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PV-6 Retrospective review of HIV infected patients: a study from Turkey
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Posters, 12th ESCV, Istanbul / Journal of Clinical Virology 46 Suppl. 1 (2009) S15–S61
Results: Among 546 serum samples tested both by Access and AxSYM assays, 540 (98.90%) were negative and 6 (1.10%) positive. The relative specificity was 100% and the agreement between the two assays was 100%. As regards the seroconversion panels, the results with Access HIV-1/2 New were comparable to those obtained with AxSYM HIV 1/2 gO. Reproducibility and repeatability were also evaluated for both assays: variation coefficient was between 7.1% and 9.4% for Access and between 3.5% and 16% for AxSYM. Conclusion: The Access HIV-1/2 New showed a good agreement with the AxSYM HIV 1/2 gO. The results obtained during this evaluation demonstrated that Access HIV-1/2 New assay performed on UniCel DxI 800 had both good specificity and sensitivity. Adapted to high throughput routine testing, Access HIV-1/2 New assay performed on UniCel DxI 800 can be easily used in a routine laboratory. PV-3 Non-Hodgkin lymphoma and tuberculosis in an AIDS patient F. Kaptan1 *, S. Ural1 , S. El1 , N. Turker1 , B. Ormen1 , I. Vardar1 , N.A. Coskun1 , E. Dik1 , B. Payzın2 , S. Bener3 . 1 Clinic of Infectious Diseases, 2 Clinic of Hematology, 3 Clinic of Pathology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey A 44 year old male patient presented with the complaints of weakness of the right arm and the leg and a tumoral lesion in the oral cavity. The patient had the diagnosis of ITP and HIV infection in 2003 but was ART naive. Treatment for pulmonary tuberculosis had been started three years ago, but he had stopped. On physical examination a tumoral mass was detected on the right upper alveolar arcus of the oral cavity. Multiple lymph nodes were palpable on cervical region. Hemiparesis was detected on right. CD4 count was 100 cells/mm3 and plasma HIV-1 RNA level was 33.200 copies/mL. Biopsy of the tumoral lesion revealed diffuse NHL (big cell). Histopathologic findings were compatible with plasmoblastic lymphoma. Intracranial supratentorial mass lesion in the left thalamic region which was peripherally and internally contrast positive and non-homogeneous was found in cranial MRI. Tuberculoma and lymphoma were among the differential diagnosis. On CT scan of the thorax, micronodular infiltration in the left apical region was found and it was interpretated as pulmonary tuberculosis. With the diagnosis of HIV infection, tuberculosis and NHL; ART, antituberculosis treatment and CHOP therapy were started. After the second chemotherapy, decrease in the size of the intracranial mass was found in cranial MRI. After the fifth chemotherapy the patient’s complaint of headache increased and odema was found around the intracranial mass lesion. Cranial radiotherapy was started. The patient deteriorated rapidly and died after two weeks of supportive treatment. PV-4 Prevalence of genotypic resistance to protease and reverse transcriptase inhibitors and genetic diversity in treatment-na¨ıve (HIV1)-infected Moroccan individuals K. Bakhouch1 *, R. Bensghir2 , M. Blaghen3 , L. Wakrim4 . 1 Laboratory of Virology, Pasteur Institute of Morocco, 2 Infectious Diseases Unit, UHC Ibn Rochd, Casablanca, 3 Hassan 2 University, Faculty of sciences, Casablanca, 4 Laboratory of Virology, Pasteur Institute of Morocco, Casablanca, Morocco The widespread use of the antiretroviral agents and the growing occurrence of HIV-1 strains resistant to these drugs have given rise to serious concerns regarding the transmission of resistant viruses to newly infected persons. The aims of this study were to assess the prevalence of resistance-associated mutations to protease inhibitors and nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs) in newly diagnosed drugna¨ıve HIV-1-infected Moroccan individuals, and also to examine the genetic diversity of HIV-1 variants circulating in Morocco. RNA was extracted from plasma samples from a total of 107 HIV-infected treatment-na¨ıve subjects. ANRS and Stanford HIV database algorithms were used for interpretation of resistance data. Results showed that, in the protease gene, various minor mutations were present in the majority of the sequenced samples (102/103) with high frequencies. Only two major mutations, M46L and V82L, were separately found in two individuals (2%). With respect to rt gene, one patient (1%) carried the NRTIs major mutation M184V. Subtyping and phylogenetic analysis of the obtained sequences indicated that subtype B was the most
prevalent subtype (66%) followed by CRF02_AG (21.4%) and CRF01_AE (6.8%). Other subtypes like G, C and F2 were also observed. Although the prevalence of major resistance was low and might not suggest a routine of drug resistance testingfor all Moroccan individuals newly diagnosed, a continuous surveillance is required. Additionally, Emergency and transmission of non-B subtypes, especially recombinant viruses, may also affect the drug resistance evolution and have potential clinical implications, which need to be investigated further. PV-5 Measuring human immunodeficiency virus type 1 RNA loads in dried blood spots specimens using NucliSENS easyQ HIV-1 v2.0 P. van Deursen1 , T. Oosterlaken1 *, P. Andre2 , A. Verhoeven1 , V. Ligeon3 , J. de Jong1 . 1 bioM´erieux, Boxtel, The Netherlands, 2 Hˆopital de la Croix Rousse, Lyon, France, 3 bioM´erieux SA, centre Christophe M´erieux, Grenoble, France Background: HIV-1 RNA plasma level is a key parameter for anti-viral treatment monitoring in HIV-1 infected individuals. Plasma stability and thereby accurate measurement of clinical state is at risk when transporting from remote areas. Dried blood spot (DBS) testing can reduce this risk. Objectives: Determine the performance of NucliSENS EasyQ HIV-1 v2.0 for DBS viral load measurement. Study Design: 100 HIV-1 negative, and 129 HIV-1 spiked blood samples (218 VQA copies) were used for diagnostic specificity and system robustness. Clinical reactivity was evaluated with samples obtained from 224 HIV-1 infected individuals. HIV-1 RNA stability was analyzed after applying several different storage conditions. Results: Diagnostic specificity was 100%, system robustness was demonstrated by 100% detection rate without invalids. Limit of detection was 80 VQA copies per extraction. Linear results were obtained over the range 25–7,100,000 VQA copies. For clinical samples percentage positive results were comparable for DBS (57%) and plasma (58%). DBS quantification was on average 0.36log10 lower as compared to plasma. Sample stability was demonstrated for 1 week 55ºC/60% humidity, 3 weeks 37ºC/80% humidity, 9 weeks 37ºC/40% humidity, 3 months −20ºC/70% humidity, 3 weeks 4ºC/100% humidity, 9 months room temperature, and 9 week shipment simulation. Conclusion: Results obtained fully support the use of dried blood spots for the NucliSENS EasyQ HIV-1 v2.0 assay. These findings are especially of importance in cases that plasma stability is currently at risk due to e.g. long transport routes from remote areas under less controlled conditions. PV-6 Retrospective review of HIV infected patients: a study from Turkey F. Kaptan *, B. Ormen, N. Turker, S. El, S. Ural, I. Vardar, N.A. Coskun. Izmir Ataturk Training and Research Hospital, Clinic of Infectious Diseases, Izmir, Turkey In this study, medical records of 92 patients (20F/72M), 23 to 67 (mean 38.5) years old, followed between January 1996 and June 2009, with the diagnosis of HIV infection were reviewed retrospectively. Duration of HIV infection and follow-up time were 2–186 (mean 67) and 1–120 (mean 35) months, respectively. Fifty-seven patients came regularly to controls and 35 patients either came irregularly or were lost to follow-up. Sexual behavioral of the patients were heterosexual, bisexual or homosexual intercourse in 73, 13 and 6 of the cases, respectively. Eight patients were injecting drug users and 11 patients were smoking or inhaling drugs. Blood transfusion, history of living in or traveling to foreign countries and imprisonment were detected in 6, 20 and 10 of the patients, respectively. CD4+ T lymphocyte count was 10– 1,480 (mean 454) cells/mm3 and plasma HIV-1 RNA was <47–107 (mean 373,000) copies/mL, respectively. Prophylaxis for opportunistic infection was given to 28 patients. HAART was started in 63 patients. Co-infections and co-morbidities were oral/oesophageal candidiasis (n = 10), syphilis (n = 8), tuberculosis (n = 7), HCV (n = 4), Herpes zoster (n = 4), chickenpox (n = 1), Toxoplasma encephalitis (n = 1), CMV retinitis (n = 1), CMV pneumoniae (n = 1), Pneumocystis jirovecii pneumoniae (n = 1), Kaposi sarcoma (n = 2), polyneuropathia (n = 3), Hodgkin’s lymphoma (n = 1), depression (n = 9). In addition to the patients presented above, 32 (3F/29M) deaths were recorded during the study period.
Posters, 12th ESCV, Istanbul / Journal of Clinical Virology 46 Suppl. 1 (2009) S15–S61
Results: Among 546 serum samples tested both by Access and AxSYM assays, 540 (98.90%) were negative and 6 (1.10%) positive. The relative specificity was 100% and the agreement between the two assays was 100%. As regards the seroconversion panels, the results with Access HIV-1/2 New were comparable to those obtained with AxSYM HIV 1/2 gO. Reproducibility and repeatability were also evaluated for both assays: variation coefficient was between 7.1% and 9.4% for Access and between 3.5% and 16% for AxSYM. Conclusion: The Access HIV-1/2 New showed a good agreement with the AxSYM HIV 1/2 gO. The results obtained during this evaluation demonstrated that Access HIV-1/2 New assay performed on UniCel DxI 800 had both good specificity and sensitivity. Adapted to high throughput routine testing, Access HIV-1/2 New assay performed on UniCel DxI 800 can be easily used in a routine laboratory. PV-3 Non-Hodgkin lymphoma and tuberculosis in an AIDS patient F. Kaptan1 *, S. Ural1 , S. El1 , N. Turker1 , B. Ormen1 , I. Vardar1 , N.A. Coskun1 , E. Dik1 , B. Payzın2 , S. Bener3 . 1 Clinic of Infectious Diseases, 2 Clinic of Hematology, 3 Clinic of Pathology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey A 44 year old male patient presented with the complaints of weakness of the right arm and the leg and a tumoral lesion in the oral cavity. The patient had the diagnosis of ITP and HIV infection in 2003 but was ART naive. Treatment for pulmonary tuberculosis had been started three years ago, but he had stopped. On physical examination a tumoral mass was detected on the right upper alveolar arcus of the oral cavity. Multiple lymph nodes were palpable on cervical region. Hemiparesis was detected on right. CD4 count was 100 cells/mm3 and plasma HIV-1 RNA level was 33.200 copies/mL. Biopsy of the tumoral lesion revealed diffuse NHL (big cell). Histopathologic findings were compatible with plasmoblastic lymphoma. Intracranial supratentorial mass lesion in the left thalamic region which was peripherally and internally contrast positive and non-homogeneous was found in cranial MRI. Tuberculoma and lymphoma were among the differential diagnosis. On CT scan of the thorax, micronodular infiltration in the left apical region was found and it was interpretated as pulmonary tuberculosis. With the diagnosis of HIV infection, tuberculosis and NHL; ART, antituberculosis treatment and CHOP therapy were started. After the second chemotherapy, decrease in the size of the intracranial mass was found in cranial MRI. After the fifth chemotherapy the patient’s complaint of headache increased and odema was found around the intracranial mass lesion. Cranial radiotherapy was started. The patient deteriorated rapidly and died after two weeks of supportive treatment. PV-4 Prevalence of genotypic resistance to protease and reverse transcriptase inhibitors and genetic diversity in treatment-na¨ıve (HIV1)-infected Moroccan individuals K. Bakhouch1 *, R. Bensghir2 , M. Blaghen3 , L. Wakrim4 . 1 Laboratory of Virology, Pasteur Institute of Morocco, 2 Infectious Diseases Unit, UHC Ibn Rochd, Casablanca, 3 Hassan 2 University, Faculty of sciences, Casablanca, 4 Laboratory of Virology, Pasteur Institute of Morocco, Casablanca, Morocco The widespread use of the antiretroviral agents and the growing occurrence of HIV-1 strains resistant to these drugs have given rise to serious concerns regarding the transmission of resistant viruses to newly infected persons. The aims of this study were to assess the prevalence of resistance-associated mutations to protease inhibitors and nucleoside and non-nucleoside reverse transcriptase inhibitors (NRTIs and NNRTIs) in newly diagnosed drugna¨ıve HIV-1-infected Moroccan individuals, and also to examine the genetic diversity of HIV-1 variants circulating in Morocco. RNA was extracted from plasma samples from a total of 107 HIV-infected treatment-na¨ıve subjects. ANRS and Stanford HIV database algorithms were used for interpretation of resistance data. Results showed that, in the protease gene, various minor mutations were present in the majority of the sequenced samples (102/103) with high frequencies. Only two major mutations, M46L and V82L, were separately found in two individuals (2%). With respect to rt gene, one patient (1%) carried the NRTIs major mutation M184V. Subtyping and phylogenetic analysis of the obtained sequences indicated that subtype B was the most
prevalent subtype (66%) followed by CRF02_AG (21.4%) and CRF01_AE (6.8%). Other subtypes like G, C and F2 were also observed. Although the prevalence of major resistance was low and might not suggest a routine of drug resistance testingfor all Moroccan individuals newly diagnosed, a continuous surveillance is required. Additionally, Emergency and transmission of non-B subtypes, especially recombinant viruses, may also affect the drug resistance evolution and have potential clinical implications, which need to be investigated further. PV-5 Measuring human immunodeficiency virus type 1 RNA loads in dried blood spots specimens using NucliSENS easyQ HIV-1 v2.0 P. van Deursen1 , T. Oosterlaken1 *, P. Andre2 , A. Verhoeven1 , V. Ligeon3 , J. de Jong1 . 1 bioM´erieux, Boxtel, The Netherlands, 2 Hˆopital de la Croix Rousse, Lyon, France, 3 bioM´erieux SA, centre Christophe M´erieux, Grenoble, France Background: HIV-1 RNA plasma level is a key parameter for anti-viral treatment monitoring in HIV-1 infected individuals. Plasma stability and thereby accurate measurement of clinical state is at risk when transporting from remote areas. Dried blood spot (DBS) testing can reduce this risk. Objectives: Determine the performance of NucliSENS EasyQ HIV-1 v2.0 for DBS viral load measurement. Study Design: 100 HIV-1 negative, and 129 HIV-1 spiked blood samples (218 VQA copies) were used for diagnostic specificity and system robustness. Clinical reactivity was evaluated with samples obtained from 224 HIV-1 infected individuals. HIV-1 RNA stability was analyzed after applying several different storage conditions. Results: Diagnostic specificity was 100%, system robustness was demonstrated by 100% detection rate without invalids. Limit of detection was 80 VQA copies per extraction. Linear results were obtained over the range 25–7,100,000 VQA copies. For clinical samples percentage positive results were comparable for DBS (57%) and plasma (58%). DBS quantification was on average 0.36log10 lower as compared to plasma. Sample stability was demonstrated for 1 week 55ºC/60% humidity, 3 weeks 37ºC/80% humidity, 9 weeks 37ºC/40% humidity, 3 months −20ºC/70% humidity, 3 weeks 4ºC/100% humidity, 9 months room temperature, and 9 week shipment simulation. Conclusion: Results obtained fully support the use of dried blood spots for the NucliSENS EasyQ HIV-1 v2.0 assay. These findings are especially of importance in cases that plasma stability is currently at risk due to e.g. long transport routes from remote areas under less controlled conditions. PV-6 Retrospective review of HIV infected patients: a study from Turkey F. Kaptan *, B. Ormen, N. Turker, S. El, S. Ural, I. Vardar, N.A. Coskun. Izmir Ataturk Training and Research Hospital, Clinic of Infectious Diseases, Izmir, Turkey In this study, medical records of 92 patients (20F/72M), 23 to 67 (mean 38.5) years old, followed between January 1996 and June 2009, with the diagnosis of HIV infection were reviewed retrospectively. Duration of HIV infection and follow-up time were 2–186 (mean 67) and 1–120 (mean 35) months, respectively. Fifty-seven patients came regularly to controls and 35 patients either came irregularly or were lost to follow-up. Sexual behavioral of the patients were heterosexual, bisexual or homosexual intercourse in 73, 13 and 6 of the cases, respectively. Eight patients were injecting drug users and 11 patients were smoking or inhaling drugs. Blood transfusion, history of living in or traveling to foreign countries and imprisonment were detected in 6, 20 and 10 of the patients, respectively. CD4+ T lymphocyte count was 10– 1,480 (mean 454) cells/mm3 and plasma HIV-1 RNA was <47–107 (mean 373,000) copies/mL, respectively. Prophylaxis for opportunistic infection was given to 28 patients. HAART was started in 63 patients. Co-infections and co-morbidities were oral/oesophageal candidiasis (n = 10), syphilis (n = 8), tuberculosis (n = 7), HCV (n = 4), Herpes zoster (n = 4), chickenpox (n = 1), Toxoplasma encephalitis (n = 1), CMV retinitis (n = 1), CMV pneumoniae (n = 1), Pneumocystis jirovecii pneumoniae (n = 1), Kaposi sarcoma (n = 2), polyneuropathia (n = 3), Hodgkin’s lymphoma (n = 1), depression (n = 9). In addition to the patients presented above, 32 (3F/29M) deaths were recorded during the study period.