽

Vol 8 (7) ◽

pp. 2458

Author(s):

Kushel Verma ◽

Sanjeev Kumar ◽

Vaishali Sharma

Keyword(s):

Hepatitis C ◽

Drug Users ◽

Hiv Infections ◽

Himachal Pradesh ◽

Hcv Infection ◽

North India ◽

Drug Addicts ◽

Injectable Drug ◽

Treatment Centre ◽

Anti Hiv

Background: There are a limited number of studies regarding the prevalence of hepatitis B, hepatitis C and HIV infections among the drug addicts in Himachal Pradesh; C virus (HCV) infection in north India especially Himachal with very high rates of substance abuse. The present study was attempted to study the prevalence of hepatitis C among the injectable drug users, which is more important in a country like India where viral hepatitis is estimated to be among the top ten causes of deaths.Methods: A study was conducted in 2019-2020 (July-April). HBsAg, anti-HBs, anti-HCV and anti-HIV tests in 235 drug addicts were studied. Urine samples obtained from drug addicts were analyzed for cannabis, opiate and cocaine metabolites.Results: The subjects included were 235 IDUs who were opioid dependent. All the 235 drug users were males, and their mean age was 30.69±9.494 years; 112 (47.7%) of them were in the age group ranging 20 - 29 years (p <0.05). Of 235 drug addicts, 113 (48.1%) and 115 (48.9%) were only cannabis and opiate users, respectively. The frequencies of HBsAg, anti-HBs and anti-HCV among drug addicts were 2.6%, 38.3%, and 9.4%, respectively.Conclusions: The obtained results showed that HCV infection was an alarming problem among opiate users in this part of Himachal. It is suggested to rapidly diagnose the infected persons; thus preventive measures and appropriate control may limit further transmission of these infections.

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The Risks and Benefits of Providing HIV Services during the COVID-19 Pandemic

10.1101/2021.03.01.21252663 ◽

2021 ◽

Author(s):

John Stover ◽

Sherrie L. Kelly ◽

Edinah Mudimu ◽

Dylan Green ◽

Tyler Smith ◽

...

Keyword(s):

Health Services ◽

Health Workers ◽

Diagnostic Testing ◽

Simulation Models ◽

Hiv Infections ◽

Early Response ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Hiv Services ◽

Trade Offs

AbstractIntroductionThe COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.MethodsWe used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.ResultsMaintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19 - 146 discounted deaths per 10,000 clients.DiscussionWhile there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

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Settings for identifying recent HIV infections: the Portuguese experience

Eurosurveillance ◽

10.2807/ese.13.36.18974-en ◽

2008 ◽

Vol 13 (36) ◽

Author(s):

H Cortes Martins ◽

M T Paixão

Keyword(s):

Hiv Infections ◽

Cross Sectional Study ◽

Western European Country ◽

Reference Laboratory ◽

Cross Sectional ◽

Sexually Transmitted ◽

Aids Epidemic ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Hiv 1

Portugal has been the western European country with the highest rate of notified acquired immunodeficiency syndrome (AIDS) cases since 1999 and human immunodeficiency virus (HIV) infection cases since 2000. Nonetheless, exact information on the magnitude and trends of recently acquired infections is missing. In a cross-sectional study we aimed to determine HIV prevalence, the proportion of recently acquired infections and the incidence among patients attending a Sexually Transmitted Infections (STI) clinic and among HIV positive cases tested at the AIDS Reference Laboratory (ARL), by using the Avidity Index (AI) of antibodies to identify recent HIV-1 seroconversions. Demographic and behavioural data were collected. At the STI clinic 253 patients were enrolled, 16 were found to be HIV infected (14 HIV-1, 2 HIV-2) and a prevalence of 6.3% was obtained. Four recent HIV-1 infections were identified and the HIV-1 incidence was 3.3% per year. At the ARL, 332 newly diagnosed cases of HIV-1 infection were studied, 59 (17.8%) were recent infections and an annual incidence of 4.1% was estimated. These findings support STI clinics as key sentinel sites for recently acquired HIV infections and illustrate the viability of testing for recent HIV infections in these settings and reinforce the value of this method in the surveillance for better monitoring current trends of the HIV/AIDS epidemic in Portugal.

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Over-diagnosis of Rotavirus Infection in Infants Due to Detection of Vaccine Virus

Clinical Infectious Diseases ◽

10.1093/cid/ciz1196 ◽

2019 ◽

Vol 71 (5) ◽

pp. 1324-1326 ◽

Cited By ~ 1

Author(s):

David M Whiley ◽

Suifang Ye ◽

Sarah Tozer ◽

Julia E Clark ◽

Cheryl Bletchly ◽

...

Keyword(s):

Clinical Management ◽

Diagnostic Testing ◽

Vaccine Virus ◽

Vaccine Effectiveness ◽

Wild Type ◽

Virus Shedding ◽

Rotavirus Infection ◽

Routine Infant ◽

Positive Results ◽

Active Disease

Abstract An accurate rotavirus diagnosis is important for clinical management and monitoring active disease and vaccine effectiveness. Between 2016–2018, rotavirus-positive results in our laboratory were from vaccine virus shedding in 71/152 (46.7%) infants with a request for rotavirus testing. Routine infant diagnostic testing should ideally distinguish vaccine from wild-type viruses.

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Retrospective Review of Clinical Utility of Shotgun Metagenomic Sequencing Testing of Cerebrospinal Fluid from a U.S. Tertiary Care Medical Center

Journal of Clinical Microbiology ◽

10.1128/jcm.01729-20 ◽

2020 ◽

Vol 58 (12) ◽

Author(s):

Kyle G. Rodino ◽

Michel Toledano ◽

Andrew P. Norgan ◽

Bobbi S. Pritt ◽

Matthew J. Binnicker ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Mayo Clinic ◽

Medical Center ◽

Tertiary Care ◽

Human Herpesvirus ◽

Reference Laboratory ◽

Metagenomic Sequencing ◽

Shotgun Metagenomic Sequencing ◽

Tertiary Care Medical Center ◽

Positive Results

ABSTRACT Shotgun metagenomic sequencing can detect nucleic acids from bacteria, fungi, viruses, and/or parasites in clinical specimens; however, little data exist to guide its optimal application to clinical practice. We retrospectively reviewed results of shotgun metagenomic sequencing testing requested on cerebrospinal fluid samples submitted to an outside reference laboratory from December 2017 through December 2019. Of the 53 samples from Mayo Clinic patients, 47 were requested by neurologists, with infectious diseases consultation in 23 cases. The majority of patients presented with difficult-to-diagnose subacute or chronic conditions. Positive results were reported for 9 (17%) Mayo Clinic patient samples, with 6 interpreted as likely contamination. Potential pathogens reported included bunyavirus, human herpesvirus 7, and enterovirus D-68, ultimately impacting care in two cases. Twenty-seven additional samples were submitted from Mayo Clinic Laboratories reference clients, with positive results reported for three (11%): two with potential pathogens (West Nile virus and Toxoplasma gondii) and one with Streptococcus species with other bacteria below the reporting threshold (considered to represent contamination). Of 68 negative results, 10 included comments on decreased sensitivity due to high DNA background (n = 5), high RNA background (n = 1), insufficient RNA read depth (n = 3), or quality control (QC) failure with an external RNA control (n = 1). The overall positive-result rate was 15% (12/80), with 58% (7/12) of these interpreted as being inconsistent with the patient’s clinical presentation. Overall, potential pathogens were found in a low percentage of cases, and positive results were often of unclear clinical significance. Testing was commonly employed in cases of diagnostic uncertainty and when immunotherapy was being considered.

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Prevalence of Self-reported Neurologic and Ocular Symptoms in Early Syphilis Cases

Clinical Infectious Diseases ◽

10.1093/cid/ciaa180 ◽

2020 ◽

Author(s):

Laura A S Quilter ◽

Alex de Voux ◽

Rachel M Amiya ◽

Erin Davies ◽

Robin R Hennessy ◽

...

Keyword(s):

Lumbar Puncture ◽

Diagnostic Testing ◽

Clinical Information ◽

Health Department ◽

Surveillance Network ◽

Ocular Syphilis ◽

Early Syphilis ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Low Prevalence

Abstract Background Neurosyphilis, a complication of syphilis, can occur at any stage of infection. Measuring the prevalence of neurosyphilis is challenging, and there are limited data on the prevalence of neurologic or ocular symptoms among patients with syphilis. We sought to describe the prevalence of neurologic and/or ocular symptoms among early syphilis (ES) cases and the clinical management of symptomatic cases enrolled in the STD Surveillance Network (SSuN) Neuro/Ocular Syphilis Surveillance project. Methods Persons diagnosed with ES were selected for interviews based on current health department protocols in 5 participating SSuN jurisdictions from November 2016 through October 2017. All interviewed ES cases were screened for self-reported neurologic and/or ocular symptoms. Additional clinical information on diagnostic testing and treatment for cases concerning for neurosyphilis/ocular syphilis was obtained from providers. Results Among 9123 patients with ES who were interviewed, 151 (1.7%; 95% confidence interval [CI], 1.4%–1.9%) reported ≥ 1 neurologic or ocular symptom. Of the 53 (35%) who underwent lumbar puncture, 22 (42%) had documented abnormal cerebrospinal fluid, of which 21 (95%) were treated for neurosyphilis/ocular syphilis. Among the remaining 98 symptomatic patients with no documented lumbar puncture (65%), 12 (12%) were treated for and/or clinically diagnosed with neurosyphilis/ocular syphilis. Conclusions We observed a low prevalence of self-reported neurologic and/or ocular symptoms in interviewed ES cases. Approximately one-third of ES cases who self-reported symptoms underwent further recommended diagnostic evaluation. Understanding barriers to appropriate clinical evaluation is important to ensuring appropriate management of patients with possible neurologic and/or ocular manifestations of syphilis.

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Analysis of risk factors for occupationally acquired HBV, HCV, HIV infections in Polish paramedics

European Journal of Public Health ◽

10.1093/eurpub/ckz186.510 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Katarzyna Topczewska ◽

Maria Gańczak

Keyword(s):

Risk Factors ◽

Infection Control ◽

Hiv Infections ◽

Serum Samples ◽

Cross Sectional ◽

Source Of Infection ◽

Occupational Risks ◽

Control Procedures ◽

Exposure Risks ◽

Anti Hiv

Abstract Background Paramedics constitute a group of professionals constantly exposed to potentially infectious biological material through close contacts with patients, possibly resulting in occupationally acquired infections. Objectives To assess the prevalence and to analyze selected risk factors for occupationally acquired HBV, HCV and HIV infections among Polish paramedics. Methods Between December 2018-April 2019 a cross-sectional sero-survey was conducted in 6 randomly selected ambulance stations in the West Pomeranian region of Poland with the use of an anonymous questionnaire. Serum samples were assessed for anti-HBc total, anti-HCV, anti-HIV with the use of 3rd-generation testing methods. Results Response rate was 83%; 141 participants (82% males, median age 33 years, median length of practice 11.9 years) agreed to participate. Anti-HBc were found in 7% participants, none of infected individuals was aware of an infection; no anti-HCV/anti-HIV positive paramedics were recognized. Risk factors for occupationally acquired infections were as follows: 5.1% paramedics were not vaccinated against HBV, 18.3% sustained ≥ 1 sharps injury in the preceding year (44.4% of incidents were not reported), 95.6% irregularly used masks/goggles, 6.2% used gloves irregularly (the lack of availability was the most commonly stated reason), 5.1% had never participated in infection control training, 61.6 % did not use safety engineered devices at work, 52.2% reported recapping a needle in the last 12 months. The risk of a single exposure to HBV was correctly defined by 40.2 % of participants, to HCV - by 33.0%, to HIV - by 28.3%. Conclusions Most risk factors for occupationally acquired blood-borne infections among Polish paramedics are modifiable. Unsatisfactory knowledge about the occupational exposure risks and poor compliance with infection-control procedures call for better risk recognition and assessment to reduce HBV, HCV and HIV infections in this group of health professionals. Key messages Paramedics showed detectable markers of HBV infection; individuals with not recognized occupationally acquired infection could be a source of infection for patients. Existing policies should be reinforced, and better surveillance for occupational risks should be instituted to minimize occupational blood borne infections among paramedics.

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Implementation of a Fully Automated Latex Immunoturbidimetric Assay for the Diagnosis of Heparin-Induced Thrombocytopenia in a High-Volume University Hospital Laboratory

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz112.057 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S30-S30

Author(s):

Christina Pierre ◽

Mary Acker ◽

Surabhi Palkimas ◽

Lindsay Bazydlo

Keyword(s):

High Volume ◽

Turnaround Time ◽

University Hospital ◽

Reference Laboratory ◽

Platelet Factor ◽

Heparin Induced Thrombocytopenia ◽

Hospital Laboratory ◽

Assay Precision ◽

Positive Results ◽

Interassay Precision

Abstract Background Heparin-induced thrombocytopenia (HIT) is an immune-mediated, adverse reaction to heparin in which heparin binds platelet factor 4 (PF4), triggering the development of heparin-PF4 antibodies (HITAb). HITAbs bind and activate platelets, causing thrombosis, platelet consumption, and thrombocytopenia. Heparin is replaced with relatively costly nonheparin anticoagulants until HIT can be ruled out. HIT diagnosis consists of a HITAb immunoassay with reflex to a serotonin release assay (SRA) for confirmation of positive results. Recently, a fully automated latex immunoturbidimetric assay (LIA) for detection of HITAbs received FDA clearance. We sought to verify the performance characteristics of the LIA with the aim of implementing the test in a high-volume university hospital laboratory. Methods The in-house HITAb LIA was performed on the Instrumentation Laboratory TOP700 analyzer using HemosIL HIT-Ab(PF4-H) reagent. The comparator method, a HITAb ELISA, was performed at a reference laboratory with positive results reflexed to SRA. All samples (36 total) sent to the reference laboratory for HIT testing from December 2017 to November 2018 were aliquoted and run in parallel by LIA. Intra-assay precision was assessed by running manufacturer-provided low and high control samples 10 times in succession, while interassay precision was assessed by running low and high samples every day for 10 days. Turnaround time to HITAb result was retrieved from the electronic medical records for HIT testing performed 60 days before and after in-house test implementation. Results The agreement between the LIA and ELISA was 92% (33/36). One discordant sample tested negative by ELISA and was not assessed by SRA. Another tested positive by ELISA and negative by LIA and was confirmed negative by SRA. The final discordant sample tested negative by LIA but positive by ELISA and was confirmed positive by SRA. Thirty-three percent (12/36) of samples tested positive for HITAb by ELISA and were reflexed to SRA. Both the ELISA and LIA showed 83% agreement (10/12) with the SRA. The coefficient of variance (CV) for the intra-assay precision studies was 18% and 5% for the low and high controls, respectively. The CV for the interassay precision studies was 28% and 5% for the low and high controls, respectively. Postimplementation quality control data revealed 61% and 20% imprecision on the low and high level controls, respectively, which declined significantly when reagents were removed from the instrument and refrigerated within 2 hours. The turnaround time for HITAb results was reduced by 74% (10.5 vs 41 hours) after in-house test implementation, significantly reducing the need for administration of nonheparin anticoagulants. Conclusion The LIA and ELISA methods compared favorably, allowing for clinical implementation of the LIA. The shortened turnaround time of the LIA significantly reduced the time to rule out HIT, enhancing patient care and reducing drug costs. The assay imprecision warrants further investigation regarding reagent stability.

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