ABSTRACT
OBJECTIVES: Micro-elimination of hepatitis C virus (HCV) in people living with HIV (PLHIV) and co-infected with HCV has been proposed as a key contribution to the overall goal of HCV elimination. While other studies have examined micro-elimination in HIV-treated cohorts, few have considered HCV micro-elimination among those not treated for HIV or at a national level. METHODS: Through data linkage of national and sentinel surveillance data, we examined the extent of HCV testing, diagnosis and treatment among a cohort of PLHIV in Scotland identified through the national database of HIV-diagnosed individuals, up to the end of 2017. RESULTS: Of 5018 PLHIV, an estimated 797 (15%) had never been tested for HCV and 70 (9%) of these had undiagnosed chronic HCV. The odds of never having been tested for HCV were the highest in those not on HIV treatment [adjusted odds ratio (aOR) = 7.21, 95% confidence interval (CI): 5.15-10.10). Overall HCV antibody positivity was 11%, and it was at its highest among people who inject drugs (49%). Most of those with chronic HCV (91%) had attended an HCV treatment clinic but only half had been successfully treated (54% for those on HIV treatment, 12% for those not) by the end of 2017. The odds of never having been treated for HCV were the highest in those not on HIV treatment (aOR = 3.60, 95% CI: 1.59-8.15). CONCLUSIONS: Our data demonstrate that micro-elimination of HCV in PLHIV is achievable but progress will require increased effort to engage and treat those co-infected, including those not being treated for their HIV.
Subject(s)
HIV Infections , Hepatitis C, Chronic , Hepatitis C , Substance Abuse, Intravenous , Antiviral Agents/therapeutic use , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Hepacivirus , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Humans , Information Storage and RetrievalABSTRACT
HIV-1 infects an estimated 37 million people worldwide, while the rarer HIV-2 infects 1-2 million worldwide. HIV-2 is mainly restricted to West African countries. The majority of patients in Scotland are diagnosed with HIV-1, but in 2013 the West of Scotland Specialist Virology Centre (WoSSVC) diagnosed Scotland's first HIV-2 positive case in a patient from Côte d'Ivoire. HIV-2 differs from HIV-1 in terms of structural viral proteins, viral transmissibility, prolonged period of latency, intrinsic resistance to certain antivirals and how to monitor the effectiveness of treatment. Over the course of 5 years the patient has required several changes in treatment due to both side effects and pill burden. This case highlights the complexity of HIV-2 patient management over time.
ABSTRACT
Respiratory point-of-care testing (POCT) for the detection of influenza A, influenza B and respiratory syncytial virus (RSV) was implemented in response to recent RSV outbreaks at a regional haemato-oncology unit in Glasgow. This descriptive study, undertaken pre- and post-POCT implementation, suggests that POCT reduces the time taken to receive results and increases diagnostic rates in outpatients. It is likely that the reduction in turnaround time afforded by POCT also leads to a faster time to antiviral treatment, prompt isolation and a reduction in the number of hospital-acquired infections.
Subject(s)
Health Plan Implementation , Influenza, Human/diagnosis , Point-of-Care Testing , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Tract Infections/diagnosis , Cohort Studies , Hematology , Humans , Influenza A virus/genetics , Influenza B virus/genetics , Molecular Diagnostic Techniques/instrumentation , Oncology Service, Hospital/statistics & numerical data , Outpatients , Qualitative Research , Respiratory Syncytial Virus, Human/genetics , Respiratory Tract Infections/virologySubject(s)
Common Cold , Influenza, Human , Respiratory Tract Infections , Humans , Population Dynamics , RhinovirusSubject(s)
Bodily Secretions/virology , Influenza, Human/diagnosis , Molecular Diagnostic Techniques/methods , Orthomyxoviridae/isolation & purification , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Virus, Human/isolation & purification , Humans , Mouth/virology , Pharynx/virology , Real-Time Polymerase Chain Reaction/methods , Sensitivity and Specificity , Trachea/virologySubject(s)
Coinfection/epidemiology , Hepatitis B/epidemiology , Hepatitis D/epidemiology , Adult , Antiviral Agents/therapeutic use , Coinfection/diagnosis , Coinfection/drug therapy , Female , Hepatitis B/diagnosis , Hepatitis B virus/isolation & purification , Hepatitis D/diagnosis , Hepatitis D/drug therapy , Hepatitis Delta Virus/genetics , Hepatitis Delta Virus/isolation & purification , Humans , Interferon-alpha/therapeutic use , Male , Middle Aged , Polyethylene Glycols/therapeutic use , Prevalence , Recombinant Proteins/therapeutic use , Risk Factors , Scotland/epidemiology , Treatment Outcome , Young AdultABSTRACT
Viral respiratory infections continue to pose a major global healthcare burden. At the community level, the co-circulation of respiratory viruses is common and yet studies generally focus on single aetiologies. We conducted the first comprehensive epidemiological analysis to encompass all major respiratory viruses in a single population. Using extensive multiplex PCR diagnostic data generated by the largest NHS board in Scotland, we analysed 44230 patient episodes of respiratory illness that were simultaneously tested for 11 virus groups between 2005 and 2013, spanning the 2009 influenza A pandemic. We measured viral infection prevalence, described co-infections, and identified factors independently associated with viral infection using multivariable logistic regression. Our study provides baseline measures and reveals new insights that will direct future research into the epidemiological consequences of virus co-circulation. In particular, our study shows that (i) human coronavirus infections are more common during influenza seasons and in co-infections than previously recognized, (ii) factors associated with co-infection differ from those associated with viral infection overall, (iii) virus prevalence has increased over time especially in infants aged <1 year, and (iv) viral infection risk is greater in the post-2009 pandemic era, likely reflecting a widespread change in the viral population that warrants further investigation.
Subject(s)
Coinfection/epidemiology , Respiratory Tract Infections/epidemiology , Virus Diseases/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Coinfection/virology , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Multiplex Polymerase Chain Reaction , Prevalence , Respiratory Tract Infections/virology , Scotland/epidemiology , Seasons , Virus Diseases/virology , Young AdultABSTRACT
It is paramount to understand the epidemiology of chronic hepatitis B to inform national policies on vaccination and screening/testing as well as cost-effectiveness studies. However, information on the national (Scottish) prevalence of chronic hepatitis B by ethnic group is lacking. To estimate the number of people with chronic hepatitis B in Scotland in 2009 by ethnicity, gender and age, the test data from virology laboratories in the four largest cities in Scotland were combined with estimates of the ethnic distribution of the Scottish population. Ethnicity in both the test data and the Scottish population was derived using a name-based ethnicity classification software (OnoMAP; Publicprofiler Ltd, UK). For 2009, we estimated 8720 [95% confidence interval (CI) 7490-10 230] people aged ⩾15 years were living with chronic hepatitis B infection in Scotland. This corresponds to 0·2% (95% CI 0·17-0·24) of the Scottish population aged ⩾15 years. Although East and South Asians make up a small proportion of the Scottish population, they make up 44% of the infected population. In addition, 75% of those infected were aged 15-44 years with almost 60% male. This study quantifies for the first time on a national level the burden of chronic hepatitis B infection by ethnicity, gender and age. It confirms the importance of promoting and targeting ethnic minority groups for hepatitis B testing.
Subject(s)
Hepatitis B, Chronic/epidemiology , Laboratories , Virology , Adolescent , Adult , Age Distribution , Asia, Western/ethnology , Asian People/statistics & numerical data , Epidemiological Monitoring , Ethnicity , Asia, Eastern/ethnology , Female , Health Services Needs and Demand , Hepatitis B, Chronic/ethnology , Humans , Male , Middle Aged , Prevalence , Scotland/epidemiology , Sex Distribution , White People/statistics & numerical data , Young AdultSubject(s)
Caliciviridae Infections/virology , Gastroenteritis/virology , Norovirus/genetics , Caliciviridae Infections/epidemiology , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/virology , Disease Outbreaks , Gastroenteritis/epidemiology , Genotype , Humans , Norovirus/classification , Norovirus/isolation & purification , Real-Time Polymerase Chain Reaction , Scotland/epidemiologyABSTRACT
In common with reports from other European countries, we describe a substantial increase in the number of laboratory reports of Mycoplasma pneumoniae in Scotland in 2010 and 2011. The highest number of reports came from those aged one year and younger. However, reports from young children were more likely to come from PCR testing than serological testing.
Subject(s)
Epidemics/statistics & numerical data , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/epidemiology , Population Surveillance , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Child, Preschool , Data Collection , Humans , Incidence , Infant , Infant, Newborn , Laboratories , Middle Aged , Mycoplasma pneumoniae/genetics , Pneumonia, Mycoplasma/diagnosis , Polymerase Chain Reaction/methods , Research Report , Respiratory Tract Infections/etiology , Scotland/epidemiology , Serologic Tests/methods , Sex Distribution , Young AdultSubject(s)
Herpes Simplex/virology , Herpesvirus 1, Human/isolation & purification , Liver Failure, Acute/virology , Pregnancy Complications, Infectious/virology , Sepsis/virology , Acyclovir/therapeutic use , Chlamydia trachomatis/isolation & purification , Chlamydiaceae Infections/diagnosis , Female , Herpes Simplex/complications , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Liver Failure, Acute/blood , Liver Failure, Acute/drug therapy , Pregnancy , Pregnancy Complications, Infectious/microbiology , Sepsis/drug therapySubject(s)
Bone Marrow/pathology , Epstein-Barr Virus Infections/diagnosis , Liver/physiopathology , Lymphohistiocytosis, Hemophagocytic/diagnosis , Adolescent , Antiviral Agents/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/drug therapy , Evidence-Based Practice , Female , Fever , Hepatomegaly/etiology , Herpesvirus 4, Human/genetics , Herpesvirus 4, Human/immunology , Herpesvirus 4, Human/isolation & purification , Humans , Immunologic Factors/therapeutic use , Infusions, Intravenous , Liver/pathology , Lymphohistiocytosis, Hemophagocytic/drug therapy , Lymphohistiocytosis, Hemophagocytic/etiology , Splenomegaly/etiologySubject(s)
Encephalitis, Varicella Zoster/diagnosis , Encephalitis, Varicella Zoster/pathology , Headache/virology , Herpesvirus 3, Human/isolation & purification , Hypesthesia/virology , Acyclovir/administration & dosage , Antibodies, Viral/cerebrospinal fluid , Antiviral Agents/administration & dosage , DNA, Viral/cerebrospinal fluid , Encephalitis, Varicella Zoster/drug therapy , Female , Humans , Immunoglobulin G/cerebrospinal fluid , Middle Aged , Skin/pathology , Skin/physiopathologyABSTRACT
Quantitative real-time PCR has become the most widely used preemptive approach for managing cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus infections in immunosuppressed patients. These three assays are normally available as separate tests, each using five quantitation standards that are tested in duplicate. We have developed an adenovirus-CMV-EBV triplex assay that uses one set of five pooled quantitative standards, tested singly rather than in duplicate. This test demonstrated a sensitivity and an accuracy of quantitation equivalent to those of our previous single tests and was shown to be able to detect mixed infections with no loss in sensitivity. This assay is now in routine use in our laboratory and has considerably simplified the work flow of the laboratory, with a resultant improvement in sample turnaround time and significantly reduced costs.
Subject(s)
Adenoviridae/isolation & purification , Cytomegalovirus/isolation & purification , Herpesvirus 4, Human/isolation & purification , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/standards , Adenoviridae/genetics , Cytomegalovirus/genetics , DNA Primers/genetics , Herpesvirus 4, Human/genetics , Humans , Reference Standards , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
An increasing number of virology laboratories are now utilising in house real time PCR assays as the frontline diagnostic tests. As the number of tests on offer increases the natural progression from this will be to rationalise their service via multiplexing. Since 2003 we have introduced a large number of qualitative and quantitative multiplex real time PCR assays into our routine testing service. This paper describes the development of the multiplex assays, the problems encountered and the resultant benefits to the routine service.
Subject(s)
Diagnostic Services , Molecular Diagnostic Techniques/methods , Polymerase Chain Reaction/methods , Virus Diseases/diagnosis , Time FactorsABSTRACT
For each month between January 2005 and August 2006, a representative number of outbreaks was examined using nucleic acid sequence analysis. Using this method, we showed that an increase in norovirus activity coincided with the emergence of a new GII genotype 4 variant, which by March 2006 was detected in the majority of health boards in Scotland.
Subject(s)
Caliciviridae Infections/epidemiology , Caliciviridae Infections/virology , Norovirus/classification , Norovirus/genetics , Disease Outbreaks , Genotype , Humans , Norovirus/isolation & purification , Scotland/epidemiology , Sequence Analysis, DNAABSTRACT
External quality control schemes are an essential part of the quality assurance of all diagnostic virology laboratories. There are a few providers of nucleic acid detection quality control panels. Consequently, diagnostic laboratories may test panels that are developed specifically for virus isolation by nucleic acid detection methods. Here, we report on a recent simulated eye swab panel from a National external quality assessment service, which was meant for virus isolation but which we tested by polymerase chain reactions assays. The results suggest that the samples had been contaminated at source leading to difficulty in interpretation of the panel and a poor score.