Search

Resume But de l’etude Evaluer les besoins de formation du personnel dans les centres d’Afrique subsaharienne francophone. Methodologie Cette etude preliminaire a analyse le nombre, le niveau de formation de tout le personnel de quatre centres de transfusions, leurs domaines de formation, leurs durees de formation et les etablissements formateurs. Resultats Les besoins restent eleves dans tous les domaines et sont cruciaux en administration des services de transfusion, en maintenance des equipements et transfusion clinique.

International survey on NAT testing of blood donations : expanding implementation and yield from 1999 to 2009.

Background and Objectives Photochemical treatment (PCT) based on amotosalen and ultraviolet A light (UVA) demonstrated a wide range of pathogen inactivation. However, coagulation proteins are affected by this treatment. The aim of this study was to evaluate the coagulation parameters in apheresis plasma units after thawing and processing by PCT. Materials and Methods Thirty apheresis plasma units were rapidly frozen at ≤ –30°C after collection. Plasma units were thawed after 7 days for PCT with amotosalen and UVA light. Treated apheresis units were refrozen and stored at ≤ –30°C for 1 month. Samples were collected for each plasma units at several times of process. Coagulation times (prothrombin time, activated partial thromboplastin time), coagulation factors (fibrinogen, Factor [F] II, FV, FVII, FVIII, FIX, FX, FXI), prothrombin fragments 1 and 2, antithrombotic proteins (protein C, protein S, antithrombin) and total protein content were measured. Functionality of ADAMTS-13 was also tested. Results After thawing, coagulation times were slightly increased and a decrease of FV, FVIII and protein C activity was found. The mean recovery for all proteins, except one, ranged from 81% to 97% of the baseline activity in plasma units after thawing and PCT. FVIII was more affected with a mean recovery of 69 ± 8%. ADAMTS-13 function was also preserved after the whole process. The effect of an additional 1-month frozen storage on coagulation parameters was minimum. Conclusion Coagulation protein levels after thawing and processing of plasma by PCT with amotosalen and UVA were preserved well in the physiological ranges.

The HIV NET 012 protocol for prevention of perinatal transmission of HIV, a single-dose of nevirapine given to the mother during labor and one given to the newborn, has been adopted by several developing countries. The implementation of this protocol may be difficult in African rural regions and must be evaluated. The study was carried out at the Oicha General Hospital, Democratic Republic of Congo. HIV-infected women with a gestational age ≥36 weeks were offered participation in the study during a prenatal visit. Among the 5,016 women tested during prenatal attendance from December 2002 to December 2004, 94 (1.9%, 95% confidence interval [CI]: 1.5–2.3%) were HIV-infected. Among these women, 59 (62.8%; 95% CI: 53.0–72.6%) received nevirapine and 35 (37.2%; 95% CI: 27.4–47.0%) did not receive nevirapine prophylaxis. Twenty-six (27.7%) of these women arrived fully dilated and 9 (9.5%) were not given the drug by the midwives. Among the 59 HIV-infected pregnant women who received nevirapine before delivery, 33 (55.9%, 95% CI: 43.2–68.6%) received the drug at the start of uterine contractions and 24 (40.7%; 95% CI: 28.2–53.2%) did not receive nevirapine within the recommended time before delivery. Two women (3.4%) received nevirapine, but this was not written in the logbook. Overall, among the 101 newborns, all children received a single-dose nevirapine: 48 (47.5%; 95% CI: 37.8–57.2%) of the 101 newborns received nevirapine in the 24–72 hr following birth and 52 (51.5%; 95% CI: 41.8–61.2%) just after birth when their mother did not receive nevirapine. Even for a protocol as simple as HIV prophylaxis with a single-dose nevirapine, the application in African rural areas encounters field difficulties. Further simplified procedures and health care re-organization are still needed to guarantee a full Prevention of Mother to Child Transmission coverage for every HIV pregnant woman in Africa. J. Med. Virol. 80:772–776, 2008. © 2008 Wiley-Liss, Inc.

Summary Objective: to evaluate the reliability of HIV antibody testing on saliva. Design: matched serum and saliva samples were collected from both seronegative (n = 344) and seropositive (n = 125) individuals in five European countries. Duplicate saliva samples collected with Omni-Sal devices provided by Saliva Diagnostic System (SDS) were pooled before analysis. Methods: all samples were analyzed by Recombinant HIV1 EIA Cambridge Bioscience and 2nd generation Abbott HIV 1&2 1A80. EIA procedures were adapted for saliva testing by modification of sample dilution and/or cut-off calculation. All saliva recording positive and/or doubtful EIA results were further analyzed by Western blot as a confirmatory method. Results: EIA results obtained from sera analysis from both seropositives and seronegatives allowed for calculation of the tests' sensitivity (HIV1 Biotech: 99.2% – 100%; Abbott: 100%) and specificity (both tests 100%). In the series of 125 saliva samples collected from seropositives, the EIA results were as follows: with Biotech (3 negative, 3 in the grey-zone and 119 reactive) and with Abbott (1 negative, 1 in the grey-zone and 123 reactive). One saliva sample found negative by both EIA tests, although fulfilling HIV1 WB criteria of positivity, was collected from an HIV2 infected person. Out of 125 saliva samples collected from seropositives, 121 produced positive Western Blot profiles, 4 were indeterminate and 1 was found negative whereas 125/125 sera were found positive. Conclusion: the reliability of HIV testing of saliva is dependent on the sensitivity of EIA tests and on the criteria used for the interpretation of Western blot tests as well. Although saliva testing offers numerous advantages for epidemiological purposes, it should not be recommended for diagnosis.

Eight Belgian AIDS Reference Laboratories established a multicentre quality control to evaluate the performance of their diagnostic human immunodeficiency virus type 1 (HIV-1) DNA polymerase chain reaction (PCR). A set of Belgian and African HIV-1 seropositive and seronegative patient samples, collected in Belgium, and the British Medical Research Council (MRC) HIV-1 PCR reference reagent kit, containing plasmid HIV-1 DNA at several dilutions in human carrier DNA with appropriate negative controls, were tested by the laboratories. No false positive results were reported. Ah laboratories were able to detect one to two copies of HIV-1 DNA. Among the 17 Belgian and African HIV-1 seropositives, some laboratories reported up to four indeterminate results, mainly due to failure of the SK38-39, SK68-69 (Ou et al. (1988) Science 239, 295-297) and/or gag881-882 (Simmonds et al. (1990) J. Virol. 64, 864-872) primers and a poorly performing algorithm. Only the H1POL4235-4538 nested pol primer set, developed by one of the laboratories, correctly identified all the tested HIV-1 positive and negative samples. Consequently, the laboratories decided to evaluate these pol primers as a reference primer set and to standardise the testing algorithm. All laboratories achieved a sensitivity and specificity of 100% on testing 10 additional Belgian and African patient samples, when adapting a standardised algorithm based on three HIV-1 primer sets, one of which is the H1POL4235-4538 primer set.

Introduction Selon les services sanitaires, le paludisme constitue le premier motif de consultation et d’hospitalisation. Il y a cependant contradiction de ces donnees avec celles du service national de la statistique de routine, d’apres lesquelles l’incidence des quinze dernieres annees varie seulement de 4 % a 15 %. L’introduction recente des tests rapides de diagnostic ne fournit pas d’eclairage suffisant au debat, car reposant sur la notion de portage d’antigenes dont la prevalence est habituellement elevee dans la population. Notre objectif est de proposer une methode d’estimation des donnees, en attendant que soit porter a grande echelle le diagnostic parasitologique qui fournirait des donnees plus credibles. Methodes Un panel d’experts constitue pour determiner une methode a procede par brainstorming couple a une meta-analyse. Resultats L’approche proposee consiste a selectionner deux districts dans chacun des facies epidemiologiques connus du pays. Tous les cas suspects y seront enregistres et documentes par goutte epaisse et frottis sur douze mois pour tenir compte de toutes les saisons. Dans ces districts, les donnees de la statistique de routine seront produites concomitamment a celles basees sur l’examen parasitologique. Ces dernieres serviront d’« etalon-or » pour les comparaisons intra-facies et nationale. Les facteurs correcteurs intra-facies et national seront determines par comparaison et utilises pour ajuster les donnees de routine pendant une periode de cinq ans avant de determiner a nouveaux les facteurs correcteurs. Discussion L’enjeu du paludisme pour le pays commande que les donnees relatives a ce theme soient conformes a la realite. La presente approche devrait y contribuer.

Recently, a novel blood-borne virus has been identified and named hepatitis G virus. Transfusion is the main route of transmission. It is known that patients on maintenance dialysis are more susceptible to infections with parenterally-transmitted viruses than the general population. The aim of the present study was to determine the prevalence of hepatitis G infection in a Belgian dialysis unit.The entire population of our dialysis unit (82 patients) was tested for the presence of hepatitis G virus (HGV) by reverse transcriptase polymerase chain reaction. History of transfusion or renal transplantation, coinfections with hepatitis B and C viruses, and serum aminotransferase levels were also tested.Thirteen patients (16%) were found positive for HGV-RNA. Among these patients, 69.2% were infected by the G virus alone, 15.4% were coinfected with B virus, and 15.4% with C virus. All but one patient had a history of transfusion. Ten of the thirteen infected patients (77%) had normal aminotransferase (30 UI/l). Three patients had elevated aminotransferase levels (23%); one was coinfected with B virus, one with C virus, and the last one had a diabetes-induced fatty liver infiltration. No liver biopsies were performed.It is concluded that infection with G virus is common among dialyzed patients. This high rate of infection could be related to previous transfusions, but may as well be due to nosocomial transmission. In our series, at least one patient has been contaminated by another road than transplantation or transfusion. Finally, it does not appear clearly that chronic infection with hepatitis G virus induces liver disease, as defined by elevated aminotransferase level.

The AIDS epidemic has focused attention on the constraints and deficiencies present in many blood transfusion services in the developing world. We discuss a variety of options for reducing transfusion-related HIV transmission, and suggest how new transfusion strategies may be implemented. We show that a transfusion service cannot rely solely on the screening of donor blood for anti-HIV antibodies and that a more comprehensive approach is needed. Important components of this approach include donor selection and improved clinical practice, in which blood and blood products are prescribed only when really necessary.