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1.
J Med Virol ; 96(9): e29881, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39221498

RESUMEN

While HC2 and GP5+/6+ PCR-EIA were pivotal in test validation of new HPV assays, they represent the first generation of comparator tests based upon technologies that are not in widespread use anymore. In the current guideline, criteria for second-generation comparator tests are presented that include more detailed resolution of HPV genotypes. Second-generation comparator tests should preferentially target only the 12 genotypes classified as carcinogenic (IARC-group I), and show consistent non-inferior sensitivity for CIN2+ and CIN3+ and specificity for ≤CIN1 compared to one of the first-generations comparators, in at least three validation studies using benchmarks of 0.95 for relative sensitivity and 0.98 for relative specificity. Validation should take into account used storage media and other sample handling procedures. Meta-analyses were conducted to identify the assays that fulfill these stringent criteria. Four tests fulfilled the new criteria: (1) RealTime High-Risk HPV Test (Abbott), (2) Cobas-4800 HPV test (Roche Molecular System), (3) Onclarity HPV Assay (BD Diagnostics), and (4) Anyplex II HPV HR Detection (Seegene), each evaluated in three to six studies. Whereas the four assays target 14 carcinogenic genotypes, the first two identify separately HPV16 and 18, the third assay identifies five types separately and the fourth identifies all the types separately.


Asunto(s)
Detección Precoz del Cáncer , Papillomaviridae , Infecciones por Papillomavirus , Sensibilidad y Especificidad , Neoplasias del Cuello Uterino , Femenino , Humanos , ADN Viral/genética , Detección Precoz del Cáncer/métodos , Genotipo , Pruebas de ADN del Papillomavirus Humano/métodos , Pruebas de ADN del Papillomavirus Humano/normas , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Papillomaviridae/genética , Papillomaviridae/clasificación , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología
2.
J Med Virol ; 93(6): 3999-4003, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-32761911

RESUMEN

BACKGROUND: Monitoring viral load (VL) is an essential part of the management of patients chronically infected with hepatitis B virus (HBV). The commercial HBV VL assays currently available are generally performed on high-throughput platforms for batch wise testing of plasma samples, with relatively long turn-around-times. Rapid VL testing could provide immediate input to clinical decision making. METHODS: One hundred two stored plasma samples from 102 patients who were previously tested for HBV VL by the Cobas Ampliprep/Taqman or Cobas 4800 (Roche, Pleasanton, CA), were analyzed by the recently introduced Cepheid Xpert HBV Viral Load Assay. Thirty-one of the 102 samples were negative for HBV DNA and 71 out of 102 samples had a detectable VL. HBV DNA loads ranged from <20 to 5E8 IU/mL. HBV genotypes (A, B, C, D, E, and G) were known for 52 of the VL positive samples. Correlation of VL results between both assays was determined by the Pearson correlation coefficient (r2 ). The level of concordance was assessed using the Bland-Altman analysis. RESULTS: HBV VLs correlated well between both assays, across all genotypes (Pearson correlation coefficient r2 = 0.987). Six samples exceeded a 0.5 log difference between assays. Bland-Altman analysis demonstrated a mean of the difference of -0.107 log and a standard deviation of 0.271 log. CONCLUSION: High correlation was observed between the Roche Cobas HBV Viral Load tests and the Xpert HBV Viral Load Assay, thus enabling rapid, random access, and accurate HBV VL assessment.


Asunto(s)
ADN Viral/sangre , Virus de la Hepatitis B/genética , Hepatitis B/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Carga Viral/instrumentación , Carga Viral/métodos , Genotipo , Hepatitis B/sangre , Hepatitis B/virología , Virus de la Hepatitis B/clasificación , Virus de la Hepatitis B/aislamiento & purificación , Humanos , Límite de Detección , Técnicas de Diagnóstico Molecular/normas , Sensibilidad y Especificidad
3.
Clin Infect Dis ; 69(7): 1243-1253, 2019 09 13.
Artículo en Inglés | MEDLINE | ID: mdl-30689772

RESUMEN

We systematically reviewed available evidence from Embase, Medline, and the Cochrane Library on diagnostic accuracy and clinical impact of commercially available rapid (results <3 hours) molecular diagnostics for respiratory viruses as compared to conventional molecular tests. Quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies criteria for diagnostic test accuracy (DTA) studies, and the Cochrane Risk of Bias Assessment and Risk of Bias in Nonrandomized Studies of Interventions criteria for randomized and observational impact studies, respectively. Sixty-three DTA reports (56 studies) were meta-analyzed with a pooled sensitivity of 90.9% (95% confidence interval [CI], 88.7%-93.1%) and specificity of 96.1% (95% CI, 94.2%-97.9%) for the detection of either influenza virus (n = 29), respiratory syncytial virus (RSV) (n = 1), influenza virus and RSV (n = 19), or a viral panel including influenza virus and RSV (n = 14). The 15 included impact studies (5 randomized) were very heterogeneous and results were therefore inconclusive. However, we suggest that implementation of rapid diagnostics in hospital care settings should be considered.


Asunto(s)
Técnicas de Diagnóstico Molecular , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/virología , Algoritmos , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Humanos , Gripe Humana/diagnóstico , Gripe Humana/virología , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Curva ROC , Reproducibilidad de los Resultados , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/virología , Sensibilidad y Especificidad
4.
BMC Med ; 17(1): 228, 2019 12 11.
Artículo en Inglés | MEDLINE | ID: mdl-31829241

RESUMEN

BACKGROUND: In January 2017, the Dutch cervical cancer screening programme transitioned from cytomorphological to primary high-risk HPV (hrHPV) DNA screening, including the introduction of self-sampling, for women aged between 30 and 60 years. The Netherlands was the first country to switch to hrHPV screening at the national level. We investigated the health impact of this transition by comparing performance indicators from the new hrHPV-based programme with the previous cytology-based programme. METHODS: We obtained data from the Dutch nationwide network and registry of histo- and cytopathology (PALGA) for 454,573 women eligible for screening in 2017 who participated in the hrHPV-based programme between 1 January 2017 and 30 June 2018 (maximum follow-up of almost 21 months) and for 483,146 women eligible for screening in 2015 who participated in the cytology-based programme between 1 January 2015 and 31 March 2016 (maximum follow-up of 40 months). We compared indicators of participation (participation rate), referral (screen positivity; referral rate) and detection (cervical intraepithelial neoplasia (CIN) detection; number of referrals per detected CIN lesion). RESULTS: Participation in the hrHPV-based programme was significantly lower than that in the cytology-based programme (61% vs 64%). Screen positivity and direct referral rates were significantly higher in the hrHPV-based programme (positivity rate: 5% vs 9%; referral rate: 1% vs 3%). CIN2+ detection increased from 11 to 14 per 1000 women screened. Overall, approximately 2.2 times more clinical irrelevant findings (i.e. ≤CIN1) were found in the hrHPV-based programme, compared with approximately 1·3 times more clinically relevant findings (i.e. CIN2+); this difference was mostly due to a national policy change recommending colposcopy, rather than observation, of hrHPV-positive, ASC-US/LSIL results in the hrHPV-based programme. CONCLUSIONS: This is the first time that comprehensive results of nationwide implementation of hrHPV-based screening have been reported using high-quality data with a long follow-up. We have shown that both benefits and potential harms are higher in one screening round of a well-implemented hrHPV-based screening programme than in an established cytology-based programme. Lower participation in the new hrHPV programme may be due to factors such as invitation policy changes and the phased roll-out of the new programme. Our findings add further to evidence from trials and modelling studies on the effectiveness of hrHPV-based screening.


Asunto(s)
Detección Precoz del Cáncer/métodos , Infecciones por Papillomavirus/complicaciones , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Tamizaje Masivo , Persona de Mediana Edad , Países Bajos , Estudios Retrospectivos
6.
Cytopathology ; 30(3): 273-280, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30657615

RESUMEN

The increased use of human papillomavirus testing within cervical screening programmes necessarily brings about changes to the laboratory services required to support them. A crucial element of such services is to demonstrate initial and ongoing quality of the test (and associated processes). In this review, we outline some of the quality considerations and challenges with an emphasis on the laboratory including assay and platform validation, internal quality control selection and strengths and weaknesses of external quality assurance schemes. The influence and role of key external entities, including regulatory agencies, guideline groups, programme commissioners and commercial providers, are also discussed.


Asunto(s)
Cuello del Útero/virología , Detección Precoz del Cáncer/normas , Tamizaje Masivo/normas , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Cuello del Útero/patología , Femenino , Humanos , Papillomaviridae/patogenicidad , Infecciones por Papillomavirus/patología , Garantía de la Calidad de Atención de Salud , Neoplasias del Cuello Uterino/patología , Frotis Vaginal/normas
7.
J Infect Dis ; 218(5): 688-697, 2018 07 24.
Artículo en Inglés | MEDLINE | ID: mdl-29617822

RESUMEN

Background: A high genetic barrier to resistance to the integrase strand transfer inhibitor (INSTI) dolutegravir has been reported in vitro and in vivo. We describe the dynamics of INSTI resistance-associated mutations (INSTI-RAMs) and mutations in the 3'-polypurine tract (3'-PPT) in relation to virologic failure (VF) observed in the randomized Dolutegravir as Maintenance Monotherapy for HIV-1 study (DOMONO, NCT02401828). Methods: From 10 patients with VF, plasma samples were collected before the start of cART and during VF, and were used to generate Sanger sequences of integrase, the 5' terminal bases of the 3' long terminal repeat (LTR), and the 3'-PPT. Results: Median human immunodeficiency virus RNA load at VF was 3490 copies/mL (interquartile range 1440-4990 copies/mL). INSTI-RAMs (S230R, R263K, N155H, and E92Q+N155H) were detected in 4 patients, no INSTI-RAMs were detected in 4 patients, and sequencing of the integrase gene was unsuccessful in 2 patients. The time to VF ranged from 4 weeks to 72 weeks. In 1 patient, mutations developed in the highly conserved 3'-PPT. No changes in the terminal bases of the 3'-LTR were observed. Conclusions: The genetic barrier to resistance is too low to justify dolutegravir maintenance monotherapy because single INSTI-RAMs are sufficient to cause VF. The large variation in time to VF suggests that stochastic reactivation of a preexisting provirus containing a single INSTI-RAM is the mechanism for failure. Changes in the 3'-PPT point to a new dolutegravir resistance mechanism in vivo. Clinical Trials Registration: NCT02401828.


Asunto(s)
Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Inhibidores de Integrasa VIH/administración & dosificación , VIH-1/efectos de los fármacos , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Mutación , Adulto , Femenino , VIH-1/aislamiento & purificación , Humanos , Quimioterapia de Mantención/métodos , Masculino , Persona de Mediana Edad , Oxazinas , Piperazinas , Piridonas , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Secuencia de ADN , Insuficiencia del Tratamiento , Carga Viral
8.
Crit Care Med ; 46(3): 368-374, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29474322

RESUMEN

OBJECTIVES: Discrimination between infectious and noninfectious causes of acute respiratory failure is difficult in patients admitted to the ICU after a period of hospitalization. Using a novel biomarker test (SeptiCyte LAB), we aimed to distinguish between infection and inflammation in this population. DESIGN: Nested cohort study. SETTING: Two tertiary mixed ICUs in the Netherlands. PATIENTS: Hospitalized patients with acute respiratory failure requiring mechanical ventilation upon ICU admission from 2011 to 2013. Patients having an established infection diagnosis or an evidently noninfectious reason for intubation were excluded. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Blood samples were collected upon ICU admission. Test results were categorized into four probability bands (higher bands indicating higher infection probability) and compared with the infection plausibility as rated by post hoc assessment using strict definitions. Of 467 included patients, 373 (80%) were treated for a suspected infection at admission. Infection plausibility was classified as ruled out, undetermined, or confirmed in 135 (29%), 135 (29%), and 197 (42%) patients, respectively. Test results correlated with infection plausibility (Spearman's rho 0.332; p < 0.001). After exclusion of undetermined cases, positive predictive values were 29%, 54%, and 76% for probability bands 2, 3, and 4, respectively, whereas the negative predictive value for band 1 was 76%. Diagnostic discrimination of SeptiCyte LAB and C-reactive protein was similar (p = 0.919). CONCLUSIONS: Among hospitalized patients admitted to the ICU with clinical uncertainty regarding the etiology of acute respiratory failure, the diagnostic value of SeptiCyte LAB was limited.


Asunto(s)
Infecciones/diagnóstico , Unidades de Cuidados Intensivos , Insuficiencia Respiratoria/diagnóstico , Enfermedad Aguda , Anciano , Biomarcadores , Estudios de Cohortes , Femenino , Humanos , Infecciones/complicaciones , Masculino , Reproducibilidad de los Resultados , Insuficiencia Respiratoria/etiología , Medición de Riesgo , Transcriptoma
9.
Clin Infect Dis ; 64(8): 1092-1097, 2017 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-28329390

RESUMEN

Background: In Western countries emergence of human immunodeficiency virus (HIV) drug resistance has tremendously decreased, and transmission of drug resistance has merely stabilized in recent years. However, in many endemic settings with limited resources rates of emerging and transmitted drug resistance are not regularly assessed. Methods: We performed a survey including all HIV-infected individuals who received resistance testing in 2010-2015 in Aruba, a highly endemic HIV area in the Caribbean. Transmitted HIV drug resistance was determined using World Health Organization (WHO) criteria. Transmission dynamics were investigated using phylogenetic analyses. In a subset, baseline samples were re-analyzed using next generation sequencing (NGS). Results: Baseline resistance testing was performed in 104 newly diagnosed untreated individuals (54% of all newly diagnosed individuals in 2010-2015): 86% were men, 39% were foreign-born, and 22% had AIDS at diagnosis. And 33% (95% CI: 24-42%) was infected with a drug-resistant HIV variant. The prevalence of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) reached 45% (95% CI: 27-64%) in 2015, all based on the prevalence of mutation K103N. NGS did not demonstrate additional minority K103N-variants compared to routine resistance testing. K103N-harboring strains were introduced into the therapy-unexposed population via at least 6 independent transmissions epidemiologically linked to the surrounding countries. Virological failure of the WHO-recommended first-line NNRTI-based regimen was higher in the presence of K103N. Conclusions: The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV.


Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH/efectos de los fármacos , Adulto , Fármacos Anti-VIH/uso terapéutico , Región del Caribe/epidemiología , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
10.
Clin Infect Dis ; 62(11): 1348-1355, 2016 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-26962074

RESUMEN

BACKGROUND: The use of nucleic acid amplification tests (NAATs) to diagnose Neisseria gonorrhoeae infections complicates the performance of a test of cure (TOC) to monitor treatment failure, if this is indicated. As evidence for the timing of TOC using modern NAATs is limited, we performed a prospective cohort study to assess time to clearance when using modern RNA- and DNA-based NAATs. METHODS: We included patients with anogenital gonorrhoea visiting the Sexually Transmitted Infection Clinic Amsterdam from March through October 2014. After treatment with ceftriaxone mono- or dual therapy (with azithromycin or doxycycline), anal, vaginal, or urine samples were self-collected during 28 consecutive days, and analyzed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800). Clearance was defined as 3 consecutive negative results, and blips as isolated positive results following clearance. RESULTS: We included 77 patients; 5 self-cleared gonorrhoea before treatment and 10 were lost to follow-up. Clearance rate of the remaining 62 patients was 100%. Median time to clearance was 2 days, with a range of 1-7 days for RNA-based NAAT and 1-15 days for DNA-based NAAT. The risk of finding a blip after clearance was 0.8% and 1.5%, respectively. One patient had a reinfection. CONCLUSIONS: If indicated, we recommend that TOC be performed for anogenital gonorrhoea at least 7 or 14 days after administering therapy, when using modern RNA- or DNA-based NAATs, respectively. When interpreting TOC results for possible treatment failure, both the occurrence of blips and a possible reinfection need to be taken into account.


Asunto(s)
ADN Bacteriano/análisis , ADN Bacteriano/genética , Gonorrea/tratamiento farmacológico , Gonorrea/microbiología , Neisseria gonorrhoeae/genética , Adulto , Canal Anal/microbiología , Antibacterianos/uso terapéutico , Carga Bacteriana/genética , Femenino , Humanos , Masculino , Neisseria gonorrhoeae/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico , Estudios Prospectivos , ARN Bacteriano/análisis , ARN Bacteriano/genética , Orina/microbiología , Vagina/microbiología , Adulto Joven
11.
J Clin Microbiol ; 54(4): 1130-2, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26763972

RESUMEN

Identification ofNeisseria gonorrhoeaeby the Bruker matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system may be affected by "B consistency categorization." A supplementary database of 17N. gonorrhoeaemain spectra was constructed. Twelve of 64N. gonorrhoeaeidentifications were categorized with B consistency, which disappeared using the supplementary database. Database extension did not result in misidentification ofNeisseria meningitidis.


Asunto(s)
Biología Computacional/métodos , Bases de Datos como Asunto , Neisseria gonorrhoeae/aislamiento & purificación , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Femenino , Humanos , Masculino , Neisseria gonorrhoeae/química
12.
J Transl Med ; 14(1): 230, 2016 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-27484705

RESUMEN

BACKGROUND: Epstein-Barr virus and Cytomegalovirus reactivations frequently occur after allogeneic stem cell transplantation (SCT). METHODS: Here we investigated the role of immune cell reconstitution in the onset and subsequent severity of EBV- and CMV-reactivation. To this end, 116 patients were prospectively sampled for absolute T cell (CD4 and CD8), B-cell (CD19) and NK-cell (CD16 and CD56) numbers weekly post-SCT during the first 3 months and thereafter monthly until 6 months post-SCT. Viral load was monitored in parallel. RESULTS: In contrast to the general belief, we found that early T-cell reconstitution does not play a role in the onset of viral reactivation. CMV reactivation in the first 7 weeks after SCT however resulted in higher absolute CD8(+) T-cell numbers 6 months post-SCT in patients with high-level reactivation, many of which were CMV-specific. Interestingly, rapid reconstitution of CD4(+) T-cells, as well as NK cells and the presence of donor KIR3DL1, are associated with the absence of CMV-reactivation after SCT, suggestive of a protective role of these cells. In contrast, EBV-reactivations were not affected in any way by the level of immune reconstitution after SCT. CONCLUSION: In conclusion, these data suggest that CD4(+) T-cells and NK cells, rather than CD8(+) T-cells, are associated with protection against CMV-reactivation.


Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Citomegalovirus/inmunología , Citoprotección , Células Asesinas Naturales/inmunología , Trasplante de Células Madre , Adolescente , Adulto , Anciano , Linfocitos T CD8-positivos/inmunología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Receptores KIR3DL1/metabolismo , Factores de Riesgo , Trasplante Homólogo , Adulto Joven
13.
BMC Infect Dis ; 16(1): 554, 2016 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-27724878

RESUMEN

BACKGROUND: Performing a test of cure (TOC) could demonstrate success or failure of antimicrobial treatment of Chlamydia trachomatis infection, but recommendations for the timing of a TOC using nucleic acid amplification tests (NAATs) are inconsistent. We assessed time to clearance of C. trachomatis after treatment, using modern RNA- and DNA-based NAATs. METHODS: We analysed data from patients with a C. trachomatis and Neisseria gonorrhoeae coinfection who visited the STI Clinic Amsterdam, The Netherlands, from March through October 2014. After treatment with ceftriaxone plus either azithromycin or doxycycline, patients self-collected anal, vaginal or urine samples during 28 consecutive days. Samples were analysed using an RNA-based NAAT (Aptima Combo 2) and a DNA-based NAAT (Cobas 4800 CT/NG). We defined clearance as three consecutive negative results, and defined "blips" as isolated positive results following clearance. RESULTS: We included 23 patients with C. trachomatis and N. gonorrhoeae coinfection. All patients cleared C. trachomatis during follow-up, and we observed no reinfections. The median time to clearance (range) was 7 days (1-13) for RNA, and 6 days (1-15) for DNA. Ninety-five per cent of patients cleared RNA at day 13, and DNA at day 14. The risk of a blip after clearance was 4.4 % (RNA) and 1.7 % (DNA). CONCLUSIONS: If a TOC for anogenital chlamydia is indicated, we recommend performing it at least 14 days after initiation of treatment, when using modern RNA- and DNA-based assays. A positive result shortly after 14 days probably indicates a blip, rather than a treatment failure or a reinfection.


Asunto(s)
Infecciones por Chlamydia/microbiología , Coinfección/microbiología , Gonorrea/microbiología , Adulto , Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Biomarcadores/orina , Ceftriaxona/administración & dosificación , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/orina , Chlamydia trachomatis/genética , Coinfección/tratamiento farmacológico , Coinfección/orina , ADN Bacteriano/genética , ADN Bacteriano/orina , Doxiciclina/administración & dosificación , Quimioterapia Combinada , Femenino , Gonorrea/tratamiento farmacológico , Gonorrea/orina , Humanos , Masculino , Técnicas de Diagnóstico Molecular , Neisseria gonorrhoeae/genética , Técnicas de Amplificación de Ácido Nucleico/métodos , Estudios Prospectivos , ARN Bacteriano/genética , ARN Bacteriano/orina , Sensibilidad y Especificidad , Resultado del Tratamiento , Adulto Joven
14.
BMC Infect Dis ; 16: 39, 2016 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-26830915

RESUMEN

BACKGROUND: Infectious intestinal disease (IID) is an important cause of morbidity in developed countries and a frequent reason for general practitioner (GP) consultation. In recent years polymerase chain reaction (PCR) based techniques have gradually replaced conventional enteropathogen detection techniques like microscopy and culture in primary care patients suspected of IID. PCR features testing of multiple enteropathogens in a single faecal sample with shorter turnaround times and greater sensitivity compared to conventional techniques. However, the associated costs and benefits have not been quantified. Furthermore, primary care incidence and prevalence estimates of enteropathogens associated with IID are sparsely available and predominantly based on conventional techniques. The PROUD-study (PCR diagnostics in Outpatients with Diarrhoea) determines: 1) health (care) effects and 2) cost-effectiveness of PCR introduction in primary care patients suspected of IID; 3) occurrence of major enteropathogens in primary care patients suspected of IID. METHODS: A before-after cohort study will be performed of patients with suspected IID consulting a GP in the Utrecht General Practitioner Network (UGPN), covering the before period (2010-2011) with conventional testing and the after period (2013-2014) with PCR testing. Prospective study data on patient characteristics and primary outcome measures (i.e. healthcare use and disease outcome) will be collected from electronic patient and laboratory records in 2015 and 2016. The effect of PCR introduction is investigated by comparing the primary outcome measures and their associated healthcare costs between the conventional period and the PCR period, and is followed by a cost-effectiveness analysis. To determine the occurrence of enteropathogens associated with IID in primary care, routine care faeces samples from the year 2014 will be screened using PCR. DISCUSSION: The PROUD-study will quantify the costs and effects of the introduction of PCR techniques for enteropathogens in primary care patients suspected of IID and generate up-to-date and sensitive estimates of enteropathogen occurrence among primary care patients.


Asunto(s)
Diarrea/diagnóstico , Heces/microbiología , Proyectos de Investigación , Bacterias/genética , Bacterias/aislamiento & purificación , Estudios de Cohortes , Bases de Datos Factuales , Diarrea/microbiología , Diarrea/virología , Heces/virología , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Gastroenteritis/virología , Costos de la Atención en Salud , Humanos , Enfermedades Intestinales/microbiología , Enfermedades Intestinales/virología , Norovirus/genética , Norovirus/aislamiento & purificación , Pacientes Ambulatorios , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Rotavirus/genética , Rotavirus/aislamiento & purificación
15.
Euro Surveill ; 21(39)2016 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-27719751

RESUMEN

The Dutch virus-typing network VIRO-TypeNed reported an increase in ECHOvirus 6 (E-6) infections with neurological symptoms in the Netherlands between June and August 2016. Of the 31 cases detected from January through August 2016, 15 presented with neurological symptoms. Ten of 15 neurological cases were detected in the same province and the identified viruses were genetically related. This report is to alert medical and public health professionals of the circulation of E-6 associated with neurological symptoms.


Asunto(s)
Brotes de Enfermedades , Echovirus 6 Humano/aislamiento & purificación , Infecciones por Echovirus/epidemiología , Meningitis Aséptica/epidemiología , Meningitis Aséptica/virología , Vigilancia de la Población/métodos , Salud Pública , Adolescente , Adulto , Líquido Cefalorraquídeo/virología , Niño , Preescolar , Sistemas de Información en Laboratorio Clínico , Echovirus 6 Humano/genética , Infecciones por Echovirus/diagnóstico , Infecciones por Echovirus/virología , Humanos , Persona de Mediana Edad , Países Bajos/epidemiología , Filogenia , Adulto Joven
16.
Euro Surveill ; 21(39)2016 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-27719752

RESUMEN

VIRO-TypeNed is a collaborative molecular surveillance platform facilitated through a web-based database. Genetic data in combination with epidemiological, clinical and patient data are shared between clinical and public health laboratories, as part of the surveillance underpinning poliovirus eradication. We analysed the combination of data submitted from 2010 to 2014 to understand circulation patterns of non-polio enteroviruses (NPEV) of public health relevance. Two epidemiological patterns were observed based on VIRO-TypeNed data and classical surveillance data dating back to 1996: (i) endemic cyclic, characterised by predictable upsurges/outbreaks every two to four years, and (ii) epidemic, where rare virus types caused upsurges/outbreaks. Genetic analysis suggests continuous temporal displacement of virus lineages due to the accumulation of (silent) genetic changes. Non-synonymous changes in the antigenic B/C loop suggest antigenic diversification, which may affect population susceptibility. Infections were frequently detected at an age under three months and at an older, parenting age (25-49 years) pointing to a distinct role of immunity in the circulation patterns. Upsurges were detected in the summer and winter which can promote increased transmissibility underlying new (cyclic) upsurges and requires close monitoring. The combination of data provide a better understanding of NPEV circulation required to control and curtail upsurges and outbreaks.


Asunto(s)
Sistemas de Información en Laboratorio Clínico , Bases de Datos de Ácidos Nucleicos , Infecciones por Enterovirus/epidemiología , Enterovirus/genética , Laboratorios , Vigilancia de la Población/métodos , Brotes de Enfermedades/prevención & control , Enfermedades Endémicas , Enterovirus/aislamiento & purificación , Infecciones por Enterovirus/diagnóstico , Infecciones por Enterovirus/virología , Epidemias , Humanos , Datos de Secuencia Molecular , Países Bajos/epidemiología , Salud Pública , Serotipificación
17.
J Antimicrob Chemother ; 70(3): 930-40, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25336166

RESUMEN

OBJECTIVES: It is still debated if pre-existing minority drug-resistant HIV-1 variants (MVs) affect the virological outcomes of first-line NNRTI-containing ART. METHODS: This Europe-wide case-control study included ART-naive subjects infected with drug-susceptible HIV-1 as revealed by population sequencing, who achieved virological suppression on first-line ART including one NNRTI. Cases experienced virological failure and controls were subjects from the same cohort whose viraemia remained suppressed at a matched time since initiation of ART. Blinded, centralized 454 pyrosequencing with parallel bioinformatic analysis in two laboratories was used to identify MVs in the 1%-25% frequency range. ORs of virological failure according to MV detection were estimated by logistic regression. RESULTS: Two hundred and sixty samples (76 cases and 184 controls), mostly subtype B (73.5%), were used for the analysis. Identical MVs were detected in the two laboratories. 31.6% of cases and 16.8% of controls harboured pre-existing MVs. Detection of at least one MV versus no MVs was associated with an increased risk of virological failure (OR = 2.75, 95% CI = 1.35-5.60, P = 0.005); similar associations were observed for at least one MV versus no NRTI MVs (OR = 2.27, 95% CI = 0.76-6.77, P = 0.140) and at least one MV versus no NNRTI MVs (OR = 2.41, 95% CI = 1.12-5.18, P = 0.024). A dose-effect relationship between virological failure and mutational load was found. CONCLUSIONS: Pre-existing MVs more than double the risk of virological failure to first-line NNRTI-based ART.


Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Biología Computacional , Europa (Continente) , Femenino , Genotipo , VIH-1/genética , VIH-1/aislamiento & purificación , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Medición de Riesgo , Análisis de Secuencia de ADN , Insuficiencia del Tratamiento , Adulto Joven
18.
J Clin Microbiol ; 52(2): 517-23, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24478482

RESUMEN

Low-level viremia during antiretroviral therapy and its accurate measurement are increasingly relevant. Here, we present an international collaboration of 4,221 paired blood plasma viral load (pVL) results from four commercial assays, emphasizing the data with low pVL. The assays compared were the Abbott RealTime assay, the Roche Amplicor assay, and the Roche TaqMan version 1 and version 2 assays. The correlation between the assays was 0.90 to 0.97. However, at a low pVL, the correlation fell to 0.45 to 0.85. The observed interassay concordance was higher when detectability was defined as 200 copies/ml than when it was defined as 50 copies/ml. A pVL of ∼100 to 125 copies/ml by the TaqMan version 1 and version 2 assays corresponded best to a 50-copies/ml threshold with the Amplicor assay. Correlation and concordance between the viral load assays were lower at a low pVL. Clear guidelines are needed on the clinical significance of low-level viremia.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , ARN Viral/sangre , Carga Viral/métodos , VIH-1/genética , Humanos , Cooperación Internacional , Plasma/virología
19.
J Antimicrob Chemother ; 69(7): 1933-7, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24695353

RESUMEN

OBJECTIVES: The reduction in mother-to-child transmission of HIV-1 by single-dose nevirapine given at birth onset is achieved at the expense of de novo HIV-1 resistance mutations. In the VITA1 study, single-dose carbamazepine accelerated nevirapine elimination, but the accompanying trend towards fewer de novo HIV-1 mutations was statistically non-significant. METHODS: We investigated if the effect of carbamazepine was confounded by the individual variability in nevirapine metabolism and transport. RESULTS: Nine of 34 (26%) single-dose nevirapine-treated women had one or more nevirapine-associated resistance mutations, compared with 3 of 34 (9%) in the single-dose nevirapine/carbamazepine arm. The genetic polymorphisms in CYP2B6 and MRP7 affected neither nevirapine kinetics nor the development of HIV-1 resistance. In contrast, the reduction in HIV-1 mutations by single-dose carbamazepine reached statistical significance at P = 0.04 with an OR of 0.1 (95% CI 0.01-0.90) upon consideration of CYP3A activity, defined as the ratio of 4ß-hydroxycholesterol to cholesterol, and it was more likely in women with higher CYP3A activity. These findings were in agreement with CYP3A induction in carbamazepine-treated patients. Likewise, carbamazepine induced CYP3A4, but not CYP2B6, in vitro when combined with nevirapine. CONCLUSIONS: The induction of nevirapine elimination reduces HIV-1 resistance mutations, but this effect is modulated by individual CYP3A activity. The study suggests that CYP3A4 activity could be monitored using an endogenous marker and, if needed, boosted to improve clinical endpoints.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Carbamazepina/administración & dosificación , Inductores del Citocromo P-450 CYP3A/administración & dosificación , Farmacorresistencia Viral , VIH-1/efectos de los fármacos , Mutación Missense/efectos de los fármacos , Nevirapina/administración & dosificación , Fármacos Anti-VIH/farmacología , Carbamazepina/metabolismo , Quimioprevención/métodos , Citocromo P-450 CYP3A/metabolismo , Inductores del Citocromo P-450 CYP3A/metabolismo , Femenino , Infecciones por VIH/prevención & control , VIH-1/genética , Humanos , Nevirapina/farmacología , Embarazo , Resultado del Tratamiento
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