1
|
Leroy P, Diamantis S, Sellier PO, Hamet G, Brun A, Rozenbaum W, Molina JM. Prescriptions of generic antiretroviral drugs in three healthcare centers in the Paris area, France. AIDS 2024; 38:1269-1272. [PMID: 38814716 DOI: 10.1097/qad.0000000000003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
In a retrospective study conducted in three hospitals in Paris, generic antiretroviral accounted for 30.2% of all prescriptions. Tenofovir disoproxil/emtricitabine (TDF/FTC) was the most prescribed generic ART (82.3% of generic prescriptions). Generic ART (gART) was more likely to be prescribed to women, to patients less than 50 years, and with recent HIV diagnosis less than 3 years. Physicians prescribed more gART if they were men, older than 55 years or worked at a university teaching hospital.
Collapse
Affiliation(s)
- Pierre Leroy
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
| | - Pierre-Olivier Sellier
- Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Sud Ile-de-France, Melun
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Gwenn Hamet
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Alexandre Brun
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Willy Rozenbaum
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
| | - Jean-Michel Molina
- Département des Maladies Infectieuses et Tropicales, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- Corevih Ile-de-France Est, Groupe Hospitalier Saint-Louis/Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris
- University of Paris Cité, Paris, France
| |
Collapse
|
2
|
Flaig J, Hocqueloux L, Palich R, Cuzin L, Robineau O, Pugliese P, Delpierre C, Voirin N, Cotte L. Epidemiological impact of Neisseria gonorrhoeae and Chlamydia trachomatis screening in men having sex with men: a modelling study. Sex Transm Infect 2024:sextrans-2023-056103. [PMID: 38789265 DOI: 10.1136/sextrans-2023-056103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES The impact of the systematic screening of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men having sex with men (MSM) on these pathogens' epidemiology remains unclear. We conducted a modelling study to analyse this impact in French MSM. METHODS We modelled NG and CT transmission using a site-specific deterministic compartmental model. We calibrated NG and CT prevalence at baseline using results from MSM enrolled in the Dat'AIDS cohort. The baseline scenario was based on 1 million MSM, 40 000 of whom were tested every 90 days and 960 000 every 200 days. Incidence rate ratios (IRRs) at steady state were simulated for NG, CT, NG and/or CT infections, for different combinations of tested sites, testing frequency and numbers of frequently tested patients. RESULTS The observed prevalence rate was 11.0%, 10.5% and 19.1% for NG, CT and NG and/or CT infections. The baseline incidence rate was estimated at 138.2 per year per 100 individuals (/100PY), 86.8/100PY and 225.0/100PY for NG, CT and NG and/or CT infections. Systematically testing anal, pharyngeal and urethral sites at the same time reduced incidence by 14%, 23% and 18% (IRR: 0.86, 0.77 and 0.82) for NG, CT and NG and/or CT infections. Reducing the screening interval to 60 days in frequently tested patients reduced incidence by 20%, 29% and 24% (IRR: 0.80, 0.71 and 0.76) for NG, CT and NG and/or CT infections. Increasing the number of frequently tested patients to 200 000 reduced incidence by 29%, 40% and 33% (IRR: 0.71, 0.60 and 0.67) for NG, CT and NG and/or CT infections. No realistic scenario could decrease pathogens' incidence by more than 50%. CONCLUSIONS To curb the epidemic of NG and CT in MSM, it would not only be necessary to drastically increase screening, but also to add other combined interventions.
Collapse
Affiliation(s)
| | | | - Romain Palich
- Department of Infectious Diseases, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Lise Cuzin
- CHU de Martinique, Fort-de-France, Martinique
| | | | | | | | | | - Laurent Cotte
- Infectious Diseases, Hopital de la Croix-Rousse, Lyon, France
| |
Collapse
|
3
|
Blot-Cossard A, Merad Y, Bachelard A, Lebreton C, Palich R, Pugliese P, Bregigeon S, Hentzien M, Bani-Sadr F. Epidemiology and characteristics of Paget's disease of bone in a French nationwide HIV cohort. AIDS 2024; 38:929-931. [PMID: 38578964 DOI: 10.1097/qad.0000000000003874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Paget's disease of bone (PDB) has rarely been reported in people with HIV (PWH). We describe the prevalence and characteristics of patients with PDB in the French multicenter Dat'AIDS cohort. Among 49 698 PWH actively followed in 2022, 9 had a diagnosis of PDB. The overall prevalence of PDB was 0.02% [95% confidence interval (CI) 0.01-0.03]. The prevalence of PDB in PWH is very low and does not appear to differ from the non-HIV population.
Collapse
Affiliation(s)
| | - Yanis Merad
- Department of Infectious Diseases, University Hospital of Lyon, Lyon
| | - Antoine Bachelard
- Department of Infectious Diseases, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, Paris
| | - Cedric Lebreton
- Department of Infectious Diseases, University Hospital of Besançon, Besançon
| | - Romain Palich
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris, Paris
| | - Pascal Pugliese
- Department of Infectious Diseases, University Hospital of Nice, Nice
| | - Sophie Bregigeon
- Department of Immunology and Hematology, Sainte-Marguerite Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Maxime Hentzien
- Department of Infectious Diseases, University Hospital of Reims, Reims
| | - Firouzé Bani-Sadr
- Department of Infectious Diseases, University Hospital of Reims, Reims
| |
Collapse
|
4
|
Secher S, Hentzien M, Cuzin L, Jacomet C, Hocqueloux L, Rey D, Menard A, Arvieux C, Raffi F, Bani-Sadr F. No Association Between HLA-B*57:01 and Prevalence and/or Outcome of Progressive Multifocal Leukoencephalopathy in a French Nationwide Human Immunodeficiency Virus Cohort. AIDS Res Hum Retroviruses 2024; 40:253-256. [PMID: 37756371 DOI: 10.1089/aid.2023.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Among 34,351 patients living with human immunodeficiency virus with available HLA-B*57:01 included in the Dat'AIDS cohort, 194 patients (0.56%) had a history of progressive multifocal leukoencephalopathy (PML) and 1,746 (5.08%) were carriers of HLA-B*57:01. The frequency of HLA-B*57:01 was similar among patients with history of PML compared with patients without a history of PML (6.19% [95% confidence interval, CI 2.8%-9.6%] vs. 5.08% [95% CI 4.8%-5.3%]; p = .48). Among patients with PML, clinical and biological characteristics at PML diagnosis and the PML outcome were not different according to HLA-B*57:01 status.
Collapse
Affiliation(s)
- Solène Secher
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Maxime Hentzien
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Lise Cuzin
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Martinique, Martinique, France
| | - Christine Jacomet
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Hocqueloux
- Department of Infectious Diseases, Centre Hospitalier Regional d'Orleans, Orléans, France
| | - David Rey
- Centre de Soins de l'Infection par le VIH, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Amélie Menard
- Marseille Public University Hospital System, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Cédric Arvieux
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - François Raffi
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Firouzé Bani-Sadr
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Reims, Reims, France
| |
Collapse
|
5
|
Cuzin L, Morisot A, Allavena C, Lert F, Pugliese P. Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009-2019: A Longitudinal Cohort Study. Clin Infect Dis 2024; 78:111-117. [PMID: 37665056 DOI: 10.1093/cid/ciad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019. METHODS We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan-Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021. RESULTS Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127-745] to 73 [48-132] days in 2009-2011 and 2018-2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009-2011 to 13 [5; 26] days in 2018-2019, and from ART to controlled VL from 83 [35; 130] in 2009-2011 to 38 [28; 90] days in 2018-2019. Differences were observed depending on patients' characteristics. CONCLUSIONS We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade.
Collapse
Affiliation(s)
- Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France
- Infectious and Tropical Diseases, Martinique University Hospital, Fort de France, Martinique (FWI)
| | - Adeline Morisot
- Corevih Paca-Est, Archet Hospital, Côte d'Azur University, Nice, France
| | - Clotilde Allavena
- Infectious and Tropical Diseases Department, Nantes University Hospital, INSERM CIC1413, Nantes, France
| | | | - Pascal Pugliese
- Corevih Paca-Est, Archet Hospital, Côte d'Azur University, Nice, France
| |
Collapse
|
6
|
Sellier P, Alexandre-Castor G, Brun A, Hamet G, Bouchaud O, Leroy P, Diamantis S, Chabrol A, Machado M, Bouldouyre MA, De Castro N, Rozenbaum W, Molina JM. Updated mortality and causes of death in 2020-2021 in people with HIV: a multicenter study in France. AIDS 2023; 37:2007-2013. [PMID: 37428209 DOI: 10.1097/qad.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The aim of this study was to assess updated mortality and causes of death in people with HIV (PWH) in France. DESIGN AND METHODS We analyzed all deaths in PWH followed up between January 1, 2020, and December 31, 2021, in 11 hospitals in the Paris region. We described the characteristics and causes of death among deceased PWH, and evaluated the incidence of mortality and associated risk factors using a multivariate logistic regression. RESULTS Of the 12 942 patients followed in 2020--2021, 202 deaths occurred. Mean annual incidence of death [95% confidence interval (95% CI)] was 7.8 per 1000 PWH (6.3-9.5). Forty-seven patients (23%) died from non-AIDS nonviral hepatitis (NANH)-related malignancies, 38 (19%) from non-AIDS infections (including 21 cases of COVID-19), 20 (10%) from AIDS, 19 (9%) from cardiovascular diseases (CVD), 17 (8.4%) from other causes, six (3%) from liver diseases, and five (2.5%) from suicides/violent deaths. The cause of death was unknown in 50 (24.7%) patients. Risks factors for death were age [adjusted odds ratio (aOR) 1.93; 1.66-2.25 by additional decade), AIDS history (2.23; 1.61-3.09), low CD4 + cell count (1.95; 1.36-2.78 for 200-500 cells/μl and 5.76; 3.65-9.08 for ≤200 versus > 500 cells/μl), and viral load more than 50 copies/ml (2.03; 1.33-3.08), both at last visit. CONCLUSION NANH malignancies remained in 2020-2021 the first cause of death. COVID-19 accounted for more than half of the mortality related to non-AIDS infections over the period. Aging, AIDS history, and a poorer viro-immunological control were associated with death.
Collapse
Affiliation(s)
- Pierre Sellier
- Département des Maladies Infectieuses et Tropicales, GH Saint-Louis/Lariboisière-Fernand Widal, Université de Paris Cité, INSERM U 944
| | | | - Alexandre Brun
- COREVIH Ile-de-France Est, GH Saint-Louis/Lariboisière-Fernand Widal, Paris
| | - Gwenn Hamet
- COREVIH Ile-de-France Est, GH Saint-Louis/Lariboisière-Fernand Widal, Paris
| | - Olivier Bouchaud
- Département des Maladies Infectieuses et Tropicales, GH Avicenne/Jean Verdier, Bobigny/Bondy
| | - Pierre Leroy
- Service de Médecine Interne et Maladies Infectieuses, Groupe Hospitalier du Sud Ile-de-France, Melun
| | - Sylvain Diamantis
- Service de Médecine Interne et Maladies Infectieuses, Groupe Hospitalier du Sud Ile-de-France, Melun
| | - Amélie Chabrol
- Service de Maladies Infectieuses, Centre Hospitalier Sud Francilien, Corbeil-Essonnes
| | - Moïse Machado
- Service des Maladies Infectieuses, Grand Hôpital de l'Est Francilien (GHEF), Marne-la-vallée/Jossigny
| | - Marie-Anne Bouldouyre
- Service de Médecine Interne, Centre Hospitalier Intercommunal Robert Ballanger, Aulnay/s/Bois, France
| | - Nathalie De Castro
- Département des Maladies Infectieuses et Tropicales, GH Saint-Louis/Lariboisière-Fernand Widal, Université de Paris Cité, INSERM U 944
| | - Willy Rozenbaum
- COREVIH Ile-de-France Est, GH Saint-Louis/Lariboisière-Fernand Widal, Paris
| | - Jean-Michel Molina
- Département des Maladies Infectieuses et Tropicales, GH Saint-Louis/Lariboisière-Fernand Widal, Université de Paris Cité, INSERM U 944
| |
Collapse
|
7
|
Palich R, Saliba S, Landowski S, Abdi B, Valantin MA, Mahrez R, Katlama C, de Truchis P. Intermittent doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintains a high level of viral suppression in virologically suppressed people living with HIV. Infect Dis Now 2023; 53:104736. [PMID: 37321402 DOI: 10.1016/j.idnow.2023.104736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION We aimed to determine whether doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) given 5 or 4 days a week was able to maintain viral suppression in people living with HIV (PLHIV). METHODS In this observational, retrospective study, we included all PLHIVs who had received intermittent DOR/3TC/TDF between 10/01/2019 and 01/31/2021, in two French hospitals. RESULTS Forty-three PLHIVs were included, median (IQR) age: 52 years (48-58), ART duration: 15 years (8-23), duration of virological suppression: 6 years (2-10). Median follow-up was 78 weeks (IQR 62-97). One virological failure (VF) occurred at W38 (HIV-RNA = 61 and 76 copies/mL), in a patient with no viral resistance at baseline or at time of VF, and during the study period five individuals discontinued DOR/3TC/TDF due to adverse events. There were no significant changes during follow-up in the CD4 count, CD4/CD8 ratio, body weight or residual viremia rate. CONCLUSION These findings suggest the potential for intermittent DOR/3TC/TDF to maintain virological control.
Collapse
Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France.
| | - Sanaa Saliba
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Stéphanie Landowski
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM U1136, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Rezak Mahrez
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Pierre de Truchis
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
| |
Collapse
|
8
|
Palich R, Hentzien M, Hocqueloux L, Duvivier C, Allavena C, Huleux T, Makinson A, Rey D, Delobel P, Cuzin L. Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France. AIDS 2023; 37:1891-1896. [PMID: 37451430 DOI: 10.1097/qad.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We aimed to examine the association of the country of birth and the other patients' characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed people with HIV (PWH) in France. DESIGN Observational study conducted from the national Dat'AIDS prospectively collected database. METHODS We included all adults who were actively in care on 31 December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/ml for at least 6 months while on antiretroviral therapy (ART). Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients' characteristics and receiving a 2DR. RESULTS We analyzed data from 28 395 PWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years [interquartile range (IQR) 44-60]; ART duration 14 years (8-23); duration of virological suppression 87 months (42-142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the 'born abroad' group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR [adjusted odds ratio (aOR): 1.62 [1.50-1.74]], independently of other characteristics. Older PLWH and those with higher CD4 + T-cell counts were also more likely to receive a 2DR. CONCLUSION Despite unrestricted access to ART in France, independently from HIV disease parameters, PWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians' prescribing practices.
Collapse
Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris
| | - Maxime Hentzien
- Infectious Diseases, Internal Medicine and Clinical Immunology Department, Centre Hospitalier Universitaire Robert Debré, Reims
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center; University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine, Institut Pasteur, Institut Pasteur Medical Center, Paris
| | | | - Thomas Huleux
- Infectious and Travel Diseases Department, Tourcoing University Hospital, Tourcoing
| | - Alain Makinson
- University of Montpellier, Infectious Diseases and Tropical department, University Hospital Montpellier, Montpellier
| | - David Rey
- HIV Infection Care Center, Strasbourg University Hospital, Strasbourg
| | - Pierre Delobel
- University of Toulouse Paul Sabatier, Infectious and Tropical Diseases Department, Toulouse University Hospital, Toulouse
| | - Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France; Martinique University Hospital, Infectious and Tropical Diseases, Fort de France, France
| |
Collapse
|
9
|
Perfezou P, Hall N, Duthe JC, Abdi B, Seang S, Arvieux C, Lamaury I, Menard A, Marcelin AG, Katlama C, Palich R. Doravirine plus lamivudine two-drug regimen as maintenance antiretroviral therapy in people living with HIV: a French observational study. J Antimicrob Chemother 2023; 78:1929-1933. [PMID: 37303236 DOI: 10.1093/jac/dkad185] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Two-drug regimens based on integrase strand transfer inhibitors (INSTIs) and boosted PIs have entered recommended ART. However, INSTIs and boosted PIs may not be suitable for all patients. We aimed to report our experience with doravirine/lamivudine as maintenance therapy in people living with HIV (PLWH) followed in French HIV settings. METHODS This observational study enrolled all adults who initiated doravirine/lamivudine between 1 September 2019 and 31 October 2021, in French HIV centres participating in the Dat'AIDS cohort. The primary outcome was the rate of virological success (plasma HIV-RNA < 50 copies/mL) at Week (W)48. Secondary outcomes included: rate of treatment discontinuation for non-virological reasons, evolution of CD4 count and CD4/CD8 ratio over follow-up. RESULTS Fifty patients were included, with 34 (68%) men; median age: 58 years (IQR 51-62), ART duration: 20 years (13-23), duration of virological suppression: 14 years (8-19), CD4 count: 784 cells/mm3 (636-889). Prior to switching, all had plasma HIV-RNA < 50 copies/mL. All but three were naive to doravirine, and 36 (72%) came from a three-drug regimen. Median follow-up was 79 weeks (IQR 60-96). Virological success rate at W48 was 98.0% (95% CI 89.4-99.9). One virological failure occurred at W18 (HIV-RNA = 101 copies/mL) in a patient who briefly discontinued doravirine/lamivudine due to intense nightmares; there was no resistance at baseline and no resistance emergence. There were three strategy discontinuations for adverse events (digestive disorders: n = 2; insomnia: n = 1). There was no significant change in CD4/CD8 ratio, while CD4 T cell count significantly increased. CONCLUSIONS These preliminary findings suggest that doravirine/lamivudine regimens can maintain high levels of viral suppression in highly ART-experienced PLWH with long-term viral suppression, and good CD4+ T cell count.
Collapse
Affiliation(s)
| | - Nolwenn Hall
- Public Health Center, Quimper Hospital, Quimper, France
| | | | - Basma Abdi
- Virology Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Seang
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Cédric Arvieux
- Infectious Diseases and Intensive Care Unit, University Hospital, Rennes, France
| | - Isabelle Lamaury
- Infectious and Tropical Diseases Department, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | - Amélie Menard
- IHU-Méditerranée Infection, Aix Marseille University, AP-HM, Marseille, France
| | - Anne-Geneviève Marcelin
- Virology Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Christine Katlama
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Romain Palich
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| |
Collapse
|
10
|
Palich R, Hentzien M, Hocqueloux L, Duvivier C, Allavena C, Huleux T, Delobel P, Makinson A, Rey D, Cuzin L. Country of birth is associated with antiretroviral therapy choice in treatment-naive persons with HIV in France. AIDS 2023; 37:1459-1466. [PMID: 37115905 DOI: 10.1097/qad.0000000000003588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVES We aimed to describe factors associated with the choice of first antiretroviral therapy (ART) in persons with HIV (PWH) in France, included the country of birth, as well as the time to undetectable viral load and treatment discontinuation. DESIGN Observational study conducted from the national Dat'AIDS prospectively collected database. METHODS We included all adults who started their first ART between 01 January 2014 and 31 December 2020, with a pretherapeutic plasma viral load (pVL) at least 400 copies/ml. Univariable and multivariable logistic regressions were used to analyze PWH characteristics driving to an integrase strand transfer inhibitors (INSTI)-based first prescribed regimen. We also analyzed time to first line discontinuation, and to a first undetectable pVL, using Kaplan-Meier model. RESULTS We analyzed data from 9094 PWH: 45% MSM, 27% women and 27% heterosexual men; 48% born abroad; 4.7 and 2.8% with concomitant hepatitis B and tuberculosis, respectively. INSTIs were prescribed as first-line therapy in 50% of PWH, which increased over time. Native French PWH were more likely to receive an INSTI-based regimen than PWH born abroad [adjusted prevalence ratio 1.47, 95% confidence interval (CI) 1.33-1.60], as were high pVL at diagnosis, hepatitis B or concomitant tuberculosis. Time before discontinuation of the first ART and reaching a first undetectable pVL was not different according to the place of birth. CONCLUSION Despite unrestricted access to INSTIs in France, independently from HIV disease parameters, PWH born abroad received INSTIs less frequently as a first regimen than those born in France. Qualitative data are needed to better understand physicians' prescribing practices.
Collapse
Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM U1136, Paris
| | - Maxime Hentzien
- Infectious Diseases, Internal Medicine and Clinical Immunology Department, Centre Hospitalier Universitaire Robert Debré, Reims
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, IHU Imagine, Institut Pasteur, Institut Pasteur Medical Center, Paris
| | | | - Thomas Huleux
- Infectious and Travel Diseases Department, Tourcoing University Hospital, Tourcoing
| | - Pierre Delobel
- Infectious and Tropical Diseases Department, Toulouse University Hospital, INSERM U1291, University of Toulouse Paul Sabatier, Toulouse
| | - Alain Makinson
- Infectious Diseases Department, University Hospital Montpellier, INSERM U1175, University of Montpellier, Montpellier
| | - David Rey
- HIV Infection Care Center, Strasbourg University Hospital, Strasbourg
| | - Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France, Martinique University Hospital, Infectious and Tropical Diseases, Fort de France, France
| |
Collapse
|
11
|
Sellem B, Abdi B, Lê M, Tubiana R, Valantin MA, Seang S, Schneider L, Fayçal A, Peytavin G, Soulié C, Marcelin AG, Katlama C, Pourcher V, Palich R. Intermittent Bictegravir/Emtricitabine/Tenofovir Alafenamide Treatment Maintains High Level of Viral Suppression in Virally Suppressed People Living with HIV. J Pers Med 2023; 13:jpm13040583. [PMID: 37108969 PMCID: PMC10145141 DOI: 10.3390/jpm13040583] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In this observational study, we aimed to evaluate whether bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) administered 5 or 4 days a week is able to maintain viral suppression in people living with HIV (PLHIV). We enrolled 85 patients who initiated intermittent B/F/TAF between 28 November 2018 and 30 July 2020: median (IQR) age 52 years (46–59), duration of virological suppression 9 years (3–13), CD4 633/mm3 (461–781). Median follow-up was 101 weeks (82–111). The virological success rate (no virological failure [VF]: confirmed plasma viral load [pVL] ≥ 50 copies/mL, or single pVL ≥ 200 copies/mL, or ≥50 copies/mL with ART change) was 100% (95%CI 95.8–100) and the strategy success rate (pVL < 50 copies/mL with no ART regimen change) was 92.9% (95%CI 85.3–97.4) at W48. Two VF occurred at W49 and W70, in 2 patients self-reporting poor compliance. No resistance mutation emerged at time of VF. Eight patients presented strategy discontinuation for adverse events. There was no significant change in the CD4 count, residual viraemia rate, neither body weight during follow-up, but a slight increase in CD4/CD8 ratio (p = 0.02). In conclusion, our findings suggest that B/F/TAF administered 5 or 4 days a week could maintain the control of HIV replication in virologically suppressed PLHIV while reducing cumulative exposition of ART.
Collapse
|
12
|
Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre. J Acquir Immune Defic Syndr 2023; 92:144-152. [PMID: 36257296 DOI: 10.1097/qai.0000000000003114] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess whether antiretroviral therapy (ART) prescriptions differ between naive and virally suppressed HIV patients born in France (PBFs) and in Sub-Saharan Africa (PBSSAs). SETTING Observational single-center study. METHODS We included all PBFs and PBSSAs who entered into care at Pitié-Salpêtrière Hospital, Paris, France, from 01/01/2000 to 31/12/2018, with plasma HIV-RNA>200 copies/mL. We first compared the initial ART in naive PBFs and PBSSAs. Second, we compared the last-prescribed ART (including drug-reduced ART: daily 2-drug regimens, daily 1-drug regimens and intermittent 3-drug regimens) in virally suppressed PBFs and PBSSAs, by focusing on patients in care in 2018 with HIV-RNA <50 copies for at least 24 months. A univariable and multivariable logistic regression model was used to assess the impact of geographical origin on ART prescriptions. RESULTS A total of 1944 naive patients were included (915 PBSSAs and 1029 PBFs). PBSSAs were more frequently women, hepatitis B coinfected, with a lower pretherapeutic CD4 T-cell count, and most had tuberculosis at HIV diagnosis. After adjustment for confounders, PBSSAs were more likely to receive a first-line protease inhibitor-based regimen (OR 1.61, 95% CI: 1.31 to 1.98), and less likely to receive an integrase inhibitor-based regimen (OR 0.61, 95% CI: 0.42 to 0.88). Of the 968 virally suppressed patients (431 PBSSAs and 537 PBFs), PBSSAs were less likely to receive drug-reduced ART, including 2-drug regimens and intermittent three-drug regimens (OR 0.48, 95% CI: 0.36 to 0.65). CONCLUSIONS Differences in ART prescriptions between PBSSAs and PBFs were not only explained by different clinical and virologic situations. Personal motivations of doctors in choosing ART according to country of birth need to be explored.
Collapse
|
13
|
Lefebvre M, Secher S, Bouchez S, Vandamme YM, Fialaire P, Leautez S, Blanchi S, Michau C, Coste-Burel M, Brunet-Cartier C, Reliquet V, Gregoire A, Raffi F, Allavena C. Measles seroprevalence in human immunodeficiency virus-infected adults born in the era of measles vaccination. AIDS 2022; 36:1273-1278. [PMID: 35262533 DOI: 10.1097/qad.0000000000003220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Widespread use of the measles vaccine should lead to the elimination of this disease. Here, we study the seroprevalence of measles in a cohort of adults living with HIV born after the introduction of measles vaccine in France and attempt to identify risk factors for the absence of serum measles antibody. DESIGN In this multi-centre cross-sectional study, adult outpatients born after 1980 were screened for the presence of measles IgG antibody. Demographic and clinical data were obtained from the standardized electronic medical record system. Univariate and multivariate logistic regressions were performed to identify factors associated with the absence of measles antibodies. RESULTS Between April 2019 and April 2020, 648 participants were enrolled. The median age was 33 years, 53.6% were born outside of France, and 74% were considered as socially deprived. Plasma HIV RNA was undetectable in 86% of patients. Among 603 evaluable patients, measles serology was positive in 87.2%. Only 81.8% of the patients with documented vaccination tested positive for measles IgG. Younger age was significantly associated with the absence of measles serum antibodies ( P = 0.004 for each 10-year lower), as was birth in France ( P < 0.001) and absence of social vulnerability ( P = 0.04). CONCLUSION The current study revealed a low seroprevalence of measles compared with that previously reported in France 6 years earlier and to the expected rate to achieve herd immunity. Checking vaccination record should be systematically carried out in patients living with HIV to fill the immunity gaps.
Collapse
Affiliation(s)
- Maeva Lefebvre
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
- Centre for Prevention of Infectious and Transmissible Diseases, CHU Nantes
| | | | - Sabelline Bouchez
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| | | | | | - Sophie Leautez
- Infectious Diseases Department, CHD Vendée, La Roche-sur-Yon
| | | | | | | | - Cécile Brunet-Cartier
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| | - Véronique Reliquet
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| | - Antoine Gregoire
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| | - François Raffi
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| | - Clotilde Allavena
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University
| |
Collapse
|
14
|
High syphilis prevalence and incidence in people living with HIV and Preexposure Prophylaxis users: A retrospective review in the French Dat’AIDS cohort. PLoS One 2022; 17:e0268670. [PMID: 35587482 PMCID: PMC9119478 DOI: 10.1371/journal.pone.0268670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background In the past years, we observed a sharp increase of Syphilis, especially among male who have sex with male (MSM), either HIV-infected, or on pre-exposure prophylaxis (PrEP). Our aim was to assess syphilis prevalence and incidence among people living with HIV (PLWH) and PrEP users. Methods PLWH were included from 2010 to 2020 and PrEP users from 2016 to 2020 from the Dat’AIDS French cohort. We calculated syphilis prevalence and incidences for first infections, re-infections, and iterative infections (> 2 times). T-Tests, Wilcoxon tests and Chi2 test were used for descriptive analysis and multivariate logistic regression models were used to estimate Odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with syphilis. Results Among the 8 583 PLWH, prevalence of subject with past or present syphilis was 19.9%. These subjects were more likely MSM or transgender and aged over 35 years, but prevalence was lower in AIDS subjects. Same pattern was seen for incident infection and re-infection. Incidence was 3.8 per 100 person-years for infection and 6.5 per 100 person-years for re-infection. Among 1 680 PrEP users, syphilis prevalence was 25.8%, with an estimated 7.2% frequency of active syphilis. Risk of syphilis infection was higher in male and increased with age. Incidence was 11.2 per 100 person-years for infection and 11.1 per 100 person-years for re-infection. Conclusion Syphilis prevalence and incidence were high, especially in older MSM with controlled HIV infection and PrEP users, enhancing the need to improve syphilis screening and behavioral risk reduction counseling among high-risk subjects.
Collapse
|
15
|
Demeulemeester R, Savy N, Mounié M, Molinier L, Delpierre C, Dellamonica P, Allavena C, Pugliesse P, Cuzin L, Saint-Pierre P, Costa N. Economic impact of generic antiretrovirals in France for HIV patients' care: a simulation between 2019 and 2023. BMC Health Serv Res 2022; 22:567. [PMID: 35477443 PMCID: PMC9044646 DOI: 10.1186/s12913-022-07859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background In a context where the economic burden of HIV is increasing as HIV patients now have a close to normal lifespan, the availability of generic antiretrovirals commonly prescribed in 2017 and the imminence of patent expiration are expected to provide substantial savings in the coming years. This article aims to assess the economic impact of these generic antiretrovirals in France and specifically over a five-year period. Methods An agent-based model was developed to simulate patient trajectories and treatment use over a five-year period. By comparing the results of costs for trajectories simulated under different predefined scenarios, a budget impact model can be created and sensitivity analyses performed on several parameters of importance. Results The potential economic savings from 2019 to 2023 generated by generic antiretrovirals range from €309 million when the penetration rate of generics is set at 10% to €1.5 billion at 70%. These savings range from €984 million to €993 million as the delay between patent and generic marketing authorisation varies from 10 to 15 years, and from €965 million to €993 million as the Negotiated Price per Unit (NPU) of generics at market-entry varies from 40 to 50% of the NPU for patents. Discussion This economic savings simulation could help decision makers to anticipate resource allocations for further innovation in antiretrovirals therapies as well as prevention, especially by funding the Pre-Exposure Prophylaxis (PrEP) or HIV screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07859-w.
Collapse
Affiliation(s)
- Romain Demeulemeester
- University of Toulouse III, 31330, Toulouse, France. .,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France. .,UMR 1295, National Institute for Health and Medical Research, Toulouse, France. .,Faculté de Médecine, Université Paul Sabatier, INSERM, UMR 1295, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Nicolas Savy
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Michaël Mounié
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Laurent Molinier
- University of Toulouse III, 31330, Toulouse, France.,Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Cyrille Delpierre
- University of Toulouse III, 31330, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| | - Pierre Dellamonica
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - Pascal Pugliesse
- Infectious Diseases Department, University of Côte d'Azur, University Hospital of Nice, Nice, France
| | - Lise Cuzin
- UMR 1295, National Institute for Health and Medical Research, Toulouse, France.,Infectious and Tropical Diseases Department, University Hospital of Martinique, Fort-de-France, France
| | - Philippe Saint-Pierre
- University of Toulouse III, 31330, Toulouse, France.,CNRS UMR 5219, Toulouse Mathematics Institute, Toulouse, France
| | - Nadège Costa
- Health Economics Unit, Medical Information Department, University Hospital of Toulouse, Toulouse, France.,UMR 1295, National Institute for Health and Medical Research, Toulouse, France
| |
Collapse
|
16
|
Rojas Rojas T, Poizot-Martin I, Rey D, Duvivier C, Bani-Sadr F, Cabie A, Delobel P, Jacomet C, Allavena C, Ferry T, Pugliese P, Valantin MA, Lamaury I, Hustache-Matthieu L, Fresard A, Houyou T, Huleux T, Cheret A, Makinson A, Obry-Roguet V, Lions C, Carrieri MP, Protopopescu C. Incidence of cervical, breast and colorectal cancers between 2010 and 2015 in people living with HIV in France. PLoS One 2022; 17:e0261069. [PMID: 35333883 PMCID: PMC8956191 DOI: 10.1371/journal.pone.0261069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to evaluate the incidence rates between 2010 and 2015 for invasive cervical cancer (ICC), breast cancer (BC), and colorectal cancer (CRC) in people living with HIV (PLWH) in France, and to compare them with those in the French general population. These cancers are targeted by the national cancer-screening program. SETTING This is a retrospective study based on the longitudinal data of the French Dat'AIDS cohort. METHODS Standardized incidence ratios (SIR) for ICC and BC, and incidence rates for all three cancers were calculated overall and for specific sub-populations according to nadir CD4 cell count, HIV transmission category, HIV diagnosis period, and HCV coinfection. RESULTS The 2010-2015 CRC incidence rate was 25.0 [95% confidence interval (CI): 18.6-33.4] per 100,000 person-years, in 44,642 PLWH (both men and women). Compared with the general population, the ICC incidence rate was significantly higher in HIV-infected women both overall (SIR = 1.93, 95% CI: 1.18-3.14) and in the following sub-populations: nadir CD4 ≤ 200 cells/mm3 (SIR = 2.62, 95% CI: 1.45-4.74), HIV transmission through intravenous drug use (SIR = 5.14, 95% CI: 1.93-13.70), HCV coinfection (SIR = 3.52, 95% CI: 1.47-8.47) and HIV diagnosis before 2000 (SIR = 2.06, 95% CI: 1.07-3.97). Conversely, the BC incidence rate was significantly lower in the study sample than in the general population (SIR = 0.56, 95% CI: 0.42-0.73). CONCLUSION The present study showed no significant linear trend between 2010 and 2015 in the incidence rates of the three cancers explored in the PLWH study sample. Specific recommendations for ICC screening are still required for HIV-infected women and should focus on sub-populations at greatest risk.
Collapse
Affiliation(s)
- Teresa Rojas Rojas
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Isabelle Poizot-Martin
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - David Rey
- Le Trait d’Union, HIV-Infection Care Center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
- Institut Cochin—CNRS 8104—INSERM U1016—RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France
- Centre Médical de l’Institut Pasteur, Institut Pasteur, Paris, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - André Cabie
- Université des Antilles, CHU de Martinique, Fort-de-France, Martinique, France
| | - Pierre Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR 1043- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christine Jacomet
- Clermont-Ferrand University Hospital Infectious and Tropical disease Department, Clermont Ferrand, France
| | - Clotilde Allavena
- Infectious Diseases Department, CHU Hôtel-Dieu, INSERM UIC 1413, CHU Nantes, Nantes, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | - Marc-Antoine Valantin
- GHPS Pitié Salpêtrière APHP, Infectious Diseases, Paris, France
- Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - Anne Fresard
- Department of Infectious and Tropical Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Tamazighth Houyou
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Thomas Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur—Centre Hospitalier G. DRON Tourcoing, Tourcoing, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Internal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Department of Infectious Diseases, Montpellier University Hospital, INSERM U1175/IRD UMI 233, Montpellier, France
| | - Véronique Obry-Roguet
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Caroline Lions
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Maria Patrizia Carrieri
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Camelia Protopopescu
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | |
Collapse
|
17
|
Dalla-Pozza P, Hentzien M, Allavena C, Doe de Maindreville A, Bouiller K, Valantin MA, Lafont E, Zaegel-Faucher O, Cheret A, Martin-Blondel G, Cotte L, Bani-Sadr F. Progressive multifocal leukoencephalopathy in patients with immunovirological control and at least 6 months of combination antiretroviral therapy. AIDS 2022; 36:539-549. [PMID: 34873087 DOI: 10.1097/qad.0000000000003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES AND METHODS : Progressive multifocal leukoencephalopathy (PML) has rarely been reported in people with HIV (PWH) with long-term HIV immune-virological control. We describe the clinical and biological characteristics of patients with confirmed PML among PWH with a CD4+ cell count more than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of combined antiretroviral therapy (cART) at the time of PML diagnosis, in the large French multicenter Dat'AIDS cohort. RESULTS : Among 571 diagnoses of PML reported in the Dat'AIDS cohort between 2000 and 2019, 10 cases (1.75%) occurred in PWH with a CD4+ cell count greater than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of cART. Median CD4+ cell count at PML diagnosis was 395 cells/μl (IQR 310-477). The median duration between the last detectable HIV viral load and the PML diagnosis was 41.1 months (IQR 8.2-67.4). Only one patient treated with rituximab-based chemotherapy for a large B-cell lymphoma had an established risk factor for PML. Among the nine other patients with no apparent severe immunodeficiency, multiple factors of impaired immunity could have led to the development of PML: hepatitis C virus (HCV) co-infection (n = 6), cirrhosis (n = 4), HHV-8 co-infection (n = 3) with Kaposi's sarcoma (n = 2) in association with Castleman's disease (n = 1) and indolent IgA multiple myeloma (n = 1). CONCLUSION : This study highlights that factors other than low CD4+ cell count and high HIV viral load may be associated with the occurrence of PML. Further studies are warranted to investigate in greater detail the immunologic characteristics of PWH with immune-virological control who develop PML.
Collapse
Affiliation(s)
- Paul Dalla-Pozza
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
| | - Maxime Hentzien
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
| | - Clotilde Allavena
- Department of Infectious Diseases, University Hospital of Nantes, Nantes
| | | | - Kévin Bouiller
- Department of Infectious Diseases, University Hospital of Besancon
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris
| | - Emmanuel Lafont
- Department of Infectious Diseases, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris
| | - Olivia Zaegel-Faucher
- Department of Immunology and Hematology, Sainte-Marguerite Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille
| | - Antoine Cheret
- Department of Internal Medicine, Kremlin Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Bicêtre
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse, Toulouse, France and Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse
| | - Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, and INSERM U1052, Lyon
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
- University of Reims Champagne-Ardenne, EA-4684/SFR CAP-SANTE, Reims, F-51095, France
| |
Collapse
|
18
|
Lajaunie R, Cuzin L, Palich R, Makinson A, Bani-Sadr F, Duvivier C, Arvieux C, Rey D, Poizot-Martin I, Delpierre C, Delobel P, Martin-Blondel G. No increased risk of Kaposi sarcoma relapse in patients with controlled HIV-1 infection after switching protease inhibitor-based antiretroviral therapy. HIV Med 2021; 23:301-306. [PMID: 34668293 DOI: 10.1111/hiv.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Our aim was to assess if switching from a protease inhibitors (PI)-based regimen to a PI-free one is associated with an increased risk of Kaposi Sarcoma (KS) relapse among patients living with HIV (PLHIV) with history of KS and controlled HIV replication. METHODS In a retrospective analysis of the prospectively collected Dat'AIDS database we selected patients who both had a past KS history and a HIV-1 viral load below 200 copies/mL while being PI-treated. We searched for KS relapses while persistent virological success was maintained for at least 6 months, whether patients kept taking the PI, or switched to PI-free regimen. RESULTS Among the 216 patients with past KS event and a history of HIV-1 infection efficiently treated by a PI-based regimen, 148 patients (68.5%) later switched to a PI-sparing regimen. Their baseline characteristics were not different from non-switching patients. We described 7 cases of relapse (3.2% of the 216 patients). Five cases of relapse occurred in switching patients (3.4%). The remaining two relapses occurred in PI-treated patients (2.9%). At KS relapse, CD4 cell count was 459 cells/μL (range 225-560) for switching patients, compared with 362 and 136 cells/μL for the other two patients. CONCLUSIONS In this large cohort of PLHIV with a history of KS and ART-controlled HIV replication, KS relapses were described in 3.2% of the patients, and were not more frequent when a PI-containing ART regimen has been switched to a PI-free regimen. Our results do not support a specific effect of PI on KS.
Collapse
Affiliation(s)
- Rébecca Lajaunie
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Lise Cuzin
- Department of Infectious and Tropical Diseases, Martinique University Hospital, Fort de France, FWI and INSERM UMR 1027 Toulouse III University, Toulouse, France
| | - Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Alain Makinson
- Department of Infectious and Tropical Diseases, Montpellier University Hospital, InsermU1175, Montpellier, France
| | - Firouzé Bani-Sadr
- Department of Infectious and Tropical Diseases, Reims University Hospital, 45, rue Cognacq-Jay - 51092 Reims Cedex, Reims, France
| | - Claudine Duvivier
- AP-HP, Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center; IHU Imagine; Université de Paris; INSERM, U1016, Institut Cochin; CNRS, UMR8104; Institut Pasteur, Medical Center of Institut Pasteur, Necker-Pasteur Infectiology Center, Paris, France
| | - Cedric Arvieux
- Department of Infectious and Tropical Diseases, Rennes University Hospital, 2 Rue Henri le Guilloux, Rennes, France
| | - David Rey
- Department of Infectious and Tropical Diseases, Strasbourg University Hospital, Strasbourg, France
| | - Isabelle Poizot-Martin
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Cyril Delpierre
- Toulouse University, Faculté de Médecine 37 Allées Jules Guesde, Toulouse, France
| | - Pierre Delobel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital and INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital and INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Toulouse, France
| | | |
Collapse
|
19
|
Brin C, Palich R, Godefroy N, Simon A, Robert J, Bébéar C, Sougakoff W, Agher R, Caumes E, Monsel G. Clinical, epidemiological and therapeutic characteristics of Mycoplasma genitalium infection in a French STI center. Infect Dis Now 2021; 52:13-17. [PMID: 34547546 DOI: 10.1016/j.idnow.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We report the characteristics of Mycoplasmagenitalium (MG) infection in patients from a STI center in Paris. We evaluated outcomes after treatment. METHODS We included all patients tested for MG, Chlamydiatrachomatis (CT) and Neisseria gonorrhoeae (NG) infection in our center from January 2017 to December 2018, using multiplex PCR on urine specimen, vaginal or rectal swabs. We collected data regarding sex, age, HIV status, PrEP use, sexual behavior, NG and CT co-infection, symptoms and treatment. RESULTS MG infection prevalence was 7% (397/5586) (95% CI 6.4-7.8). It ranged from 4.6% in patients consulting for routine STI testing (3.9% in women, 5% in men), to 16% in HIV-positive patients and 25% in PrEP users. Among the 397 MG infected patients, 351 (88%) were asymptomatic and 87 (22%) were co-infected with NG or CT. Among the 270 (68%) treated patients, 249 (92%) received azithromycin. Failure rate was 74% in the 103 patients tested post-treatment. Treatment failure tended to be higher with azithromycin single dose than with 5-day azithromycin (88% vs. 70%; P=0.07). Azithromycin and moxifloxacin were used as second-line treatment in 24 and 23 patients, respectively. Post-treatment PCR remained positive in 55% of the 44 tested patients with a better eradication rate with moxifloxacin than with azithromycin (70% vs. 33%; P=0.04). CONCLUSION MG infection is highly prevalent in PrEP users and HIV-positive patients and is mostly asymptomatic. Management of MG infection should be tailored and adapted to the risk of antibiotic resistance and reinfection.
Collapse
Affiliation(s)
- Cécile Brin
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France.
| | - Romain Palich
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Inserm, institut Pierre-Louis épidémiologie et santé publique (iPLESP), Sorbonne Université, Paris, France
| | - Nagisa Godefroy
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Anne Simon
- Centre de santé sexuelle CeGIDD (centre gratuit d'information, de dépistage et de diagnostic), Sorbonne Université, AP-HP, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Jérôme Robert
- Inserm (U1135-E2), laboratoire de bactériologie-hygiène, centre d'immunologie et des maladies infectieuses, Sorbonne Université, GH AP-HP, Site Pitié, Paris, France
| | - Cécile Bébéar
- Laboratoire de bactériologie, centre national de référence des IST bactériennes, CHU de Bordeaux, Bordeaux, France
| | - Wladimir Sougakoff
- Inserm (U1135-E2), laboratoire de bactériologie-hygiène, centre d'immunologie et des maladies infectieuses, Sorbonne Université, GH AP-HP, Site Pitié, Paris, France
| | - Rachid Agher
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France
| | - Eric Caumes
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Inserm, institut Pierre-Louis épidémiologie et santé publique (iPLESP), Sorbonne Université, Paris, France
| | - Gentiane Monsel
- Services des maladies infectieuses et tropicales, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Sorbonne Université, AP-HP, Paris, France; Centre de santé sexuelle CeGIDD (centre gratuit d'information, de dépistage et de diagnostic), Sorbonne Université, AP-HP, hôpitaux universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| |
Collapse
|
20
|
Palich R, Teyssou E, Sayon S, Abdi B, Soulie C, Cuzin L, Tubiana R, Valantin MA, Schneider L, Seang S, Wirden M, Pourcher V, Katlama C, Calvez V, Marcelin AG. Kinetics of archived M184V mutation in treatment-experienced virally suppressed HIV-infected patients. J Infect Dis 2021; 225:502-509. [PMID: 34415048 DOI: 10.1093/infdis/jiab413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to assess the kinetics of drug-resistant viral variants (DRVs) harboring the M184V mutation in the proviral DNA of long-term virally suppressed patients, and factors associated with DRV persistence. METHODS HIV-DNA from blood cells stored in 2019 and 2016 was sequenced using both Sanger and ultradeep sequencing (SS and UDS, with a detection threshold of 1%) in ART-treated patients with HIV-RNA <50 copies/mL for at least 5 years, with past M184V mutation documented in HIV-RNA. RESULTS Among the 79 tested patients, by combining SS and UDS, the M184V was found to be absent in 26/79 (33%) patients (M184V- patients), and persisted in 53/79 (67%) (M184V+ patients). The M184V+ patients had a longer history of ART, a lower CD4 nadir and higher pretherapeutic HIV-RNA. Among the 37 patients with viral sequences assessed by UDS, the proportion of M184V+ DRVs significantly decreased between 2016 and 2019 (40% versus 14%, p=0.005). The persistence of M184V was associated with the duration and level of HIV-RNA replication under 3TC/FTC (p=0.0009 and p=0.009, respectively). CONCLUSION While it decreased over time in HIV-DNA, the M184V mutation was more frequently persistent in the HIV-DNA of more experienced patients with longer past replication under 3TC/FTC.
Collapse
Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France.,Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Elisa Teyssou
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Sophie Sayon
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Cathia Soulie
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Lise Cuzin
- CERPOP, Toulouse University, Inserm UMR, UPS, Toulouse, France.,Martinique University Hospital, Infectious Diseases Department, Fort-de-France, France
| | - Roland Tubiana
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Luminita Schneider
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Sophie Seang
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Marc Wirden
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Valérie Pourcher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Vincent Calvez
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| |
Collapse
|
21
|
Cuzin L, Allavena C, Cotte L, Delpierre C, Huleux T, Palich R, Delobel P, Raffi F, Cabié A. No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study. J Antimicrob Chemother 2021; 76:1573-1579. [PMID: 33704444 DOI: 10.1093/jac/dkab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Even in an 'optimal' health system, patients' characteristics may have an impact on their care. We investigated whether age, gender and place of birth have an impact in the HIV care continuum in France, a country with a universal free healthcare system. METHODS We estimated differences in the 5 year restricted mean percentage of person-time spent (i) in care, (ii) receiving ART and (iii) on ART and virally suppressed among 2432 (30.2%) women, 3925 MSM (48.7%) and 1709 men who have sex with women (MSW; 21.2%) entering care in the Dat'AIDS French prospective cohort between 1 January 2013 and 31 December 2017. Trial registration: Clinicaltrials.gov reference NCT02898987. RESULTS Men and women spent 85.6% and 82.8% of person-time on ART and 69.9% and 65% suppressed, respectively. MSM, MSW and women spent 86.9%, 82.6% and 82.8% of person-time on ART and 72.5%, 63.7% and 65% suppressed, respectively. Patients born in France (47%) and patients born abroad spent 87.9% and 81.9% of person-time on ART and 74.6% and 62.9% suppressed, respectively. Young men born abroad were found to spend the smallest person-time with non-detectable viral load (53% for MSW and 58.1% for MSM). CONCLUSIONS Despite free access to care and universal ART in France, disparities remain in the HIV continuum care across age, country of birth and way of HIV acquisition. Clinical and public health interventions targeting specific patients' conditions are needed.
Collapse
Affiliation(s)
- Lise Cuzin
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort-de-France, France.,INSERM UMR1027, Toulouse III University, Toulouse, France
| | - Clotilde Allavena
- Infectious and Tropical Diseases, Nantes University Hospital, Nantes, France.,CIC 1413, INSERM, Nantes, France
| | - Laurent Cotte
- Infectious Diseases University Department, Hospices Civils de Lyon, Lyon, France
| | | | - Thomas Huleux
- Infectious Diseases University Department, Tourcoing Hospital, Tourcoing, France
| | - Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM 1136, Paris, France
| | - Pierre Delobel
- Infectious and Tropical Diseases Department, Toulouse University Hospital, Toulouse, France.,INSERM UMR1043, Toulouse III University, Toulouse, France
| | - François Raffi
- Infectious and Tropical Diseases, Nantes University Hospital, Nantes, France.,CIC 1413, INSERM, Nantes, France
| | - André Cabié
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort-de-France, France.,CIC1424, INSERM, Fort-de-France, France
| | | |
Collapse
|
22
|
Palich R, Abdi B, Wirden M, Lourida G, Tubiana R, Faycal A, Valantin MA, Schneider L, Seang S, Agher R, Simon A, Soulie C, Le MP, Peytavin G, Calvez V, Marcelin AG, Katlama C. Intermittent two-drug antiretroviral therapies maintain long-term viral suppression in real life in highly experienced HIV-infected patients. J Antimicrob Chemother 2021; 76:1893-1897. [PMID: 33855355 DOI: 10.1093/jac/dkab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess in real life whether two-drug regimens (2-DRs) given 4-5 days a week in virally suppressed patients can maintain viral suppression over 48 and 96 weeks. METHODS This observational single-centre study enrolled all patients who initiated an intermittent 2-DR between 01/01/2016 and 30/06/2019. The primary outcome was the rate of virological failure (VF), defined as confirmed plasma viral load (pVL) ≥50 copies/mL or single pVL ≥50 copies/mL followed by ART change at week 48 (W48) and W96. Secondary outcomes were the 2-DR intermittent strategy success rate (pVL <50 copies/mL with no ART change), change in CD4 count, CD4/CD8 ratio and rate of residual viraemia. RESULTS Eighty-five patients were included; 67/85 (79%) were men, median age = 57 years (IQR = 50-63), CD4 nadir = 233 cells/mm3 (110-327), ART duration = 21 years (13-24), duration of virological suppression = 6.5 years (3.7-10.8) and CD4 count = 658 cells/mm3 (519-867). Intermittent 2-DRs consisted of integrase strand transfer inhibitor (INSTI)/NNRTI (58%), INSTI/NRTI (13%), two NRTIs (11%), PI/NRTI (7%) and other combinations (11%). The median follow-up was 90 weeks (IQR = 64-111). Overall, four VFs occurred, leading to a virological success rate of 98.8% (95% CI = 93.6-100) at W48 and 95.3% (95% CI = 88.4-98.7) at W96. Resuming the same 2-DR 7 days a week led to viral resuppression in three patients, whereas the M184V mutation emerged in one patient, leading to ART modification. There was no significant change in the CD4 count or residual viraemia rate, but a small increase in the CD4/CD8 ratio (P = 0.009) occurred over the study period. CONCLUSIONS This observational study shows the potential for intermittent 2-DRs to maintain a high virological success rate, which should be assessed in larger prospective randomized studies.
Collapse
Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Marc Wirden
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Giota Lourida
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Roland Tubiana
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Antoine Faycal
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Luminita Schneider
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Seang
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Rachid Agher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Anne Simon
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Cathia Soulie
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Minh-Patrick Le
- Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, AP-HP, INSERM, UMRS 1144, Université de Paris, Paris, France
| | - Gilles Peytavin
- Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, AP-HP, IAME, INSERM, UMRS 1137, Université de Paris, Paris, France
| | - Vincent Calvez
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| |
Collapse
|
23
|
Dramatic decline in new HIV diagnoses in persons born in France in a large nationwide HIV cohort. Public Health 2021; 196:129-134. [PMID: 34192605 DOI: 10.1016/j.puhe.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/28/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. STUDY DESIGN We performed a retrospective cohort study using data from the mainland French Dat'AIDS cohort. METHODS Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. RESULTS Between 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat'AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (-38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (-43.6%), P < 0.01, than in those born abroad (-23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was -46.7% among men who have sex with men (MSM), -43.5% for heterosexual women and -33.3% for heterosexual men. CONCLUSION Our findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention.
Collapse
|
24
|
Palich R, Wirden M, Peytavin G, Lê MP, Seang S, Abdi B, Schneider L, Tubiana R, Valantin MA, Paccoud O, Soulié C, Calvez V, Katlama C, Marcelin AG. Persistent low-level viraemia in antiretroviral treatment-experienced patients is not linked to viral resistance or inadequate drug concentrations. J Antimicrob Chemother 2021; 75:2981-2985. [PMID: 32642769 DOI: 10.1093/jac/dkaa273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To assess genotypic sensitivity scores (GSSs), plasma antiretroviral concentrations (PACs) and immunovirological outcomes at Week 96 (W96) in patients with persistent low-level viraemia (LLV). METHODS On 1 January 2017, we analysed data from patients on three-drug regimens with persistent LLV defined as at least two consecutive plasma viral loads (pVLs) between 21 and 200 copies/mL (including one pVL of ≥50 copies/mL), at the Pitié-Salpêtrière Hospital. Outcomes were: GSS, PACs and HIV-DNA load at study entry; and virological status and proportion of patients with resistance-associated mutations (RAMs) at W96. RESULTS Fifty-seven patients were included, with median age of 52.6 years (IQR 45.2-57.9), last CD4 count of 658 cells/mm3 (IQR 462-909) and total ART duration of 10.2 years (IQR 5.7-15.2). LLV duration was 14.0 months (IQR 5.5-22.3). GSS was 3 in 46/57 (81%) patients and PACs were adequate in 53/57 (93%) patients. Median total HIV-DNA was 2.65 log10 copies/106 cells (IQR 2.44-2.86). During follow-up, 26/57 (46%) had experienced ART modifications. At W96, 38/57 (67%) patients remained with LLV, 15/60 (26%) had achieved confirmed pVL of <20 copies/mL and 4/57 (7%) had virological failure. The four virological failures were due to three ART interruptions and one incomplete adherence (selection of Y181C RAM). No factors (patient characteristics at study entry, GSS, PACs, total HIV-DNA load and ART modification) were associated with W96 viral outcome, except for time from HIV diagnosis and the LLV duration at study entry. CONCLUSIONS A substantial number of patients harbouring LLV had no resistance to ART and adequate PACs. Two-thirds of these patients remained with this LLV status.
Collapse
Affiliation(s)
- R Palich
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - M Wirden
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - G Peytavin
- Bichat University Hospital, AP-HP, Pharmacology and Toxicology Department, IAME, INSERM 1137, Paris, France
| | - M-P Lê
- Bichat University Hospital, AP-HP, Pharmacology and Toxicology Department, IAME, INSERM 1137, Paris, France
| | - S Seang
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - B Abdi
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - L Schneider
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - R Tubiana
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - M-A Valantin
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - O Paccoud
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - C Soulié
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - V Calvez
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| | - C Katlama
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - A-G Marcelin
- Sorbonne Université, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, F-75013 Paris, France
| |
Collapse
|
25
|
Curlier E, Fagour L, Herrmann-Storck C, Staelen A, Vingadassalom I, Breurec S, Abel S, Pierre-François S, Jean-Marie J, Laouénan C, Césaire R, Hoen B, Cabié A. Seroprevalence of chikungunya virus infection among HIV-infected adults in French Caribbean Islands of Martinique and Guadeloupe in 2015: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009267. [PMID: 33836004 PMCID: PMC8059839 DOI: 10.1371/journal.pntd.0009267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/21/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2014, a first outbreak of chikungunya hit the Caribbean area where chikungunya virus (CHIKV) had never circulated before. METHODOLOGY/PRINCIPAL FINDINGS We conducted a cross-sectional study to measure the seroprevalence of CHIKV immediately after the end of the 2014 outbreak in HIV-infected people followed up in two clinical cohorts at the University hospitals of Guadeloupe and Martinique. Study patients were identified during the first months of 2015 and randomly selected to match the age and sex distribution of the general population in the two islands. They were invited to complete a survey that explored the symptoms consistent with chikungunya they could have developed during 2014 and to have a blood sample drawn for CHIKV serology. The study population consisted of 377 patients (198 in Martinique and 179 in Guadeloupe, 178 men and 199 women), 182 of whom reported they had developed symptoms consistent with chikungunya. CHIKV serology was positive in 230 patients, which accounted for an overall seroprevalence rate of 61% [95%CI 56-66], with only 153 patients who reported symptoms consistent with chikungunya. Most frequent symptoms included arthralgia (94.1%), fever (73.2%), myalgia (53.6%), headache (45.8%), and skin rash (26.1%). CONCLUSIONS/SIGNIFICANCE This study showed that the seroprevalence of CHIKV infection was 61% after the 2014 outbreak, with one third of asymptomatic infections. TRIAL REGISTRATION ClinicalTrials.gov NCT02553369.
Collapse
Affiliation(s)
- Elodie Curlier
- Department of Infectious Diseases, CHU de la Guadeloupe, Pointe-à-Pitre, France
- INSERM Centre d’Investigation Clinique Antilles-Guyane, Cayenne, France
- * E-mail:
| | - Laurence Fagour
- Department of Microbiology, CHU de la Martinique, Fort-de-France, France
| | | | - Adrien Staelen
- Department of Infectious Diseases, CHU de la Martinique, Fort-de-France, France
| | | | - Sébastien Breurec
- Department of Microbiology, CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - Sylvie Abel
- Department of Infectious Diseases, CHU de la Martinique, Fort-de-France, France
- Université des Antilles, EA 4537, Fort de France, France
| | | | | | - Cédric Laouénan
- INSERM, IAME, UMR 1137; Université Paris Diderot, Paris, France
| | - Raymond Césaire
- Department of Microbiology, CHU de la Martinique, Fort-de-France, France
- Université des Antilles, EA 4537, Fort de France, France
| | - Bruno Hoen
- Department of Infectious Diseases, CHU de la Guadeloupe, Pointe-à-Pitre, France
- INSERM Centre d’Investigation Clinique Antilles-Guyane, Cayenne, France
- Université des Antilles, EA 4537, Fort de France, France
| | - André Cabié
- INSERM Centre d’Investigation Clinique Antilles-Guyane, Cayenne, France
- Department of Infectious Diseases, CHU de la Martinique, Fort-de-France, France
- Université des Antilles, EA 4537, Fort de France, France
| |
Collapse
|
26
|
Le Guillou A, Pugliese P, Raffi F, Cabie A, Cuzin L, Katlama C, Allavena C, Drame M, Cotte L, Bani-Sadr F. Reaching the Second and Third Joint United Nations Programme on HIV/AIDS 90-90-90 Targets Is Accompanied by a Dramatic Reduction in Primary Human Immunodeficiency Virus (HIV) Infection and in Recent HIV Infections in a Large French Nationwide HIV Cohort. Clin Infect Dis 2021; 71:293-300. [PMID: 31612225 DOI: 10.1093/cid/ciz800] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count. METHODS To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis. RESULTS During the study period, 61 822 patients were followed in the Dat'AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39-33.47) months in 2007 to 0.77 (IQR, 0.37-1.60) months in 2017. A decrease in PHI (-35.1%) and PRHI (-25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8-2014.4) and 2013.1 (95% CI, 2011.3-2014.8), respectively. CONCLUSIONS Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017. CLINICAL TRIALS REGISTRATION NCT02898987.
Collapse
Affiliation(s)
- Adrien Le Guillou
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - François Raffi
- Department of Infectious Diseases, CHU de Nantes and CIC 1413, INSERM; Université de Nantes, Nantes, France
| | - André Cabie
- Department of Infectious Diseases, University Hospital of Martinique, INSERM CIC 1424, Martinique, France
| | - Lise Cuzin
- Department of Infectious Diseases; University Hospital of Martinique, Martinique; INSERM UMR 1027, Toulouse, France
| | - Christine Katlama
- Department of Infectious Diseases, Hôpital Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Clotilde Allavena
- Department of Infectious Diseases, CHU de Nantes and CIC 1413, INSERM; Université de Nantes, Nantes, France
| | - Moustapha Drame
- Department of Research and Public Health, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France.,Department of Clinical Research and Innovation, University Hospitals of Martinique, Martinique, France
| | - Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, and INSERM U1052, Lyon, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, University Hospital, Reims, France.,University of Reims Champagne-Ardenne, EA-4684/SFR CAP-SANTE, Reims, France
| | | |
Collapse
|
27
|
Cotte L, Hocqueloux L, Lefebvre M, Pradat P, Bani-Sadr F, Huleux T, Poizot-Martin I, Pugliese P, Rey D, Cabié A, Chirouze C, Drobacheff-Thiébaut C, Foltzer A, Bouiller K, Hustache-Mathieu L, Lepiller Q, Bozon F, Babre O, Brunel AS, Muret P, Chevalier E, Jacomet C, Laurichesse H, Lesens O, Vidal M, Mrozek N, Aumeran C, Baud O, Corbin V, Goncalvez E, Mirand A, brebion A, Henquell C, Lamaury I, Fabre I, Curlier E, Ouissa R, Herrmann-Storck C, Tressieres B, Receveur MC, Boulard F, Daniel C, Clavel C, Roger PM, Markowicz S, Chellum Rungen N, Merrien D, Perré P, Guimard T, Bollangier O, Leautez S, Morrier M, Laine L, Boucher D, Point P, Cotte L, Ader F, Becker A, Boibieux A, Brochier C, Brunel-Dalmas F, Cannesson O, Chiarello P, Chidiac C, Degroodt S, Ferry T, Godinot M, Livrozet JM, Makhloufi D, Miailhes P, Perpoint T, Perry M, Pouderoux C, Roux S, Triffault-Fillit C, Valour F, Charre C, Icard V, Tardy JC, Trabaud MA, Ravaux I, Ménard A, Belkhir AY, Colson P, Dhiver C, Madrid A, Martin-Degioanni M, Meddeb L, Mokhtari M, Motte A, Raoux A, Toméi C, Tissot-Dupont H, Poizot-Martin I, Brégigeon S, Zaegel-Faucher O, Obry-Roguet V, Laroche H, Orticoni M, Soavi MJ, Ressiot E, Ducassou MJ, Jaquet I, Galie S, Colson H, Ritleng AS, Ivanova A, Debreux C, Lions C, Rojas-Rojas T, Cabié A, Abel S, Bavay J, Bigeard B, Cabras O, Cuzin L, Dupin de Majoubert R, Fagour L, Guitteaud K, Marquise A, Najioullah F, Pierre-François S, Pasquier J, Richard P, Rome K, Turmel JM, Varache C, Atoui N, Bistoquet M, Delaporte E, Le Moing V, Makinson A, Meftah N, Merle de Boever C, Montes B, Montoya Ferrer A, Tuaillon E, Reynes J, Lefèvre B, Jeanmaire E, Hénard S, Frentiu E, Charmillon A, Legoff A, Tissot N, André M, Boyer L, Bouillon MP, Delestan M, Goehringer F, Bevilacqua S, Rabaud C, May T, Raffi F, Allavena C, Aubry O, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet-Cartier C, Deschanvres C, Gaborit BJ, Grégoire A, Grégoire M, Grossi O, Guéry R, Jovelin T, Lefebvre M, Le Turnier P, Lecomte R, Morineau P, Reliquet V, Sécher S, Cavellec M, Paredes E, Soria A, Ferré V, André-Garnier E, Rodallec A, Pugliese P, Breaud S, Ceppi C, Chirio D, Cua E, Dellamonica P, Demonchy E, De Monte A, Durant J, Etienne C, Ferrando S, Garraffo R, Michelangeli C, Mondain V, Naqvi A, Oran N, Perbost I, Carles M, Klotz C, Maka A, Pradier C, Prouvost-Keller B, Risso K, Rio V, Rosenthal E, Touitou I, Wehrlen-Pugliese S, Zouzou G, Hocqueloux L, Prazuck T, Gubavu C, Sève A, Giaché S, Rzepecki V, Colin M, Boulard C, Thomas G, Cheret A, Goujard C, Quertainmont Y, Teicher E, Lerolle N, Jaureguiberry S, Colarino R, Deradji O, Castro A, Barrail-Tran A, Yazdanpanah Y, Landman R, Joly V, Ghosn J, Rioux C, Lariven S, Gervais A, Lescure FX, Matheron S, Louni F, Julia Z, Le GAC S, Charpentier C, Descamps D, Peytavin G, Duvivier C, Aguilar C, Alby-Laurent F, Amazzough K, Benabdelmoumen G, Bossi P, Cessot G, Charlier C, Consigny PH, Jidar K, Lafont E, Lanternier F, Leporrier J, Lortholary O, Louisin C, Lourenco J, Parize P, Pilmis B, Rouzaud C, Touam F, Valantin MA, Tubiana R, Agher R, Seang S, Schneider L, PaLich R, Blanc C, Katlama C, Bani-Sadr F, Berger JL, N’Guyen Y, Lambert D, Kmiec I, Hentzien M, Brunet A, Romaru J, Marty H, Brodard V, Arvieux C, Tattevin P, Revest M, Souala F, Baldeyrou M, Patrat-Delon S, Chapplain JM, Benezit F, Dupont M, Poinot M, Maillard A, Pronier C, Lemaitre F, Morlat C, Poisson-Vannier M, Jovelin T, Sinteff JP, Gagneux-Brunon A, Botelho-Nevers E, Frésard A, Ronat V, Lucht F, Rey D, Fischer P, Partisani M, Cheneau C, Priester M, Mélounou C, Bernard-Henry C, de Mautort E, Fafi-Kremer S, Delobel P, Alvarez M, Biezunski N, Debard A, Delpierre C, Gaube G, Lansalot P, Lelièvre L, Marcel M, Martin-Blondel G, Piffaut M, Porte L, Saune K, Robineau O, Ajana F, Aïssi E, Alcaraz I, Alidjinou E, Baclet V, Bocket L, Boucher A, Digumber M, Huleux T, Lafon-Desmurs B, Meybeck A, Pradier M, Tetart M, Thill P, Viget N, Valette M. Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018. Clin Infect Dis 2021; 73:e3266-e3274. [DOI: 10.1093/cid/ciaa1940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.
Methods
This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.
Results
From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.
Conclusions
A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.
Clinical Trials Registration. NCT02898987.
Collapse
Affiliation(s)
- Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1052, Lyon, France
| | - Laurent Hocqueloux
- Department of Infectious Diseases, Centre Hospitalier Régional d’Orléans – La Source, Orléans, France
| | - Maeva Lefebvre
- Department of Infectious Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes; Centre d’Investigation Clinique (CIC) 1413, INSERM, Nantes, France
| | - Pierre Pradat
- Center for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Isabelle Poizot-Martin
- Immuno-Hematology Clinic, Assistance Publique–Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, Aix-MarseilleUniversity–Inserm–Institut de Recherche pour le Développement (IRD), Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet, Nice, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg
| | - André Cabié
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Martinique, Fort de France, Université des Antilles EA4537, Fort de France, INSERM CIC1424, Fort-de-France, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Poizot-Martin I, Lions C, Allavena C, Huleux T, Bani-Sadr F, Cheret A, Rey D, Duvivier C, Jacomet C, Ferry T, Cabie A, Fresard A, Pugliese P, Delobel P, Lamaury I, Chirouze C, Zaegel-Faucher O, Brégigeon S, Rojas Rojas T, Obry-Roguet V, Makinson A. Spectrum and Incidence Trends of AIDS- and Non-AIDS-Defining Cancers between 2010 and 2015 in the French Dat'AIDS Cohort. Cancer Epidemiol Biomarkers Prev 2020; 30:554-563. [PMID: 33310788 DOI: 10.1158/1055-9965.epi-20-1045] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer risk is higher in people living with HIV (PLWH) compared with the general population, and cancers related to age are expected to be most prevalent. METHODS We determined the spectrum and incidence rates of AIDS-defining cancers (ADC) and non-AIDS-defining cancers (NADC) and of lung, Hodgkin lymphoma (HL), head and neck (HNC), colon-rectum, anal, liver, breast, prostate, and urinary bladder cancers between January 2010 and December 2015 in the French Dat'AIDS cohort. Incidence rates were calculated by year and compared using the χ 2 test for linear trend. Standardized incidence ratios [SIR (95% confidence interval)] were calculated relative to the French general population. RESULTS Among 44,642 patients, corresponding to 180,216.4 person-years (PY), 1,440 cancer cases occurred in 1,314 patients. ADC incidence was 191.4 (172.3-212.7)/105 PY and declined over time overall and in men, whereas NADC incidence was higher [548.8 (515.6-584.1)/105 PY] and did not change. In men, non-Hodgkin lymphoma was the most common cancer, but prostate cancer had the highest incidence among NADCs. Breast cancer was the most common cancer in women. SIRs were higher for cervical cancer [1.93 (1.18-3.14)], HNC in women [2.4 (1.4-4.2)], liver [overall: 3.8 (3.1-4.6); men: 3.2 (2.5-4.0); women: 12.9 (8.3-20.0)], and HL [overall: 13.8 (11.1-17.1); men: 16.2 (12.9-20.4); women: 6.2 (3.22-11.9)] but lower for lung [overall: 0.7 (0.6-0.9); men: 0.7 (0.5-0.8)], prostate [0.6 (0.5-0.7)], and breast cancers [0.6 (0.4-0.7)]. CONCLUSIONS Spectrum of NADCs has changed, with prostate and breast cancers becoming the most common despite their lower SIR. IMPACT These results confirm the need to maintain regular epidemiologic cancer monitoring in order to update screening guidelines.
Collapse
Affiliation(s)
- Isabelle Poizot-Martin
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, APHM Sainte-Marguerite, Service d'immuno-Hématologie Clinique, Marseille, France. .,Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Caroline Lions
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Clotilde Allavena
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, Nantes, France
| | - Thomas Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur - Centre Hospitalier G. DRON Tourcoing, Tourcoing, France
| | - Firouze Bani-Sadr
- Département de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, Centre Hospitalier Universitaire, Reims, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, Service de Médecine Interne - Immunologie Clinique - Hôpital Bicêtre - AP-HP, Le Kremlin-Bicêtre, France
| | - David Rey
- Le Trait d'Union, Centre de Soins de l'infection par le VIH, Hôpitaux Universitaires, Strasbourg, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France, IHU Imagine, Paris, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Christine Jacomet
- Centre Hospitalier Universitaire de Clermont-Ferrand, Département des Maladies Infectieuses et Tropicales, Clermont-Ferrand, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - André Cabie
- CHU de Martinique, Fort-de-France, Université des Antilles, EA4537, Fort-de-France, Inserm CIC1424, CHU de Martinique, Fort-de-France, France
| | - Anne Fresard
- Centre Hospitalier Universitaire de Saint-Étienne, Département des Maladies Infectieuses et Tropicales, Saint-Etienne, France
| | | | - Pierre Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales, INSERM, UMR1043, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Isabelle Lamaury
- Département d'Infectiologie, Dermatologie et Immunologie Clinique, CHU Guadeloupe BP 465, Pointe-à-Pitre Cedex, France
| | - Catherine Chirouze
- Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Département des Maladies Infectieuses et Tropicales, Besançon, France
| | - Olivia Zaegel-Faucher
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Sylvie Brégigeon
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Teresa Rojas Rojas
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Véronique Obry-Roguet
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'immuno-hématologie Clinique, Marseille, France
| | - Alain Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, Montpellier, France
| |
Collapse
|
29
|
Lefebvre M, Walencik A, Allavena C, Billaud E, Kassi A, Cesbron A, Joyau C, Secher S, Ruellan AL, Raffi F. Rate of DRESS Syndrome With Raltegravir and Role of the HLA-B*53: 01 Allele. J Acquir Immune Defic Syndr 2020; 85:e77-e80. [PMID: 33136758 DOI: 10.1097/qai.0000000000002474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maeva Lefebvre
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - Alexandre Walencik
- HLA laboratory, Etablissement Français du Sang Centre-Pays de la Loire, Nantes, France
| | - Clotilde Allavena
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - Eric Billaud
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - Alain Kassi
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
- Infectious Diseases Department, CHU de Treichville, BP V 3, Abidjan, Côte d'Ivoire; and
| | - Anne Cesbron
- HLA laboratory, Etablissement Français du Sang Centre-Pays de la Loire, Nantes, France
| | - Caroline Joyau
- Clinical Pharmacology Department, Biology Institute, CHU Hôtel Dieu, Nantes, France
| | - Solène Secher
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| | - Anne-Lise Ruellan
- Clinical Pharmacology Department, Biology Institute, CHU Hôtel Dieu, Nantes, France
| | - François Raffi
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Nantes, France
| |
Collapse
|
30
|
Hepatitis C virus-microelimination program and patient trajectories after hepatitis C virus cure in an outpatient HIV clinical unit. Eur J Gastroenterol Hepatol 2020; 32:1212-1221. [PMID: 31851097 DOI: 10.1097/meg.0000000000001640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Treatment recommendations for hepatitis C now make no distinction between HIV/HCV-coinfected and HCV-monoinfected patients. The largest challenge remained lack of effective models to eliminate HCV in people living with HIV. We report the results of a microelimination program evaluating the possibility of eradicating HCV in an HIV-outpatient clinical unit within 12 months. METHODS This HCV-microelimination program began in February 2016 in an unit following approximately 1000 HIV-infected patients and combined screening and therapeutic components according to the French guideline. A nested cohort study evaluating the impact of HCV cure on different health outcomes was conducted through self-administered questionnaires and using generalized mixed models. RESULTS Among 601 patients eligible for HCV serological testing, 445 were evaluated, and two HCV acute infections were diagnosed. Among the 151 patients eligible for HCV RNA quantification, 119 were evaluated, and one reinfection with HCV was diagnosed. Among the 110 patients eligible for direct-acting antiviral treatment, 51 (46.4%) initiated treatment within the 12 months program, and 35 (31.8%) after. Sustained virologic response (SVR) rate was 96.1%, and two treatments failed. At least one self-reported symptom was declared by 72.5% (n = 29) of patients. Positive impact of HCV cure was observed on various markers of physical and mental health as well as on health habits. CONCLUSION Our program should be considered as a proof of concept, which confirmed the feasibility of a HCV-microelimination program at the scale of an HIV clinical unit. However, 12 months were not sufficient to achieve our objective despite the specific organization.
Collapse
|
31
|
Pircher M, Pitono E, Pierre-François S, Molcard S, Brunier-Agot L, Fagour L, Najioullah F, Cesaire R, Abel S, Cuzin L, Cabié A. The effects of chikungunya virus infection on people living with HIV during the 2014 Martinique outbreak. PLoS One 2020; 15:e0234267. [PMID: 32503031 PMCID: PMC7274814 DOI: 10.1371/journal.pone.0234267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
Our objective was to describe the clinical presentation of chikungunya virus (CHIKV) infection in patients living with HIV (PLHIV) during the 2014 Martinique outbreak. During the outbreak and the 6 following months, all PLHIV coming in our unit for a medical evaluation answered questions about potential CHIKV related symptoms, and had blood tests to assess the diagnosis. For patients coming in at the acute phase of infection, we are able to provide and analyze CD4+, CD8+ T-cells and HIV viral load evolution before, during and after CHIK infection. Among the 1 003 PLHIV in care in the center at the time of the outbreak, 188 (94 men and 94 women) had confirmed (following the WHO definition) CHIKV infection. Clinical presentation was common in 63% of the cases, severe and atypical forms were scarce. During the acute phase, CD4+ and CD8+ T-cells (evaluated in 30 PLHIV, 15 men and 15 women) absolute numbers dropped significantly, but returned to pre-CHIKV values after the acute phase. Reassuringly, CD4 and CD8 T cells proportions did not decrease during the acute phase. CHIKV infection had no significant impact on this anti-retroviral treated population.
Collapse
Affiliation(s)
- Mathilde Pircher
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
| | - Edwin Pitono
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
| | - Sandrine Pierre-François
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
| | - Sabine Molcard
- Unit of Physical and Rehabilitation Medicine, University Hospital of Martinique, Fort de France, France
| | - Lauren Brunier-Agot
- Department of Rheumatology, University Hospital of Martinique, Fort de France, France
| | - Laurence Fagour
- Virology Laboratory, University Hospital of Martinique, Fort de France, France
- Antilles University, EA 7524, Fort-de-France, France
| | - Fatiha Najioullah
- Virology Laboratory, University Hospital of Martinique, Fort de France, France
- Antilles University, EA 7524, Fort-de-France, France
| | - Raymond Cesaire
- Virology Laboratory, University Hospital of Martinique, Fort de France, France
- Antilles University, EA 7524, Fort-de-France, France
| | - Sylvie Abel
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
- Antilles University, EA 7524, Fort-de-France, France
| | - Lise Cuzin
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
- INSERM UMR1017, Toulouse III University, Toulouse, France
- * E-mail:
| | - André Cabié
- Infectious Diseases and Tropical Medicine Unit, University Hospital of Martinique, Fort de France, France
- Antilles University, EA 7524, Fort-de-France, France
- INSERM CIC1424, Fort-de-France, France
| |
Collapse
|
32
|
Cuzin L, Pugliese P, Katlama C, Bani-Sadr F, Ferry T, Rey D, Lourenco J, Bregigeon S, Allavena C, Reynes J, Cabié A. Integrase strand transfer inhibitors and neuropsychiatric adverse events in a large prospective cohort. J Antimicrob Chemother 2020; 74:754-760. [PMID: 30534993 DOI: 10.1093/jac/dky497] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse the frequency and causes of treatment discontinuation in patients who were treated with an integrase strand transfer inhibitor (INSTI), with a focus on neuropsychiatric adverse events (NPAEs). METHODS Patients in 18 HIV reference centres in France were prospectively included in the Dat'AIDS cohort. Data were collected from all patients starting an INSTI-containing regimen between 1 January 2006 and 31 December 2016. All causes of INSTI-containing regimen discontinuations were analysed, and patients' characteristics related to discontinuation due to NPAEs were sought. RESULTS INSTIs were prescribed to 21315 patients: 6274 received dolutegravir, 3421 received elvitegravir boosted by cobicistat, and 11620 received raltegravir. Discontinuation was observed in 12.5%, 20.2% and 50.9% of the dolutegravir-, elvitegravir- and raltegravir-treated patients, respectively (P < 0.001). Discontinuation for NPAEs occurred in 2.7%, 1.3% and 1.7% of the dolutegravir-, elvitegravir-, and raltegravir-treated patients, respectively (P < 0.001). In the multivariate analysis, discontinuation for NPAEs was related to dolutegravir versus elvitegravir (HR = 2.27; 95% CI 1.63-3.17; P < 0.0001) and versus raltegravir (HR = 2.46; 95% CI 2.00-3.40; P < 0.0001), but neither gender (HR for women = 1.19; 95% CI 0.97-1.46; P = 0.09) nor age (P = 0.12) was related. The association with abacavir was not retained in the final model. CONCLUSIONS Although discontinuation for side effects was less frequent with dolutegravir than with boosted elvitegravir, discontinuation for NPAEs, although rare (2.7%), was more frequent with dolutegravir. No patient characteristic was found to be associated with these side effects in this very large population.
Collapse
Affiliation(s)
- Lise Cuzin
- Infectious and Tropical Diseases, Martinique University Hospital, Fort-de-France, France.,INSERM UMR1027, Toulouse University, Toulouse, France
| | - Pascal Pugliese
- Infectious Diseases Department, Nice University Hospital, Nice, France
| | - Christine Katlama
- Sorbonne Univ., UPMC Univ Paris 06-UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.,AP-HP, Infectious Diseases Department, APHP Pitié Salpêtrière Hospital, Paris, France
| | - Firouzé Bani-Sadr
- Reims Champagne-Ardenne University, EA-4684/SFR CAPSANTE, Reims, France.,Tropical and Infectious Diseases Department, University Hospital Reims, Reims, France
| | - Tristan Ferry
- Infectious Disease Unit, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, CIRI, INSERM U1111, Lyon, France
| | - David Rey
- HIV Infection Care Centre, University Hospital, Strasbourg, France
| | - Jeremy Lourenco
- Infectious Diseases Department, AP-HP-Necker Hospital, Paris, France
| | - Sylvie Bregigeon
- Aix Marseille University, APHM Sainte-Marguerite, Marseille, France
| | - Clotilde Allavena
- Infectious Diseases Department, Nantes University Hospital, Nantes, France.,UIC 1413 INSERM, Nantes, France
| | - Jacques Reynes
- Infectious Diseases Department, Montpellier University Hospital, Montpellier, France.,INSERM U1175, IRD UMI233, Montpellier University, Montpellier, France
| | - André Cabié
- Infectious and Tropical Diseases, Martinique University Hospital, Fort-de-France, France.,INSERM CIC1424, Fort-de-France, France
| | | |
Collapse
|
33
|
Factors associated with psoriasis in a French Nationwide HIV cohort: the independent role of HLA-B*57:01. AIDS 2020; 34:1057-1063. [PMID: 32167971 DOI: 10.1097/qad.0000000000002519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Psoriasis is a T-cell-mediated inflammatory disease with genetic factors involved in its etiopathogenesis. In non-HIV populations, HLA-B57:01 has been associated with a higher risk of psoriasis. The aim of this study was to investigate demographic and immunovirological characteristics associated with psoriasis, and to assess whether HLA-B57:01 is associated with psoriasis among people living with HIV (PLHIV) followed in a large French multicenter Dat'AIDS cohort. METHODS All PLHIV followed up from January 2000 to December 2018 with an available result for HLA-B57:01 were included. Logistic regression models were used to identify associations between psoriasis (outcome variable) and explanatory variables. RESULTS Among 31 076 PLHIV, the overall prevalence of psoriasis and HLA-B57:01 were 2.25 and 4.73%, respectively and varied according to ethnicity. By multivariate analysis, male gender [OR 1.81 (95% CI 1.46-2.24), P < 10], positive HLA-B57:01 [OR 2.66 (95% CI 2.12-3.33), P < 10], nadir CD4 cell count less than 200 cells/μl [OR 1.41 (95% CI 1.19-1.67), P < 10] and positive HCV serology [OR 1.45 (95% CI 1.20-1.76), P < 10] were significantly associated with a higher risk of psoriasis. Being born in West and Central Africa [OR 0.15 (95% CI 0.10-0.25), P < 10], the Caribbean islands [OR 0.14 (95% CI 0.05-0.45), P = 0.0008] or Latin America [OR 0.31 (95% CI 0.14-0.69), P = 0.004] was associated with a lower risk of psoriasis compared with patients born in mainland France. CONCLUSION PLHIV carrying HLA-B57:01 have around a three-fold increased risk of psoriasis. This association might provide a possible explanation for the observed differences in psoriasis prevalence between ethnic groups.
Collapse
|
34
|
Sellier P, Hamet G, Brun A, Ponscarme D, De Castro N, Alexandre G, Rozenbaum W, Molina JM, Abgrall S. Mortality of People Living with HIV in Paris Area from 2011 to 2015. AIDS Res Hum Retroviruses 2020; 36:373-380. [PMID: 31565958 DOI: 10.1089/aid.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In high-income countries, causes of death in people living with HIV (PLHIV) have changed. Three French national surveys from 2000 to 2010 showed a decrease in AIDS-related and an increase in non-AIDS-related deaths. Deaths notified in PLHIV followed between January 1, 2011 and December 31, 2015 in 1 of 13 participating hospitals northeast of Paris area were described. Risk factors for death were assessed, using a multivariable logistic regression model. Of 14,403 individuals, 295 died. Median age at death was 52 years (interquartile range = 47-60) and 77% were men. Sixty-seven individuals (23%) died from non-AIDS-defining nonviral hepatitis-related (NaNH) malignancy, 40 (14%) from AIDS, 34 (12%) from cardiovascular disease (CVD), 33 (11%) from non-AIDS infection, 21 (7%) from liver disease, and 12 (4%) from suicide. Men and women born in sub-Saharan Africa had a lower adjusted odds ratio (aOR) of dying than men having sex with men (MSM) born in France (0.70, 95% confidence interval = 0.45-1.09; and 0.45, 0.28-0.73, respectively). Risk factors for death were older age (aOR = 2.26, 1.36-3.77 for 40-49 years and 2.91, 1.75-4.84 for >50 years vs. 18-39 years), male intravenous drug users (IVDU) transmission (2.24, 1.42-3.54 vs. MSM born in France), AIDS (2.75, 2.10-3.59), antiretroviral therapy initiation in earlier periods, time since HIV diagnosis <1 year, low CD4 cell count nadir, hepatitis B virus and/or hepatitis C virus coinfection (1.69, 1.23-2.30), and psychiatric disorders (1.73, 1.27-2.38). Our study confirms the increasing frequency of non-AIDS-related deaths, mainly NaNH malignancies and CVD, in PLHIV, justifying overall and in some specific populations (psychiatric and IVDU) prevention and screening.
Collapse
Affiliation(s)
- Pierre Sellier
- Department of Internal Medicine, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Diane Ponscarme
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Nathalie De Castro
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | | | - Willy Rozenbaum
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
- University Paris Diderot, Paris, France
| | - Sophie Abgrall
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France
| |
Collapse
|
35
|
Poizot-Martin I, Obry-Roguet V, Duvivier C, Lions C, Huleux T, Jacomet C, Ferry T, Cheret A, Allavena C, Bani-Sadr F, Palich R, Cabié A, Fresard A, Pugliese P, Delobel P, Lamaury I, Hustache-Mathieu L, Brégigeon S, Makinson A, Rey D. Kaposi sarcoma among people living with HIV in the French DAT'AIDS cohort between 2010 and 2015. J Eur Acad Dermatol Venereol 2020; 34:1065-1073. [PMID: 31953902 PMCID: PMC7318618 DOI: 10.1111/jdv.16204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023]
Abstract
Background Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV‐infected people. Objective To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. Methods Retrospective study using longitudinal data from 44 642 patients in the French Dat’AIDS multicenter cohort. Patients’ characteristics were described at KS diagnosis according to ART exposure and to HIV‐plasma viral load (HIV‐pVL) (≤50 or >50) copies/mL. Results Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART‐experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV‐pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted‐PI‐based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. Limitations Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. Conclusion Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV‐pVL ≤50 cp/mL remain to be explored.
Collapse
Affiliation(s)
- I Poizot-Martin
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - V Obry-Roguet
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - C Duvivier
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, APHP-Hôpital Necker-Enfants Malades, Paris, France.,IHU Imagine, Paris, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Centre Médical de l'Institut Pasteur, Institut Pasteur, Paris, France
| | - C Lions
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - T Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur - Centre Hospitalier G. DRON, Tourcoing, France
| | - C Jacomet
- Centre Hospitalier Universitaire de Clermont-Ferrand, Département des Maladies Infectieuses et Tropicales, Clermont Ferrand, France
| | - T Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - A Cheret
- Sorbonne Paris Cité, EA7327, Université Paris Descartes, Paris, France.,Service de Médecine Interne - Immunologie Clinique - Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - C Allavena
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, Nantes, France
| | - F Bani-Sadr
- Département de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hêpital Robert Debré, Centre Hospitalier Universitaire, Reims, France
| | - R Palich
- Service des Maladies Infectieuses et Tropicales, GHPS Pitié Salpêtrière APHP, Paris, France.,UMR 1136, Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - A Cabié
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, France.,EA 4537 Maladies Infectieuses et Tropicales dans la Caraï be, Université des Antilles, Pointe-à-Pitre, France.,INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier Andrée Rosemon, Cayenne, France
| | - A Fresard
- Centre Hospitalier Universitaire de Saint-Étienne, Département des Maladies Infectieuses et Tropicales, Saint-Etienne, France
| | - P Pugliese
- CHU de Nice, Universite Côte d'Azur, Nice, France
| | - P Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR1043-Université Toulouse III Paul Sabatier, Toulouse, France
| | - I Lamaury
- Département d'Infectiologie, Dermatologie et Immunologie Clinique, Pointe-à-Pitre Cedex, France
| | - L Hustache-Mathieu
- Service des Maladies Infectieuses et Tropicales, CHRU de Besançon - Hôpital Jean Minjoz, Besançon, France
| | - S Brégigeon
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - A Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, Montpellier, France
| | - D Rey
- Le Trait d'Union, Centre de Soins de l'infection par le VIH, Hôpitaux Universitaires, Strasbourg, France
| | | |
Collapse
|
36
|
Kaposi sarcoma in people living with HIV: incidence and associated factors in a French cohort between 2010 and 2015. AIDS 2020; 34:569-577. [PMID: 31764070 DOI: 10.1097/qad.0000000000002450] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Kaposi sarcoma is still observed among people living with HIV (PLHIV) including those on ART with undetectable HIV viral load (HIV-VL). We aimed to assess Kaposi sarcoma incidence and trends between 2010 and 2015 in France and to highlight associated factors. DESIGN Retrospective study using longitudinal data from the Dat'AIDS cohort including 44 642 PLWH. For the incidence assessment, Kaposi sarcoma cases occurring within 30 days of cohort enrollment were excluded. METHODS Demographic, immunological, and therapeutic characteristics collected at time of Kaposi sarcoma diagnosis or at last visit for patients without Kaposi sarcoma. RESULTS Among 180 216.4 person-years, Kaposi sarcoma incidence was 76 (95% CI 64.3-89.9)/10 person-years. Multivariate analysis (Poisson regression) revealed the positive association with male sex, MSM transmission route, lower CD4 T-cell count, higher CD8 T-cell count, not to be on ART, whereas HIV follow-up time, duration with an HIV-VL 50 copies/ml or less were negatively associated with Kaposi sarcoma. According to the different models tested, HIV-VL, CD4 : CD8 ratio and nadir CD4 cell count were associated with Kaposi sarcoma. Moreover, stratified analysis showed that patients with a CD4 : CD8 ratio 0.5 or less or a CD8 T-cell count greater than 1000 cells/μl were at higher risk of Kaposi sarcoma regardless of the CD4 T-cell count. CONCLUSION This study showed that in a resource-rich country setting with high ART coverage, Kaposi sarcoma still occurred among PLWH. CD8 hyperlymphocytosis and CD4 : CD8 ratio should be now considered as two useful markers to better identify patients at increased Kaposi sarcoma risk, including those with a CD4 T-cell count greater than 500 cells/μl.
Collapse
|
37
|
Higher rates of HBsAg clearance with tenofovir-containing therapy in HBV/HIV co-infection. PLoS One 2019; 14:e0215464. [PMID: 30998789 PMCID: PMC6472771 DOI: 10.1371/journal.pone.0215464] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Achieving functional cure of chronic HBV infection (Hepatitis B surface antigen [HBsAg] clearance, eventually followed by acquisition of anti-hepatitis B surface antigen [Anti-HBs]) in individuals with HIV and HBV infections is a rare event. In this setting, factors related to HBV cure have not yet been fully characterized. METHODS HIV-infected individuals with chronic HBV infection enrolled in the French Dat'AIDS cohort (NCT02898987), who started combined antiretroviral (cART)-anti-HBV treatment were retrospectively analyzed for HBsAg loss and Anti-HBs seroconversion. RESULTS Overall, 1419 naïve-subjects received three different cART-anti-HBV treatment schedule: (1) 3TC or FTC only (n = 150), (2) TDF with or without 3TC or FTC (n = 489) and (3) 3TC or FTC as first line followed by adding/switching to TDF as second line (n = 780). Individuals were followed-up for a median of 89 months (IQR, 56-118). HBV-DNA was < 15 IU/mL in 91% of individuals at the end of the follow-up. Overall, 97 individuals cleared HBsAg (0.7/100 patient-years), of whom, 67 seroconverted for Anti-HBs (0.5/100 patient-years). A high CD4 nadir, a short delay between HBV diagnosis and treatment, a longer time on HBV therapy, an African origin and TDF-based therapy were independent predictors of HBsAg clearance (Probability of odds ratio [OR]>1, >95%) suggested by Bayesian analysis. Also, TDF-based regimen as first line (OR, 3.03) or second line (OR, 2.95) increased rates of HBsAg clearance compared to 3TC or FTC alone, with a 99% probability. CONCLUSIONS HBsAg clearance rate was low in HIV-HBV co-infected cART-anti-HBV treated individuals, but was slightly improved on TDF-based regimen.
Collapse
|
38
|
Lions C, Cabras O, Cotte L, Huleux T, Gagneux-Brugnon A, Makinson A, Cabié A, Bonnet B, Duvivier C, Hocqueloux L, Cua E, Cheret A, Hustache-Mathieu L, Obry-Roguet V, Jacomet C, Poizot-Martin I. Missed opportunities of HIV pre-exposure prophylaxis in France: a retrospective analysis in the French DAT'AIDS cohort. BMC Infect Dis 2019; 19:278. [PMID: 30909885 PMCID: PMC6434788 DOI: 10.1186/s12879-019-3915-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016. METHODS Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. RESULTS Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). CONCLUSION With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.
Collapse
Affiliation(s)
- C. Lions
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
| | - O. Cabras
- Service des maladies infectieuses et tropicales, CHU Bichat, Paris, France
| | - L. Cotte
- Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
| | - T. Huleux
- Service Universitaire des maladies infectieuses et du voyageur, CH Tourcoing, Tourcoing, France
| | - A. Gagneux-Brugnon
- Service d’Infectiologie, CHU Sainte-Etienne, Groupe Immunité des Muqueuses et Agents Pathogènes, Institut Presage, Université de Lyon, Lyon, France
| | - A. Makinson
- Infectious and Tropical Diseases Department, University Hospital Montpellier, Montpellier, France
- UMI 233/INSERMU1175, IRD, University Montpellier, Montpellier, France
| | - A. Cabié
- Service des maladies infectieuses et tropicales, CHU de Martinique, INSERM CIC 1425 and Université des Antilles EA 4537, La Martinique, France
| | - B. Bonnet
- Maladies Infectieuses et tropicales, CHU HOTEL DIEU, Nantes, France
| | - C. Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’infectiologie Necker-Pasteur, F-75015 Paris, France
- Institut Pasteur, Centre Médical de l’Institut Pasteur, Centre d’infectiologie Necker-Pasteur, F-75015 Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Equipe d’Accueil EA 7327, F-75015 Paris, France
- IHU Imagine, F-75015 Paris, France
| | - L. Hocqueloux
- Service des maladies infectieuses et tropicales, CHR d’Orléans –La Source, Orléans, France
| | - E. Cua
- Service des maladies infectieuses et tropicales, CHU de Nice, Nice, France
| | - A. Cheret
- Service de Médecine Interne, CHU Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France
| | - L. Hustache-Mathieu
- Service des maladies infectieuses et tropicales, CHU Besançon, Besançon, France
| | - V. Obry-Roguet
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
| | - C. Jacomet
- Service des maladies infectieuses et tropicales, CHU Clermont Ferrand, Clermont Ferrand, France
| | - I. Poizot-Martin
- APHM Hôpital Sainte-Marguerite, Service d’Immuno-hématologie clinique, Aix-Marseille University, Marseille, France
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Aix Marseille Univ, Marseille, France
- Immuno hematological Unit/ service d’Immuno- hématologie Clinique, Centre d’Informations et de Soins de l’Immunodéficience Humaine et des Hépatites virales, 270 boulevard de Sainte Marguerite, 13009 Marseille, France
| |
Collapse
|
39
|
Hentzien M, Dramé M, Delpierre C, Allavena C, Cabié A, Cuzin L, Rey D, Pugliese P, Hédelin G, Bani-Sadr F. HIV-related excess mortality and age-related comorbidities in patients with HIV aged ≥60: a relative survival analysis in the French Dat'AIDS cohort. BMJ Open 2019; 9:e024841. [PMID: 30782744 PMCID: PMC6352790 DOI: 10.1136/bmjopen-2018-024841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The objective was to evaluate the association between age-related comorbidities (ARCs) and 5-year HIV-related excess mortality in people living with HIV aged ≥60 years. DESIGN Cohort study using relative survival analysis (Estève's model). SETTING The French multicentre prospective Dat'AIDS cohort that involves 12 French hospitals. PARTICIPANTS Inclusion of 1415 HIV-1 infected patients actively followed aged ≥60 years on January 2008, with a 5-year follow-up period in the late combination antiretroviral therapy era. RESULTS Among 1415 patients included, 154 died. By multivariable analysis, factors predictive of 5-year HIV-related excess mortality were non-AIDS-related cancer (adjusted excess HR (aEHR)=2.94; 95% CI 1.32 to 6.57), cardiovascular disease (aEHR=6.00; 95% CI 2.45 to 14.65), chronic renal disease (aEHR=4.86; 95% CI 2.24 to 10.53), cirrhosis (aEHR=3.58; 95% CI 1.25 to 10.28), hepatitis C co-infection (aEHR=3.63; 95% CI 1.44 to 9.12), body mass index<18.5 kg/m² (aEHR=4.10; 95% CI 1.61 to 10.48) and having a CD4 cell count ≤200/mm3 (aEHR=5.79; 95% CI 2.28 to 14.69). CONCLUSIONS ARCs, particularly cardiovascular disease and chronic renal disease, are predictive of HIV-related excess mortality, with an increase in hazard similar to that of CD4 cell count. TRIAL REGISTRATION NUMBER NCT02898987.
Collapse
Affiliation(s)
- Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, CHU Reims, Reims, France
- Université de Reims Champagne-Ardenne, France, Reims, France
| | - Moustapha Dramé
- Université de Reims Champagne-Ardenne, France, Reims, France
- Department of Research and Innovation, Reims Teaching Hospitals, Robert Debré Hospital, Reims, France
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Clotilde Allavena
- Infectious Diseases Department, University of Nantes, CHU Hôtel Dieu, Nantes, France
| | - André Cabié
- Department of Infectious and Tropical Diseases, Martinique Teaching Hospitals, Fort-De-France Hospital, Fort-De-France, France
| | - Lise Cuzin
- INSERM, UMR1027, Toulouse, France
- CHU Toulouse, COREVIH Toulouse, Toulouse, France
| | - David Rey
- Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, HIV Care Center, Strasbourg, France
| | - Pascal Pugliese
- Infectious Diseases Department, University of Nice, CHU L’Archet, Nice, France
| | - Guy Hédelin
- Epidémiologie en entreprises. INRS, Vandoeuvre, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, CHU Reims, Reims, France
| | | |
Collapse
|
40
|
Zebina M, Melot B, Binachon B, Ouissa R, Lamaury I, Hoen B. Impact of an SMS reminder service on outpatient clinic attendance rates by patients with HIV followed-up at Pointe-à-Pitre University Hospital. Patient Prefer Adherence 2019; 13:215-221. [PMID: 30774317 PMCID: PMC6354684 DOI: 10.2147/ppa.s182186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. METHODS The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. RESULTS A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking anti-retroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. CONCLUSION Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.
Collapse
Affiliation(s)
- Marine Zebina
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bénédicte Melot
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Blandine Binachon
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Rachida Ouissa
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
| | - Bruno Hoen
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France,
- INSERM, Center for Clinical Investigation, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
- EA 4537, Faculty of Medicine Hyacinthe Bastaraud, University of the French West Indies and French Guiana, Pointe-à-Pitre, France
| |
Collapse
|
41
|
Gatey C, Brun A, Hamet G, Diamantis S, Sellier P, Bouchaud O, Garrait V, Rozenbaum W, Molina JM, Abgrall S. Does region of origin influence the timing and outcome of first-line antiretroviral therapy in France? HIV Med 2018; 20:175-181. [PMID: 30506853 DOI: 10.1111/hiv.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
Collapse
Affiliation(s)
- C Gatey
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France
| | - A Brun
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - G Hamet
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - S Diamantis
- Department of Infectious Diseases, Marc Jacquet Hospital, Melun, France
| | - P Sellier
- Department of Internal Medicine, Saint Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - O Bouchaud
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France.,Laboratory Health Education and Practice (LEPS EA 3412), Paris 13 University, Bobigny, France
| | - V Garrait
- Department of Internal Medicine, Intercommunal Hospital Centre, Créteil, France
| | - W Rozenbaum
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - J M Molina
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,University of Paris Diderot, Sorbonne Paris University, Paris, France
| | - S Abgrall
- Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France.,University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France.,CESP INSERM U1018, Le Kremlin-Bicêtre, France
| | | |
Collapse
|
42
|
Which antiretrovirals should be prescribed as first-line treatments? Changes over the past 10 years in France. Med Mal Infect 2018; 49:264-269. [PMID: 30409541 DOI: 10.1016/j.medmal.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/18/2017] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015. METHODS We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. RESULTS We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load ˃5 log copies/mL were less likely to receive NNRTI (OR=0.08) or INSTI regimens (OR=0.69) than bPIs. Patients with initial CD4+ T cell count ˂200/mm3 were less likely to receive an NNRTI (OR=0.28) or an INSTI regimen (OR=0.52) than a bPI. Women were less likely to receive an NNRTI (OR=0.79) or an INSTI regimen (OR=0.71) than a bPI; although this depended on age. CONCLUSION The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4+ T cell count, and in women.
Collapse
|
43
|
Noret M, Balavoine S, Pintado C, Siguier M, Brun A, Bauer R, Loze B, Leplatois A, Aslan A, Moudachirou K, Delaugerre C, Rozenbaum W, Molina JM. Daily or on-demand oral tenofovir disoproxil fumarate/emtricitabine for HIV pre-exposure prophylaxis: experience from a hospital-based clinic in France. AIDS 2018; 32:2161-2169. [PMID: 30212403 DOI: 10.1097/qad.0000000000001939] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND On-demand oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) has been approved for pre-exposure prophylaxis (PrEP) in MSM in France following the results of clinical studies, but data are limited on real-world experience. DESIGN A single-center, open-label, prospective cohort study that recruited people at high risk of HIV infection in Paris. METHODS Participants were enrolled in a single hospital-based outpatient clinic and were proposed to start PrEP with daily or on demand TDF/FTC. At baseline and every 3 months thereafter, patients were tested for HIV and creatinine plasma levels, and data on sexual behavior, other sexually transmitted infections (STIs), and tolerability were collected. RESULTS From 10 November 2015 to 30 April 2017, 1069 patients were screened and 1049 (98.1%) started PrEP. Median age was 36 years, 99.4% were MSM with a median number of partners of 10, and 793 (75.6%) opted for on demand PrEP. Over 486 person-years of follow-up, four HIV-infections were diagnosed in poorly or nonadherent patients (incidence 0.82/100 person-years). Rate of condomless sex at last intercourse increased from 53.3% at baseline to 79% at month 12 (P < 10), but increase in bacterial STI rates was modest (14.6% at baseline vs. 19.2% at month 12; P < 10). Most adverse events were gastrointestinal and did not lead to PrEP discontinuation. CONCLUSIONS Most PrEP users were high-risk MSM and opted for on-demand PrEP. PrEP use was associated with a low HIV incidence and a high rate of condomless sex with a modest increase in bacterial STIs.
Collapse
|
44
|
Allavena C, Hanf M, Rey D, Duvivier C, BaniSadr F, Poizot-Martin I, Jacomet C, Pugliese P, Delobel P, Katlama C, Joly V, Chidiac C, Dournon N, Merrien D, May T, Reynes J, Gagneux-Brunon A, Chirouze C, Huleux T, Cabié A, Raffi F. Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients. PLoS One 2018; 13:e0203895. [PMID: 30240419 PMCID: PMC6150468 DOI: 10.1371/journal.pone.0203895] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
As HIV-infected adults on successful antiretroviral therapy (ART) are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. The objective of this cross-sectional study was to compare in the French Dat’AIDS cohort, the HIV geriatric population, aged 75 years and over, to the elderly one, aged from 50 to 74 years. As of Dec 2015, 16,436 subjects (43.8% of the French Dat’AIDS cohort) were aged from 50 to 74 (elderly group) and 572 subjects (1.5%) were aged 75 and over (geriatric group). Durations of HIV infection and of ART were slightly but significantly different, median at 19 and 18 years, and 15 and 16 years in the elderly and geriatric group, respectively. The geriatric group was more frequently at CDC stage C and had a lower nadir CD4. This group had been more exposed to first generation protease inhibitors and thymidine analogues. Despite similar virologic suppression, type of ART at the last visit significantly differed between the 2 groups: triple ART in 74% versus 68.2%, ART ≥ 4 drugs in 4.7% versus 2.7%; dual therapy in 11.6% versus 16.4% in the elderly group and the geriatric group, respectively. In the geriatric group all co-morbidities were significantly more frequent, except dyslipidemia, 4.3% of the elderly group had ≥4 co-morbidities versus18.4% in the geriatric group. Despite more co-morbidities and more advanced HIV infection the geriatric population achieve similar high rate of virologic suppression than the elderly population. A multidisciplinary approach should be developed to face the incoming challenge of aging HIV population.
Collapse
Affiliation(s)
- Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
- * E-mail:
| | - Matthieu Hanf
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
- INSERM UMR 1181 B2PHI, Versailles Saint Quentin University, institut Pasteur, Villejuif, France
| | - David Rey
- Centre for HIV Infection Care, Strasbourg, France
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Centre, Paris, France
- Medical Centre of Pasteur Institut, Necker-Pasteur Infectiology Centre, Paris, France
- EA7327, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Firouze BaniSadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, University of Reims, Reims, France
- Université de Reims Champagne-Ardenne, Faculté de médecine, EA-4684 / SFR CAP-SANTE, Reims, France
| | - Isabelle Poizot-Martin
- Immuno-Hematology Clinic, Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Marseille, France
- Inserm U912 (SESSTIM), Marseille, France
| | - Christine Jacomet
- Infectious Diseases Department, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France
| | - Pierre Delobel
- INSERM, UMR1043, Toulouse and Université Toulouse III Paul Sabatier, Toulouse, France
- Department of Infectious Diseases, Toulouse University Hospital, Toulouse, France
| | - Christine Katlama
- Department of Infectious Diseases, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
- Inserm Unité Mixte de Recherche en Santé 1136, Université Pierre et Marie Curie Paris 06, Sorbonne Universités, Paris, France
| | - Véronique Joly
- Infectious Diseases Department, Hôpital Bichat, AP-HP, Paris, France
- National Institute of Health and Medical Research (INSERM) IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Christian Chidiac
- Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Nathalie Dournon
- Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Pointe à Pitre, France
- Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Dominique Merrien
- Departement of infectious diseases, CHD Vendee, La Roche sur yon, France
| | - Thierry May
- Department of infectious diseases, University Hospital Centre, Nancy, France
| | - Jacques Reynes
- Infectious Diseases Department, Montpellier University Hospital, Montpellier, France
- UMI233 INSERM U1175, Montpellier University Hospital, Montpellier, France
| | | | - Catherine Chirouze
- Infectious Diseases Department, University hospital of Besançon, Besançon, France
- UMR CNRS 6249, University of Bourgogne-Franche Comté, Besançon, France
| | - Thomas Huleux
- Infectious Diseases Department, University hospital of Tourcoing, Tourcoing, France
| | - André Cabié
- Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
- Infectious Diseases Department, University Hospital of Martinique, Fort-de-France, France
- EA4537, Université des Antilles, Fort-de-France, France
| | - François Raffi
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
| | | |
Collapse
|
45
|
Poizot-Martin I, Obry-Roguet V, Zaegel-Faucher O, Lions C, Cano C, Ivanova A, Ritleng A, Debreux C, Bregigeon S. HIV infection and care pathway: From guidelines to clinical practice. Med Mal Infect 2018; 49:23-33. [PMID: 30195462 DOI: 10.1016/j.medmal.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/31/2018] [Accepted: 07/24/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To quantify within a cohort of HIV-infected individuals the number of medical visits and procedures to be carried out according to comorbidities and risk factors to implement a personalized care pathway. PATIENTS AND METHODS Retrospective study of 915 patients consulting from January 1 to December 31, 2016 at an outpatient unit of multidisciplinary consultations, using an electronic patient record. We built an algorithm using parameters required for the application of the national guidelines for the management of HIV-infected individuals. The frequency of comorbidities was measured according to gender, transmission risk group, and nadir CD4 (<or>200/mm3). RESULTS Patients were mostly men (median age: 52 years), of whom 16% were aged≥60 years. Viral load was<40 copies/mL in 93.5% of treated patients and CD4 cell count≥500/mm3 for 73%. Overall, 74.5% of patients had at least one comorbidity. The number of comorbidities was similar in men and women but was significantly higher in patients with a nadir CD4 <200/mm3 and increased with age (irrespective of gender). The minimum number of consultations to be scheduled per year was 8123: 70% for the management of comorbidities with an average of six consultations/year/patient. Overall, 53% of patients should attend a proctology consultation. The minimum number of paramedical procedures to be performed was 5115. CONCLUSION The implementation of a personalized multidisciplinary management within a single facility seems to be a suitable care model to address the needs of HIV-infected individuals.
Collapse
Affiliation(s)
- I Poizot-Martin
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France; INSERM, IRD, SESSTIM, sciences économiques & Sociales de la Santé & Traitement de l'Information Médicale, AP-HM Sainte-Marguerite, service d'Immuno-hématologie clinique, biostatistique et technologies de l'information et de la communication, Aix Marseille Université, AP-HM, 13009 Marseille, France.
| | - V Obry-Roguet
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - O Zaegel-Faucher
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - C Lions
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - C Cano
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - A Ivanova
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - A Ritleng
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - C Debreux
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| | - S Bregigeon
- Service d'immuno-hématologie clinique, Aix-Marseille université, AP-HM hôpital Sainte-Marguerite, 13009 Marseille, France
| |
Collapse
|
46
|
Abel S, Cuzin L, Da Cunha S, Bolivard JM, Fagour L, Miossec C, Pircher M, Thioune M, Césaire R, Cabié A. Reaching the WHO target of testing persons in jails in prisons will need diverse efforts and resources. PLoS One 2018; 13:e0202985. [PMID: 30161176 PMCID: PMC6116985 DOI: 10.1371/journal.pone.0202985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background The Caribbean is the second most affected region in the world by human immunodeficiency virus (HIV), and HIV prevalence is significantly higher among persons in jails and prisons than in the free population. The aim of our study was to assess the screening rates of HIV, hepatitis B and C, syphilis and human T cell leukaemia virus type 1 among newly-arrived persons in 2014, at Ducos facility in Martinique and the testing process performance. Methods This is an observational monocentric study conducted within the prison’s health unit. The study population consisted of all individuals incarcerated between 01/01/14 and 31/12/14. At the initial medical visit, HIV and STI testing were proposed to every newcomer. The rate of acceptance was calculated, as well as the screening process performance. Results In 2014 778 new persons were incarcerated, among those, 461 (59.3%) were tested. The main reasons for missing the testing opportunity were due to organization of the judiciary system (persons on electronic monitoring or day parole, transferred or quickly released before completion of the process) or to individual refusal. Finally, 75 persons did not get their results (all of them negative), 41 of them due to the medical staff work overload. Conclusions HIV and STI testing rates among newcomers at Ducos have notable room for improvement. The future availability of combined (HIV, HBV, HCV and syphilis) rapid tests may be very useful in case of short term incarceration, if their cost is not prohibitive. Reaching higher levels of testing will also require more resources.
Collapse
Affiliation(s)
- Sylvie Abel
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Lise Cuzin
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
- INSERM, UMR 1027, Toulouse, France
- * E-mail:
| | - Séverine Da Cunha
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
| | | | - Laurence Fagour
- Virology Laboratory, Martinique University Hospital, Fort de France, France
| | - Charline Miossec
- Parasitology Laboratory, Martinique University Hospital, Fort de France, France
| | - Mathilde Pircher
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Marême Thioune
- Prison Medical Unit, Martinique University Hospital, Fort de France, France
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
| | - Raymond Césaire
- Virology Laboratory, Martinique University Hospital, Fort de France, France
- Antilles University, EA4537, Fort de France, France
| | - André Cabié
- Infectious and Tropical Diseases Unit, Martinique University Hospital, Fort de France, France
- Antilles University, EA4537, Fort de France, France
- Inserm CIC1424, Martinique University Hospital, Fort de France, France
| |
Collapse
|
47
|
Provoost A, Dramé M, Cotte L, Cuzin L, Garraffo R, Rey D, Raffi F, Poizot-Martin I, Pugliese P, Bani-Sadr F. Risk of diabetes in HIV-infected patients is associated with cirrhosis but not with chronic HCV coinfection in a French nationwide HIV cohort. Aliment Pharmacol Ther 2018; 48:281-289. [PMID: 29901821 DOI: 10.1111/apt.14812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/12/2018] [Accepted: 04/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections have been reportedly associated with a higher risk of diabetes mellitus (DM) but results are conflicting. AIMS To determine whether there is an association between chronic HCV and the incidence of DM, and to study the role of factors such as cirrhosis, IFN-based HCV therapy, sustained virologic response (SVR) and chronic HBV infection among patients living with HIV (PLHIV) followed in a large French multicentre cohort in the combination antiretroviral therapy (cART) era. METHODS All PLHIV followed up in the Dat'AIDS cohort were eligible. Cox models for survival analysis were used to study the time to occurrence of DM. RESULTS Among 28 699 PLHIV, 4004 patients had chronic HCV infection. The mean duration of HCV follow-up was 12.5 ± 8.1 years. The rate ratio of DM was 2.74 per 1000 person-years. By multivariate analysis, increasing age, body mass index>25, AIDS status, nadir CD4 cell count ≤200/mm3 , detectable HIV viral load and cirrhosis (HR 2.26 95% CI 1.14-1.18; P < 0.0001) were predictors of DM, whereas longer cART duration was associated with a lower risk of DM. Chronic HCV and HBV infection and IFN-based HCV therapy were not associated with DM. In a subanalysis among HCV-infected patients, SVR was not related to DM. CONCLUSIONS Our study shows that in the HIV population, cirrhosis is associated with an increased occurrence of DM, but not chronic HCV infection or duration of HCV infection.
Collapse
|
48
|
Raffi F, Hanf M, Ferry T, Khatchatourian L, Joly V, Pugliese P, Katlama C, Robineau O, Chirouze C, Jacomet C, Delobel P, Poizot-Martin I, Ravaux I, Duvivier C, Gagneux-Brunon A, Rey D, Reynes J, May T, Bani-Sadr F, Hoen B, Morrier M, Cabie A, Allavena C. Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen. J Antimicrob Chemother 2018; 72:3425-3434. [PMID: 28961719 DOI: 10.1093/jac/dkx300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023] Open
Abstract
Objectives We investigated the risk of virological rebound in HIV-1-infected patients achieving virological suppression on first-line combined ART (cART) according to baseline HIV-1 RNA, time to virological suppression and type of regimen. Patients and methods Subjects were 10 836 adults who initiated first-line cART (two nucleoside or nucleotide reverse transcriptase inhibitors + efavirenz, a ritonavir-boosted protease inhibitor or an integrase inhibitor) from 1 January 2007 to 31 December 2014. Cox proportional hazards models with multiple adjustment and propensity score matching were used to investigate the effect of baseline HIV-1 RNA and time to virological suppression on the occurrence of virological rebound. Results During 411 436 patient-months of follow-up, risk of virological rebound was higher in patients with baseline HIV-1 RNA ≥100 000 copies/mL versus <100 000 copies/mL, in those achieving virological suppression in > 6 months versus <6 months, and lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. Baseline HIV-1 RNA >100 000 copies/mL was associated with virological rebound for ritonavir-boosted protease inhibitors but not for efavirenz or integrase inhibitors. Time to virological suppression >6 months was strongly associated with virological rebound for all regimens. Conclusions In HIV-1-infected patients starting cART, risk of virological rebound was lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. These data, from a very large observational cohort, in addition to the more rapid initial virological suppression obtained with integrase inhibitors, reinforce the positioning of this class as the preferred one for first-line therapy.
Collapse
Affiliation(s)
- François Raffi
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Matthieu Hanf
- INSERM CIC 1413, Nantes University Hospital, Nantes, France.,INSERM UMR 1181 B2PHI, Versailles Saint Quentin University, Institut Pasteur, Villejuif, France
| | - Tristan Ferry
- Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Lydie Khatchatourian
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Véronique Joly
- Infectious Diseases Department, Hôpital Bichat, AP-HP, Paris, France.,National Institute of Health and Medical Research (INSERM) IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France
| | - Christine Katlama
- Department of Infectious Diseases, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France.,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Unité Mixte de Recherche en Santé 1136, Inserm, Paris and Université Pierre et Marie Curie Paris 06, Sorbonne Universités, Paris, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Catherine Chirouze
- Infectious Diseases Department, University Hospital of Besançon, UMR CNRS 6249, University of Bourgogne-Franche Comté, Besançon, France
| | - Christine Jacomet
- Infectious Diseases Department, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Delobel
- INSERM, UMR1043, Toulouse and Université Toulouse III Paul Sabatier, Toulouse, France.,Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, Toulouse, France
| | - Isabelle Poizot-Martin
- Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Immuno-Hematology Clinic, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - Isabelle Ravaux
- Department of Infectious Diseases, Aix-Marseille University, APHM, Hôpital de La Conception, Marseille, France
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Centre, Paris, France.,Medical Centre of Pasteur Institut, Necker-Pasteur Infectiology Centre, Paris, France.,EA7327, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - David Rey
- Centre for HIV Infection Care, Strasbourg, France
| | - Jacques Reynes
- Infectious Diseases Department, UMI233 INSERM U1175, Montpellier University Hospital, Montpellier, France
| | - Thierry May
- Department of Infectious Diseases, University Hospital Centre, Nancy, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology Reims Teaching Hospitals, University of Reims, Reims, France
| | - Bruno Hoen
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Point-á-Pitre, France.,Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Marine Morrier
- Departement of Infectious Diseases, CHD Vendee, La Roche sur yon, France
| | - André Cabie
- Infectious Diseases Department, University Hospital of Martinique, Fort-de-France, France
| | - Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France.,INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | | |
Collapse
|
49
|
Cotte L, Cua E, Reynes J, Raffi F, Rey D, Delobel P, Gagneux-Brunon A, Jacomet C, Palich R, Laroche H, Cabie A, Hoen B, Chidiac C, Pradat P. Hepatitis C virus incidence in HIV-infected and in preexposure prophylaxis (PrEP)-using men having sex with men. Liver Int 2018; 38:1736-1740. [PMID: 29959866 DOI: 10.1111/liv.13922] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/22/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS HCV incidence still appears on the rise in HIV-infected MSM in France. We assessed the incidence of HCV infection in HIV-positive and in preexposure prophylaxis (PrEP)-using MSM. METHODS HIV-infected, HCV-negative MSM with serological follow-up in 2016 and HIV-negative, HCV-negative PrEP-using MSM enrolled from January 2016 to May 2017 in the French Dat'AIDS cohort were analyzed to assess the incidence of a primary HCV infection. The incidence of HCV reinfection was also determined in patients having cured a previous infection. RESULTS Among 10,049 HIV-infected MSM followed in 2016, 681 patients were already HCV-infected when entering the study (prevalence 6.8%). Serological follow-up was available in 2016 for 4,151 HCV-negative patients. Virological follow-up was available for 478 patients who had cured a previous infection. Fifty-seven HCV infections occurred in 2016 (42 primary infections, 15 reinfections). Incidence of primary HCV infection, reinfection and overall HCV infection was respectively 1.0, 3.1 and 1.2/100 person-years (PY). From January 2016 to May 2017, 930 HIV-negative subjects were enrolled for PrEP. Seventeen patients were already HCV-infected (prevalence 1.8%). Twelve HCV infections occurred during follow-up (10 primary infections, 2 reinfections) giving an incidence of primary infection of 1.0/100 PY and an overall incidence of 1.2/100 PY. CONCLUSIONS The overall incidence of HCV infection and of a primary HCV infection in HIV-positive and in PrEP-using MSM appeared similar in France in 2016-early 2017. HIV-positive and PrEP-using MSM probably share similar at-risk practices and both should be targeted for preventative interventions. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon
- INSERM U1052, Lyon
| | - Eric Cua
- Department of Infectious Diseases, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice, Nice
| | - Jacques Reynes
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Montpellier, Montpellier
- INSERM U1175, UMI 233, Université de Montpellier, Montpellier
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital, Centre Hospitalier Universitaire de Nantes, Nantes
- INSERM CIC 1413, Nantes
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg
| | - Pierre Delobel
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Toulouse, Toulouse
- INSERM, UMR1043, Toulouse
- Université Toulouse III Paul Sabatier, Toulouse
| | - Amandine Gagneux-Brunon
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne
| | - Christine Jacomet
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - Romain Palich
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris
| | - Hélène Laroche
- Service d'Immuno-Hématologie clinique, APHM Hôpital Sainte-Marguerite, Marseille
- Aix-Marseille University
- INSERM U912 (SESSTIM), Marseille
| | - André Cabie
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Martinique, Fort, de France
- Université des Antilles EA4537, Fort, de France
- INSERM CIC1424, Fort-de-France
| | - Bruno Hoen
- Service de Maladies Infectieuses et Tropicales, Dermatologie et Médecine Interne, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Pointe-à-Pitre
- INSERM CIC 1424, Pointe-à-Pitre
| | - Christian Chidiac
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon
- Université, Claude Bernard Lyon 1, Lyon
| | - Pierre Pradat
- Center for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
50
|
Nacher M, Adenis A, Huber F, Hallet E, Abboud P, Mosnier E, Bideau B, Marty C, Lucarelli A, Morel V, Lacapère F, Epelboin L, Couppié P. Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: Strategic information to reduce the proportion of undiagnosed infections. PLoS One 2018; 13:e0199267. [PMID: 29933374 PMCID: PMC6014655 DOI: 10.1371/journal.pone.0199267] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/22/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana. METHODS CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis. RESULTS The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (β = +3.7 years, P = 0.001), Surinamese (β = +4.2 years, P<0.0001), Haitian origins (β = +1.5 years, P = 0.049) but not for those originating from Guyana (β = -0.03 years, P = 0.9); Men independently had a longer interval than women (β = +3.5 years, P<0.0001). CONCLUSIONS Despite great efforts in French Guiana regarding HIV testing both in terms of diversification and intensification we still need to tailor the offer to better reach the communities in need. These results should help authorities scale up and optimize initiatives to reduce the proportion of patients who are unaware of their infection. They also raise the question of the role of stigma and discrimination as a barrier to HIV testing in small communities, and further emphasize the importance of reducing it.
Collapse
Affiliation(s)
- Mathieu Nacher
- Centre d’Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane (Coordination de la lutte contre le VIH), Centre Hospitalier de Cayenne, Cayenne, French Guiana
- * E-mail:
| | - Antoine Adenis
- Centre d’Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Florence Huber
- COREVIH Guyane (Coordination de la lutte contre le VIH), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Edouard Hallet
- COREVIH Guyane (Coordination de la lutte contre le VIH), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Philippe Abboud
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Emilie Mosnier
- Département des centres délocalisés de prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, Cayenne, French Guiana
| | - Bastien Bideau
- Département des centres délocalisés de prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, Cayenne, French Guiana
| | - Christian Marty
- Croix Rouge Française Centre Prévention Santé, Cayenne, French Guiana
| | - Aude Lucarelli
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Vanessa Morel
- COREVIH Guyane (Coordination de la lutte contre le VIH), Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Loïc Epelboin
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| |
Collapse
|