Prize laureate Nelson Rolihlahla Mandela (Madiba) was the first black president of the Republic o... more Prize laureate Nelson Rolihlahla Mandela (Madiba) was the first black president of the Republic of South Africa (SA), the iconic figure of the liberation struggle against apartheid and the unique moral voice of the world. [1] Many books have been written about Madiba, including his own autobiography, Long Walk to Freedom, [2] but none has drawn more controversy than the recently published book, Mandela's Last Days, authored by retired military doctor, Lieut. Gen. Vejay Ramlakan (VR). [3] According to the publisher's author biography, VR has been a member of the African National Congress (ANC) for approximately 40 years, he was incarcerated on Robben Island from 1987 to 1991 and he was the surgeon general of the SA National Defence Force (SANDF) from 1995 to 2013. [3] He was charged with the responsibility of providing healthcare to Madiba from 2005 until his death on Thursday 5 December 2013. [3] His rationale for penning the book was to 'recount one of the greatest triumphs of the human spirit and to set the record straight by rectifying the misconceptions, untruths, speculations and rumours about Mandela's last years'. [3] Subsequently, VR has been accused of violating doctorpatient confidentiality by making Madiba's medical records and treatment public without consent, and for making intimate personal disclosures about the Mandela family, thus violating their dignity, trust and respect. [4] In response, the publishers, Penguin Random House SA, without contestation and at their own expense, withdrew the book from bookstores countrywide within less than a month of its publication (June 2017), and all further sales of the book have been censored 'out of respect for Madiba's family'. [4] In his recent publication, McQuoid-Mason (MM) [6] details the ethical and legal principles that ought to be followed with regard to who should consent to disclosing the medical records and treatment protocols of a deceased public figure, and whether such disclosures are in the public interest. It is a legal requirement that all healthcare workers (HCWs) must be registered with the Health Professions Council of SA (HPCSA), a statutory body, in order to practise their profession. Citing the HPCSA's ethical rules of conduct, MM states that 'confidential information about a deceased patient should only be divulged with the written consent of his or her next of kin or the executor of his or her estate, failing which such information ought to be disclosed in terms of a statute or court order or the disclosure if justified in the public interest.' [6] Neither the HPCSA rule [6] nor the dictionary [7] provides a clear definition of next-of-kin. The latter defines next of kin as a 'person's closest living relative or relatives, next to 1. bedside, 2. following in order of importance'. [7] Who should consent in instances where there are family disagreements? Under such circumstances, MM submits that one should be guided by the National Health Act (NHA) No. 61 of 2003, which describes the order of persons who can give written consent on behalf of incompetent live patients or deceased persons to make public personal medical information and treatment. [6] The specific order of precedence is:
Sera from 70 patients on maintenance haemodialysis, 98 patients with chronic liver disease, and 2... more Sera from 70 patients on maintenance haemodialysis, 98 patients with chronic liver disease, and 232 volunteer blood donors in the province of KwaZulu Natal, South Africa, were screened for GB virus/hepatitis G virus (GBV-C/HGV) RNA and anti-E2 by reverse transcription-polymerase chain reaction (RT-PCR) and by an enzyme-linked immunosorbent assay (ELISA), respectively. GBV-C/HGV RNA was detected in 17/70 (24.3%) haemodialysis patients, 12/98 (12.2%) patients with chronic liver disease, and 44/232 (18.9%) blood donors (Africans [29/76; 38.2%]; Asians [2/52; 3.8%]; Whites [11/49; 22.4%], and "Coloureds" [persons of mixed origin; 2/55; 3.6%]). Overall (anti-E2 and/or RNA) 43.9% (43/98) of patients with chronic liver disease, 47.1% (33/70) of haemodialysis patients, and 31.9% (74/232) of blood donors (Africans [44/76; 5.9%]; Asians [5/52; 9.6%]; Whites [15/49; 30.6%], and Coloureds [9/54; 16.6%]) were exposed to GBV-C/HGV infection. There was a significant difference in the prevalence of GBV-C/HGV infection (RNA and/or anti-E2) between African blood donors and the other racial groups (P < .001), and between blood donors and haemodialysis patients (P = .02) and patients with chronic liver disease (P = .04). Anti-E2 antibodies and GBV-C/HGV RNA were almost mutually exclusive. GBV-C/HGV-infected haemodialysis patients received more transfusions (P = .03) than noninfected patients. There was no significant difference in liver biochemistry between GBV-C/HGV-infected and noninfected patients and between blood donors in each of the four racial groups. The high prevalence of GBV-C/HGV infection in blood donors and chronic liver disease patients, and the lack of elevated liver enzymes and clinical hepatitis in blood donors and haemodialysis patients, suggest that GBV-C/HGV may not be associated with liver disease.
International Journal of Experimental Pathology, 2000
GB Virus C and Hepatitis G Virus (GBV-C/HGV) are positive, single-stranded flaviviruses. GBV-C an... more GB Virus C and Hepatitis G Virus (GBV-C/HGV) are positive, single-stranded flaviviruses. GBV-C and HGV are independent isolates of the same virus. Transmission via the blood-borne route is the commonest mode, although vertical and sexual transmission is well documented. GBV-C/HGV is distributed globally; its prevalence in the general population is 10 fold higher in African countries than in non-African countries. High prevalences of GBV-C/HGV have been found in subjects with frequent parenteral exposure and in groups at high risk of exposure to blood and blood products. The clinical significance of human infection with GBV-C/HGV is currently unclear. The virus can establish both acute and chronic infection and appears to be sensitive to interferon. Only some 12±15% of chronic Non-A, B, C hepatitis cases are infected with GBV-C/HGV. A direct association with liver pathology is still lacking and it is not yet clear as to whether GBV-C/HGV is indeed a hepatotropic virus. Current evidence suggests that the spectrum of association of GBV-C/HGV infection with extrahepatic diseases ranges from haematalogical diseases, aplastic anaemia, human immunodeficiency virus (HIV)-positive idiopathic thrombocytopenia and thalassemia, through to common variable immune deficiency and cryoglobunemia.
GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-... more GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-naive African mothers with human immunodeficiency virus infection and their infants. GBV-C RNA was extracted from serum and amplified by reverse-transcriptase polymerase chain reaction. Twenty-seven (36%) of these 75 HIV-infected women tested positive for GBV-C RNA. To study transmission dynamics, we chose a random subsample of 20 of these women and their infants. In this cohort, there was evidence of postnatal transmission of GBV-C; however, it was not possible to demonstrate evidence of in utero or intrapartum transmission. In this pilot observational study, transmission of HIV from mother-to-infant occurs independently of the GBV-C infection status of the mother. The immunological indices measured tend to suggest an association with protection and or delayed progression of HIV disease in GBV-C-infected mothers.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1996
The incidence of Helicobacter pylori infection in very young children was determined, based on th... more The incidence of Helicobacter pylori infection in very young children was determined, based on the emergence of specific IgG antibodies in sequential serum samples from birth to 2 years of age. The risk of acquiring H pyloni infection in infancy as a result of maternal exposure to the organism was also assessed, based on the determination of maternal cord-blood antibodies. Serum IgG class H pylon antibodies were analysed in the cord blood samples of 195 newborns and in their follow up samples until the age of 2 years. Maternal antibodies were detected in the cord-blood samples of 21 children (10-6%). These antibodies disappeared in all but one child before 7 months of age and no new seroconversions occurred in these children. Ten originally cord-blood negative children seroconverted up to the age of 2 years (5 1%). It is concluded that a major proportion of H pyloni infections observed in young adults in Finland are acquired during the first two years of life. Maternal seropositivity is not a straightforward risk factor for acquiring Hpylori infection in infancy.
The manner in which the ‘case’ against Professor Cyril Karabus, a South African paediatric oncolo... more The manner in which the ‘case’ against Professor Cyril Karabus, a South African paediatric oncologist, was conducted in the United Arab Emirates was a travesty of justice. It drew not only worldwide protests and condemnation, but also public commentary that questioned the ethical conduct of medical doctors and healthcare organisations which boycotted the African Health Conference, in a matter some considered to be purely political.
Human biological material (HBM) is an invaluable resource in biomedical research. Although resear... more Human biological material (HBM) is an invaluable resource in biomedical research. Although research ethics committees (RECs) are guided by international guidelines and frameworks, some RECs might not be fully informed about local ethical and regulatory requirements regarding the use, collection, storage, ownership, transfer and benefit-sharing of HBM in collaborative research.
African journal of medicine and medical sciences, 1995
The "one-minute" urease test to detect Helicobacter (Campylobacter) pylori infection wa... more The "one-minute" urease test to detect Helicobacter (Campylobacter) pylori infection was evaluated using histology and culture as the "gold standard". The test was performed in a blinded manner and compared with the conventional Christensen's urease test. Helicobacter pylori was detected in 88 of 100 consecutive patients attending the gastrointestinal clinic for upper endoscopy. Although the "one-minute" urease test was more sensitive [86% (76/88)] than the conventional Christensen's urease test [70% (62/88)], this difference was not statistically significant (P = 0.22). Histology was the most sensitive [97% (85/88)] whilst culture was 80% (70/88) sensitive. All tests exhibited specifications of 100%. The "one-minute" urease test is a simple, rapid and highly specific test to detect Helicobacter pylori which can be performed at endoscopy.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, Jan 7, 1991
Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection o... more Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection of H. pylori, which entails histological examination and culture of gastric biopsy specimens, takes several days. There has been much interest in developing more rapid tests, including non-invasive ones. Using histology and/or culture as the 'gold standard', several methods to detect H. pylori were compared and evaluated. The organism was detected in 84 of 100 consecutive patients attending the Gastrointestinal Unit of King Edward VIII Hospital for upper gastrointestinal tract endoscopy. Histological examination was the most sensitive (98%) and specific (100%) method used in detecting H. pylori in gastric biopsy specimens. An enzyme-linked immunosorbent assay to detect specific IgG antibodies to whole H. pylori organisms is a moderately sensitive (82%), non-invasive method but it is nonspecific (38%). Although culture was specific (100%), it was less sensitive (68%) than histologi...
Phylogenetic analysis of the 5% non-coding region (5%NCR) sequences has demonstrated that GB viru... more Phylogenetic analysis of the 5% non-coding region (5%NCR) sequences has demonstrated that GB virus C/hepatitis G virus (GBV-C/HGV) can be separated into three major groups that correlate with the geographic origin of the isolate. Sequence analysis of the 5%NCR of 54 GBV-C/HGV isolates from 31 blood donors, 11 haemodialysis patients and 12 patients with chronic liver disease suggests the presence of a new variant of GBV-C/HGV in the province of KwaZulu Natal, South Africa. Eleven isolates grouped as group 1 variants (bootstrap support, 90%) found predominantly in West and Central Africa, a further six isolates grouped as group 2 variants (bootstrap support, 58%) found in Europe and North America; five of which grouped as 2a (bootstrap support, 91%) and one as 2b (bootstrap support, 87%), the latter also includes isolates from Japan, East Africa and Pakistan. Although the remaining 37 GBV-C/HGV isolates were more closely related to group 1 variants (bootstrap support, 90%), they formed a cluster, which was distinct from all other known GBV-C/HGV sequences. None of the South African isolates grouped with group 3 variants described from Southeast Asia. Three variants of GBV-C/HGV exist in KwaZulu Natal: groups 1, 2 and a new variant, which is distinct from other African isolates.
GB virus C (GBV-C) is a common, apparently nonpathogenic human flavivirus that has been associate... more GB virus C (GBV-C) is a common, apparently nonpathogenic human flavivirus that has been associated in some studies with prolonged survival in human immunodeficiency virus (HIV)-positive persons. There are 5 distinct GBV-C genotypes localized to specific geographic regions, and genotype 2 has been previously shown to inhibit HIV replication in vitro in lymphocyte cultures. We identified GBV-C virus isolates representing genotypes 1, 2, and 5 in samples from South African blood donors. GBV-C genotype 1 and 5 isolates replicated in lymphocyte culture, inhibited X4 and R5 HIV-1 isolates, and induced RANTES and stromal-derived factor-1 chemokines in vitro. Thus, African GBV-C genotypes can inhibit HIV replication in vitro. GB virus type C (GBV-C, also called hepatitis G virus) is a positive-sense, single-strand RNA virus in the Flaviviridae family. The genome organization resembles that of hepatitis C virus, and GBV-C shares ∼30% amino-acid identity with hepatitis C virus [1, 2]. GBV-C does not appear to replicate in vivo in hepatocytes but, rather, in lymphocytes. Thus, it is not surprising that epidemiological studies of GBV-C infection have not found any association between GBV-C and chronic hepatitis [1]. To date, GBV-C has not been conclusively associated with any known disease, although it is a very common infection
GB virus type C (GBV-C) is a common human flavivirus that has been associated with prolonged surv... more GB virus type C (GBV-C) is a common human flavivirus that has been associated with prolonged survival in HIV-positive individuals in several, though not all, epidemiological studies. There are five distinct GBV-C genotypes that are geographically localized, and it has been speculated that GBV-C genotypic differences may explain variable outcomes observed in different clinical studies. Expression of an 85 aa fragment of the GBV-C NS5A phosphoprotein (genotype 2) in a CD4+ T cell line (Jurkat) resulted in inhibition of HIV replication, mediated in part by decreased surface expression of the HIV coreceptor CXCR4 and upregulation of SDF-1. We expressed the NS5A protein from genotypes 1, 2, 3 and 5 in Jurkat cells, and demonstrated that all genotypes inhibited HIV replication. Further deletion mapping demonstrated that expression of a 30 aa fragment resulted in decreased CXCR4 surface expression, upregulation of SDF-1 and inhibition of HIV replication.
GB virus C (GBV-C), a positive-strand RNA virus, currently infects approximately one-sixth of the... more GB virus C (GBV-C), a positive-strand RNA virus, currently infects approximately one-sixth of the world's population. This virus exists as a collection of genotypes whose global distribution correlates with geographical origin. Genotyping of GBV-C isolates by phylogenetic analysis has relied upon the use of 5′-untranslated region (5′-UTR) sequences, however, complete genome sequences are used to demonstrate definitively their existence and geographical correlation. Initial identification of the fifth genotype from South Africa was based upon phylogenetic analysis of the 5′-UTR. It was sought to confirm this classification by analysis of full-length E2 genes from South African isolates and by analysis of a complete genotype 5 genome. Analysis of full-length E2 genes from 28 GBV-C-infected South African individuals revealed the existence of a unique group of 18 isolates, distinct from the other four genotypes. Bootstrap analysis provided strong support (95 %) for this fifth group....
Human Biological Materials (HBMs) are an invaluable resource in biomedical research. Objective: T... more Human Biological Materials (HBMs) are an invaluable resource in biomedical research. Objective: To determine if researchers and a Research Ethics Committee (REC) at a South African institution addressed ethical issues pertaining to HBMs in collaborative research with developed countries. Study Design: Ethically approved retrospective cross-sectional descriptive audit. Results: Of the 1305 protocols audited, 151 (11.57%) fulfilled the study's inclusion criteria. Compared to other developed countries, a majority of sponsors (90) were from the USA (p = 0.0001). The principle investigators (PIs) in all 151 protocols informed the REC of their intent to store HBMs. Only 132 protocols informed research participants (P < 0.0001). In 148 protocols informed consent (IC) was obtained from research participants, 116 protocols (76.8%) solicited broad consent compared to specific consent (32; 21.2%) [p < 0.0001]. In 105 cases a code was used to maintain confidentiality. HBMs were anonymised in 14 protocols [p < 0.0001]. More protocols informed the REC (90) than the research participants (67) that HBMs would be exported (p = 0.011). Export permits (EPs) and Material Transfer Agreements (MTAs) were not available in 109 and 143 protocols, respectively. Conclusions: Researchers and the REC did not adequately address the interrelated ethical and regulatory issues pertaining to HBMs. There was a lack of congruence between the ethical guidelines of developed countries and their actions which are central to the access to HBMs in collaborative research. HBMs may be leaving South Africa without EPs and MTAs during the process of international collaborative research.
Recurrent hepatitis C is a major cause of mortality in HIV/hepatitis C virus (HCV)-co-infected pa... more Recurrent hepatitis C is a major cause of mortality in HIV/hepatitis C virus (HCV)-co-infected patients after orthotopic liver transplantation. We report sustained viral clearance in all four transplanted HIV/HCV-positive patients treated with pegylated interferon/ribavirin. Early therapy after HCV recurrence, tailoring treatment duration to the individual decline in HCV-RNA and the management of side effects are key factors for improved efficacy. At experienced centres interferon treatment is a valuable option for recurrent hepatitis C in HIV-positive patients. Hepatitis C has become a frequent cause of orthotopic liver transplantation (OLT) in HIV-infected patients [1,2]. The recurrence of chronic hepatitis C is, however, universal and within 5 years can lead to cirrhosis in approximately 20% of HIV-infected patients [1-5]. Treatment for hepatitis C virus (HCV)/HIV-positive patients to eliminate recurrent hepatitis after OLT is urgently needed.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1996
The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodie... more The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodies to hepatitis C virus (HCV) (anti-HCV) in patients with cirrhosis, hepatocellular carcinoma (HCC) and chronic active hepatitis (CAH) attending a referral hospital in a hepatitis B virus (HBV)-endemic area in South Africa. One hundred and ten patients with suspected cirrhosis, 44 with suspected HCC and 6 with chronic hepatitis were initially included. The diagnoses were confirmed in 77 patients with cirrhosis (histologically or macroscopically at peritoneoscopy), 33 patients with HCC (histologically or elevated alpha-fetoprotein levels plus focal lesion on hepatic imaging) and 6 patients with CAH (histologically) without antinuclear antibodies. All patients were tested for anti-HCV with the Abbott second-generation enzyme immunoassay combined with a supplemental neutralisation assay, and hepatitis B surface antigen (HBsAg). Anti-HCV seroprevalence for cirrhosis, HCC and CAH were 18/77 (2...
The y interferon (,y-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated... more The y interferon (,y-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated in 30 patients with tuberculous peritonitis, 21 patients with ascites due to a malignant disorder, and 41 patients with cirrhosis. The y-IFN concentrations were significantly higher (p<0.0001) in tuberculous peritonitis patients (mean: 6-70 U/ml) than in the malignant (mean: 3.10 U/ml) and cirrhotic (mean: 3.08 U/ml) groups. Use of a cut off value of ¢3.2 U/mli gave the assay a sensitivity of93% (25 of 27), a specificity of 98% (54 of 55), positive (P+) and negative (P-) predictive values of 96% and a test accuracy of 96%. The ADA activity was significantly (p<0-0001) higher in the tuberculous peritonitis group (mean: 101.84 U/i) than in the control groups (cirrhosis (mean: 13-49 U/I) and malignancy (mean: 19.35 U/i)). A cut offvalue of >30 U/l gave the ADA test a sensitivity of 93% (26 of 28) a specificity of 96% (51 of 53), a (P+) value of 93%, a (P-) value of 96%, and a test accuracy of 95%. There was a significant (p<0-0001) correlation (r=0.72) between ADA activity and-y-IFN values in patients with tuberculous peritonitis. These results show that a high concentration of y-IFN in ascitic fluid is as valuable as the ADA activity in the diagnosis of tuberculous peritonitis. Both are rapid non-invasive diagnostic tests for tuberculous peritonitis.
Prize laureate Nelson Rolihlahla Mandela (Madiba) was the first black president of the Republic o... more Prize laureate Nelson Rolihlahla Mandela (Madiba) was the first black president of the Republic of South Africa (SA), the iconic figure of the liberation struggle against apartheid and the unique moral voice of the world. [1] Many books have been written about Madiba, including his own autobiography, Long Walk to Freedom, [2] but none has drawn more controversy than the recently published book, Mandela's Last Days, authored by retired military doctor, Lieut. Gen. Vejay Ramlakan (VR). [3] According to the publisher's author biography, VR has been a member of the African National Congress (ANC) for approximately 40 years, he was incarcerated on Robben Island from 1987 to 1991 and he was the surgeon general of the SA National Defence Force (SANDF) from 1995 to 2013. [3] He was charged with the responsibility of providing healthcare to Madiba from 2005 until his death on Thursday 5 December 2013. [3] His rationale for penning the book was to 'recount one of the greatest triumphs of the human spirit and to set the record straight by rectifying the misconceptions, untruths, speculations and rumours about Mandela's last years'. [3] Subsequently, VR has been accused of violating doctorpatient confidentiality by making Madiba's medical records and treatment public without consent, and for making intimate personal disclosures about the Mandela family, thus violating their dignity, trust and respect. [4] In response, the publishers, Penguin Random House SA, without contestation and at their own expense, withdrew the book from bookstores countrywide within less than a month of its publication (June 2017), and all further sales of the book have been censored 'out of respect for Madiba's family'. [4] In his recent publication, McQuoid-Mason (MM) [6] details the ethical and legal principles that ought to be followed with regard to who should consent to disclosing the medical records and treatment protocols of a deceased public figure, and whether such disclosures are in the public interest. It is a legal requirement that all healthcare workers (HCWs) must be registered with the Health Professions Council of SA (HPCSA), a statutory body, in order to practise their profession. Citing the HPCSA's ethical rules of conduct, MM states that 'confidential information about a deceased patient should only be divulged with the written consent of his or her next of kin or the executor of his or her estate, failing which such information ought to be disclosed in terms of a statute or court order or the disclosure if justified in the public interest.' [6] Neither the HPCSA rule [6] nor the dictionary [7] provides a clear definition of next-of-kin. The latter defines next of kin as a 'person's closest living relative or relatives, next to 1. bedside, 2. following in order of importance'. [7] Who should consent in instances where there are family disagreements? Under such circumstances, MM submits that one should be guided by the National Health Act (NHA) No. 61 of 2003, which describes the order of persons who can give written consent on behalf of incompetent live patients or deceased persons to make public personal medical information and treatment. [6] The specific order of precedence is:
Sera from 70 patients on maintenance haemodialysis, 98 patients with chronic liver disease, and 2... more Sera from 70 patients on maintenance haemodialysis, 98 patients with chronic liver disease, and 232 volunteer blood donors in the province of KwaZulu Natal, South Africa, were screened for GB virus/hepatitis G virus (GBV-C/HGV) RNA and anti-E2 by reverse transcription-polymerase chain reaction (RT-PCR) and by an enzyme-linked immunosorbent assay (ELISA), respectively. GBV-C/HGV RNA was detected in 17/70 (24.3%) haemodialysis patients, 12/98 (12.2%) patients with chronic liver disease, and 44/232 (18.9%) blood donors (Africans [29/76; 38.2%]; Asians [2/52; 3.8%]; Whites [11/49; 22.4%], and &quot;Coloureds&quot; [persons of mixed origin; 2/55; 3.6%]). Overall (anti-E2 and/or RNA) 43.9% (43/98) of patients with chronic liver disease, 47.1% (33/70) of haemodialysis patients, and 31.9% (74/232) of blood donors (Africans [44/76; 5.9%]; Asians [5/52; 9.6%]; Whites [15/49; 30.6%], and Coloureds [9/54; 16.6%]) were exposed to GBV-C/HGV infection. There was a significant difference in the prevalence of GBV-C/HGV infection (RNA and/or anti-E2) between African blood donors and the other racial groups (P &lt; .001), and between blood donors and haemodialysis patients (P = .02) and patients with chronic liver disease (P = .04). Anti-E2 antibodies and GBV-C/HGV RNA were almost mutually exclusive. GBV-C/HGV-infected haemodialysis patients received more transfusions (P = .03) than noninfected patients. There was no significant difference in liver biochemistry between GBV-C/HGV-infected and noninfected patients and between blood donors in each of the four racial groups. The high prevalence of GBV-C/HGV infection in blood donors and chronic liver disease patients, and the lack of elevated liver enzymes and clinical hepatitis in blood donors and haemodialysis patients, suggest that GBV-C/HGV may not be associated with liver disease.
International Journal of Experimental Pathology, 2000
GB Virus C and Hepatitis G Virus (GBV-C/HGV) are positive, single-stranded flaviviruses. GBV-C an... more GB Virus C and Hepatitis G Virus (GBV-C/HGV) are positive, single-stranded flaviviruses. GBV-C and HGV are independent isolates of the same virus. Transmission via the blood-borne route is the commonest mode, although vertical and sexual transmission is well documented. GBV-C/HGV is distributed globally; its prevalence in the general population is 10 fold higher in African countries than in non-African countries. High prevalences of GBV-C/HGV have been found in subjects with frequent parenteral exposure and in groups at high risk of exposure to blood and blood products. The clinical significance of human infection with GBV-C/HGV is currently unclear. The virus can establish both acute and chronic infection and appears to be sensitive to interferon. Only some 12±15% of chronic Non-A, B, C hepatitis cases are infected with GBV-C/HGV. A direct association with liver pathology is still lacking and it is not yet clear as to whether GBV-C/HGV is indeed a hepatotropic virus. Current evidence suggests that the spectrum of association of GBV-C/HGV infection with extrahepatic diseases ranges from haematalogical diseases, aplastic anaemia, human immunodeficiency virus (HIV)-positive idiopathic thrombocytopenia and thalassemia, through to common variable immune deficiency and cryoglobunemia.
GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-... more GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-naive African mothers with human immunodeficiency virus infection and their infants. GBV-C RNA was extracted from serum and amplified by reverse-transcriptase polymerase chain reaction. Twenty-seven (36%) of these 75 HIV-infected women tested positive for GBV-C RNA. To study transmission dynamics, we chose a random subsample of 20 of these women and their infants. In this cohort, there was evidence of postnatal transmission of GBV-C; however, it was not possible to demonstrate evidence of in utero or intrapartum transmission. In this pilot observational study, transmission of HIV from mother-to-infant occurs independently of the GBV-C infection status of the mother. The immunological indices measured tend to suggest an association with protection and or delayed progression of HIV disease in GBV-C-infected mothers.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1996
The incidence of Helicobacter pylori infection in very young children was determined, based on th... more The incidence of Helicobacter pylori infection in very young children was determined, based on the emergence of specific IgG antibodies in sequential serum samples from birth to 2 years of age. The risk of acquiring H pyloni infection in infancy as a result of maternal exposure to the organism was also assessed, based on the determination of maternal cord-blood antibodies. Serum IgG class H pylon antibodies were analysed in the cord blood samples of 195 newborns and in their follow up samples until the age of 2 years. Maternal antibodies were detected in the cord-blood samples of 21 children (10-6%). These antibodies disappeared in all but one child before 7 months of age and no new seroconversions occurred in these children. Ten originally cord-blood negative children seroconverted up to the age of 2 years (5 1%). It is concluded that a major proportion of H pyloni infections observed in young adults in Finland are acquired during the first two years of life. Maternal seropositivity is not a straightforward risk factor for acquiring Hpylori infection in infancy.
The manner in which the ‘case’ against Professor Cyril Karabus, a South African paediatric oncolo... more The manner in which the ‘case’ against Professor Cyril Karabus, a South African paediatric oncologist, was conducted in the United Arab Emirates was a travesty of justice. It drew not only worldwide protests and condemnation, but also public commentary that questioned the ethical conduct of medical doctors and healthcare organisations which boycotted the African Health Conference, in a matter some considered to be purely political.
Human biological material (HBM) is an invaluable resource in biomedical research. Although resear... more Human biological material (HBM) is an invaluable resource in biomedical research. Although research ethics committees (RECs) are guided by international guidelines and frameworks, some RECs might not be fully informed about local ethical and regulatory requirements regarding the use, collection, storage, ownership, transfer and benefit-sharing of HBM in collaborative research.
African journal of medicine and medical sciences, 1995
The "one-minute" urease test to detect Helicobacter (Campylobacter) pylori infection wa... more The "one-minute" urease test to detect Helicobacter (Campylobacter) pylori infection was evaluated using histology and culture as the "gold standard". The test was performed in a blinded manner and compared with the conventional Christensen's urease test. Helicobacter pylori was detected in 88 of 100 consecutive patients attending the gastrointestinal clinic for upper endoscopy. Although the "one-minute" urease test was more sensitive [86% (76/88)] than the conventional Christensen's urease test [70% (62/88)], this difference was not statistically significant (P = 0.22). Histology was the most sensitive [97% (85/88)] whilst culture was 80% (70/88) sensitive. All tests exhibited specifications of 100%. The "one-minute" urease test is a simple, rapid and highly specific test to detect Helicobacter pylori which can be performed at endoscopy.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, Jan 7, 1991
Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection o... more Helicobacter (Campylobacter) pylori is strongly associated with type B gastritis. The detection of H. pylori, which entails histological examination and culture of gastric biopsy specimens, takes several days. There has been much interest in developing more rapid tests, including non-invasive ones. Using histology and/or culture as the 'gold standard', several methods to detect H. pylori were compared and evaluated. The organism was detected in 84 of 100 consecutive patients attending the Gastrointestinal Unit of King Edward VIII Hospital for upper gastrointestinal tract endoscopy. Histological examination was the most sensitive (98%) and specific (100%) method used in detecting H. pylori in gastric biopsy specimens. An enzyme-linked immunosorbent assay to detect specific IgG antibodies to whole H. pylori organisms is a moderately sensitive (82%), non-invasive method but it is nonspecific (38%). Although culture was specific (100%), it was less sensitive (68%) than histologi...
Phylogenetic analysis of the 5% non-coding region (5%NCR) sequences has demonstrated that GB viru... more Phylogenetic analysis of the 5% non-coding region (5%NCR) sequences has demonstrated that GB virus C/hepatitis G virus (GBV-C/HGV) can be separated into three major groups that correlate with the geographic origin of the isolate. Sequence analysis of the 5%NCR of 54 GBV-C/HGV isolates from 31 blood donors, 11 haemodialysis patients and 12 patients with chronic liver disease suggests the presence of a new variant of GBV-C/HGV in the province of KwaZulu Natal, South Africa. Eleven isolates grouped as group 1 variants (bootstrap support, 90%) found predominantly in West and Central Africa, a further six isolates grouped as group 2 variants (bootstrap support, 58%) found in Europe and North America; five of which grouped as 2a (bootstrap support, 91%) and one as 2b (bootstrap support, 87%), the latter also includes isolates from Japan, East Africa and Pakistan. Although the remaining 37 GBV-C/HGV isolates were more closely related to group 1 variants (bootstrap support, 90%), they formed a cluster, which was distinct from all other known GBV-C/HGV sequences. None of the South African isolates grouped with group 3 variants described from Southeast Asia. Three variants of GBV-C/HGV exist in KwaZulu Natal: groups 1, 2 and a new variant, which is distinct from other African isolates.
GB virus C (GBV-C) is a common, apparently nonpathogenic human flavivirus that has been associate... more GB virus C (GBV-C) is a common, apparently nonpathogenic human flavivirus that has been associated in some studies with prolonged survival in human immunodeficiency virus (HIV)-positive persons. There are 5 distinct GBV-C genotypes localized to specific geographic regions, and genotype 2 has been previously shown to inhibit HIV replication in vitro in lymphocyte cultures. We identified GBV-C virus isolates representing genotypes 1, 2, and 5 in samples from South African blood donors. GBV-C genotype 1 and 5 isolates replicated in lymphocyte culture, inhibited X4 and R5 HIV-1 isolates, and induced RANTES and stromal-derived factor-1 chemokines in vitro. Thus, African GBV-C genotypes can inhibit HIV replication in vitro. GB virus type C (GBV-C, also called hepatitis G virus) is a positive-sense, single-strand RNA virus in the Flaviviridae family. The genome organization resembles that of hepatitis C virus, and GBV-C shares ∼30% amino-acid identity with hepatitis C virus [1, 2]. GBV-C does not appear to replicate in vivo in hepatocytes but, rather, in lymphocytes. Thus, it is not surprising that epidemiological studies of GBV-C infection have not found any association between GBV-C and chronic hepatitis [1]. To date, GBV-C has not been conclusively associated with any known disease, although it is a very common infection
GB virus type C (GBV-C) is a common human flavivirus that has been associated with prolonged surv... more GB virus type C (GBV-C) is a common human flavivirus that has been associated with prolonged survival in HIV-positive individuals in several, though not all, epidemiological studies. There are five distinct GBV-C genotypes that are geographically localized, and it has been speculated that GBV-C genotypic differences may explain variable outcomes observed in different clinical studies. Expression of an 85 aa fragment of the GBV-C NS5A phosphoprotein (genotype 2) in a CD4+ T cell line (Jurkat) resulted in inhibition of HIV replication, mediated in part by decreased surface expression of the HIV coreceptor CXCR4 and upregulation of SDF-1. We expressed the NS5A protein from genotypes 1, 2, 3 and 5 in Jurkat cells, and demonstrated that all genotypes inhibited HIV replication. Further deletion mapping demonstrated that expression of a 30 aa fragment resulted in decreased CXCR4 surface expression, upregulation of SDF-1 and inhibition of HIV replication.
GB virus C (GBV-C), a positive-strand RNA virus, currently infects approximately one-sixth of the... more GB virus C (GBV-C), a positive-strand RNA virus, currently infects approximately one-sixth of the world's population. This virus exists as a collection of genotypes whose global distribution correlates with geographical origin. Genotyping of GBV-C isolates by phylogenetic analysis has relied upon the use of 5′-untranslated region (5′-UTR) sequences, however, complete genome sequences are used to demonstrate definitively their existence and geographical correlation. Initial identification of the fifth genotype from South Africa was based upon phylogenetic analysis of the 5′-UTR. It was sought to confirm this classification by analysis of full-length E2 genes from South African isolates and by analysis of a complete genotype 5 genome. Analysis of full-length E2 genes from 28 GBV-C-infected South African individuals revealed the existence of a unique group of 18 isolates, distinct from the other four genotypes. Bootstrap analysis provided strong support (95 %) for this fifth group....
Human Biological Materials (HBMs) are an invaluable resource in biomedical research. Objective: T... more Human Biological Materials (HBMs) are an invaluable resource in biomedical research. Objective: To determine if researchers and a Research Ethics Committee (REC) at a South African institution addressed ethical issues pertaining to HBMs in collaborative research with developed countries. Study Design: Ethically approved retrospective cross-sectional descriptive audit. Results: Of the 1305 protocols audited, 151 (11.57%) fulfilled the study's inclusion criteria. Compared to other developed countries, a majority of sponsors (90) were from the USA (p = 0.0001). The principle investigators (PIs) in all 151 protocols informed the REC of their intent to store HBMs. Only 132 protocols informed research participants (P < 0.0001). In 148 protocols informed consent (IC) was obtained from research participants, 116 protocols (76.8%) solicited broad consent compared to specific consent (32; 21.2%) [p < 0.0001]. In 105 cases a code was used to maintain confidentiality. HBMs were anonymised in 14 protocols [p < 0.0001]. More protocols informed the REC (90) than the research participants (67) that HBMs would be exported (p = 0.011). Export permits (EPs) and Material Transfer Agreements (MTAs) were not available in 109 and 143 protocols, respectively. Conclusions: Researchers and the REC did not adequately address the interrelated ethical and regulatory issues pertaining to HBMs. There was a lack of congruence between the ethical guidelines of developed countries and their actions which are central to the access to HBMs in collaborative research. HBMs may be leaving South Africa without EPs and MTAs during the process of international collaborative research.
Recurrent hepatitis C is a major cause of mortality in HIV/hepatitis C virus (HCV)-co-infected pa... more Recurrent hepatitis C is a major cause of mortality in HIV/hepatitis C virus (HCV)-co-infected patients after orthotopic liver transplantation. We report sustained viral clearance in all four transplanted HIV/HCV-positive patients treated with pegylated interferon/ribavirin. Early therapy after HCV recurrence, tailoring treatment duration to the individual decline in HCV-RNA and the management of side effects are key factors for improved efficacy. At experienced centres interferon treatment is a valuable option for recurrent hepatitis C in HIV-positive patients. Hepatitis C has become a frequent cause of orthotopic liver transplantation (OLT) in HIV-infected patients [1,2]. The recurrence of chronic hepatitis C is, however, universal and within 5 years can lead to cirrhosis in approximately 20% of HIV-infected patients [1-5]. Treatment for hepatitis C virus (HCV)/HIV-positive patients to eliminate recurrent hepatitis after OLT is urgently needed.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1996
The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodie... more The aim of this cross-sectional seroprevalence study was to determine the prevalence of antibodies to hepatitis C virus (HCV) (anti-HCV) in patients with cirrhosis, hepatocellular carcinoma (HCC) and chronic active hepatitis (CAH) attending a referral hospital in a hepatitis B virus (HBV)-endemic area in South Africa. One hundred and ten patients with suspected cirrhosis, 44 with suspected HCC and 6 with chronic hepatitis were initially included. The diagnoses were confirmed in 77 patients with cirrhosis (histologically or macroscopically at peritoneoscopy), 33 patients with HCC (histologically or elevated alpha-fetoprotein levels plus focal lesion on hepatic imaging) and 6 patients with CAH (histologically) without antinuclear antibodies. All patients were tested for anti-HCV with the Abbott second-generation enzyme immunoassay combined with a supplemental neutralisation assay, and hepatitis B surface antigen (HBsAg). Anti-HCV seroprevalence for cirrhosis, HCC and CAH were 18/77 (2...
The y interferon (,y-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated... more The y interferon (,y-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated in 30 patients with tuberculous peritonitis, 21 patients with ascites due to a malignant disorder, and 41 patients with cirrhosis. The y-IFN concentrations were significantly higher (p<0.0001) in tuberculous peritonitis patients (mean: 6-70 U/ml) than in the malignant (mean: 3.10 U/ml) and cirrhotic (mean: 3.08 U/ml) groups. Use of a cut off value of ¢3.2 U/mli gave the assay a sensitivity of93% (25 of 27), a specificity of 98% (54 of 55), positive (P+) and negative (P-) predictive values of 96% and a test accuracy of 96%. The ADA activity was significantly (p<0-0001) higher in the tuberculous peritonitis group (mean: 101.84 U/i) than in the control groups (cirrhosis (mean: 13-49 U/I) and malignancy (mean: 19.35 U/i)). A cut offvalue of >30 U/l gave the ADA test a sensitivity of 93% (26 of 28) a specificity of 96% (51 of 53), a (P+) value of 93%, a (P-) value of 96%, and a test accuracy of 95%. There was a significant (p<0-0001) correlation (r=0.72) between ADA activity and-y-IFN values in patients with tuberculous peritonitis. These results show that a high concentration of y-IFN in ascitic fluid is as valuable as the ADA activity in the diagnosis of tuberculous peritonitis. Both are rapid non-invasive diagnostic tests for tuberculous peritonitis.
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