Although the World Health Organization (WHO) has set targets for safe blood by 2012, Sub-Saharan Africa remains confronted with multi-factorial issues that compromise blood safety in most countries of the region. Some of these include the development and implementation of national policies for transfusion, the recruitment of voluntary and unpaid donors, proper screening of collected blood as well as a strategy for its rational use in a setting already plagued by a high prevalence of blood-borne agents, poverty, and sometimes organizational deficits. Furthermore, the organization of hemovigilance, as well as quality systems that could monitor transfusion practices is lacking in these settings. There is no funding and global improvement of blood safety has to be cheap to be feasible. Specific solutions for the African continent need to be developed and implemented. This paper examines the current status and difficulties of blood safety in Africa and reviews available data on transfusion medicine in the region.

This cross-sectional study aimed to investigate, during a short period between 2000 and 2001, in a large population of patients with chronic hepatitis C, the epidemiological characteristics of hepatitis C virus (HCV) genotypes in France. Data from 26 referral centres, corresponding to 1769 patients with chronic hepatitis C were collected consecutively during a 6-month period. HCV genotyping in the 5'-non-coding region (NCR) was performed in each center using the line probe assay (LiPA, in 63% of cases), sequencing (25%) or primer-specific polymerase chain reaction (PCR) (12%). HCV genotypes 1a, 1b, 2, 3, 4, 5, non-subtyped 1 and mixed infection were found in 18, 27, 9, 21, 9, 3, 11 and 1% of our population, respectively. HCV genotype distribution was associated with gender, age, source and duration of infection, alanine aminotransferase (ALT) levels, cirrhosis, alcohol consumption, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection. In multivariate analysis, only the source of infection was the independent factor significantly associated with genotype (P = 0.0001). In conclusion, this study shows a changing pattern of HCV genotypes in France, with i.v. drug abuse as the major risk factor, an increase of genotype 4, and to a lesser extent 1a and 5, and a decrease of genotypes 1b and 2. The modification of the HCV genotype pattern in France in the next 10 years may require new therapeutic strategies, and further survey studies.

The prevalence of GB virus C (GBV-C) infection is high in human immunodeficiency virus (HIV)-infected persons. However, the long-term consequences of coinfection are unknown. HIV-positive persons with a well-defined duration of infection were screened on the basis of their GBV-C/hepatitis G virus (HGV) RNA status and studied. GBV-C/HGV viremia was observed in 23, who carried the virus over a mean of 7.7 years. All parameters (survival, CDC stage B/C, HIV RNA load, CD4 T cell count) showed significant differences in terms of the cumulative progression rate between persons positive and negative for GBV-C/HGV RNA. When GBV-C/HGV RNA-positive and -unexposed subjects were matched by age, sex, baseline HIV RNA load, and baseline CD4 T cell count, HIV disease progression appeared worse in GBV-C/HGV RNA-negative subjects. The carriage of GBV-C/HGV RNA is associated with a slower progression of HIV disease in coinfected persons.

The aim of this study was to investigate the following in a large population of French patients with chronic hepatitis C: the geographical distribution of hepatitis C virus (HCV) genotypes; the relationship between HCV genotypes and epidemiological characteristics; severity of the disease; and response to interferon (IFN) therapy. Data from 14 tertiary referral centres, corresponding to 1872 patients with chronic hepatitis C, were prospectively collected from 1989 to 1997. HCV genotyping was performed using the line probe assay (LiPA). HCV genotypes 1b, 3, 1a, 2, 4 and a mixed infection were found in 41%, 22%, 16%, 11%, 4% and 4% of our population, respectively. HCV genotype distribution was homogeneous, except for genotype 2 that was found more frequently in the southwest than in the other regions (21% vs 9.2%) (P=0.001). HCV distribution was associated with gender, age, and source and duration of infection. In multivariate analysis, these correlations were related to the source of infection, which was the only independent factor significantly associated with genotype (P=0.001). Genotype 1b was significantly more common in patients with cirrhosis, but in multivariate analysis cirrhosis was independently related to older age at exposure and longer duration of infection (P=0.001). A sustained response to IFN therapy was observed in 11% of patients infected with genotypes 1a or 1b vs 32% of those infected with genotypes 2 or 3 (P=0.001). This study shows that HCV genotype is mainly related to the source infection, but not to the intrinsic pathogenicity of HCV, and is a strong predictor of sustained response to therapy.

Recent reports suggested that parvovirus B19 (B19) might persist in immunocompetent individuals such as blood donors, but only cross-sectional data were available. Serial samples from a cohort of multitransfused patients with hemoglobinopathies and a cross-sectional population of pregnant women were tested for B19 markers. Of 76 red cell recipients, 6 (8%) had persistent viral DNA for 1 to 3 or more years, depending on the sensitivity of the genomic amplification assay. All patients also carried B19-specific immunoglobulin G (IgG). In contrast, 0.8% of 500 pregnant women carried both detectable B19 DNA and specific IgG. These results demonstrate that persistence of low levels of B19 DNA suggested by cross-sectional studies is frequent in multitransfused patients and that the virus may remain detectable several years after infection in nonimmunodeficient individuals. (Blood. 2005;106:2890-2895)

Since its discovery, human parvovirus B19 (B19V), now termed erythrovirus, has been associated with many clinical situations (neurological and myocardium infections, persistent B19V DNAemia) in addition to the prototype clinical manifestations, i.e., erythema infectiosum and erythroblastopenia crisis. In 2002, the use of new molecular tools led to the characterization of three different genotypes of human B19 erythrovirus. Although the genomic organization is conserved, the geographic distribution of the different genotypes varies worldwide, and the nucleotidic divergences can impact the molecular diagnosis of B19 virus infection. The cell cycle of the virus remains partially unresolved; however, recent studies have shed light on the mechanism of cell entry and the interactions of B19V proteins with apoptosis pathways.Before the recent descriptions of human bocavirus (2) and human parvovirus 4 (PARV4) (41), parvovirus B19 ([B19V] or erythrovirus B19) was the only known member of the Parvoviridae family to infect humans. The Erythrovirus genus contains B19V, erythroviruses that infect several simian species, and the parvovirus from Manchurian chipmunks (87a). These viruses share the remarkable property of replicating in and destroying erythroid progenitors. This strong in vitro tropism explains the difficulties in studying the replicative cycle of these viruses; indeed, the in vitro production and culture of erythroid progenitor cells remain delicate. An infectious B19V clone was described only recently (102), and its use, although mostly limited and allowing only a small amount of progeny production, led to constructions of recombinant viruses that were helpful in understanding the steps of the virus life cycle and the toxicity of the virus. Discovered in 1975 (19), B19V can cause a wide range of mild and self-limiting clinical manifestations, such as erythema infectiosum (fifth disease) and oligoarthritis (98). B19V infection can also cause acute anemia by aplastic crisis in patients whose red blood cells have shortened survival times (i.e., patients with sickle cell disease, thalassemia, spherocytosis, or any disorder of hemoglobin gene expression or red cell membrane constitution), chronic anemia in patients with congenital immunodeficiencies or human immunodeficiency virus (HIV) infection or who are undergoing chemotherapy for malignancies or organ transplants (48, 58), and hydrops fetalis or intrauterine death in infected fetuses (86). Recently, cases of neurological manifestations have been associated with B19V infection (22), as have myocardium infections (4,5,47,83), and the spectrum of B19V-linked diseases may further increase. CLINICAL MANIFESTATIONSThe primary route of transmission of B19V is the respiratory tract (via aerosol droplets), with a majority of infections occurring during childhood, but the infection may also be transmitted by organ transplantation and especially by transfusion of blood components, in particular by packed red cells from blood collected during the short preseroconversion vi...

A national evaluation study was performed in 11 specialized laboratories with the objective of assessing their capacities to genotype hepatitis C virus (HCV) and define the applicability of a given genotyping method. The panel consisted of 14 samples positive for HCV RNA of different genotypes (including 3 samples with two different artificially mixed genotypes) and 1 HCV-negative sample. Seventeen sets of data were gathered from the 11 participating laboratories. The sensitivities ranged from 64.3 to 100% and from 42.7 to 85.7% for the methods that used sequencing of the NS5b region and the 5 noncoding (5 NC) region, respectively. When the data for the artificially mixed samples were excluded, NS5b genotyping gave correct results for 80% of the samples, 1.7% of the samples were misclassified, and 18.3% of the samples had false-negative results. By 5 NC-region genotyping methods, 58.3% of the results were correct, 29.7% were incomplete, 8.3% were misclassifications, 1.2% were false positive, and 2.4% were false negative. Only two procedures based on NS5b sequencing correctly identified one of the three samples with mixtures of genotypes; the other methods identified the genotype corresponding to the strain with the highest viral load in the sample. Our results suggest that HCV 5 NC-region genotyping methods give sufficient information for clinical purposes, in which the determination of the subtype is not essential, and that NS5b genotyping methods are more reliable for subtype determination, which is required in epidemiological studies.

Hepatitis C virus (HCV) isolates have been classified into six main genotypes. Genotyping methods, and especially the widely used line probe assay (LiPA), are frequently based on the 5-untranslated region (5UTR). However, this region is not appropriate for discriminating HCV strains at the subtype level and for distinguishing many genotype 6 samples from genotype 1. We investigated the capacity of a novel LiPA (Versant HCV Genotype 2.0 assay) based on the simultaneous detection of 5UTR and Core regions for genotypes 1 and 6 to provide correct HCV genotypes (characterized with a phylogenetic analysis) in a set of HCV strains mainly encountered in Western countries. The improvement was assessed by comparing the results to those obtained with the previous version of the assay. Of the 135 tested samples, 64.7% were concordant for genotype group and subtype with sequencing reference results using the Versant HCV Genotype 2.0 assay versus 37.5% with the previous version. The yield was mainly related to a better characterization of genotype 1, since the accuracy, tested in 62 genotype 1 samples, increased from 45.2% with the first version to 96.8% with the new one. However, this new version necessitates a specific PCR and could no longer be used after 5UTR PCR used for current HCV infection diagnosis. Moreover, the information provided by 5UTR hybridization is not reliable for correctly identifying the diversity within genotypes 2 and 4. Thus, the Versant HCV Genotype 2.0 assay remains a useful tool for clinical practice when only the discrimination between major HCV genotypes is necessary.