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Objectives C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers’ behaviour, we aimed to review available evidence generated in LMICs. Methods We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas. Results Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis. Conclusions Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence.

Introduction: The incidence of newly diagnosed older patients diagnosed with human immunodeficiency virus (HIV) has increased worldwide in recent years. In this study, we compared the demographics and clinical presentation of younger and older patients in our HIV sentinel cohort. Materials and Methods: Among all HIV patients presenting to the Communicable Disease Centre (CDC), Singapore from 2006 to 2011, 793 were randomly included in our cohort, representing about 50% of the patients seen during that period. We collected demographic, clinical, laboratory, and outcome data from patient records to compare younger (

Introduction: Highly active antiretroviral therapy (HAART) has improved outcomes for individuals infected with human immunodeficiency virus (HIV). This study describes the causes of death in hospitalised HIV-positive patients from 2008 to 2010 in Tan Tock Seng Hospital, the national referral centre for HIV management in Singapore. Materials and Methods: Data were retrospectively collected from HIV-positive patients who died in Tan Tock Seng Hospital from January 2008 to December 2010. Results: Sixty-seven deaths occurred in the study period. A majority of patients died of non-acquired immune deficiency syndrome (AIDS)-defining illnesses (54.7%). The median CD4 count was 39.5 (range, 20.0 to 97.0), and 7 patients had HIV viral loads of

This assay provides results in less time than routine PCR and is equally sensitive., Rapid diagnostic methods are essential in control of Ebola outbreaks and lead to timely isolation of cases and improved epidemiologic surveillance. Diagnosis during Ebola outbreaks in West Africa has relied on PCR performed in laboratories outside this region. Because time between sampling and PCR results can be considerable, we assessed the feasibility and added value of using the Xpert Ebola Assay in an Ebola control program in Guinea. A total of 218 samples were collected during diagnosis, treatment, and convalescence of patients. Median time for obtaining results was reduced from 334 min to 165 min. Twenty-six samples were positive for Ebola virus. Xpert cycle thresholds were consistently lower, and 8 (31%) samples were negative by routine PCR. Several logistic and safety issues were identified. We suggest that implementation of the Xpert Ebola Assay under programmatic conditions is feasible and represents a major advance in diagnosis of Ebola virus disease without apparent loss of assay sensitivity.

There is a lack of representative samples to provide reliable and accurate seroprevalence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) as well as behavioural information among men who have sex with men (MSM) in Singapore. We used respondent driven sampling (RDS) to recruit MSM. Participants completed a survey used by Asian Internet MSM Sex Survey (AIMSS) and were tested for HIV and syphilis. We compared the characteristics of the RDS participants with STI diagnosis against those who did not have any STI diagnosis in the past 6 months. We compared RDS participants with AIMSS participants. Of 72 MSM recruited, 1 was positive for HIV (1.3%) and 4 (5.5%) tested positive for syphilis. Median age was 30 years and majority was Chinese (69.4%). RDS participants who had any STI diagnosis reported to have more use of recreational drugs (P = 0.006), and lower condom use (P = 0.054). Comparing RDS participants (n = 72) with the AIMSS participants (n = 2075), RDS respondents had ≥1 male partner in the past 6 months (P = 0.003), more casual sex partners (P = 0.012) and more STI symptoms (P = 0.019). There was no difference in terms of HIV testing and recreational drug use. The HIV and syphilis seroprevalence rates from our study are similar to previous reports conducted in high-risk MSM. In contrast to other settings, RDS did not work well among MSM in Singapore. The public health implications of our study highlight the challenges in obtaining data for HIV surveillance in assessing prevalence and risk behaviours among MSM. Key words: Sexually transmitted infection (STI), Behaviour

The incidence of newly diagnosed older patients diagnosed with human immunodeficiency virus (HIV) has increased worldwide in recent years. In this study, we compared the demographics and clinical presentation of younger and older patients in our HIV sentinel cohort.Among all HIV patients presenting to the Communicable Disease Centre (CDC), Singapore from 2006 to 2011, 793 were randomly included in our cohort, representing about 50% of the patients seen during that period. We collected demographic, clinical, laboratory, and outcome data from patient records to compare younger (50 years old) and older (≥50 years old) HIV patients.Older patients comprised 27.1% of our HIV cohort and presented with lower median CD4 T cell counts (65 cells/mm³, interquartile range [IQR]: 27 to 214 cells/mm³) compared to younger patients (250 cells/mm³, IQR: 74 to 400 cells/mm³; P0.001). The median time from HIV diagnosis to initiation of antiretroviral therapy (ART) differed significantly for both age groups as well (49 days for patients50 years old, IQR: 18 to 294 days; versus 35 days for patients ≥50 years old, IQR: 14 to 102 days; P = 0.008). More of our younger patients were single (72.2%) or homosexual (44.1%), in contrast to older patients, of whom 48.8% were married and 84.7% were heterosexual.Upon comparison of our younger and older patients, we identified distinct differences in risk transmission and clinical presentation. Increased awareness of older patients at risk of HIV may improve time to diagnosis among this age group.

Highly active antiretroviral therapy (HAART) has improved outcomes for individuals infected with human immunodeficiency virus (HIV). This study describes the causes of death in hospitalised HIV-positive patients from 2008 to 2010 in Tan Tock Seng Hospital, the national referral centre for HIV management in Singapore.Data were retrospectively collected from HIV-positive patients who died in Tan Tock Seng Hospital from January 2008 to December 2010.Sixty-seven deaths occurred in the study period. A majority of patients died of non-acquired immune deficiency syndrome (AIDS)-defining illnesses (54.7%). The median CD4 count was 39.5 (range, 20.0 to 97.0), and 7 patients had HIV viral loads of200 copies/mL. There were 27 deaths due to opportunistic infections, 27 due to non AIDS-defining infections, 4 due to non AIDS-associated malignancies. This study also describes 3 deaths due to cardiovascular events, and 1 due to hepatic failure. Patients who had virologic suppression were more likely to die from non AIDS-defining causes.Causes of death in HIV-positive patients have changed in the HAART era. More research is required to further understand and address barriers to testing and treatment to further improve outcomes in HIV/AIDS.

www.thelancet.com Vol 386 December 5, 2015 2255 2 altona Diagnostics. RealStar Filovirus Screen RT-PCR Kit 1.0, instructions for use. August, 2014. http://www.altona-diagnostics. com/tl_fi les/website/downloads/RealStar_ Filovirus%20Screen%20RT-PCR%20Kit%2010_ CE_WEB_2014-08-29.pdf (accessed Nov 9, 2015). 3 Janvier F, Gorbatch S, Queval L, et al. Diffi culties of interpretation of Zaire Ebola Virus PCR results and implication in the fi eld. J Clin Virol 2015; 67: 36–37. 4 TIB MOLBIOL. LightMix Modular Ebola Virus Zaire (2014), instructions for use. April, 2014. http://www.roche-as.es/logs/MDx_53–0649– 96_Ebola_V140404_07383428001.pdf (accessed Nov 9, 2015). 5 Trombley AR, Wachter L, Garrison J, et al. Comprehensive panel of real-time TaqMan polymerase chain reaction assays for detection and absolute quantifi cation of fi loviruses, arenaviruses, and New World hantaviruses. Am J Trop Med Hyg 2010; 82: 954–60. 6 altona Diagnostics. RealStar Ebolavirus RT-PCR Kit 1.0, instructions for use. November, 2014. http://www.altona-diagnostics.com/tl_fi les/ website/downloads/RealStar_Ebolavirus%20 1.0%20RT-PCR%20Kit%20Instructions%20 for%20use%20clean%202014-11-26.pdf (accessed Nov 9, 2015). 7 Janvier F, Foissaud V, Sagui E, et al. Monitoring of laboratory values over the course of Ebola virus disease in Healthcare Workers Ebola Treatment Center, Conakry, Guinea. J Infect Dis (in press). false test results can be disastrous at the community level, with potentially serious consequences for outbreak control. Second, the authors state that rapid diagnostic tests for Ebola virus are easy to use; however, their use necessitates strict biosafety protocols and equipment to avoid health-care workers becoming infected. In view of these limitations, the ReEBOV Antigen Rapid Test can be safely used only in a setting with strict biosafety measures. Thus, the kit confers little added value since PCR technologies are already available in such settings. Technical guidance on rapid diagn os tic tests for Ebola virus is urgently needed and should include a description of how test results should be incor porated in diagnostic algorithms, taking into account the availability of new, integ rated PCR methods and biosafety measures.