Hepatitis: Elghouzzi MH

Traineau R, Elghouzzi MH, Bierling P. · Etablissement français du sang Ile-de-France, hôpital Saint-Louis, 75475 Paris Cedex 10, France. · Rev Prat. · Pubmed #19253889 No free full text.

Abstract: Many infectious diseases are transmissible by blood transfusion but the overall risk of transfusion transmitted infections is very low through the combination of restrictive donor selection and increasingly sensitive screening. The noninfectious risks (hemolytic transfusion reactions, circulatory overload, transfusion related lung injury) are higher than the current infectious risks. Bacterial contamination of blood components remains the most frequent infectious risk from transfusion but are constantly declining. The estimated residual risk for transfusion transmitted HIV and hepatitis are lower 1/2 600 000 for HIV, 1/6 500 000 for HCV, 1/1 700 000 for HBV. For the future, the concerns are the risks of emerging or reemerging infections transmitted by blood as dengue, Chickungunya, West Nile Virus... Four transfusion transmissions of vCJD have been reported in UK, uncertainties about the incubation periods, the number of infected donors and the lack of sensitive assays for screening blood aggravate concerns about the transfusion transmission risks for vCJD. The ultimate strategy against infectious disease (all but vCJD) could be to develop inactivation methods. Pathogen inactivation have been implemented for plasma, are expected to become available for platelets, but for red blood cells are only in development.

Cantaloube JF, Gallian P, Laperche S, Elghouzzi MH, Piquet Y, Bouchardeau F, Jordier F, Biagini P, Attoui H, de Micco P. · Unité Emergence et coévolution virale, UMR 6578, CNRS-Etablissement Français du Sang Alpes-Méditerranée, Marseille, France. · J Med Virol. · Pubmed #18712846 No free full text.

Abstract: The subtype distribution of 142 genotype 2 and 97 genotype 4 hepatitis C virus (HCV) isolates from the sera of 1,319 volunteer blood donors in France was determined by gene sequencing and by phylogenetic analysis of the NS5B region and E1 envelope. Findings underlined a wide range of subtypes in both genotypes, that is, 20 in HCV-2 and 11 in HCV-4. Eighteen of these 31 subtypes had not been defined previously. Some subtypes, that is, 2a, 2b, 2c, 2i, 2k, 4a, and 4d, showed numerous strains while subtypes in donors from West Africa or Central Africa showed an endemic profile with only a few strains. A Bayesian coalescence approach was used to estimate the demographic history of each HCV subtype. The estimated mean dates of the most recent common ancestors (MRCA) were 1,889 (confidence interval (CI), 1,842-1,930) for HCV-2a, 1,886 (CI, 1,843-1,921) for HCV-2b, 1,791 (CI, 1,699-1,848) for HCV-2c, 1,846 (CI, 1,803-1,878) for HCV-2i, 1,911 (CI, 1,879-1,937) for HCV-4a, and 1,957 (CI, 1,943-1,967) for HCV-4d. The period of spread for subtype 2b, 2c, and 2i was between 1900 and 1960 whereas rapid exponential spread for subtype 2a, 4a, and 4d occurred in the 1960s. The inferred histories of population growth indicated that transmission rates differed according to HCV subtype. These results may help to predict the future burden of HCV in France.

Laperche S, Elghouzzi MH, Morel P, Asso-Bonnet M, Le Marrec N, Girault A, Servant-Delmas A, Bouchardeau F, Deschaseaux M, Piquet Y. · National Reference Center for Hepatitis B and C in Transfusion, National Institute of Blood Transfusion, Paris, France. · Transfusion. · Pubmed #16371051 No free full text.

Abstract: BACKGROUND: A new enzyme immunoassay based on the simultaneous detection of nucleocapsid proteins of hepatitis C virus (HCV) and anti-HCV (Monolisa HCV antigen-antibody Ultra, Bio-Rad) was evaluated as an alternative to nucleic acid testing (NAT) for the diagnosis of HCV infection during the window period in blood donations. STUDY DESIGN AND METHODS: The study included 107 sequential samples from 10 HCV seroconversion commercial panels; 81 samples were in the preseroconversion phase, and 26 were collected after seroconversion. All samples were tested with HCV antigen-antibody assay and the two minipool (MP) NAT procedures that are routinely used in France (transcription-mediated amplification in pools of 8 and COBAS AmpliScreen HCV test [Roche Diagnostic] in pools of 24 donations). RESULTS: From the 44 samples collected during window period that were MP-NAT-positive, 31 (70.5%) were also positive with the Monolisa HCV antigen-antibody assay. The mean delay in detecting HCV infection between these two methods was 5.1 days (range, 0-24 days). The Monolisa HCV antigen-antibody assay led to a reduction in the window period of 26.8 days (range, 0-72 days). All samples collected after seroconversion were detected with the HCV antigen-antibody assay. The specificity analyzed in 2503 consecutive blood donations was estimated at 99.88 percent. CONCLUSION: This new developed assay presents an improvement for the detection of HCV infection, especially in the early phase of infection when antibodies are undetectable. Although less sensitive than NAT, this assay could be a suitable solution for blood screening in developing countries where NAT (or HCV core antigen-specific assay) is not affordable or its implementation is not feasible.

Merle P, Elghouzzi MH, Pradat P, Vidal F, Boiret E, Trépo C. · Inserm U271, virus des hépatites et pathologies associées, 151, cours Albert-Thomas, 69424 , Lyon cedex 03, France. · Transfus Clin Biol. · Pubmed #15120103 No free full text.

Abstract: The GBV-C/HGV (HGV) virus was discovered a few years ago. This virus is known to be parenterally as well as sexually transmitted. However, no study has found some pathogenic roles for HGV so far. In the present study, we aimed to investigate the transmission of HGV by blood components transfused to 284 patients hospitalized in surgery unit in 1995. We tested two parameters of infection in blood components transfused to infected recipients: viral RNA by PCR and anti-E2 antibodies by ELISA. We tried to suspect some potent hepatocyte impacts by assessing the levels of two enzymes in serums: alanine aminotransferase (ALT) and alpha-glutathion S-transferase (alpha-GST). We found that HGV-RNA was detectable in 3.6% of recipients prior to transfusion and 7.5% post-transfusion. For each infected recipient, we retrospectively did a search for HGV-RNA in each transfused blood component, and we found at least one blood component as HGV-RNA-positive for each transfusional infected recipient. Anti-E2 antibody prevalence standing for a former and cured infection was 39.6% in all the recipients. In viremic recipients, ALT levels were mostly normal, while alpha-GST levels were found more commonly elevated than in non-viremic recipients although non-significantly (20% vs. 6.3%; P = 0.07). The present study underlines that HGV transmission is mostly transfusional in surgery units, and that infectiosity of blood components can be anticipated by detection of the viral RNA by PCR. Furthermore, the possible relationship between the serum activity of alpha-GST and the hepatotropism of HGV, although non-admitted as pathogenic, should be investigated.

Elghouzzi MH, Bouchardeau F, Pillonel J, Boiret E, Tirtaine C, Barlet V, Moncharmont P, Maisonneuve P, du Puy-Montbrun MC, Lyon-Caen D, Couroucé AM. · Etablissement de Transfusion Sanguine de l'Ouest Francilien, Rungis, France. · Vox Sang. · Pubmed #11111231 No free full text.

Abstract: BACKGROUND: We evaluated and analysed risk factors of HCV-infected blood donors according to HCV genotypes in order to improve the transfusion policy and safety of blood supply. MATERIALS AND METHODS: HCV-RNA was analysed in sera from 518 anti-HCV-positive blood donors, who were invited to medical consultation and interview as to risk factors by means of an extensive questionnaire. HCV genotyping was done on all samples positive for HCV-RNA. RESULTS: Of the 518 sera, 399 (77%) were HCV-RNA positive, and 394 of 399 HCV genotypes were identified. Major genotypes were 1b (34.3%), 3a (24%), 1a (19.5%) and 2 (11.4%). Of the donors, 289 (55.8%) were interviewed regarding their risk behaviour: 27% were former intravenous drug users (IVDUs), 26% had been transfused, 8% had a history of invasive diagnostic procedures, and 13% a history of surgery. Among the 224 interviewed donors, genotypes 1a and 3a were mainly associated with IVDU (51 and 45% respectively) and genotype 1b, with transfusion and nosocomial infections (40 and 25%, respectively). CONCLUSION: In this population of anti-HCV-positive blood donors, nosocomial infection may be a route of HCV spread, but the main risk factor remains IVDU, particularly in young men. The transfusion policy will improve if predonation interviews of such young men are done with a specific and sensitive questionnaire.

Bouchardeau F, Laperche S, Pillonel J, Elghouzzi MH, Maisonneuve P, Tirtaine C, Boiret E, Razer A, Girault A, Beaulieu MJ, Couroucé AM. · National Institute of Blood Transfusion, Paris, France. · Transfusion. · Pubmed #10924619 No free full text.

Abstract: BACKGROUND: Exposure to GB virus type C/HGV (GBV-C/HGV) could be determined by detection either of RNA by RT-PCR or of antibodies of the envelope protein E2. STUDY DESIGN AND METHODS: The aim of the study was to determine the proportion of the GBV-C/HGV markers of infection in a blood donor population infected with HCV and to identify GBV-C/HGV routes of transmission that are associated with HCV genotypes and risk factors. RESULTS: Among 306 HCV RNA-positive blood donors, the proportion of GBV-C/HGV RNA-positive donors and anti-E2-positive donors was 19.3 percent (95% CI = 15.0-24.2%) and 42.1 percent (95% CI = 36.6-47.9%), respectively. Exposure to GBV-C/HGV (RNA or anti-E2) was significantly associated with the risk factor of IV drug use. There was a trend toward association with HCV subtypes 1a and 3a, probably because these HCV subtypes are the most frequent in IV drug users. No correlation was observed between ALT elevation and the presence of GBV-C/HGV RNA. CONCLUSION: In persons with HCV infection, IV drug use seems to be a major route of GBV-C/HGV transmission. Precautions taken to avoid HCV infection will probably also decrease GBV-C/HGV transmission.

Laperche S, Bouchardeau F, Maniez M, Béolet M, Elghouzzi MH, Lefrère JJ. · No affiliation provided · Vox Sang. · Pubmed #15078255 No free full text.

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