Summary Hepatocellular carcinoma ( HCC ) incidence is high in The Gambia, and hepatitis B virus ( HBV ) infection is the main cause. People coinfected with HBV and hepatitis D virus ( HDV ) have an even greater risk of HCC and cirrhosis. Using a new HDV quantitative microarray antibody capture (Q‐ MAC ) assay, we evaluated the association between HDV infection and HCC or cirrhosis among participants in The Gambia Liver Cancer Study. In this case‐control study, cases had HCC (n = 312) or cirrhosis (n = 119). Controls (n = 470) had no clinical evidence of liver disease and normal serum alpha‐foetoprotein. Participants were previously tested for hepatitis B surface antigen ( HB sAg); we tested HB sAg+ specimens by HDV Q‐ MAC , western blot and RNA assays. We evaluated separate cut‐offs of the Q‐ MAC assay for predicting anti‐ HDV and RNA positivity. Q‐ MAC correctly identified 29/29 subjects who were western blot‐positive (sensitivity = 100%, specificity = 99.4%) and 16/17 who were RNA ‐positive (sensitivity = 94.1%, specificity = 100%). Compared to controls, cases more often had HBV monoinfection ( HB sAg+/ HDV RNA −; 54.1% vs 17.0%; odds ratio [ OR ] = 6.28; P < 0.001) or HBV ‐ HDV coinfection ( HB sAg+/ HDV RNA +; 3.9% vs 0%; P < 0.001). Risk estimates (for HCC or cirrhosis) based on HDV antibody status and adjusted for covariates (demographics, alcohol, smoking, body mass index, anti‐ HCV and aflatoxin B1 exposure) yielded consistent results for both HBV monoinfection (adjusted OR = 8.29; 95% confidence interval = 5.74‐11.98) and HBV ‐ HDV coinfection (adjusted OR = 30.66; 95% confidence interval = 6.97‐134.95). In this Gambian population, HDV Q‐ MAC had high sensitivity and specificity for both anti‐ HDV and HDV RNA . HDV infection contributed to the high risk of HCC in The Gambia.

People who inject drugs (PWID) are commonly exposed to hepatitis B virus (HBV) and hepatitis D virus (HDV). We evaluated the prevalence of HDV viremia among hepatitis B surface antigen (HBsAg)-positive PWID (n = 73) using a new quantitative microarray antibody capture (Q-MAC) assay, HDV western blot, and HDV RNA. HDV Q-MAC performed well in this cohort: anti-HDV, 100% sensitivity and specificity; HDV viremia, 61.5% sensitivity and 100% specificity. Hepatitis D viremia was present in 35.6% of HBsAg-positive participants and was more common in those with resolved compared to chronic hepatitis C (5.1% vs 0.6%; adjusted odds ratio, 9.80; P < .0001).

Background Hepatocellular carcinoma (HCC) causes over 800,000 deaths worldwide annually, mainly in low income countries, and incidence is rising rapidly in the developed world with the spread of hepatitis B (HBV) and C (HCV) viruses. Natural Killer (NK) cells protect against viral infections and tumours by killing abnormal cells recognised by Killer-cell Immunoglobulin-like Receptors (KIR). Thus genes and haplotypes encoding these receptors may be important in determining both outcome of initial hepatitis infection and subsequent chronic liver disease and tumour formation. HBV is highly prevalent in The Gambia and the commonest cause of liver disease. The Gambia Liver Cancer Study was a matched case-control study conducted between September 1997 and January 2001 where cases with liver disease were identified in three tertiary referral hospitals and matched with out-patient controls with no clinical evidence of liver disease. Methods We typed 15 KIR genes using the polymerase chain reaction with sequence specific primers (PCR-SSP) in 279 adult Gambians, 136 with liver disease (HCC or Cirrhosis) and 143 matched controls. We investigated effects of KIR genotypes and haplotypes on HBV infection and associations with cirrhosis and HCC. Results Homozygosity for KIR group A gene-content haplotype was associated with HBsAg carriage (OR 3.7, 95% CI 1.4–10.0) whilst telomeric A genotype (t-AA) was associated with reduced risk of e antigenaemia (OR 0.2, 95% CI 0.0–0.6) and lower viral loads (mean log viral load 5.2 vs. 6.9, pc = 0.022). One novel telomeric B genotype (t-ABx2) containing KIR3DS1 (which is rare in West Africa) was also linked to e antigenaemia (OR 8.8, 95% CI 1.3–60.5). There were no associations with cirrhosis or HCC. Conclusion Certain KIR profiles may promote clearance of hepatitis B surface antigen whilst others predispose to e antigen carriage and high viral load. Larger studies are necessary to quantify the effects of individual KIR genes, haplotypes and KIR/HLA combinations on long-term viral carriage and risk of liver cancer. KIR status could potentially inform antiviral therapy and identify those at increased risk of complications for enhanced surveillance.

Kaposi sarcoma (KS) risk is affected by perturbed immunity. Herein, we compared plasma from 15 human immunodeficiency virus (HIV)-negative classic KS cases to plasma from 29 matched controls, using a multiplex panel of immunity markers. Of 70 markers, CXCL10 (IP-10), sIL-1RII, sIL-2RA, and CCL3 (MIP-1A) were strongly and significantly associated with KS, after adjustment for age and smoking status. These and previous observations are consistent with a tumor-promoting role for these cytokines, particularly CXCL10, but the small sample size and case-control design preclude firm conclusions on KS risk or pathogenesis. Larger, well-designed prospective studies are needed to better assess the association of these markers with KS.

As people infected with the human immunodeficiency virus (HIV) in Sub-Saharan Africa live longer due to availability of antiretroviral treatment (ART), so is the rise of associated infections with their burdens on patients. But reliable data on the prevalence of co-infection with hepatitis B (HBV) or C (HCV) still remains sparse and many individuals with HIV do not know their co-infection status. This study attempted to estimate the seroprevalence and identify risk factors associated with hepatitis B and/or C co-infections in HIV-infected individuals from five Regions of Cameroon by screening 531 HIV infected subjects for the presence of HBV surface antigen (HBsAg) and antibodies to HCV (HCV-Ab). A Screening and a confirmatory Enzyme linked immunosorbent assay were used to detect presence of markers of infection. CD4 count levels were also examined. The results indicate that of the 531 participants, 68% were females and 32% males. Mean CD4 count was ~400 cells/μl. Seroprevalence rates for HBsAg and HCV-Ab were 23.7%, and 7.2%, respectively. Associations assessed using logistic regression revealed that HBsAg but not HCV-Ab positivity was linked to age, lower CD4 count and residing in an urban rather than in a rural setting. This high prevalence of co-infection with HBV raises the urgent need to systematically screen all newly diagnosed HIV cases for co-infection in Cameroon and other regions of sub-Saharan Africa where HIV accounts for the majority of the global infection, so as to improve management strategies for HBV infection and ART implementation.

Interferon lambda 4 protein can be generated in IFNL4-ΔG carriers but not IFNL4-TT homozygotes. We studied 890 anti-hepatitis C virus (HCV)-positive participants in the Women's Interagency HIV Study. Among blacks (n = 555), HCV was more often cleared for those with genotype IFNL4-TT/TT (32.6%; odds ratio [OR], 3.59; P = 3.3 × 10(-5)) than IFNL4-TT/ΔG (11.3%; OR, 0.95; P = .86) or IFNL4-ΔG/ΔG (11.9%; referent). Pooling these data with published results in blacks (n = 1678), ORs were 3.84 (P = 8.6 × 10(-14)) for IFNL4-TT/TT and 1.44 (P = .03) IFNL4-TT/ΔG, and the area under the curve was 0.64 for IFNL4-ΔG genotype and 0.61 for rs12979860 (IL28B). IFNL4-ΔG is strongly associated with impaired spontaneous HCV clearance.

Killer-cell immunoglobulin-like receptors (KIRs) are a group of natural killer cell receptors (NKRs) that regulate NK-cell-mediated production of interferon gamma (IFN-γ) in response to infection. These receptors have recently been suggested to influence the severity of clinical Plasmodium falciparum malaria infection. We examined the KIR locus in relation to malaria in children from southwest Nigeria. Sequence specific priming (SSP)-PCR was used to detect the KIR genes. The presence or absence of fifteen different KIR genes was determined in each individual and the proportions compared across 3 clinical groups; asymptomatic malaria, uncomplicated clinical malaria and severe clinical malaria. The genes KIR2DL5, KIR2DS3 and KIR2DS5 were present in a significantly higher proportion of individuals in the asymptomatic control group than in the malaria cases. Furthermore, KIR2DS3 and KIR2DS5 were present in a higher proportion of uncomplicated malaria cases than severe malaria cases. Carriage c-AB2 genotype (which comprises all centromeric KIR genes including KIR2DL5, KIR2DS3 and KIR2DS5) decreases with severity of the disease suggesting that the KIR AB profile might be associated with protection from severe malaria infection in this population in Nigeria.

Hematological OncologyVolume 32, Issue 4 p. 218-220 Letter to the Editor Elevated serum levels of interleukin-6 in endemic Burkitt lymphoma in Ghana Peter Aka, Peter Aka Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorBenjamin Emmanuel, Benjamin Emmanuel Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorMaria Candida Vila, Maria Candida Vila Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorAmar Jariwala, Amar Jariwala Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorFrancis Nkrumah, Francis Nkrumah Noguchi Memorial Institute, Accra, GhanaSearch for more papers by this authorMaria V. Periago, Maria V. Periago Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorJanet Neequaye, Janet Neequaye Department of Child Health, Korle Bu University Teaching Hospital in Accra, GhanaSearch for more papers by this authorChristine Kiruthu, Christine Kiruthu Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorPaul H. Levine, Paul H. Levine Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorRobert J. Biggar, Robert J. Biggar Institute of Health and Biotechnology, Queensland University of Technology, Brisbane, AustraliaSearch for more papers by this authorKishor Bhatia, Kishor Bhatia Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorJeffrey M. Bethony, Jeffrey M. Bethony Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorSam M. Mbulaiteye, Sam M. Mbulaiteye [email protected] Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this author Peter Aka, Peter Aka Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorBenjamin Emmanuel, Benjamin Emmanuel Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorMaria Candida Vila, Maria Candida Vila Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorAmar Jariwala, Amar Jariwala Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorFrancis Nkrumah, Francis Nkrumah Noguchi Memorial Institute, Accra, GhanaSearch for more papers by this authorMaria V. Periago, Maria V. Periago Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorJanet Neequaye, Janet Neequaye Department of Child Health, Korle Bu University Teaching Hospital in Accra, GhanaSearch for more papers by this authorChristine Kiruthu, Christine Kiruthu Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorPaul H. Levine, Paul H. Levine Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorRobert J. Biggar, Robert J. Biggar Institute of Health and Biotechnology, Queensland University of Technology, Brisbane, AustraliaSearch for more papers by this authorKishor Bhatia, Kishor Bhatia Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this authorJeffrey M. Bethony, Jeffrey M. Bethony Department of Microbiology and Tropical Medicine, George Washington University, Washington, District of Columbia, USASearch for more papers by this authorSam M. Mbulaiteye, Sam M. Mbulaiteye [email protected] Division of Cancer Epidemiology and Genetics, DCEG, NCI, Bethesda, Maryland, USASearch for more papers by this author First published: 06 January 2014 https://doi.org/10.1002/hon.2121Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume32, Issue4December 2014Pages 218-220 RelatedInformation

Endemic Burkitt lymphoma (eBL) has been linked to Plasmodium falciparum (Pf) malaria infection, but the contribution of infection with multiple Pf genotypes is uncertain. We studied 303 eBL (cases) and 274 non eBL-related cancers (controls) in Malawi using a sensitive and specific molecular-barcode array of 24 independently segregating Pf single nucleotide polymorphisms. Cases had a higher Pf malaria prevalence than controls (64.7% versus 45.3%; odds ratio [OR] 2.1, 95% confidence interval (CI): 1.5 to 3.1). Cases and controls were similar in terms of Pf density (4.9 versus 4.5 log copies, p = 0.28) and having ≥3 non-clonal calls (OR 2.7, 95% CI: 0.7-9.9, P = 0.14). However, cases were more likely to have a higher Pf genetic diversity score (153.9 versus 133.1, p = 0.036), which measures a combination of clonal and non-clonal calls, than controls. Further work is needed to evaluate the possible role of Pf genetic diversity in the pathogenesis of endemic BL.

Rationale: Biomarkers that can be used to evaluate new interventions against latent tuberculosis infection (LTBI) and predict reactivation TB disease are urgently required.Objectives: To evaluate ESAT-6 and CFP-10 (EC) IFN-gamma ELISPOT as a biomarker for treatment efficacy in LTBI.Methods: This was a randomized, blinded, and placebo-controlled trial of INH in EC ELISPOT and Mantoux test positive participants.Measurements and Main Results: Participants received a 6-month course of 900 mg INH twice weekly or a matching placebo. INH acetylator genotypes were determined and urine tested for INH metabolites to confirm adherence. The proportion of positive responders for CFP-10 and ESAT-6 between treatment arms was compared using mixed effects logistic regression models. A Tweedie (compound Poisson) model was fitted to allow for zero inflation and overdispersion of quantitative response. The proportions of EC ELISPOT-positive subjects reduced over time (P < 0.001) but did not differ by study arm (P = 0.36). Median spot-forming units for ESAT-6 and CFP-10 also declined significantly with time (P < 0.001) but did not differ by study arm (P = 0.74 and 0.71, respectively). There was no evidence of an interaction between acetylator status and INH treatment with respect to ELISPOT results over time.Conclusions: In contacts with LTBI, INH therapy plays no role in observed decreases in Mycobacterium tuberculosis antigen specific T-cell responses over time. IFN-gamma ELISPOT is probably not a useful biomarker of treatment efficacy in LTBI.Clinical trial registered with www.clinicaltrials.gov (NCT 00130325).

Endemic Burkitt lymphoma (eBL) is linked to Plasmodium falciparum (Pf) infection geographically, but evidence from individual-level studies is limited. We investigated this issue among 354 childhood eBL cases and 384 age-, sex-, and location-matched controls enrolled in Ghana from 1965 to 1994. Immunoglobulin G1 (IgG1) and immunoglobulin G3 (IgG3) antibodies to antigens diagnostic of recent infection Pf histidine-rich protein-II (HRP-II) and 6NANP, Pf-vaccine candidates SE36 and 42-kDa region of the 3D7 Pf merozoite surface protein-1 (MSP-1), and tetanus toxoid were measured by indirect enzyme-linked immunoassay. Odds ratios (ORs) and 95% confidence intervals (CIs) for association with eBL were estimated using unconditional logistic regression. After adjustments, eBL was positively associated with HRP-IIIgG3 seropositivity (adjusted OR: 1.60; 95% CI 1.08-2.36) and inversely associated with SE36IgG1 seropositivity (adjusted OR: 0.37; 95% CI 0.21-0.64) and with tetanus toxoidIgG3 levels equal or higher than the mean (adjusted OR: 0.46; 95% CI 0.32-0.66). Anti-MSP-1IgG3 and anti-6NANPIgG3 were indeterminate. eBL risk was potentially 21 times higher (95% CI 5.8-74) in HRP-IIIgG3-seropositive and SE36IgG1-seronegative responders compared with HRP-IIIgG3-seronegative and SE36IgG1-seropositive responders. Our results suggest that recent malaria may be associated with risk of eBL but long-term infection may be protective.

Heme oxygenase 1 (HO-1) is an essential enzyme induced by heme and multiple stimuli associated with critical illness. In humans, polymorphisms in the HMOX1 gene promoter may influence the magnitude of HO-1 expression. In many diseases including murine malaria, HO-1 induction produces protective anti-inflammatory effects, but observations from patients suggest these may be limited to a narrow range of HO-1 induction, prompting us to investigate the role of HO-1 in malaria infection. In 307 Gambian children with either severe or uncomplicated P. falciparum malaria, we characterized the associations of HMOX1 promoter polymorphisms, HMOX1 mRNA inducibility, HO-1 protein levels in leucocytes (flow cytometry), and plasma (ELISA) with disease severity. The (GT)(n) repeat polymorphism in the HMOX1 promoter was associated with HMOX1 mRNA expression in white blood cells in vitro, and with severe disease and death, while high HO-1 levels were associated with severe disease. Neutrophils were the main HO-1-expressing cells in peripheral blood, and HMOX1 mRNA expression was upregulated by heme-moieties of lysed erythrocytes. We provide mechanistic evidence that induction of HMOX1 expression in neutrophils potentiates the respiratory burst, and propose this may be part of the causal pathway explaining the association between short (GT)(n) repeats and increased disease severity in malaria and other critical illnesses. Our findings suggest a genetic predisposition to higher levels of HO-1 is associated with severe illness, and enhances the neutrophil burst leading to oxidative damage of endothelial cells. These add important information to the discussion about possible therapeutic manipulation of HO-1 in critically ill patients.

Burkitt lymphoma (BL) is endemic in parts of Tanzania, but there is scant country or region level data about burden and trends of BL in Tanzania over the past three decades. Here, we update baseline epidemiology of BL in northern Tanzania using recent data.

Abstract Abstract LBA-3 The incidence of endemic Burkitt lymphoma (eBL) is high in areas where Plasmodium falciparum (Pf) malaria is endemic, which suggests a role of malaria in eBL etiology. Previous data suggest that children with eBL are 5–12 times more likely to have elevated antibody titers to the whole schizont extract, a surrogate of exposure to malaria, compared to controls of comparable age and sex without eBL. However, the corollary studies to understand the role of protective malarial antibodies in eBL have not been conducted. We hypothesized that the risk for eBL might be different according to the breadth and strength of protective immunity to clinical malaria in children exposed to Pf malaria parasites. We investigated this hypothesis in children with and without eBL cases using samples from the National Cancer Institutes (NCI) Ghana Burkitt Lymphoma Study. Cases were children aged 0–15 years enrolled at the Korle-Bu Teaching Hospital, Accra, Ghana, during 1965–1994. Controls were children enrolled contemporaneously from the same villages as the cases or children who were referred to Korle-Bu as BL but diagnosed with benign or a non-hematologic malignancy. Antibodies to recombinant Pf serine repeat antigen 36 (SE 36) and merozoite surface protein-1 (MSP-1), which are blood stage vaccine candidates, and antibodies to histidine-rich protein-II (HRP-II), an exposure antigen expressed during the blood stage, and the peptide 6NANP, which is a circumsporozoite protein (CSP) expressed in the pre-hepatic stage, were measured using sub-class-specific enzyme-linked absorbent immunoassays (ELISAs). Antibodies to tetanus toxoid were measured as an irrelevant antigen control. Markers were included if the within (W)- and between (B)-plate coefficients of variation for the sub-class-specific IgG results was <30% (Figure 1). The independent association of each malaria marker with eBL was determined by calculating the odds ratio (ORs) and 95% confidence intervals (95% CIs) using unconditional multivariable logistic regression adjusted for sex, age, calendar year, and for all the other malaria markers, which were hypothesized to be contributory. In adjusted results, eBL was inversely associated with IgG1 seropositivity to SE36 (OR 0.54 [95% CI 0.34–0.86], p=0.01) and positively associated with HRPII (OR 1.47 [95% CI 1.06–2.02], p=0.019). The ORs for eBL were significantly decreased for low, medium, and high titers, but without a trend (0.44, 0.47, and 0.58 for low, medium, and high, respectively [ptrend=0.216]) (Figure 2: Odds ratios and 95% confidence intervals of association of eBL with different malaria markers). They increased significantly with increasing titers of IgG3 antibodies to HRPII (ORs 1.83, 1.91, to 2.25 for low, medium, and high titers, respectively [ptrend<0.002]) and showed a trend. Having antibodies to 6NANP was associated with eBL (OR 1.48 [95% CI 0.90–2.43]), but among the positives, having medium and high IgG3 antibodies to 6NANP as opposed to being sero-negative was associated with decreased risk of BL (ORs 0.79 and OR 0.60, respectively [ptrend=0.002]). Models with three markers (IgG1 to SE36, IgG3 to HRP-II, and IgG3 to 6NANP) predicted eBL better than models with just one of the markers. These data suggest children with eBL in Ghana had decreased SE36 IgG1 and increased HRPII IgG3 antibodies compared to children without eBL from the same Pf endemic areas. These results fit with the hypothesis that eBL risk increases with greater exposure to Pf malaria parasites. They also provide the first confirmation of the hypothesis that antibodies elicited by antigens targeted by protective immunity might be protective for eBL. However, they also highlight that the relationship between eBL and Pf antibodies is complex as it appears to depend on whether the antibodies reflect exposure, protection, or both. A better understanding of the specific contribution of immune response to malaria in eBL risk should be the priority of efforts to discover a biomarker profile for eBL. Disclosures: No relevant conflicts of interest to declare.