Search

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.Study Design and Methods: A total of 1431 persons or patients at low or high risk of sexually, blood-, or graft-transmitted viral infections were tested by means of a standardized immunofluorescence serologic assay detecting anti-HHV-8.Results: The persons or patients could be classified into three distinct groups according to anti-HHV-8 prevalence: a low prevalence group (0.0% to 5.0%), including healthy blood donors, healthy pregnant women, multiply transfused patients with thalassemia major, and IV drug users; an intermediate prevalence group (5.0% to 20.0%), including organ donors, kidney transplant recipients, and multiply transfused patients with sickle cell disease; a high prevalence group (>20.0%), including HIV-negative persons at high risk of sexually-transmitted viral infections, and HIV-infected homosexual men and heterosexuals.Conclusion: The sexual route appears to be the main route of HHV-8 transmission; bloodborne transmission of HHV-8, if it exists, is rare. In contrast, organ transplantation recipients might be exposed to HHV-8 transmission by the transplanted organ, which raises the issue of systematic screening of organ donors. [ABSTRACT FROM AUTHOR]

Organ transplantation recipients are exposed to the transmission of various viruses. Viral safety is based on careful selection of the grafts, based on both clinical criteria and systematic screening for the following markers: anti-human immunodeficiency virus antibodies and p24 antigen, anti human T-cell leukemia virus antibodies, anti-cytomegalovirus antibodies, anti-Epstein- Barr virus antibodies, HBs antigen, anti-HBs antibodies and anti-HBc antibodies, and anti-hepatitis C virus (HCV) antibodies. A residual risk of HCV transmission is theoretically associated with the "serological window" that can occur in an acutely infected patient before seroconversion, and that can last for up to 70 days. The objective of this study was to determine the value of HCV core antigen detection and of nucleic acid testing (NAT) to improve viral safety of organ grafts. We tested blood samples prospectively collected between may 1992 and may 2000 in 2000 consecutive organ donors from the Paris area for the presence of: i) HCV core antigen with a new enzyme immunoassay (Core Antigen ELISA Test System, Ortho-Clinical Diagnostics, Raritan, New Jersey), ii) HCV RNA using the Transcription-Mediated Amplification assay (Chiron Procleix[sup TM] TMA HIV-1/HCV Assay, Chiron). HCV core antigen positive results were confirmed by neutralization. Of 2000 samples tested, 5 were found to be positive for the HCV core on first determination, among which 4 were confirmed to be specific (prevalence 0.20%; 95% confidence interval: 0.10%-0.30%). These four donors were also anti-HCV antibody-positive. The donor with a nonspecific reaction was antibody-negative and HCV RNA negative in PCR. NAT preliminary results show that 1.2% of sample tested were reactive. In conclusion, the residual risk of HCV transmission by organ transplantation appears to be very small. HCV-infected patients are well identified by the detection of anti-HCV antibodies and implementation of HCV core antigen detection would increase the cost without clear benefit for viral safety. [ABSTRACT FROM AUTHOR]

Background: Prevention of viral transmission in grafts is based on clinical and biological selection of organ donors. Clinical selection, involving any history of intravenous drug use, of multiple sexual partners, of symptoms of viral infections, has limitations and selection based on detection of markers of viral infection is essential. In France, the following markers are systematically sought in organ donors: anti-human immunodeficiency virus (HIV) antibodies and p24 antigen, anti human T-cell leukemia virus antibodies (HTLV-I), Hepatitis B surface (HBs) antigen, anti-HBs antibodies, anti-HBc antibodies, anti-hepatitis C virus (HCV) antibodies, anti-cytomegalovirus (CMV) antibodies and anti-Epstein-Barr virus (EBV) antibodies. Our unit performs serological testing in organ donors from the Paris area. Study design : we are reporting our experience of systematic testing of potential organ donors from May 1992 to May 2001; 2316 serum samples were tested for previous markers of viral infection using available assays. All samples were tested for HCV and HIV antibody by use of latest generation assays. Results: the prevalence of markers of viral infection over time was steady: anti-HIV antibodies: 1-2%; p24 antigen +/anti-HIV antibodies-: 0%; HBs antigen: 1.52%; anti-HBc antibodies: 12-15%; anti-HCV antibodies: 3.5-5%. Thus, the prevalence of HIV and HCV infection is five and four times higher in organ donors than in the general population in France (0.2% and 1%, respectively). Conclusion: These results suggest that organ donors are at high risk of HIV and/or hepatitis virus infection, which exposes organ recipients to the risk of viral transmission by graft. [ABSTRACT FROM AUTHOR]