The HIV-1 seroprevalence rate of injured patients admitted through California emergency departments. California HIV-1 Emergency Department Seroprevalence Study Group

STUDY OBJECTIVES: To measure the HIV seroprevalence of injured emergency department patients in a number of California hospitals and to examine the relationship between ED seroprevalence and local AIDS incidence. DESIGN: Prospective blinded testing for HIV-1 antibody was performed on routinely collected blood samples. SETTING: Ten California hospitals; group 1 included three hospitals from counties of high AIDS incidence (more than 40 cases per 100,000 population), group 2 included three hospitals from counties of intermediate AIDS incidence (20 to 40 cases per 100,000 population); and group 3 included four hospitals from counties of low AIDS incidence (less than 20 cases per 100,000 population). TYPE OF PARTICIPANTS: Eligible patients were all adult trauma victims admitted to a participating hospital through the ED during a consecutive three-month period occurring between June and November 1989. MEASUREMENTS: HIV-1 antibody testing was done using enzyme immunoassay confirmed by immunofluorescence assay. Equivocal results were confirmed by Western blot. Mann-Whitney U test, chi 2 test, and multiple logistic regression were used where appropriate. RESULTS: There were 2,264 patients with adequate blood samples for serologic testing. The seroprevalence rates for hospitals in groups 1, 2, and 3 were significantly different (chi 2 = 8.44, P = .02): Group 1, 2.5% (19 of 756: 95% confidence interval [CI], 1.5% to 3.9%); group 2, 0.9% (10 of 1,078; CI, 0.5% to 1.7%); and group 3, 0.5% (two of 430; CI, 0.06% to 1.7%). CONCLUSION: This study suggests that local AIDS incidence rates do not necessarily predict the seroprevalence rates of injured patients who are admitted through local EDs.     

Patterns of HIV-1 and HTLV-I/II in intravenous drug abusers from the middle atlantic and central regions of the USA

Seroprevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) was determined among 1160 intravenous (iv) drug abusers from five drug treatment or medical centers (Manhattan, Brooklyn, New Jersey, Detroit, and New Orleans). HIV-1 infection ranged from 5% in New Orleans to 48% in New York City. Hispanics and blacks had a significantly higher rate of HIV-1 infection than whites (P less than .01), but within each group rates were similar between males and females and by age stratum. HTLV-I/II seroprevalence increased with age from 3% in the 20-29 year age group to 37% in the group greater than 50 years. New Orleans and Manhattan (24%) had the highest rate, and blacks (19%) had a higher rate than either Hispanics (6.3%) or whites (7.3%). No association between HIV-1 and HTLV-I/II infection was observed except in Manhattan. When compared with iv drug abusers infected only with HIV-1, dually infected subjects had more clinical symptoms related to immune deficiency but a lower prevalence of HIV antigenemia. These data document the frequent occurrence of retroviral infections in iv drug abusers. The contrast between the two classes of virus suggests that HIV-1 is more efficiently transmitted, while the age-dependent rise in HTLV-I/II seroprevalence suggests cumulative exposure of a less-transmissible agent.     

Seroepidemiological study of retroviruses (HTLV-I/II, HIV-1, HIV-2) in the Department of Atacora, Northern Benin

A seroepidemiological survey to determine the prevalence of retrovirus infection (HTLV-I/II, HIV-I, HIV-2) by representative sampling of the general population in the Department of Atacora in north-western Benin is reported. The seroprevalence rate of HTLV-I in this sample was at 1.86% (95% CI 1.20–2.52%). This is in agreement with prevalence rates reported from neighbouring countries of the sub-region. No sera were found positive for HTLV-II. Seropositivity to HIV-I was 0.3%; HIV-2 seropositivity was not encountered.     

Antibody prevalence of parenterally transmitted viruses (HIV-1, HTLV- I,HBV, HCV) in Austrian intravenous drug users

Summary From 1985 to 1990 the sera of 372 newly imprisoned intravenous drug users (IDU) were tested for HIV-1 antibodies. The seroprevalence was 18%, males 16% and females 31%. HIV-1 seroprevalence in Austrian IDU has not increased since 1986. All sera tested for HTLV-I-antibodies were negative. The majority of the HIV-1 seropositive drug users had been infected before 1985. The reported frequency of needle sharing has decreased since 1986. Of 151 IDU tested for HCV antibodies 75% were positive for anti-HCV, 68% were positive for hepatitis B markers, 59% were positive for both HBV and HCV markers, and 13% were positive for HIV-1 antibodies. In conclusion: in Austrian IDU HCV seems to be the most frequent parenterally transmitted virus; HIV-1 seroprevalence has not increased since 1986; HLTV-I infection has not yet begun.

---

Prävalenz von Markern parenteral übertragbarer Viren (HIV-1, HTLV-I, HBV, HCV) bei i.v. Drogenabhängigen in Österreich

Zusammenfassung Die Seren von 372 neu inhaftierten intravenös Drogenabhängigen (IDU) wurden von 1985 bis 1990 auf HIV-1-Antikörper untersucht. Die Prävalenz liegt bei 18% (Männer 16%, Frauen 31%) und hat seit 1986 nicht zugenommen. Alle Seren, die auf HTLV-I-Antikörper getestet wurden, waren negativ. Anamnestische Daten zeigen, daß die meisten HIV-1-Infektionen österreichischer IDU vor 1985 stattgefunden haben und daß das gemeinsame Benützen von Injektionsutensilien seit 1985 seltener geworden ist. Von 151 IDU, die auf HCV-Antikörper untersucht wurden, waren 75% anti-HCV positiv, 68% hatten Marker einer Hepatitis B-Infektion, bei 59% waren sowohl anti-HCV als auch Hepatitis B-Marker positiv und 13% hatten HIV-1-Antikörper. Bei österreichischen IDU scheint HCV das am häufigsten parenteral übertragene Virus zu sein; die HIV-1 Antikörperprävalenz hat seit 1986 nicht zugenommen; HTLV-I Infektionen sind noch nicht nachweisbar.

     

Human immunodeficiency virus type 1 and other viral co-infections among young heterosexual men and women in Argentina

Infections with hepatitis C virus, (HCV), hepatitis B virus (HBV), and human T lymphotropic type I/II (HTLV-I/II) virus are commonly found in patients infected with human immunodeficiency virus type 1 (HIV-1). We conducted a seroepidemiologic study among 174 HIV-positive heterosexuals in Buenos Aires, Argentina in 1999. Evidence of exposure to HCV, HBV, and HTLV-I/II was found in 32%, 17%, and 5%, respectively. A higher prevalence of HBV infection was observed among males (33%) compared with females (12%; P < 0.05). Among women, a prior history of a sexually transmitted infection, injecting drug use (IDU), having had more than five lifetime sex partners, and having exchanged sex-for-goods were significantly associated with HCV infection, whereas an IDU history, syringe sharing, and having exchanged sex-for-goods were found to be associated with HBV infection. Among men, an IDU history and syringe/needle sharing were significantly associated with HCV infection. The IDU-related and sexual transmission of hepatitis viruses constitute a significant problem among young, HIV-infected, heterosexuals in Argentina.     

Presence of human immunodeficiency virus (HIV) and T-lymphotropic virus type I and II (HTLV-I/II) in a Haemophiliac population in Belo Horizonte, Brazil, and correlation with additional serological results

The aim of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV-1) and human T lymphotropic virus types I and II (HTLV-I/II) infections in 226 Haemophiliac patients treated at Fundação Hemominas in Belo Horizonte, Minas Gerais State, Brazil, and to verify association with other serological results. Patients positive for HTLV-I/II had also a neurological, heamatological and ophthalmological evaluation. Fundação Hemominas offers comprehensive care for all Haemophiliac patients in Minas Gerais. Thirty-six (15.9%) of the 226 patients showed reactive results to HIV-1 [ELISA, Abbott, USA, confirmed by Western blot (WB), Cambridge Biotech, USA, and/or immunofluorescence, Fiocruz, Brazil] and 16 (7.1%) had reactive sera to HTLV-I/II (ELISA, Ortho). Eleven of these 16 (4.9%) were positive, 3/16 (1.3%) were indeterminate and 2/16 (0.9%) were negative in the HTLV WB (Cambridge Biotech). Neurological, heamatological and ophthalmological examination of 9/16 patients revealed no abnormality suggestive of HTLV disease. Of the 16 patients reactive to HTLV-I/II ELISA test, six (37.5%) were also positive to HIV-1 (χ²= 5.92; P = 0.01). Seropositivity for HTLV-I/II and HIV-1 was associated with advancing age and positive results for hepatitis C virus (HCV), Chagas' disease ( T. cruzi infection) and syphilis. No association between the presence of HTLV with type and severity of Haemophilia and hepatitis B results was detected. The prevalence of antibodies against HIV-1 is approximately three times that of HTLV-I/II and a patient positive for HTLV-I/II had a significantly increased risk of being positive for HIV-1, HCV and T. cruzi .     

Co-infection of HIV and HBV in voluntary counseling and testing center in Abidjan

ObjectiveTo evaluate the co-infection of hepatitis B virus (HBV) and immune deficiency virus (HIV) among clients consulting at the Voluntary Counseling and Testing Center (VCT Center) of the Institut Pasteur de Côte d’Ivoire (IPCI).MethodsA cross-sectional study was conducted from April to June 2010 at the VCT of IPCI. All clients attending the VCT of IPCI for HIV test after having signed the informed consent form were included in the study. Venous blood samples were collected from the clients after an interview. Then the rapid tests for screening of HIV infection (Determine HIV 1/2 of Abbott and Genie II HIV-1/HIV-2, Bio-Rad) were performed. As for hepatitis B surface antigen (HBsAg) test, it was performed using ELISA test system using Monolisa HBsAg Ultra-Bio-Rad.ResultsOf 278 samples analyzed, 30 were positive to antibody against HIV-1, giving a seroprevalence of about 10.8%, and 35 were positive to HBsAg, giving a seroprevalence of 12.6%. As for co-infection of HIV and HBV, it was 7/278 cases about 2.5%.ConclusionsIt can be concluded that co-infection of HBV and HIV is relatively low among clients consulting at the VCT of the IPCI. Serological surveillance should be systematic in various HIV testing centers in the country. The use of rapid tests for detection of HBsAg allows a lot of tests to be realized. However, the choice of these tests depends on the evaluation results in reference laboratories and situation on ground.     

Herpes simplex virus type 2 infection, syphilis, and hepatitis B virus infection in Haitian women with human immunodeficiency virus type 1 and human T lymphotropic virus type I infections. The Johns Hopkins University (JHU)/Centre pour le Developpement et la Santé (CDS) HIV Study Group.

Antibodies to herpes simplex virus type 2 (HSV-2), antibodies to hepatitis B virus (HBV) core antigen (anti-HBc), and VDRL antibodies (serologic evidence of syphilis) were evaluated in women known to be infected with human immunodeficiency virus type 1 (HIV-1) (n = 95) or human T lymphotropic virus type I (HTLV-I) (n = 45) and controls (n = 89). HIV-1-seropositive women were more likely than controls to have antibodies to HSV-2 (88% vs. 54%; P less than .001), anti-HBc (67% vs. 43%; P = .008), and VDRL antibodies (21% vs. 8%; P = .02). Similarly, HTLV-I-seropositive women were more likely than controls to have antibodies to HSV-2 (82% vs. 54%; P = .003) and anti-HBc (67% vs. 43%; P = .008). There was no evidence that HIV-1 or HTLV-I predisposed to chronic hepatitis B virus infection. The stronger associations between HIV-1 and HTLV-I with HSV-2 than the associations with syphilis or HBV are consistent with the hypothesis that recurrent disruptions of mucous membranes caused by HSV-2 infections predispose to sexual transmission of HIV-1 and HTLV-I.     

Immunofluorescence assay reactivity patterns of serum samples presenting indeterminate Western blot results for antibodies to HIV-1 and HTLV-I/II in Cordoba, Argentina.

Serum samples (n: 110) from blood donors and high risk individuals from Cordoba, Argentina with indeterminate HIV-1 and HTLV-I/II Wb profiles were studied for specific antibodies to HTLV-I/II and HIV-1 by indirect immunofluorescence assay (IFA) and for the presence or absence of HIV-1 and HTLV-I/II specific bands by Wb. This study was carried out in order to characterize their putative reactions with HIV-1 and HTLV-I/II proteins and to resolve the retrovirus infection status of these individuals. Results indicated that blood donors sera displaying indeterminate HIV-1 or HTLV-I/II Wb patterns were not immunoreactive to HTLV-I/II and HIV-1 on IFA. However, a high rate of indeterminate HIV-1 and HTLV-I/II Wb samples from high risk individuals had positive HTLV-I/II and HIV-1 IFA results respectively. Our study supports the growing evidence that HTLV-HIV indeterminate seroreactivity in low risk population is due to a cross reaction against nonviral antigens, and in high risk populations the indeterminate samples show serological cross-recognition between HIV-1 proteins and HTLV-I/II proteins on Wb. These results point out the necessity to investigate the HTLV-I/II reactivity in indeterminate HIV-1 samples and vice versa in order to confirm the diagnosis. Finally, this study shows the potential usefulness of IFA in elucidating the status of HIV-1 and HTLV-I/II infection of individuals with indeterminate Wb profiles, thus enabling resolution of retrovirus infection status.     

Seroprevalence of HCV and its co-infection with HBV and HIV among liver disease patients of South Tamil Nadu

AIM: To determine the seroprevalence of hepatitis C virus (HCV) and its co-infection with hepatitis B virus (HBV), hepatitis delta agent (HDV) and human immunodeficiency virus (HIV) among liver disease patients of south Tamil Nadu.METHODS: A total of 1012 samples comprising 512 clinically diagnosed cases of liver disease patients and 500 apparently healthy age and sex matched individuals were screened for Hepatitis C virus (anti HCV and HCV RNA), Hepatitis B virus (HBsAg), Hepatitis delta agent (anti HDV) and Human immuno virus (antibodies to HIV-1 and HIV-2) using commercially available enzyme linked immunosorbent assay kits. HCV RNA was detected by RT-PCR. Liver function tests like ALT, AST, GGT, ALP, bilirubin and albumin were also studied.RESULTS: The seroprevalence of HCV was found to be 5.6% among liver disease patients by ELISA. 27/512, 49/512 and 12/512 patients were positive for HIV, HBV & HDV respectively. Co-infection of HCV & HBV was found in 8 patients, with 6 for HCV & HIV and 4 for HCV, HBV & HIV co-infections. Sex-wise analysis showed that HIV, HCV & HBV and HCV & HIV co-infection was high among females whereas for HBV it was high in males. The mean ALT and AST in HCV positive cases were 42.1 ± 8.3 and 49 ± 10.1. In people co-infected with HCV & HBV or HCV & HIV or HCV, HBV & HIV the mean ALT of 58.0 ± 03.16, 56.78 ± 4.401 and 64.37 ± 4.01 respectively.CONCLUSION: We strongly recommend routine test of the blood for HCV in addition to HBV and HIV. We also recommend individualized counseling to identify those at risk and testing for those who want it. Improved surveillance and periodic epidemiological studies will have to be undertaken to monitor and prevent these blood-borne viruses.     

Health care worker exposure to HIV-1 and HTLV I-II in critically ill, resuscitated emergency department patients.

STUDY OBJECTIVE: Exposure to HIV-1 is of profound concern to health care workers. HTLV-I and HTLV-II, retroviruses with similar modes of transmission as HIV-1, also cause disease in human beings. Emergency department resuscitations are high-risk situations for such exposure. The purpose was to determine the seroprevalence of HIV-1 and HTLV I-II in patients undergoing ED resuscitations, the magnitude of health care worker exposure, and risk factors associated with infection. DESIGN: Prospective identity-unlinked seroepidemiologic study. SETTING: ED of a 950-bed private inner-city teaching hospital. Participants included 370 patients undergoing ED resuscitations. MEASUREMENTS: Serum was tested for antibodies to HIV-1 and HTLV I-II. Questionnaires were completed by the physician in charge of the ED resuscitations. RESULTS: Fifteen (4.1%) (95% confidence interval [CI], 2.1% to 6.1%) patients were HIV-1 seropositive, and seven (1.9%) (95% CI, 0.7% to 3.1%) were HTLV I-II positive. Eleven (5.6%) (95% CI, 2.4% to 8.8%) of 197 trauma patients and 11 (6.4%) (95% CI, 2.8% to 10.0%) of 173 medical patients were infected with one of these viruses. Health care workers had direct cutaneous contact with patient blood during 114 (31%) ED resuscitations and with infected patient blood during 11 (3%) ED resuscitations. An additional 11 ED resuscitations involved parenteral exposures, one to HIV-1-infected blood. No factors could be identified that would quickly and reliably predict infection. CONCLUSION: Health care workers must protect themselves in such high-risk situations by strict compliance to mandatory universal precautions.     

Concomitant carriage of hepatitis B virus and human T-lymphotropic virus type I among blood donors in Kitakyushu, Japan

The seroprevalence of hepatitis B surface antigen (HBsAg) by gender and age and of human T-lymphotropic virus type I (HTLV-I), and their concomitant carriage was examined among blood donors at the Kitakyushu Red Cross Blood Centre in the fiscal year of 1988. The positive rates of HBsAg among males were consistently higher than those of females; the peaks were detected in male donors aged 30-39 years and in females aged 40-49 years. Declining seropositive rates in individuals aged 50 years or over were observed for both genders. Self-selection due to chronic HBV infection may partly account for such tendencies. On the other hand, the prevalence rates of anti-HTLV-I antibodies among males were uniformly lower than those of females, which must be attributable to male-to-female transmission of HTLV-I via sexual contact. Elevated positive rates in proportion to age were noted for both genders, which may be explained in part by birth cohort effect. The seropositive rates of HBsAg among HTLV-1 carriers were not statistically different from those of non-HTLV-I carriers. Conversely, the prevalence of antibodies to HTLV-I was unrelated to the status of seropositivity of HBsAg.     

HIV-1 and hepatitis B virus infections in adolescents lodged in security institutes of Buenos Aires

The goal of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections in street youth lodged in security institutes, from February 1992 to March 1995, to correlate these infections with nontherapeutic drug use, and to compare these results with a previous study done in a similar population. A total of 1460 white adolescents, 276 females and 1184 males, were enrolled (mean age 16.6 years). Prevalence of HIV-1 was 4.58% and of HBV was 6.78%. The prevalence of dual HIV-1/HBV infection was 1.91%; the prevalence of HBV infection was significantly higher in HIV-positive subjects (p < 0.0000000, chi 2 = 136.17, OR = 13.37) than in those not infected with HIV-1. Prevalences were higher in males. Intravenous drug addiction proved to be a significant risk factor for both viruses (HIV-1, p < 0.0000000, chi 2 = 171.34, OR = 16.84; HBV, p = 0.000044, chi 2 = 16.67, OR = 3.17); 6.43% of the total population were intravenous drug users. Comparison of the current results with our previous study (1989-1992) showed that the prevalence of HIV-1, HBV, and concurrent HIV/HBV as well as intravenous drug addiction has decreased significantly in our current cohort (chi 2 = 134.85, p < 0.0000000; chi 2 = 126.62, p < 0.0000000; chi 2 = 110.05, p < 0.0000000; and chi 2 = 158.3, p < 0.0000000) respectively. Progress appears to have been made in the fight against acquired immunodeficiency syndrome (AIDS), and promising results have been obtained. However, if further viral spread is to be avoided, the emphasis on prevention should be energetically maintained.     

Trends in hepatitis B and hepatitis C seroprevalence among Nepalese blood donors

In Nepal, hepatitis B and hepatitis C are considerable health problems. This study aimed to assess the trends of hepatitis B virus (HBV) and hepatitis C virus (HCV) seroprevalence in blood donors over the last 6 years nationwide and in the urbanized setting of Kathmandu Valley. This was a retrospective study conducted among Nepalese blood donors through the years 2001/2002-2006/2007. Serum samples were tested for hepatitis B surface antigen and anti-HCV antibodies using third generation ELISA tests. The donors' information was collected via the donor record register through their respective Blood Transfusion Services. The software, Winpepi ver 3.8 was used for statistical analysis. The overall seroprevalence rates of HBV and HCV in a nationwide analysis were observed to be 0.82 and 0.47%, respectively, and at Central Blood Transfusion Service (CBTS), Kathmandu, the rates were 0.92 and 0.71%, respectively. The seroprevalence of HBV was significantly higher than the seroprevalence of HCV, both nationwide and at CBTS (P < 0.05). An overall significantly decreasing trend was observed in HBV and HCV seroprevalence both nationwide and at CBTS, Kathmandu, over the last 6 years (P < 0.05). Though the overall trend was significantly decreasing, the test for departure from a linear trend also showed a statistically significant result (P < 0.05).     

Comparative trends of seroprevalence and seroincidence rates of human T cell lymphotropic virus type I and human immunodeficiency virus 1 in pregnant women of various ethnic groups sharing the same environment in French Guiana

The objectives of this study were to compare the seroprevalence and seroincidence rates of human T cell lymphotropic virus type I (HTLV-I) and human immunodeficiency virus 1 (HIV-1) in pregnant women in several ethnic groups in French Guiana between July 1, 1991 and June 30, 2001. This study was conducted in the obstetrics unit of the hospital in Saint Laurent du Maroni in a dynamic cohort of 6,921 pregnant women with 11,679 deliveries, with new entrants each year. The overall seroprevalence of HTLV for all women differed between ethnic groups and was restricted mainly to the descendents of fugitive slaves of African origin known as Noir-Marron (181 of 4,266, 4.24%) and to Haitian women (12 of 287, 4.18%). A decrease in the biennial seroprevalence of HTLV-I was observed over time among deliveries of the Haitian women (P = 0.037), but it remained stable among Noir-Marron (P = 0.22). Fifteen of the 17 HTLV-I seroconversions occurred in the Noir-Marron, giving an incidence of 0.18 per 100 person-years. The overall seroprevalence of HIV-1 was higher in the Haitian women (10 of 293, 3.41%) than in the Noir-Marron (34 of 4,310, 0.79%) and Amerindians (4 of 552, 0.72%). A highly significant increase in the biennial seroprevalence of HIV-1 was observed among the deliveries of the Noir-Marron (P = 0.0003), but it remained stable among Haitian women (P = 0.44). Ten of the 13 HIV-1 seroconversions were observed in Noir-Marron, giving an incidence rate of 0.12 per 100 person-years. These data demonstrate the differential spreading of these two human retroviruses among pregnant women in different ethnic groups living in the same environment. While HTLV-I, which is highly endemic in groups of African origin, showed a slight decrease over time in a suspected cohort effect, HIV-1 spread rapidly in an epidemic mode, especially in the groups of the lowest socioeconomic levels.     

Seroconversion of acute hepatitis B by antiretroviral therapy in an HIV-1 infected patient

A 33-year-old man with human immunodeficiency virus type1 (HIV-1) infection was admitted because of acute hepatitis B. His serum alanine aminotransferase level was 1200 IU/mL and CD4 cells count was 268/mm3. Antiretroviral therapy including tenofovir and emtricitabine, which suppresses both HIV and hepatitis B virus (HBV) replication, was initiated. The liver enzymes decreased dramatically. The viral loads of both HIV-1 and HBV were suppressed below detectable limits. Seroconversion from hepatitis B surface antigen to hepatitis B surface antibody was acquired 19 weeks later. In this case, the initiation of antiretroviral therapy with anti-HBV activity during the acute phase of hepatitis B had a favourable effect on HBV serostatus.     

Transmission of retroviruses from seronegative donors by transfusion during cardiac surgery. A multicenter study of HIV-1 and HTLV-I/II infections.

OBJECTIVE: To evaluate the effectiveness of serologic testing of blood donors for human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus types I and II (HTLV-I/II) infections and to estimate the risk for transmission of HIV-1 and HTLV-I/II by transfusion of seronegative blood from screened donors. DESIGN: A prospective multicenter cohort study of cardiac surgery patients who received multiple transfusions between 1985 and 1991. SETTING: Cardiac surgery services of three large tertiary care hospitals. PATIENTS: The study included 11,532 patients in three hospitals who had cardiovascular surgery. MEASUREMENTS: Incident HIV-1 and HTLV-I or HTLV-II infection. RESULTS: We detected two new HIV-1 infections among patients transfused with 120,312 units of blood components from seronegative donors. In each case a donor was detected on follow-up who had seroconverted since the donation. The HIV-1 infection rate was 0.0017% with an upper limit of the 95% CI of 0.0053%. Before donor screening for HTLV-I, transfusion of 51,026 units resulted in two HTLV-I infections (0.0039%) and four HTLV-II infections (0.0078%). After HTLV-I screening was instituted, one recipient was infected with HTLV-II among participants exposed to 69,272 units, a rate of 0.0014%. A corresponding HTLV-I/II-infected donor was found for this patient. CONCLUSION: Serologic screening of donors for antibodies to HIV-1 and HTLV-I coupled with exclusion of donors from groups having a relatively high risk for infection has led to a low incidence of transfusion-transmitted HIV-1 and HTLV-I/II infection in the United States. A small risk remains, however, despite these measures. We estimate the residual risk for HIV-1 and HTLV-II infection from transfusion of screened blood during the time of this study to be about 1 in 60,000 units.     

Seroprevalence of hepatitis B, hepatitis C, CMV and HIV in multiply transfused thalassemia patients: results from a thalassemia day care center in Malaysia

Regular blood transfusions for patients with thalassemia have improved their overall survival although these transfusions carry a definite risk of the transmission of certain viruses. Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV) and human immunodeficiency virus (HIV) leads to complications which contribute to the morbidity and mortality of patients with thalassemia. We analyzed the blood samples taken from 85 transfusion dependent thalassemics receiving treatment at the day care center in Hospital Universiti Kebangsaan Malaysia and found that the seroprevalence rates for HBV, HCV and CMV were 2.4%, 22.4% and 91.8% respectively. None of the patients tested positive for HIV. Those positive for HBV and HCV will require further tests and treatment if chronic hepatitis is confirmed.     

Markers of hepatitis viruses and human T-lymphotropic virus types I/II in patients who have undergone open-heart surgery: evidence of increased risk for exposure to HBV and HEV

BACKGROUND: Open-heart procedure is characterized by a high-risk for contracting blood-borne infections. We evaluated the prevalence of several markers of hepatitis viruses (B-E) and human T-cell lymphotropic virus types I/II (HTLV-I/II) in a consecutive series of patients who had undergone open-heart surgery. METHODS: 204 patients and 158 selected age- and sex-matched healthy volunteers were investigated. Samples were collected at least 6-12 months postoperatively. Commercial enzyme immunoassays and confirmatory immunoblot assays for HCV, HEV and HTLV-I/II were used. RESULTS: None of the subjects tested positive for antibodies to HTLV-I/II. Prevalence of markers of past HBV infection and antibodies to HEV (anti-HEV) were higher in patients than in healthy controls (anti-HBc: 45.1% vs. 31%, p=0.009; anti-HBs: 31.9% vs. 22.2%, p=0.02; anti-HBe: 32.4% vs. 10.1%, p=0.000; anti-HEV: 5.4% vs. 0%, p=0.008). HBsAg and antibodies to HCV did not differ between the groups. CONCLUSIONS: HTLV, HBsAg and HCV infection markers did not differ between patients and healthy controls. However, patients had significantly increased prevalence of markers of previous HBV infection suggesting that an intensive vaccination schedule against HBV preoperatively might be helpful in minimizing the risk. The increased prevalence of anti-HEV in cardiac patients requires further investigation. Prospective studies are needed in order to definitely address whether the high prevalence of exposure to HBV and HEV infections in patients who had undergone open-heart surgery is procedure-related or not and whether it has any impact on morbidity of these patients.     

Sexual transmission of human T-lymphotropic virus type I (HTLV-I)

STUDY OBJECTIVE: To study the seroprevalence of human T-lymphotropic virus type I (HTLV-I) in a sexually active population and to determine sexual behavior risk factors for infection. DESIGN: Cross-sectional seroprevalence study using enzyme-linked immunosorbent assay (ELISA) and Western blot. Risk-factor data were gathered by administered questionnaire and chart review. SETTING: Two urban, primary care clinics for persons with sexually transmitted diseases run by the Jamaican Ministry of Health. PATIENTS: Of the 2050 consecutive patients presenting with new episodes of sexually transmitted disease, 1977 patients were eligible for analysis. MEASUREMENTS AND RESULTS: Overall HTLV-I seroprevalence was 5.7%; prevalence increased with age from 1.6% (age, 14 to 19 years) to 5.1% (age, 30 years and older) in men and from 5.3% (age, 14 to 19 years) to 14.1% (age, 30 years and older) in women. Compared with a reference cohort of food service employees, age-adjusted HTLV-I seroprevalence was increased in female patients with sexually transmitted disease (odds ratio = 1.83; CI, 1.41 to 2.83) but not in male patients with sexually transmitted disease. Independent risk factors for HTLV-I infection in women included having had more than ten lifetime sexual partners (odds ratio = 3.52, CI, 1.28 to 9.69) and a current diagnosis of syphilis (odds ratio = 2.12; CI, 1.12 to 3.99). In men, a history of penile sores or ulcers (odds ratio = 2.13; CI, 1.05 to 4.33) and a current diagnosis of syphilis (odds ratio = 3.56; CI, 1.24 to 10.22) were independent risk factors for HTLV-I infection. Of 1977 patients, 5 (0.3%) had antibodies to human immunodeficiency virus type 1 (HIV-1), including 2 with HTLV-I and HIV-1 coinfection. CONCLUSIONS: We conclude that HTLV-I is transmitted from infected men to women during sexual intercourse. Our data are consistent with the lower efficiency of female-to-male sexual transmission of HTLV-I, but penile ulcers or concurrent syphilis may increase a man's risk of infection.