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Amele S, Peters L, Sluzhynska M, Yakovlev A, Scherrer A, Domingo P, Gerstoft J, Viard JP, Gisinger M, Flisiak R, Bhaghani S, Ristola M, Leen C, Jablonowska E, Wandeler G, Stellbrink H, Falconer K, D'Arminio Monforte A, Horban A, Rockstroh JK, Lundgren JD, Mocroft A. Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA. HIV Med 2019; 20:264-273. [PMID: 30734998 DOI: 10.1111/hiv.12711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy. METHODS Stages included in the continuum were as follows: anti-HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. RESULTS Numbers and percentages for the stages of the HCV continuum of care were as follows: anti-HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow-up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001). CONCLUSIONS In the proposed HCV continuum of care for HIV/HCV-coinfected individuals, we found major gaps at all stages, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.
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Affiliation(s)
- S Amele
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - L Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - M Sluzhynska
- Lviv Regional HIV/AIDS Prevention and Control CTR, Lviv, Ukraine
| | - A Yakovlev
- Medical Academy Botkin Hospital, St Petersburg, Russia
| | - A Scherrer
- University Hospital Zurich, Zurich, Switzerland
| | | | - J Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - J P Viard
- Assistance Publique-Hôpitaux de Paris, Hôtel-Dieu Hospital and Paris Descartes University, Paris, France
| | - M Gisinger
- Medical University Innsbruck, Innsbruck, Austria
| | - R Flisiak
- Department of Infectious Diseases and Hepatology, Medical University, Bialystok, Poland
| | - S Bhaghani
- Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, London, UK
| | - M Ristola
- Helsinki University Hospital, Helsinki, Finland
| | - C Leen
- Western General Hospital, Edinburgh, UK
| | - E Jablonowska
- Department of Infectious Diseases and Hepatology, Medical University, Lodz, Poland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - K Falconer
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - A Horban
- Warsaw Medical University & Hospital of Infectious Diseases, Warsaw, Poland
| | | | - J D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
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Avettand-Fénoël V, Mélard A, Gueudin M, Maillard A, Dina J, Gousset M, Chaix ML, Lerolle N, Viard JP, Meyer L, Plantier JC, Rouzioux C. Comparative performance of the Biocentric Generic Viral Load, Roche CAP/CTM v1.5, Roche CAP/CTM v2.0 and m2000 Abbott assays for quantifying HIV-1 B and non-B strains: Underestimation of some CRF02 strains. J Clin Virol 2018; 110:36-41. [PMID: 30530097 DOI: 10.1016/j.jcv.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND HIV-1 viral load testing is now recommended by the World Health Organization for every patient receiving antiretroviral therapy (ART). OBJECTIVES The objective of this study is to evaluate the performance of commercial assays for their ability to quantify HIV-1 strains currently circulating in France. STUDY DESIGN The performances of the Generic HIV-RNA assay from Biocentric were compared to those of the Roche CAP/CTM v1.5, Roche CAP/CTM v2.0 and Abbott m2000 RealTime HIV-1 assays. A total of 1885 HIV-1 plasma samples were tested, including 684 samples from patients included in the ANRS-Primo Cohort. RESULTS We found a good concordance of quantification between the Roche v2.0 and the Biocentric assays, both of which were superior to the Roche v1.5 assay. We show moderate agreement between techniques; however, CRF02_AG strains and undetermined viruses were underestimated when quantified with the Roche CAP/CTM v2.0. In contrast, a comparison of the Biocentric and Abbott assay results showed strong agreement between assays, indicating that both are well suited for quantification of CRF02_AG strains. Moreover, a 2% underestimation of the B subtypes was observed with the Biocentric assay. CONCLUSIONS These results have implications for viral load monitoring in Western Africa, where CRF02_AG strains are highly prevalent. Closer epidemiological surveillance and evaluation of commercial assays are still necessary to better evaluate the impact of the genetic evolution of circulating viruses on HIV-RNA quantification in the regions most affected by the HIV-1 epidemic.
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Affiliation(s)
- V Avettand-Fénoël
- Université Paris Descartes, EA 7327, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Necker, Paris, France
| | - A Mélard
- Université Paris Descartes, EA 7327, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Necker, Paris, France
| | - M Gueudin
- Normandie Université, UNIROUEN, EA2656 GRAM, CHU de Rouen, Laboratoire de virologie, F-76000, Rouen, France
| | - A Maillard
- Laboratoire de Virologie, Hôpital de Rennes, Rennes, France
| | - J Dina
- Université de Normandie, EA 2556, Hôpital de Caen, département de Virologie, Caen, France
| | - M Gousset
- Université Paris Descartes, EA 7327, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Necker, Paris, France
| | - M L Chaix
- INSERM UMR 942 Université Paris Diderot, Laboratoire de Virologie, APHP Hôpital Saint-Louis, Paris, France
| | - N Lerolle
- INSERM CESP U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - J P Viard
- Université Paris Descartes, EA 7327, Sorbonne Paris Cité, AP-HP, Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel Dieu, France
| | - L Meyer
- INSERM CESP U1018, Université Paris Sud, Le Kremlin Bicêtre, France
| | - J C Plantier
- Normandie Université, UNIROUEN, EA2656 GRAM, CHU de Rouen, Laboratoire de virologie, F-76000, Rouen, France
| | - C Rouzioux
- Université Paris Descartes, EA 7327, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Necker, Paris, France.
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Wastiaux A, Levine M, Viard J, Matheron S, Girard T. Transition des adolescents infectés par le VIH par transmission mère–enfant : évaluation à 10 ans d’un modèle créé dans une structure hospitalière ambulatoire pour adolescents/jeunes adultes. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Tubiana R, Mandelbrot L, Le Chenadec J, Delmas S, Rouzioux C, Hirt D, Treluyer JM, Ekoukou D, Bui E, Chaix ML, Blanche S, Warszawski J, Ngondi J, Chernai N, Teglas JP, Laurent C, Huyn P, Le Chenadec J, Delmas S, Warszawski J, Muret P, Baazia Y, Jeantils V, Lachassine E, Rodrigues A, Sackho A, Sagnet-Pham I, Tassi S, Breilh D, Iriard X, Andre G, Douard D, Reigadas S, Roux D, Louis I, Morlat P, Pedebosq S, Barre J, Estrangin E, Fauveau E, Garrait V, Ledudal P, Pichon C, Richier L, Thebault A, Touboul C, Bornarel D, Chambrin V, Clech L, Dubreuil P, Foix L'helias L, Picone O, Schoen H, Stralka M, Crenn-Hebert C, Floch-Tudal C, Hery E, Ichou H, Mandelbrot L, Meier F, Tournier V, Walter S, Chevojon P, Devidas A, Granier M, Khanfar-boudjemai M, Malbrunot C, Nguyen R, Ollivier B, Radideau E, Turpault I, Jault T, Barrail A, Colmant C, Fourcade C, Goujard C, Pallier C, Peretti D, Taburet AM, Bocket L, D'angelo S, Godart F, Hammou Y, Houdret N, Mazingue F, Thielemans B, Brochier C, Cotte L, Januel F, Le Thi T, Gagneux MC, Bozio A, Massardier J, Kebaïli K, Ben AK, Heller-Roussin B, Riehl C, Roos S, Taccot F, Winter C, Arias J, Brunet-François C, Dailly E, Flet L, Gournay V, Mechinaud F, Reliquet V, Winner N, Peytavin G, Bardin C, Boudjoudi N, Compagnucci A, Guerin C, Krivine A, Pannier E, Salmon D, Treluyer JM, Firtion G, Ayral D, Ciraru-Vigneron N, Mazeron MC, Rizzo Badoin N, Trout H, Benachi A, Boissand C, Bonnet D, Boucly S, Blanche S, Chaix ML, Duvivier C, Parat S, Cayol V, Oucherif S, Rouzioux C, Viard JP, Bonmarchand M, De Montgolfier I, Dommergues M, Fievet MH, Iguertsira M, Pauchard M, Quetin F, Soulie C, Tubiana R, Faye A, Magnier S, Bui E, Carbonne B, Daguenel Nguyen A, Harchi N, Meyohas MC, Poirier JM, Rodriguez J, Hervé F, Pialloux G, Dehee A, Dollfus C, Tillous Borde I, Vaudre G, Wallet A, Allemon MC, Bolot P, Boussairi A, Chaplain C, Ekoukou D, Ghibaudo N, Kana JM, Khuong MA, Weil M, Entz-Werle N, Livolsi Lutz P, Beretz L, Cheneau M, Partisani ML, Schmitt MP, Acar P, Armand E, Berrebi A, Guibaud Plo C, Lavit M, Nicot F, Tricoire J, Ajana F, Huleux T. Lopinavir/Ritonavir Monotherapy as a Nucleoside Analogue–Sparing Strategy to Prevent HIV-1 Mother-to-Child Transmission: The ANRS 135 PRIMEVA Phase 2/3 Randomized Trial. Clin Infect Dis 2013; 57:891-902. [DOI: 10.1093/cid/cit390] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Touzot M, Pillebout E, Matignon M, Tricot L, Viard JP, Rondeau E, Legendre C, Glotz D, Delahousse M, Lang P, Peraldi MN. Renal transplantation in HIV-infected patients: the Paris experience. Am J Transplant 2010; 10:2263-9. [PMID: 20840478 DOI: 10.1111/j.1600-6143.2010.03258.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Kidney transplantation is now considered as a reasonable option for HIV-infected patients with end-stage renal disease. We describe here a retrospective study conducted in five transplantation centers in Paris. Twenty-seven patients were included. Immunosuppressive protocol associated an induction therapy and a long-term treatment combining mycophenolate mofetil, steroids and either tacrolimus or cyclosporine. All the patients had protocol biopsies at 3 months and 1 year. Patient's survival was 100% at 1 year and 98% at 2 years. Graft survival at 1 and 2 years is 98% and 96% at 1 and 2 years, respectively. The mean glomerular filteration rate values at 12 and 24 months were 60.6 mL/min/1.73 m² (range 23-98) and 65.4 mL/min/1.73 m² (range 24-110), respectively. Acute cellular rejection was diagnosed in four cases (15%). Because of high trough levels of calcineurin inhibitor, protease-inhibitor therapies were withdrawn in 11 cases. HIV disease progression was not observed. One patient developed B-cell lymphoma. In conclusion, our study confirms the safety of renal transplantation in HIV-infected patients with few adverse events and a low incidence of acute rejection.
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Affiliation(s)
- M Touzot
- Service de Néphrologie, Université Denis Diderot-Paris VII, Hôpital Saint Louis, Paris, France
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Duchet-Niedziolka P, Launay O, Coutsinos Z, Ajana F, Arlet P, Barrou B, Beytout J, Bouchaud O, Brouqui P, Buzyn A, Chidiac C, Couderc LJ, Debord T, Dellamonica P, Dhote R, Duboust A, Durrbach A, Fain O, Fior R, Godeau B, Goujard C, Hachulla E, Marchou B, Mariette X, May T, Meyer O, Milpied N, Morlat P, Pouchot J, Tattevin P, Viard JP, Lortholary O, Hanslik T. Vaccination in adults with auto-immune disease and/or drug related immune deficiency: results of the GEVACCIM Delphi survey. Vaccine 2009; 27:1523-9. [PMID: 19168104 DOI: 10.1016/j.vaccine.2009.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/09/2008] [Accepted: 01/07/2009] [Indexed: 11/17/2022]
Abstract
INTRODUCTION There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. METHODS A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts' opinion and level of agreement were evaluated. RESULTS The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3-6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was "very good" for eleven, and "good" for the remaining three. CONCLUSION Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.
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Affiliation(s)
- P Duchet-Niedziolka
- Université Paris Descartes, Faculté de Médecine; AP-HP, Groupe Hospitalier Cochin Saint-Vincent de Paul, Pôle de Médecine, CIC de Vaccinologie Cochin-Pasteur; INSERM, CIC BT505, Paris, France
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7
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Lanternier F, Boutboul D, Menotti J, Chandesris MO, Sarfati C, Mamzer Bruneel MF, Calmus Y, Mechaï F, Viard JP, Lecuit M, Bougnoux ME, Lortholary O. Microsporidiosis in solid organ transplant recipients: two Enterocytozoon bieneusi cases and review. Transpl Infect Dis 2008; 11:83-8. [PMID: 18803616 DOI: 10.1111/j.1399-3062.2008.00347.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Microsporidiosis first came to prominence as an opportunistic infection in patients with acquired immunodeficiency syndrome. Microsporidia are now emerging pathogens responsible for severe diarrhea during solid organ transplantation. Two main clinical entities can be identified: infection by Enterocytozoon bieneusi, causing diarrhea with limited treatment options; and infection by Encephalitozoon intestinalis, which may disseminate and usually responds to albendazole treatment. We describe here 2 cases of microsporidiosis caused by E. bieneusi in a renal and a liver transplant recipient, respectively, in whom complete clinical efficacy of a short course of fumagillin therapy was obtained. Long-term microbiological eradication was assessed using classical methods and monitored using a real-time quantitative polymerase chain reaction-based method. Both patients experienced drug-induced thrombocytopenia, which resolved after withdrawal of the treatment. We also review the 18 other previously reported cases of microsporidiosis in transplant recipients. In case of persistent diarrhea in solid organ transplant patients, microsporidiosis should be considered. Based on the present experience, treating E. bieneusi infection with 7 days of fumagillin therapy is adequate to eradicate E. bieneusi in this context.
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Affiliation(s)
- F Lanternier
- Centre d'Infectiologie Necker-Pasteur, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Université Paris Descartes, Paris, France
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Schmulewitz L, Chandesris MO, Mainardi JL, Poirée S, Viard JP, Lecuit M, Mamzer-Bruneel MF, Lortholary O. Invasive Pasteurella multocida sinusitis in a renal transplant patient. Transpl Infect Dis 2008; 10:206-8. [PMID: 17655653 DOI: 10.1111/j.1399-3062.2007.00270.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pasteurella are commensal gram-negative bacteria isolated from the oral cavity of many domesticated animals. Most human infections occur post animal bite or scratch injury resulting in local cutaneous infection; however, case reports suggest that transmission may occur via animal secretions. Pasteurella species can be associated with serious systemic infections particularly in those with underlying disease and in the immunocompromised. We present a case of invasive Pasteurella multocida sinusitis in an immunocompromised renal transplant patient most likely acquired from a pet dog through direct mucosal inoculation via licking.
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Affiliation(s)
- L Schmulewitz
- Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Université Paris V, René Descartes, Paris, France
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Abstract
As tolerance not only depends on protease inhibitors (PI) dosing but also on their trough concentrations, the enhanced exposure associated with PI boosting goes together with a reduced tolerance, especially at the biological level. Moreover, the toxicity associated with the low doses ritonavir used in boosting seems to compromise, at least partly, the favourable metabolic profile of certain PI. Eventually, boosted lopinavir tolerance is similar to that of other PI. Even if the advantage/risk ratio of lopinavir or other boosted PI globally seems favourable, the final choice belongs to the physician in charge of evaluating the individual risk of a lesser, especially metabolic tolerance, for his or her patient.
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Affiliation(s)
- J P Viard
- Service des maladies infectieuses, hôpital Necker-enfants malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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Costagliola D, Potard V, Duvivier C, Pradier C, Dupont C, Salmon D, Duval X, Billaud E, Boué F, Costagliola D, Duval X, Duvivier C, Enel P, Fournier S, Gasnault J, Gaud C, Gilquin J, Grabar S, Khuong MA, Lang JM, Mary-Krause M, Matheron S, Meyohas MC, Pialoux G, Poizot-Martin I, Pradier C, Rouveix E, Salmon-Ceron D, Sobel A, Tattevin P, Tissot-Dupont H, Yasdanpanah Y, Aronica E, Tirard-Fleury V, Tortay I, Abgrall S, Costagliola D, Grabar S, Guiguet M, Lanoy E, Leneman H, Lièvre L, Mary-Krause M, Potard V, Saidi S, Matheron S, Vildé JL, Leport C, Yeni P, Bouvet E, Gaudebout C, Crickx B, Picard-Dahan C, Weiss L, Tisne-Dessus D, Tarnier-Cochin GH, Sicard D, Salmon D, Gilquin J, Auperin I, Viard JP, Roudière L, Boué F, Fior R, Delfraissy JF, Goujard C, Lesprit P, Jung C, Meyohas MC, Meynard JL, Picard O, Desplanque N, Cadranel J, Mayaud C, Pialoux JF, Rozenbaum W, Bricaire F, Katlama C, Herson S, Simon A, Decazes JM, Molina JM, Clauvel JF, Gerard L, Widal GHLF, Sellier P, Diemer M, Dupont C, Berthé H, Saïag P, Mortier E, Chandemerle C, de Truchis P, Bentata M, Honoré P, Tassi S, Jeantils V, Mechali D, Taverne B, Laurichesse H, Gourdon F, Lucht JF, Fresard A, de Dijon C, de Belfort CH, Faller JP, Eglinger P, Bazin C, Verdon R, de Grenoble C, de Lyon C, Peyramond D, Boibieux A, Touraine JL, Livrozet JM, Trepo C, Cotte L, Ravaux I, Tissot-Dupont H, Delmont JP, Moreau J, Gastaut JA, Poizot-Martin I, Soubeyrand J, Retornaz F, Blanc PA, Allegre T, Galinier A, Ruiz JM, d'Arles CH, d'Avignon CH, Lepeu G, Granet-Brunello P, Pelissier L, Esterni JP, de Martigues CH, Nezri M, Cohen-Valensi R, Laffeuillade A, Chadapaud S, de Nîmes JRCHG, May T, Rabaud C, Raffi F, Billaud E, Pradier C, Pugliese P, Michelet C, Arvieux C, Caron F, Borsa-Lebas F, Lang JM, Rey D, de Mulhouse PFCH, Massip P, Cuzin L, Arlet-Suau E, Legrand MFT, Rangueil CHU, de Tourcoing CH, Yasdanpanah Y, Sobesky M, Pradinaud R, Gaud C, Contant M. Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals. Antivir Ther 2005. [DOI: 10.1177/135965350501000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs). Design Cohort study. Setting: French Hospital Database on HIV. Patients Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml. Main outcome measures Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline. Results The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk. Conclusions The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.
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Affiliation(s)
| | | | - Valérie Potard
- INSERM U720, Université Pierre et Marie Curie, Paris, France
| | - Claudine Duvivier
- INSERM U720, Université Pierre et Marie Curie, Paris, France
- CHU Pitié-Salpétrière, AP-HP, Paris, France
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- Hôpital Bichat-Claude Bernard
| | | | | | | | | | - L Weiss
- Hôpital Européen Georges Pompidou
| | | | | | - D Sicard
- Hôpital Européen Georges Pompidou
| | - D Salmon
- Hôpital Européen Georges Pompidou
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Mocroft A, Ledergerber B, Viard JP, Staszewski S, Murphy M, Chiesi A, Horban A, Hansen ABE, Phillips AN, Lundgren JD. Time to Virological Failure of 3 Classes of Antiretrovirals after Initiation of Highly Active Antiretroviral Therapy: Results from the EuroSIDA Study Group. J Infect Dis 2004; 190:1947-56. [PMID: 15529259 DOI: 10.1086/425424] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Accepted: 06/04/2004] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to determine the prevalence and incidence of virological triple drug-class failure (TCF) and to summarize the clinical outcome for patients who started receiving highly active antiretroviral therapy (HAART). METHODS The present study is an observational longitudinal study of 3496 treatment-experienced (TE) and treatment-naive (TN) patients monitored from the time they started receiving HAART (baseline) until TCF occurred (as determined on the basis of viral loads), until AIDS was newly diagnosed, or until death. RESULTS Four hundred forty-five patients (12.7%) had TCF; 370 (16.6%) of 2230 patients were TE, and 75 (5.9%) of 1266 patients were TN. At 6 years after starting HAART, 21.4% of TE and 11.2% of TN patients had TCF (P<.0001). The prevalence of TCF at or after 2002 was 15.5% in TE patients and 4.8% in TN patients. TN patients had a 32% annual increase in the incidence of TCF (95% confidence interval [CI], 14%-54%; P<.0001); at 5 years after starting HAART, the rate was comparable for TE and TN patients (3.3 and 3.4 cases/100 person-years of follow-up [PYFU], respectively). The incidence of new cases of AIDS or death was 2.7 cases/100 PYFU in patients who did not experience TCF and 5.0 cases/100 PYFU in patients who did experience TCF, an estimated 36% increase with each category of TCF (95% CI, 19%-56%; P<.0001). CONCLUSION The prevalence of TCF was low after patients started receiving HAART, particularly among TN patients. Despite the influx of patients who had started receiving HAART more recently, the prevalence of TCF increased over calendar time. Patients with TCF had a higher incidence of newly diagnosed AIDS or death. Treatment of patients with TCF deserves further investigation.
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Affiliation(s)
- A Mocroft
- Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College London Medical Schools, London, United Kingdom.
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Viard JP. [Lipodystrophy syndrome of patients infected by HIV receiving antiretroviral treatment]. Journ Annu Diabetol Hotel Dieu 2003:111-23. [PMID: 12868306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- J P Viard
- Service d'Immunologie Clinique, Hôpital Necker, Paris, France
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Abstract
PURPOSE Castleman's disease is a polyclonal lymphoplasmacytic and vascular proliferation prominant in lymphoid tissues. It is associated with lymph node enlargement, hepatosplenomegaly and fever. This manifestations could be secondary to hyperproduction of interleukin 6. The prognosis is poor. The opportunistic infections which are characteristic of severe HIV infection worsen the prognosis. Prolonged monochemotherapy with vinblastine or etoposide can control Castleman's disease. CURRENT KNOWLEDGE AND KEY POINTS Recent advances in human herpesvirus 8 (HHV8) knowledge and its predominance in the forms which are linked to the HIV seropositivity have partly explained the clinical manifestations of Castleman's disease. Indeed, HHV8 produce an homologous interleukin 6, the vIL-6, responsible for lymphoplasmacytic proliferation. The presence of other homologues of human cytokines produced by HHV8 could contribute to lymphoplasmacytosis and to endothelial proliferation. FUTURE AND PROSPECTS Taking into account this viral origin, alpha interferon could be an alternative in forms which are less progressive. However, antiviral therapy against HHV8 or HIV and the immunitary restoration do not have any influence on the evolution of Castleman's disease, contrary to opportunistic infections.
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Affiliation(s)
- L Aaron
- Service de maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France
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Weiss L, Burgard M, Cahen YD, Chaix ML, Laureillard D, Gilquin J, Piketty C, Viard JP, Kazatchkine MD, Girard PM, Rouzioux C. Immunological and virological features of HIV-infected patients with increasing CD4 cell numbers despite virological failure during protease inhibitor-based therapy. HIV Med 2002; 3:12-20. [PMID: 12059946 DOI: 10.1046/j.1464-2662.2001.00095.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the extent of functional T cell recovery and to characterize plasma virus and virus producing cells in patients with increasing CD4 cell counts despite virological failure during protease inhibitor (PI) based therapy. METHODS The study group included 13 patients who were treated for at least 12 months with a PI based regimen and were selected on the basis of a sustained immunological response (increase of > 70 CD4 cells/microL) despite virological failure (< 1 log10 copies/mL decrease in HIV-1 RNA plasma levels). RESULTS Compared to a historical series of 11 complete responders with less advanced disease, the proportion of memory CD4 T cells was significantly higher (67.8+/-17.8 vs. 52.8+/-11.0; P=0.045) and the proportion of naive CD4 T cells significantly lower (30.5+/-14.8 vs. 45.0+/-10.4, P=0.021) in patients who were immunological responders/virological nonresponders. In those patients, ongoing viral replication was associated with a strong activation of circulating CD8 T lymphocytes; interleukin-2 production remained decreased. CD4 T cell reactivity to cytomegalovirus proteins was observed in nine of 11 patients tested. In the study group, the proportion of infectious virus present in plasma as well as the levels of intracellular viral replication were similar to those measured in untreated patients. Virological failure in this group of patients probably resulted from pre-existing mutations in the reverse transcriptase gene. CONCLUSIONS This study of patients with increasing CD4 cell numbers despite virological failure shows the persistence of immune activation and partial immune restoration with no evidence of specific viral dynamics in vivo.
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Affiliation(s)
- L Weiss
- Service d'Immunologie Clinique, Université Pierre et Marie Curie and Institut National de la Santé et de la Recherche Médicale (INSERM) U430, Hôpital Européen Georges Pompidou, Paris, France.
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Gougeon ML, Rouzioux C, Liberman I, Burgard M, Taoufik Y, Viard JP, Bouchenafa K, Capitant C, Delfraissy JF, Levy Y. Immunological and virological effects of long term IL-2 therapy in HIV-1-infected patients. AIDS 2001; 15:1729-31. [PMID: 11546950 DOI: 10.1097/00002030-200109070-00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the long-term outcome of 27 HIV-infected patients treated for over 3 years with IL-2 and binucleoside analogues. These patients experienced a sustained increase in CD4 cells and a decrease of proviral DNA with infrequent IL-2 cycles. In three cases, virus could not be isolated from activated peripheral cells. A high frequency of HIV-1-specific memory CD4 T cells was found in the patients studied. IL-2 maintains specific effector cells and reduces the pool of infected cells in patients, albeit treated only with binucleosides.
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Affiliation(s)
- M L Gougeon
- Département SIDA et Rétrovirus, Institut Pasteur, Paris, France
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Rakotoambinina B, Médioni J, Rabian C, Jubault V, Jais JP, Viard JP. Lipodystrophic syndromes and hyperlipidemia in a cohort of HIV-1-infected patients receiving triple combination antiretroviral therapy with a protease inhibitor. J Acquir Immune Defic Syndr 2001; 27:443-9. [PMID: 11511820 DOI: 10.1097/00126334-200108150-00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the frequency and features of lipodystrophic syndromes in HIV-1-infected patients receiving highly active antiretroviral therapy (HAART) with a protease inhibitor (PI), and examine whether clinical and biologic abnormalities are always associated in these conditions. METHODS Retrospective-prospective single-center observational study of 175 patients. Comparisons for continuous variables by t-test and paired t-test, and Kaplan-Meier analysis of time to onset of lipodystrophy were performed. RESULTS In all, 51 patients (29%) had morphologic changes, after a mean HAART duration of 20.0 +/- 6.1 months, and were categorized into pure lipoatrophy (n = 16), mixed syndrome (truncal fat accumulation and face or limb lipoatrophy) (n = 30) or pure truncal fat accumulation (n = 5). Because of the small number, the latter group was not analyzed statistically. No differences were found among patients with lipoatrophy, mixed syndrome, or no lipodystrophy, in terms of gender, CD4 count, and HIV RNA plasma load at time of HAART initiation, nor in response to treatment. Patients with a mixed syndrome were older. Patients with lipoatrophy had longer duration of HIV disease, pre-HAART exposure to nucleoside analog therapy, and HAART. Baseline and pre-HAART fasting triglyceride levels were higher in patients who developed lipoatrophy, whereas weight and fasting cholesterol were higher in patients who developed a mixed syndrome. After 12 and 24 months on HAART, triglycerides and cholesterol rose significantly in all patients, independently of lipodystrophy, whereas these parameters were not increased during nucleoside analog therapy. CONCLUSIONS Nucleoside analog exposure appears as a risk factor for lipoatrophy. Age and nutritional status (reflected by baseline weight, triglycerides and cholesterol) may influence the evolution to lipoatrophy or a mixed syndrome. Hyperlipidemia is observed in the absence of lipodystrophy and depends on PI exposure.
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Affiliation(s)
- B Rakotoambinina
- Service d'Immunologie Clinique, Hôpital Necker, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Kirk O, Mocroft A, Pradier C, Bruun JN, Hemmer R, Clotet B, Miller V, Viard JP, Phillips AN, Lundgren JD. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir. AIDS 2001; 15:999-1008. [PMID: 11399982 DOI: 10.1097/00002030-200105250-00008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow-up within the EuroSIDA study. METHODS Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical progression (new AIDS/death). Adjustment was made for differences in baseline parameters, in particular pVL, CD4 cell count, and region of Europe. RESULTS A total of 2708 patients (median follow-up: 30 months) were included, of which 556 started ritonavir (21%), 1342 indinavir (50%), and 810 saquinavir hgc (30%). The three groups were fairly evenly balanced at baseline regarding CD4 count, previous diagnosis of AIDS and pVL, After 12 months, the median changes in CD4 cell count were 90, 96 and 74 x 10(6) cells/l, respectively;P < 0.001, the proportions of patients with pVL < 500 copies/ml were 47, 54 and 41%; P < 0.001, and the proportions with clinical progression were 11.9, 9.2 and 11.9%, respectively; P = 0.20 (log-rank test). In multivariate models the relative risk of clinical progression for indinavir compared with saquinavir hgc was: 0.77 (0.60--0.99); P = 0.043, and for ritonavir 0.83 (0.62--1.11); P = 0.20. CONCLUSIONS Saquinavir hgc was associated with an inferior long-term clinical response relative to indinavir, which was consistent with the observed differences in virological and immunological responses.
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Affiliation(s)
- O Kirk
- EuroSIDA Coordinating Centre, Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
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Viard JP, Mocroft A, Chiesi A, Kirk O, Røge B, Panos G, Vetter N, Bruun JN, Johnson M, Lundgren JD. Influence of age on CD4 cell recovery in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy: evidence from the EuroSIDA study. J Infect Dis 2001; 183:1290-4. [PMID: 11262215 DOI: 10.1086/319678] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2000] [Revised: 01/18/2001] [Indexed: 11/03/2022] Open
Abstract
Influence of age on the CD4 cell response to highly active antiretroviral therapy (HAART) was examined in 1956 patients (median age, 37.2 years) in the EuroSIDA study. Median initial CD4 cell count was 192x106 cells/L, follow-up was 31 months, and time to maximum CD4 cell response was 20 months. Age groups were not different for baseline CD4 cell count, baseline human immunodeficiency virus RNA load, or treatment history. CD4 cell increase, stratified by age quartiles, differed during months 3-36 of HAART (P=.023). Maximum CD4 cell increase from start of HAART differed by age group (P=.0003), as did maximum CD4 cell count (P<10-4). Multivariate analysis confirmed the inverse relationship between age and maximum CD4 cell response (P=.023). Time to a CD4 increase of >200x106 cells/L was shorter for patients in the younger age groups (P=.0026), as confirmed by multivariate analysis (P<10-4). Younger age may favor CD4 cell restoration because of preserved thymic function.
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Affiliation(s)
- J P Viard
- Service d'Immunologie Clinique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, Paris, France.
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Jubault V, Penfornis A, Schillo F, Hoen B, Izembart M, Timsit J, Kazatchkine MD, Gilquin J, Viard JP. Sequential occurrence of thyroid autoantibodies and Graves' disease after immune restoration in severely immunocompromised human immunodeficiency virus-1-infected patients. J Clin Endocrinol Metab 2000; 85:4254-7. [PMID: 11095463 DOI: 10.1210/jcem.85.11.6988] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We analyzed the kinetics of CD4 cells, human immunodeficiency virus (HIV) viral load, and autoantibodies in acquired immune deficiency syndrome patients with Graves' disease (GD) after immune restoration on highly active antiretroviral therapy (HAART; retrospective study). Five patients (median age, 41 yr) were diagnosed with GD after 20 (range, 14-22) months on HAART on the basis of clinical and biological hyperthyroidism, diffuse hyperfixation of thyroid scan, and the presence of anti-TSH receptor (anti-TSHR) antibodies (Ab). GD was diagnosed several months after the plasma HIV ribonucleic acid load became undetectable, when the CD4+ cell count had risen from 14 (range, 0-62) to 340 (range, 163-460) x 10(6) cells/L. Antithyroid peroxidase (anti-TPO) and anti-TSHRAb appeared 14 (range, 9-18) and 14 (range, 11-20) months after starting HAART and 12 (range, 6-15) and 11 (range, 9-17) months after the increase in CD4+ cells. In 3 patients, TPOAb preceded TSHRAb by 3-10 months. No other autoantibodies were detected. Thyroid antibodies were absent in a group of 55 HIV-1-positive patients with comparable response to HAART and no symptoms of hyperthyroidism (cross-sectional study). Thyroid-specific autoimmunity can occur upon immune restoration with HAART. Our observations suggest a relationship between thymus-dependent immune reconstitution after immunosuppression and autoimmunity and may provide insight into the pathophysiology of GD.
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Affiliation(s)
- V Jubault
- Service d'Immunologie Clinique, Hôpital Necker, Paris, France
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Zylberberg H, Nalpas B, Pol S, Bréchot C, Viard JP. Is there a relationship between hepatitis C virus infection and antiretroviral-associated lipoatrophy? AIDS 2000; 14:2055. [PMID: 10997414 DOI: 10.1097/00002030-200009080-00025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Jubault V, Pacanowski J, Rabian C, Viard JP. Interruption of prophylaxis for major opportunistic infections in HIV-infected patients receiving triple combination antiretroviral therapy. Ann Med Interne (Paris) 2000; 151:163-8. [PMID: 10896967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
UNLABELLED Interruption of prophylaxis for major opportunistic infections in HIV-infected patients receiving triple combination antiretroviral therapy. OBJECTIVE To determine whether HIV-infected patients receiving highly active antiretroviral therapy (HAART) and recovering a CD4 cell number above 200x10(6)/l may safely discontinue primary and secondary prophylaxes for major opportunistic infections. DESIGN Retrospective study of a single-center, prospectively constituted cohort of 223 patients receiving HAART with a protease inhibitor, of whom 137 received at least one prophylaxis. METHODS Exhaustive informations on prophylaxis use, clinical and laboratory data were used to produce descriptive statistics on infectious events, duration of HIV infection, time on HAART, time to prophylaxis interruption, length of follow-up and biological values at relevant time points. RESULTS Fifty-one patients with a history of severe immunodepression (median CD4 nadir: 62x10(6)/l), including 16 patients with CDC stage C infection, discontinued at least one prophylaxis. Primary or secondary P. carinii pneumonia prophylaxis was discontinued in 43 patients: 1 first episode of PCP occurred after 2 months but no other episode was recorded after a median follow-up of 16 months. Toxoplasmosis primary or secondary prophylaxis, secondary cytomegalovirus prophylaxis and primary or secondary M. avium complex prophylaxes were discontinued in respectively 37, 5 and 5 patients, and no event was recorded after respective follow-ups of 16, 7 and 15 months. Nine secondary and 2 primary acyclovir prophylaxes were discontinued, and two events were observed after 1 and 19 months; no other event was noted after a follow-up of 22 months. CONCLUSION Prophylaxis for opportunistic infections could be safely interrupted in most of these severely immunodeficient patients recovering a CD4 cell count above 200x10(6)/l on HAART. This confirms the efficiency of immune restoration and is beneficial to patients but, since 3 infectious events were recorded, caution should be taken before making a decision based on immunological and virological considerations.
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Affiliation(s)
- V Jubault
- Service d'Immunologie Clinique, Hôpital Necker, 149-161, rue de Sèvres, 75743 Paris Cedex 15, France
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Hennequin C, Kauffmann-Lacroix C, Jobert A, Viard JP, Ricour C, Jacquemin JL, Berche P. Possible role of catheters in Saccharomyces boulardii fungemia. Eur J Clin Microbiol Infect Dis 2000; 19:16-20. [PMID: 10706174 DOI: 10.1007/s100960050003] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Four cases of Saccharomyces boulardii fungemia, a very rare side effect of Saccharomyces boulardii therapy, are reported. The clinical impact of Saccharomyces boulardii infection appeared to be moderate. However, even though organ involvement was never demonstrated, septic shock with no other etiology was observed in one of our patients. All patients had an indwelling vascular catheter. Contamination of the air, environmental surfaces, and hands following the opening of a packet suggests that catheter contamination may have been a source of infection. To prevent catheter contamination it is recommended that packets or capsules of Saccharomyces boulardii be opened with gloves, outside the patient's room.
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Affiliation(s)
- C Hennequin
- Service de Microbiologie, Hôpital Necker-Enfants Malades, Paris, France
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Mocroft A, Madge S, Johnson AM, Lazzarin A, Clumeck N, Goebel FD, Viard JP, Gatell J, Blaxhult A, Lundgren JD. A comparison of exposure groups in the EuroSIDA study: starting highly active antiretroviral therapy (HAART), response to HAART, and survival. J Acquir Immune Defic Syndr 1999; 22:369-78. [PMID: 10634199 DOI: 10.1097/00126334-199912010-00008] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concerns have been raised that intravenous drug users may be less likely to start highly active antiretroviral therapy (HAART) and that adherence to therapy may be poor among this group of patients. Given the decreased mortality and incidence of AIDS-defining illnesses among patients with HIV who start HAART, this may lead to a poorer prognosis among intravenous drug users. PURPOSE To compare homosexual men, intravenous drug users, and heterosexuals in EuroSIDA, a prospective European cohort of 7331 patients with HIV in terms of starting a HAART treatment regimen, immunologic and virologic response to therapy, and survival. METHODS 6645 patients were included in this analysis. Logistic regression and Cox proportional hazards models were used to investigate the factors associated with use of HAART regimens and survival following recruitment to the EuroSIDA study. RESULTS In a multivariate logistic regression model, intravenous drug users were significantly less likely to be receiving HAART at recruitment to EuroSIDA (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.37-0.62; p<.0001) when compared with homosexual men. Similarly, during follow-up, intravenous drug users were at a 27% reduced risk of starting HAART, after adjustment for other factors related to starting HAART (relative hazard [RH], 0.73; 95% CI, 0.64-0.82; p<.0001). There were no differences between heterosexual and homosexual patients, and similar results were found within regions of Europe (South, Central and Northern). Among those patients who started HAART, there were no significant differences between exposure groups in CD4 lymphocyte count response to HAART or virologic response to HAART. After adjustment for factors related to survival, intravenous drug users were at a small, but nonsignificant increased risk of death compared with homosexuals (RH 1.16; 95% CI, 0.99-1.38; p = .074). CONCLUSIONS Intravenous drug users were significantly less likely to start HAART, but among those who did, response to therapy was similar to that of other exposure groups. There were no differences in risk of death. If intravenous drug users continue to use HAART less commonly than other exposure groups, it may result in a poorer prognosis, a different spectrum of AIDS-defining illnesses, and differential long-term clinical needs.
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Affiliation(s)
- A Mocroft
- Royal Free Centre for HIV Medicine, Royal Free and University College Medical School, London, England.
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Levy Y, Capitant C, Houhou S, Carriere I, Viard JP, Goujard C, Gastaut JA, Oksenhendler E, Boumsell L, Gomard E, Rabian C, Weiss L, Guillet JG, Delfraissy JF, Aboulker JP, Seligmann M. Comparison of subcutaneous and intravenous interleukin-2 in asymptomatic HIV-1 infection: a randomised controlled trial. ANRS 048 study group. Lancet 1999; 353:1923-9. [PMID: 10371571 DOI: 10.1016/s0140-6736(98)07345-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intermittent interleukin-2 therapy for HIV-1 by continuous intravenous infusion leads to sustained increase of CD4 T cells. This method of administration is, however, inconvenient and has limiting toxic effects. We did a randomised study to compare safety and efficacy of antiviral treatment alone or combined with various interleukin-2 regimens in HIV-1-infected patients. METHODS 94 symptom-free patients, naïve to antiretroviral treatment, with CD4-T-cell counts of 250-550 cells/microL at baseline were randomly assigned zidovudine and didanosine alone (n=26) or combined with interleukin-2 administered intravenously (12 million IU/day, n=22) or subcutaneously (3 million IU/m2 twice daily, n=24) for 5 days, or were given polyethylene-glycol-modified (PEG) interleukin-2 (2 million IU/m2 intravenous bolus, n=22) administered every 2 months from week 2 to week 50 (seven cycles). Safety and immunological and virological results were monitored until week 56. FINDINGS CD4-T-cell count increased to higher than baseline by a mean of 564 cells/microL (subcutaneous group), 676 cells/microL (intravenous group), 105 cells/microL (PEG group), and 55 cells/microL (antiretroviral-therapy group, p=0.0001). 68% and 77% of patients in the subcutaneous and intravenous groups, respectively, achieved an 80% increase of CD4 T cells (p<0.001). In these two groups, 50% of patients restored a CD4/CD8-T-cell ratio of more than 1. The groups did not differ significantly for changes in plasma HIV-1 RNA loads throughout the study. The duration of common side-effects of interleukin-2 was shorter in the subcutaneous group, which enabled outpatient treatment. Naïve and memory CD4 T cells, CD28 expression on CD4 and CD8 T cells, and restoration of in-vitro proliferative response to mitogens and recall antigens increased in the intravenous and subcutaneous groups. INTERPRETATION Subcutaneous interleukin-2 is a convenient regimen that, as well as intravenous therapy, improves immunological function in HIV-1-infected patients receiving two nucleosides. Larger studies are needed to show whether immunological improvements translate into clinical benefit.
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Affiliation(s)
- Y Levy
- Unité d'Immunologie clinique, Hôpital Henri Mondor, Creteil, France.
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Dupin N, Rubin De Cervens V, Gorin I, Calvez V, Pessis E, Grandadam M, Rabian C, Viard JP, Huraux JM, Escande JP. The influence of highly active antiretroviral therapy on AIDS-associated Kaposi's sarcoma. Br J Dermatol 1999; 140:875-81. [PMID: 10354025 DOI: 10.1046/j.1365-2133.1999.02818.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To assess the clinical and biological benefit of highly active antiretroviral therapy on AIDS-associated Kaposi's sarcoma (KS), 13 patients with AIDS-associated Kaposi's sarcoma (five pulmonary KS and eight cutaneous KS) were prospectively followed for a mean duration of 12 months. Six patients were treated with specific anti-KS chemotherapy before or simultaneously with the introduction of antiretroviral therapy. Clinical response was assessed according to the AIDS Clinical Trial Group (ACTG) criteria. CD4 cell counts, plasma HIV-1 RNA and human herpesvirus 8 (HHV-8) viraemia were measured at baseline and at different points. Among patients with pulmonary KS, we observed three complete responses (CR), one partial response (PR) and one progression. The median survival time after the diagnosis of pulmonary KS was 15 months with a median duration of the response after the discontinuation of specific chemotherapy for KS of 8 months. Among patients with cutaneous KS, we observed four CR, three PR and one stable response. A complete response was significantly associated with a reversal in HHV-8 viraemia (five of six vs. one of six; P = 0.02, Mann-Whitney test).
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Affiliation(s)
- N Dupin
- Service de Dermato-Vénéréologie, Hôpital Tarnier-Cochin, Paris, France; Laboratoire de Virologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
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Saraux A, Jouquan J, Le Goff P, Youinou P, Levy Y, Piette JC, Guillevin L, Semana G, Salmon D, Viard JP, Bach JF, Shoenfeld Y. Environmental factors may modulate antiphospholipid antibody production in family members of patients with systemic lupus erythematosus. Arthritis Rheum 1999; 42:1062-4. [PMID: 10323466 DOI: 10.1002/1529-0131(199905)42:5<1062::aid-anr28>3.0.co;2-g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- A Saraux
- Brest University Medical School, France
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Gilquin J, Viard JP, Jubault V, Sert C, Kazatchkine MD. Delayed occurrence of Graves' disease after immune restoration with HAART. Highly active antiretroviral therapy. Lancet 1998; 352:1907-8. [PMID: 9863795 DOI: 10.1016/s0140-6736(05)60398-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jubault V, Burgard M, Le Corfec E, Costagliola D, Rouzioux C, Viard JP. High rebound of plasma and cellular HIV load after discontinuation of triple combination therapy. AIDS 1998; 12:2358-9. [PMID: 9863885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Tissot O, Viard JP, Rabian C, Ngo N, Burgard M, Rouzioux C, Penit C. No evidence for proliferation in the blood CD4+ T-cell pool during HIV-1 infection and triple combination therapy. AIDS 1998; 12:879-84. [PMID: 9631141 DOI: 10.1097/00002030-199808000-00010] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the role of cell proliferation in peripheral blood lymphocyte (PBL) dynamics during HIV infection and potent antiretroviral therapy including protease inhibitors. DESIGN Transverse study of 150 patients at different stages of infection. Longitudinal study of 50 patients on triple combination antiretroviral therapy with 9-month follow-up. METHODS Ex vivo incubation of fresh PBL with the DNA biosynthetic marker bromodeoxyuridine (BrdU). Flow cytometric analysis of cell phenotypes and BrdU incorporation. Parallel determination of plasma virus load and CD4+ cell counts. RESULTS Percentages of BrdU+ B and T lymphocytes found in patients with asymptomatic HIV infection were not different from the low values found in HIV-seronegative controls, and were not correlated with the CD4+ cell count. DNA synthesis increased significantly only during acute opportunistic infections occurring in patients with high plasma viral load and fewer than 100 x 10(6) CD4+ cells/l. Triple combination therapy induced a decrease of plasma virus load and a rise of CD4+ cell counts, whereas BrdU incorporation remained low or decreased. CONCLUSION Proliferation of peripheral blood T cells observed at late stages of HIV infection corresponds to a response to opportunistic infections. Apart from these particular cases, proliferation in this compartment does not appear as a critical parameter of CD4+ cell kinetics during chronic HIV infection and potent therapy.
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Affiliation(s)
- O Tissot
- INSERM U345, Institut Necker, Paris, France
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32
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Karras A, Rabian C, Zylberberg H, Hermine O, Duchatelle V, Durand F, Valla D, Viard JP. Severe anoxic hepatic necrosis in an HIV-1-hepatitis C virus-co-infected patient starting antiretroviral triple combination therapy. AIDS 1998; 12:827-9. [PMID: 9619823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Zylberberg H, Chaix ML, Rabian C, Rouzioux C, Aulong B, Bréchot C, Viard JP, Pol S. Tritherapy for human immunodeficiency virus infection does not modify replication of hepatitis C virus in coinfected subjects. Clin Infect Dis 1998; 26:1104-6. [PMID: 9597236 DOI: 10.1086/520281] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Triple antiretroviral therapy combining reverse transcriptase and protease inhibitors modifies the prognosis for human immunodeficiency virus (HIV) infection, with dramatic improvement in immune status. In an attempt to evaluate the impact of anti-HIV triple combination therapy on the course of hepatitis C virus (HCV)-related chronic hepatitis and on HCV replication, we studied the biological and virological characteristics of 22 HCV/HIV-coinfected patients who were given triple combination therapy. In comparison with baseline values, there was (1) a significant increase in the CD4 and CD8 cell counts and a decrease in the HIV RNA load and (2) no significant variation in aminotransferase activities or the HCV RNA load at 3, 6, or 9 months of tritherapy. Antiretroviral tritherapy seems to modify neither the biological activity of HCV-related chronic hepatitis nor the HCV load, despite immune restoration. Hepatic histopathologic analysis is warranted to assess the impact of immune restoration on liver lesions.
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Affiliation(s)
- H Zylberberg
- Unité d'Hépatologie, Hôpital Necker, Paris, France
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34
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Iftimovici E, Rabian C, Burgard M, Peytavin G, Rouzioux C, Viard JP. Longitudinal comparison of HIV-1 RNA burden in plasma and cerebrospinal fluid in two patients starting triple combination antiretroviral therapy. AIDS 1998; 12:535-7. [PMID: 9543456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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35
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Lesprit P, Godeau B, Authier FJ, Soubrier M, Zuber M, Larroche C, Viard JP, Wechsler B, Gherardi R. Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines. Am J Respir Crit Care Med 1998; 157:907-11. [PMID: 9517610 DOI: 10.1164/ajrccm.157.3.9707095] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare variant of plasma cell dyscrasia with multiple systemic manifestations. We followed the progress of 20 patients with POEMS syndrome in our institution over a 10-yr period. Pulmonary hypertension (PH) was observed in five patients. All patients suffered dyspnea on exertion, which always appeared during an exacerbation of POEMS syndrome. The typical echocardiographic signs of PH were observed in all of these patients, and the median pulmonary-artery systolic pressure was 57 mm Hg (range, 50 to 65 mm Hg). Mean pulmonary-artery pressure during right side heart catheterization in two patients was 32 mm Hg. No other explanation for the PH could be found. Overproduction of cytokines was found in all cases, with high serum concentrations of interleukin-1beta, interleukin-6, tumor necrosis factor-alpha, and vascular endothelial growth factor. We suggest that PH should be added to the list of symptoms of POEMS syndrome. Cytokines may mediate POEMS syndrome-associated PH, as proposed for the other systemic manifestations of this disorder.
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Affiliation(s)
- P Lesprit
- Département de Pathologie, Hôpital Henri Mondor, Créteil, France
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Rimaniol AC, Zylberberg H, Rabian C, DeGroote D, Zavala F, Viard JP. Imbalance between IL-1 and IL-1 receptor antagonist in the cerebrospinal fluid of HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16:340-2. [PMID: 9420311 DOI: 10.1097/00042560-199712150-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inflammatory cytokines (interleukin [IL]-1 and tumor necrosis factor [TNF]) have specific inhibitors (IL-1 receptor antagonist [IL-1Ra] and TNF-soluble receptors), the concentration of which can indicate activation and regulation of this system. We measured IL-1 and IL-1Ra in the cerebrospinal fluid (CSF) of HIV-infected patients and seronegative controls. High IL-1Ra concentrations were found in samples from patients with opportunistic meningoencephalitis, even in the presence of normal cell count and protein content, not in samples from patients with leucoencephalopathies or controls. Therefore, IL-1Ra appears to be a sensitive marker of inflammation in the central nervous system. In contradistinction to previous results obtained from blood measurement, IL-1alpha and IL-1beta remained below detectable levels in all cases, suggesting that IL-1 may be regulated differently in the central nervous system and in the blood.
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Affiliation(s)
- A C Rimaniol
- Institut National de la Santé et de la Recherche Médicale U25, Hôpital Necker, Paris, France
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37
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Daudon M, Estépa L, Kébédé M, Viard JP, Montagnac R, Deray G, Bricaire F. [Urinary calculi and crystalluria in HIV+ patients treated with indinavir sulfate]. Presse Med 1997; 26:1612-5. [PMID: 9452724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Anti-proteases, a new class of anti-HIV drugs used in combination with reverse transcriptase inhibitors have led to spectacular improvement in the patients' clinical status. Since April 1996, indinavir is the most widely prescribed anti-protease in France. PATIENTS AND METHODS From July 1996 to July 1997, we analyzed 46 spontaneously expulsed stones in 45 HIV+ patients (35 men and 10 women; age range 25 to 64 years) given indinavir in combination with other drugs since one week to ten months. Only six patients were known to have a past history of renal lithiasis. RESULTS Forty-one calculi contained indinavir monohydrate (INDM) identified by mass spectrometry and infrared spectrophotometry. INDM was the only component excepting proteins in 39/45 calculi. In the 12 others, other compounds were also identified. Among the 114 urine samples collected 2 to 3 hours after an 800 mg dose of indinavir, 38 (33%) monohydrate indinavir crystals, identified by infrared microscopy. Mean urinary pH was significantly higher than in samples without INDM crystals (6.53 +/- 0.68 versus 5.96 +/- 0.71, p < 0.001). CONCLUSION Two measures could possibly reduce the risk of crystalization: administration of urine acidifiers and increased fluid intake to raise diuresis. Alkalinisation is not indicated. Long-term increased fluid intake should be preferred over acidification which could be reserved solely for the treatment of drug-induced lithiasis.
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Affiliation(s)
- M Daudon
- Service de Biochimie A, Hôpital Necker, Paris
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38
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Rimaniol AC, Zylberberg H, Zavala F, Viard JP. Inflammatory cytokines and inhibitors in HIV infection: correlation between interleukin-1 receptor antagonist and weight loss. AIDS 1996; 10:1349-56. [PMID: 8902063 DOI: 10.1097/00002030-199610000-00006] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine serum levels of the interleukin-1 receptor antagonist (IL-1Ra), together with cytokines, other cytokine inhibitors and markers of immune activation in HIV-infected patients. METHODS Sixty-one HIV-patients were classified into Center for Disease Control and Prevention (CDC) groups A (n = 14), B (n = 14) and C (n = 33). Serum levels of IL-1Ra, IL-1 beta, IL-6, tumour necrosis factor (TNF-alpha, TNF soluble receptors (TNF-sR) and IL-2sR were measured by enzyme-linked immunosorbent assay. CD4+ cell counts, p24 antigen, immunoglobulin (Ig) A, beta 2-microglobulin, triglycerides and neopterin were measured according to standard procedures. Weight variation was measured as the percentage of baseline weight lost or gained during the 3 months before sampling. RESULTS Serum levels of IL-1Ra were significantly elevated in HIV-infected patients, compared with control subjects (S47 +/- 104 and 133 +/- 7 pg/ml), but did not vary significantly with the HIV disease stage, CD4+ cell count or p24 antigenaemia. IL-1Ra levels correlated with IL-1 beta (P < 0.005), IL-6 (P < 0.0001) and TNF-sR55 (P < 0.0001) levels, but not with those of TNF-alpha, TNF-sR75, IL-2sR, neopterin or IgA. IL-1 Ra and IL-1 Ra/IL-1 beta ratio were the only parameters significantly elevated (R = -0.67, P < 0.0001) in the HIV-infected patients with marked weight loss (n = 12; mean of weight variation, -13.9 +/- 2.1% relative to the other patients, regardless of HIV disease stage and opportunistic infections. CONCLUSIONS IL-1Ra levels are significantly elevated in HIV infected patients, independently of immune deficiency. We propose that IL-1Ra accumulates in intense systemic inflammation, a state which does not seem to be reflected by the elevation of a single cytokine or the activation at a single cell system and which is correlated with marked weight loss.
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Affiliation(s)
- A C Rimaniol
- Institut National de la Santé et de la Recherche Médicale (INSERM) U25, Necker Hospital, Paris, France
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Zylberberg H, Vargaftig J, Barbieux C, Pertuiset N, Rothschild C, Viard JP. Prolonged efficiency of secondary prophylaxis with colistin aerosols for respiratory infection due to Pseudomonas aeruginosa in patients infected with human immunodeficiency virus. Clin Infect Dis 1996; 23:641-3. [PMID: 8879797 DOI: 10.1093/clinids/23.3.641] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- H Zylberberg
- Service d'Immunologie Clinique, Hôpital Necker, Paris, France
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41
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Tazi Z, Cacoub P, Koskas F, Chabanel A, Chadefaux-Vekemans B, Horellou MH, Viard JP, Piette JC, Kieffer E, Godeau P. [Value of an extensive biological study in venous or arterial thromboses]. Presse Med 1996; 25:531-6. [PMID: 8731796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The aim of this work is to study the signification of an extensive biological evaluation in patients with "unexplained" thrombosis. We studied 78 patients with more than one arterial and/or venous thromboembolic event. METHODS Fifty-four patients were admitted for unexplained deep venous thrombosis (group I, n = 19, 9 men and 10 women) and/or arterial thrombosis (group II, n = 35, 21 men and 14 women). A third group (group III) included 24 patients (13 men, 11 women) known to have a pathologic state which can lead to a thrombotic event. RESULTS The patients in both groups I and II had, more often than normal subjects, a high level of homocysteinemia (26% vs 3%, p < 0.001), anti-beta 2 glycoprotein 1 (18.5% vs 3%, p < 0.001) and antiphospholipid antibodies (13% vs 3%, p < 0.02). We also found a significant association between an increase of erythrocytic aggregation and arterial thrombosis (group II). In the third group, for both arterial (n = 14) and venous (n = 10) thrombosis, we found a high level of anticardiolipin antibodies (25% vs 3%, p < 0.001), anti-beta 2 glycoprotein 1 antibodies (12.5% vs 3%, p < 0.05) and abnormal erythrocytic aggregation (16.5% vs 3%, p < 0.01). In these 3 groups the other studied parameters (Lp(a), platelet aggregation, cryoglobulin, cryofibrinogen, antinuclear antibodies, anticytoplasm antibodies, plasma and urine immunoelectrophoresis, protein C, protein S, antithrombin III, plasminogen) were not different from levels observed in normal subjects. CONCLUSION An extensive biological analysis, including plasma homocystein level, anticardiolipin antibodies, anti-beta 2 glycoprotein 1 antibodies and a study of the erythrocytic aggregation would appear to be of value in patients presenting recurrent arterial or venous thromboembolic events. Specific therapy can be applied in case of abnormal results continued anticoagulant therapy for anticardiolipin and anti-beta 2 glycoprotein 1 antibodies, and a vitamin therapy for increased homocysteinemia.
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Affiliation(s)
- Z Tazi
- Service de Médecine interne, Hôpital Pitié-Salpêtrière, Paris
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42
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Gherardi RK, Bélec L, Soubrier M, Malapert D, Zuber M, Viard JP, Intrator L, Degos JD, Authier FJ. Overproduction of proinflammatory cytokines imbalanced by their antagonists in POEMS syndrome. Blood 1996; 87:1458-65. [PMID: 8608236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes (POEMS) syndrome is a rare multisystem disorder of obscure pathogenesis associated with osteosclerotic myeloma. Circulating levels of proinflammatory cytokines (tumor necrosis factor-alpha (TNF-alpha) interleukin-1 beta [IL-1 beta], IL-2, IL-6, and interferon-gamma [IFN-gamma]), anti-inflammatory cytokines (transforming growth factor beta 1 [TGF beta 1], IL-4, IL-10, and IL-13), the cytokine carrier protein alpha 2 macroglobulin, IL-1 receptor antagonist (IL-1ra), soluble TNF receptors (sTNFr) p55 and p75, and soluble IL-6 receptor (sIL-6r) were determined in 15 patients with POEMS syndrome and 15 with multiple myeloma. Patients with POEMS syndrome had higher serum levels of IL-1 beta, TNF-alpha, and IL-6 and lower serum levels of TGF beta 1 than did patients with multiple myeloma. Serum levels of IL-2, IL-4, IL-10, IL-13, IFN-gamma, alpha 2 macroglobulin, and sIL-6r were similar in both groups. IL-1ra and sTNFrs were increased in POEMS syndrome, but out of proportion to the increase of IL-1 beta and TNF-alpha. Serial evaluations in 1 patient showed that proinflammatory cytokine serum levels paralleled disease activity assessed by platelet count and neurologic involvement. Our results suggest that the manifestations of POEMS syndrome might be regarded as the result of a marked activation of the proinflammatory cytokine network (IL-1 beta, IL-6, and TNF-alpha) associated with a weak or even decreased (TGF beta 1) antagonistic reaction insufficient to counteract the noxious effects of cytokines.
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Affiliation(s)
- R K Gherardi
- Groupe d'Etude et de Recherche sur le Nerf le Muscle, GERMEN, Faculté de Médecine de Créteil-Paris XII, Paris, France
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43
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Zylberberg H, Robert F, Le Gal FA, Dupouy-Camet J, Zylberberg L, Viard JP. Prolonged isolated fever due to attenuated extracerebral toxoplasmosis in patients infected with human immunodeficiency virus who are receiving trimethoprim-sulfamethoxazole as prophylaxis. Clin Infect Dis 1995; 21:680-1. [PMID: 8527569 DOI: 10.1093/clinids/21.3.680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report two cases of prolonged fever in deeply immunocompromised patients with AIDS who had been receiving trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis for several months. Investigations of the cause of fever yielded normal or negative findings except that the polymerase chain reaction (PCR) for Toxoplasma gondii in the blood was positive in both cases, and PCR of the bronchoalveolar lavage fluid was positive in one case. After a few days of treatment with pyrimethamine plus clindamycin, the two patients became afebrile and the T. gondii PCR became negative. The patients probably had disseminated toxoplasmosis attenuated by TMP-SMZ. PCR examination of blood for evidence of T. gondii genome may be useful in screening for causes of unexplained fever in patients with AIDS, even those who receive prophylaxis with TMP-SMZ.
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Affiliation(s)
- H Zylberberg
- Service d'Immunologie Clinique, Hôpital Necker, Paris, France
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45
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Bessis D, Sotto A, Viard JP, Bérard M, Ciurana AJ, Boffa MC. Trousseau's syndrome with nonbacterial thrombotic endocarditis: pathogenic role of antiphospholipid syndrome. Am J Med 1995; 98:511-3. [PMID: 7733133 DOI: 10.1016/s0002-9343(99)80355-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- D Bessis
- Hôpital Saint-Eloi, Montpellier, France
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Grossetête B, Viard JP, Lehuen A, Bach JF, Monteiro RC. Impaired Fc alpha receptor expression is linked to increased immunoglobulin A levels and disease progression in HIV-1-infected patients. AIDS 1995; 9:229-34. [PMID: 7755910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Expression of immunoglobulin (Ig) A Fc receptors (Fc alpha R) and their saturation by endogenous IgA were studied on blood monocytes and neutrophils to evaluate the role of Fc alpha R in the formation of increased serum levels of IgA and IgA-immune complexes (IgA-IC) observed during HIV-1 infection. METHODS Peripheral blood samples were obtained from 45 patients at different stages of HIV-1 infection and from 22 healthy volunteers. This study was performed using a quantitative flow cytometry method in which blood cells were stained with anti-Fc alpha R monoclonal antibodies (MAb) recognizing epitopes outside the IgA-binding site and with F(ab')2 fragments of anti-IgA antibodies. Immunoprecipitations of radiolabelled surface Fc alpha R molecules were analysed by sodium dodecylsulphate-polyacrylamide gel electrophoresis under glycosylated and deglycosylated conditions. RESULTS This study reveals a diminished surface expression of Fc alpha R on blood monocytes of HIV-1-infected patients, which follows disease progression. Fc alpha R molecules on patients' neutrophils have a higher apparent molecular mass (60-90 kD) with normal protein core, suggesting expression of receptors with altered carbohydrate moieties. Increased levels of serum IgA significantly correlate with decreased levels of Fc alpha R in HIV-1-infected patients. Surface Fc alpha R molecules are saturated by endogenous IgA1 in both cell types. CONCLUSION These findings suggest that defective expression and/or altered glycosylation of Fc alpha R may result in receptor saturation, impairment of IgA catabolism and diminished clearance of IgA-IC in HIV-1-infected patients. Fc alpha R expression represents a new marker for disease progression.
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Affiliation(s)
- J P Viard
- Service d'Immunologie Clinique-INSERM U25, Hôpital Necker, Paris, France
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48
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Vittecoq D, Chevret S, Morand-Joubert L, Heshmati F, Audat F, Bary M, Dusautoir T, Bismuth A, Viard JP, Barré-Sinoussi F. Passive immunotherapy in AIDS: a double-blind randomized study based on transfusions of plasma rich in anti-human immunodeficiency virus 1 antibodies vs. transfusions of seronegative plasma. Proc Natl Acad Sci U S A 1995; 92:1195-9. [PMID: 7862660 PMCID: PMC42665 DOI: 10.1073/pnas.92.4.1195] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A randomized double-blind controlled trial was conducted to determine the efficacy of passive immunotherapy in the treatment of symptomatic human immunodeficiency virus (HIV) infection. This trial included 86 symptomatic patients randomized to receive plasma rich in anti-HIV-1 antibody or standard seronegative plasma. Each patient in both groups received a 300-ml infusion every 14 days over a 1-year period, and every 28 days thereafter, in addition to zidovudine and other conventional prophylactic treatments. Plasma donors were selected among symptomless seropositive individuals with a CD4 lymphocyte count > or = 400 x 10(6) cells per liter, a negative p24 antigen assay, and a high concentration of anti-p24 antibody. The plasmas were heat-inactivated before infusion. During the study period (day 28-day 365) scheduled by the protocol, clinical benefit from passive immunotherapy was observed in delaying the appearance of the first AIDS-defining event (P < 0.009) and reducing the cumulative incidence of such events, which was estimated 3-fold higher in the control group compared to the treatment group. Seven deaths occurred in the treatment group vs. 11 in the control group (P = 0.27). A total of 47 patients died or exhibited new AIDS-defining events, 18 in the treatment group and 29 in the control group (P = 0.009). No clinical benefit was observed after the 1-year period with infusions performed every 4 weeks. These results indicate a favorable effect of passive immunotherapy on the evolution of advanced AIDS.
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Affiliation(s)
- D Vittecoq
- Service d'Infectiologie, Hôpital Paul-Brousse, Villejuif, France
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Garchon HJ, Djabiri F, Viard JP, Gajdos P, Bach JF. Involvement of human muscle acetylcholine receptor alpha-subunit gene (CHRNA) in susceptibility to myasthenia gravis. Proc Natl Acad Sci U S A 1994; 91:4668-72. [PMID: 7910962 PMCID: PMC43849 DOI: 10.1073/pnas.91.11.4668] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The muscle acetylcholine receptor is the major target of the autoimmune response in generalized myasthenia gravis. To investigate the role of the gene encoding the alpha subunit of the receptor (CHRNA), two stable polymorphic d[(GT).(CA)]dinucleotide repeats, designated HB and BB, were characterized within the first intron of CHRNA. The HB*14 allele conferred a relative risk for myasthenia gravis of 2.5 in 81 unrelated patients compared with 100 control subjects. Very significantly, family analysis based on haplotype segregation data indicated that parental haplotypes associated with HB*14 always segregated to the child with myasthenia gravis (P < 0.0002 for the comparison with the transmission of haplotypes not bearing HB*14), whereas their transmission to unaffected siblings was equilibrated. Myasthenia gravis patients also showed a high frequency of microsatellite variants unseen in controls. These findings implicate the CHRNA in susceptibility to myasthenia gravis.
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Affiliation(s)
- H J Garchon
- Institut National de la Santé et de la Recherche Médicale U25, Hôpital Necker, Paris, France
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