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Richard P, Fillet AM, Malard L, Leclerc C, Chanut C, Woimant G, Jacquot C, Leleu H, Morel P, Vimont A. Impact of donor ferritin testing on iron deficiency prevention and blood availability in France: A cohort simulation study. Vox Sang 2023; 118:24-32. [PMID: 36427060 DOI: 10.1111/vox.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/12/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Implementing a ferritin testing policy for whole blood (WB) donors may prevent iron deficiency (ID, ferritin <26 ng/mL) and anaemia, but may induce donation losses. As part of a national prevention plan in France, we aimed to estimate its impact on ID, anaemias and WB donations among donors at high risk of ID. MATERIALS AND METHODS A micro-simulation model was developed to evaluate different scenarios compared to the current situation without ferritin testing as a reference scenario. The following scenarios were simulated: a minimum scenario with a 6-month deferral for donors with absent iron store (AIS, ferritinemia <15 ng/ml), a main scenario with additional delayed invitations for donors with ferritinemia 15-25 ng/ml and a supplementation scenario with additional iron supplementation for 50% of the donors with AIS. RESULTS In the main scenario, 52,699 WB donations per year were estimated to be lost after 1 year (-8%), falling to 27,687 (-4.7%) after 5 years. IDs and anaemias were reduced by 13.6% and 29.3%, respectively, after 1 year. The supplementation scenario increased the number of prevented IDs and anaemias to 24.1% and 35.4%, respectively, after 1 year, and halved the number of anaemias at 5 years. The latter scenario also had the least impact on the number of donations (-3.2% after 5 years). CONCLUSION A ferritin testing policy resulting in delayed donations for ID donors is effective in reducing IDs and anaemias, but significantly impacts the number of donations, thereby posing a self-sufficiency challenge.
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Affiliation(s)
- Pascale Richard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Anne-Marie Fillet
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Lucile Malard
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Carole Leclerc
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Claire Chanut
- Innovation and Projects Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Geneviève Woimant
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | - Chantal Jacquot
- Blood Product Collection Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
| | | | - Pascal Morel
- Medical Department, Etablissement Français du Sang, la Plaine Saint-Denis, France
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Cognasse F, Hamzeh-Cognasse H, Rosa M, Corseaux D, Bonneaudeau B, Pierre C, Huet J, Arthaud CA, Eyraud MA, Prier A, Duchez AC, Ebermeyer T, Heestermans M, Audoux-Caire E, Philippot Q, Le Voyer T, Hequet O, Fillet AM, Chavarin P, Legrand D, Richard P, Pirenne F, Gallian P, Casanova JL, Susen S, Morel P, Lacombe K, Bastard P, Tiberghien P. Inflammatory markers and auto-Abs to type I IFNs in COVID-19 convalescent plasma cohort study. EBioMedicine 2022; 87:104414. [PMID: 36535107 PMCID: PMC9758484 DOI: 10.1016/j.ebiom.2022.104414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND COVID-19 convalescent plasma (CCP) contains neutralising anti-SARS-CoV-2 antibodies that may be useful as COVID-19 passive immunotherapy in patients at risk of developing severe disease. Such plasma from convalescent patients may also have additional immune-modulatory properties when transfused to COVID-19 patients. METHODS CCP (n = 766) was compared to non-convalescent control plasma (n = 166) for soluble inflammatory markers, ex-vivo inflammatory bioactivity on endothelial cells, neutralising auto-Abs to type I IFNs and reported adverse events in the recipients. FINDINGS CCP exhibited a statistically significant increase in IL-6 and TNF-alpha levels (0.531 ± 0.04 vs 0.271 ± 0.04; (95% confidence interval [CI], 0.07371-0.4446; p = 0.0061) and 0.900 ± 0.07 vs 0.283 ± 0.07 pg/mL; (95% [CI], 0.3097-0.9202; p = 0.0000829) and lower IL-10 (0.731 ± 0.07 vs 1.22 ± 0.19 pg/mL; (95% [CI], -0.8180 to -0.1633; p = 0.0034) levels than control plasma. Neutralising auto-Abs against type I IFNs were detected in 14/766 (1.8%) CCPs and were not associated with reported adverse events when transfused. Inflammatory markers and bioactivity in CCP with or without auto-Abs, or in CCP whether or not linked to adverse events in transfused patients, did not differ to a statistically significant extent. INTERPRETATION Overall, CCP exhibited moderately increased inflammatory markers compared to the control plasma with no discernible differences in ex-vivo bioactivity. Auto-Abs to type I IFNs detected in a small fraction of CCP were not associated with reported adverse events or differences in inflammatory markers. Additional studies, including careful clinical evaluation of patients treated with CCP, are required in order to further define the clinical relevance of these findings. FUNDING French National Blood Service-EFS, the Association "Les Amis de Rémi" Savigneux, France, the "Fondation pour la Recherche Médicale (Medical Research Foundation)-REACTing 2020".
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Affiliation(s)
- Fabrice Cognasse
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France,Corresponding author. Etablissement Français du Sang Auvergne-Rhône-Alpes, INSERM U1059, Campus Santé Innovation - 10 rue de la Marandière, 42270, Saint-Priest-en-Jarez, France.
| | - Hind Hamzeh-Cognasse
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Mickael Rosa
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Delphine Corseaux
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | | | - Chloe Pierre
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Julie Huet
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Charles Antoine Arthaud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marie Ange Eyraud
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Amélie Prier
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Anne Claire Duchez
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Theo Ebermeyer
- Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Marco Heestermans
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Estelle Audoux-Caire
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France,Univ Jean Monnet, Mines Saint-Étienne, INSERM, U 1059 Sainbiose, 42023, Saint-Étienne, France
| | - Quentin Philippot
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Tom Le Voyer
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France
| | - Olivier Hequet
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - Patricia Chavarin
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - Dominique Legrand
- Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | | | - France Pirenne
- Univ Paris Est Creteil, INSERM U955, Institut Mondor de Recherche Biomédicale (Mondor Biomedical Research Institute) (IMRB), Creteil, France & Laboratory of Excellence GR-Ex, Paris, France
| | - Pierre Gallian
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR “Unité des Virus Emergents” (Emerging Virus Unit), Aix-Marseille University - IRD 190 - INSERM 1207 - IRBA - EFS - IHU Méditerranée Infection, Marseille, France
| | - Jean Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,University of Paris, Imagine Institute, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA,Howard Hughes Medical Institute, New York, NY, USA
| | - Sophie Susen
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, CNRS, U1011- EGID, F-59000 Lille, France,Centre National de la Recherche Scientifique (National Scientific Research Centre), Surgical Critical Care, Department of Anaesthesiology and Critical Care, U1019 - Unité Mixte de Recherche 9017 (Mixed Research Unit 9017) – Lille Centre for Infection and Immunity, France
| | - Pascal Morel
- Etablissement Français du Sang, La Plaine, St Denis, France
| | - Karine Lacombe
- Sorbonne University, Inserm IPLESP, Infectious Diseases Department, Saint-Antoine Hospital, APHP (University Hospital Trust), Paris, France
| | - Paul Bastard
- Etablissement Français du Sang, La Plaine, St Denis, France,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163 (National Institute for Health and Medical Research), Necker Hospital for Sick Children, Paris, France,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine, St Denis, France,UMR RIGHT U1098, INSERM, Etablissement Français du Sang, University of Franche-Comté, Besançon, France
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Malard L, Fillet AM, Richard P, Chabli L, Jbilou S, Ferrera-Tourenc V. Analyse nationale des données d’hémoglobine inférieure à 14 g/dL ou 13 g/dL chez les donneur.euse.s de sang total en 2020. Transfus Clin Biol 2021. [DOI: 10.1016/j.tracli.2021.08.265] [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: 10/19/2022]
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Richard P, Leclerc C, Malard L, Fillet AM, Chanut C, Woimant G, Jacquot C, Leleu H, Vimont A. Modélisation de l’impact du dosage de la ferritine. Transfus Clin Biol 2021. [DOI: 10.1016/j.tracli.2021.08.054] [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: 10/19/2022]
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5
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Fillet AM, Leclerc C, Martinaud C, Malard L, Le Cam S, Hejl C, Jacquot C, Woimant G, Chueca M, Bésiers C, Jacquot E, Morel P, Richard P. Carence en fer chez les donneurs de sang en France : état des lieux et perspectives de prévention. Transfus Clin Biol 2021. [DOI: 10.1016/j.tracli.2021.08.052] [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: 11/28/2022]
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Fillet AM, Ferrera-Tourenc V, François M, François A, Porra V, Dettori I, Resch E, Humbrecht C, Bourreille G, Beguet M, Delettre F, Hervé F, Pirenne F, Raba M, Morel P, Richard P. Protocole d’usage thérapeutique du plasma de convalescent de COVID-19–Suivi. Transfus Clin Biol 2021. [PMCID: PMC8610203 DOI: 10.1016/j.tracli.2021.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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7
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Fillet AM, Martinaud C, Malard L, Le Cam S, Hejl C, Chenus F, Woimant G, Chueca M, Jacquot E, Besiers C, Morel P, Djoudi R, Garrabé E, Gross S. Iron deficiency among French whole-blood donors: first assessment and identification of predictive factors. Vox Sang 2020; 116:42-52. [PMID: 32965040 DOI: 10.1111/vox.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/11/2020] [Revised: 07/17/2020] [Accepted: 08/09/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The objectives of this study are to estimate the prevalence of iron deficiency (ID) among French whole-blood (WB) donors to identify factors associated with ID and to generate decision trees. STUDY DESIGN AND METHODS A prospective National multicentre study was performed on WB donors from March 11, to April 5th, 2019. Samples were selected randomly to perform serum ferritin. ID was defined as ferritin value under 26 ng/ml. All results were stratified by sex. Factors associated with ID were analysed using multivariate logistic regression model. CART algorithm was used for decision trees. RESULTS Eleven thousand two hundred fifty eight WB donors were included. ID was more frequent in women (39·5%) than in men (18·0%). Among 7200 repeated donors, women below 50 yo had a higher risk (OR = 2·37; [1·97-2·85] IC95) than those above 50 yo. Factors associated with ID were: haemoglobin level under the threshold at donation n-1 except for women and n-2 donation; a low mean corpuscular haemoglobin at n-1 and n-2 donations; a shorter interval since n-1 donation and between n-1 and n-2 donations except for women; and women who had given three or four times in the last year. CART algorithm defined high risk of ID subgroups within three populations of donors, new female donors, repeated male donors and repeated female donors. In these identified subgroups, prevalence of ID was up to 72·1%. CONCLUSIONS Our study showed the high prevalence of ID among French WB donors, identified well-known and new factors associated with ID and defined algorithms predicting ID in three populations.
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Affiliation(s)
| | | | - Lucile Malard
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Sophie Le Cam
- Etablissent Français du sang, Blood Biological Qualification, Angers, France
| | - Carine Hejl
- Laboratory Medicine Department, Military Medical Center Percy, Clamart, France
| | - Florence Chenus
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | | | - Marine Chueca
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | - Eric Jacquot
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | | | - Pascal Morel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Rachid Djoudi
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Eliane Garrabé
- Centre de Transfusion Sanguine des Armées, Clamart, France
| | - Sylvie Gross
- Etablissement Français du Sang, La Plaine Saint-Denis, France
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Fillet AM, Martinaud C, Malard L, Le Cam S, Hejl C, Chenus F, Woimant G, Jacquot E, Bésiers C, Garrabé E, Gross S. Prévalence de la carence martiale chez les donneurs de sang total en France – Étude FERRIDON. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Fillet AM, Danic B, Benomar D, Malard L, Vidal C, Bésiers C, Pugin A, Gueyffier F, Djoudi R, Pagadoy M, Binda D, Gross S. Risque cardiovasculaire et don de sang – Cardiodon et étude cas-témoin. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.252] [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: 10/26/2022]
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10
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Burin des Roziers N, Chadebech P, Malard L, Vingert B, Gallon P, Samuel D, Djoudi R, Fillet AM, Pirenne F. Predisposing factors for anti-D immune response in D - patients with chronic liver disease transfused with D + platelet concentrates. Transfusion 2019; 59:1353-1358. [PMID: 30604873 DOI: 10.1111/trf.15129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent reports have indicated that the risk of anti-D alloimmunization following D-incompatible platelet (PLT) transfusion is low in hematology and oncology patients. We investigated the rate of anti-D alloimmunization in RhD-negative (D- ) patients with chronic liver disease transfused with D+ platelet concentrates (PCs) and the factors involved, at a liver transplant (LT) center. STUDY DESIGN AND METHODS We reviewed the blood bank database from January 2003 to October 2016. D- patients who had received D+ PLT transfusions were eligible if they had undergone antibody screening at least 28 days after the first D+ PC transfusion, had no previous or concomitant exposure to D+ blood products, and had not received anti-D immunoglobulins. RESULTS Six of the 56 eligible patients (10.7%) had anti-D antibodies. All had received whole blood-derived PCs. Four of 20 patients (20%) untransplanted or transfused before LT and only two of 36 patients (5.6%) transfused during or after LT produced anti-D antibodies. These two patients were on maintenance immunosuppression based on low-dose steroids and tacrolimus. The factors identified as significantly associated with anti-D immune response were the presence of red blood cell immune alloantibodies before D+ PLT transfusion (p = 0.003), and D+ PLT transfusion outside the operative and postoperative (5 days) periods for LT (p = 0.023). CONCLUSION D- patients with chronic liver disease transfused with D+ PLTs before LT are at high risk of developing anti-D antibodies. Preventive measures should be considered for these patients.
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Affiliation(s)
| | - Philippe Chadebech
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Lucile Malard
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | - Benoit Vingert
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Philippe Gallon
- Unité d'hémovigilance, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Didier Samuel
- Centre hépato-biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Rachid Djoudi
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | | | - France Pirenne
- Etablissement Français du Sang Ile de France, Hôpital Henri Mondor, Créteil, France.,Inserm U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB) and Université Paris-Est-Créteil (UPEC), Créteil, France.,Laboratoire d'Excellence GR-Ex, Paris, France
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Fillet AM. [State of play on transfusion]. Rev Prat 2018; 68:1013-1014. [PMID: 30869360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Fillet AM, Desmarets M, Assari S, Quaranta JF, François A, Pugin A, Schuhmacher A, Lassale B, Monnet E, Cabre P, Legrand D, Binda D, Djoudi R. Blood products use in France: a nationwide cross-sectional survey. Transfusion 2016; 56:3033-3041. [DOI: 10.1111/trf.13887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anne-Marie Fillet
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Suzanne Assari
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | | | - Anne François
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
| | - Aurore Pugin
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Anne Schuhmacher
- Etablissement Français du Sang, Lorraine Champagne; Nancy France
| | | | - Elisabeth Monnet
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Philippe Cabre
- Agence régionale de santé; Nord-Pas-de-Calais-Picardie France
| | | | - Delphine Binda
- Centre d'investigation clinique Inserm CIC1431; CHRU de Besançon; Besançon France
| | - Rachid Djoudi
- Medical Department; Etablissement Français du Sang; La Plaine Saint Denis France
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Piotrowski A, Fillet AM, Perez P, Walkowiak P, Simon D, Corniere MJ, Cabanes PA, Lambrozo J. Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005. Burns 2013; 40:480-8. [PMID: 24028742 DOI: 10.1016/j.burns.2013.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 11/17/2022]
Abstract
This study reviewed records of all electrical incidents involving work-related injury to employees Electricité de France (EDF) from 1996 through 2005 and analysed data for 311 incidents. The results are compared with 1231 electrical incidents that occurred during 1970-1979 and 996 incidents during 1980-1989. A total of 311 electrical incidents were observed. The medical consequences of electrical incident remain severe and particularly, the current fatality rate (3.2%) is similar to that recorded in the 1980s (2.7%) and 1970s (3.3%). Among individuals with non-fatal incidents, any change has occurred in the prevalence of permanent functional sequelae (23.6% in the 1970s vs. 27.6% in the 1980s and 32.5% currently). An increase in the incidence of neuropsychiatric sequelae (5.4% in the 1980s vs. 13% currently) has been observed and they are now the second most common type of sequelae after those directly related to burns. Among the neurological sequelae, peripheral nervous system disorders are the most common, as observed in the 1980s. Since the definition of post-traumatic stress disorder (PTSD) has changed between the two periods, we can only report that the current prevalence of PTSD is 7.6%. This study emphasises the need for specific management of neurological and psychological impairments after electrical injuries, including especially early recognition and initiation of effective treatment.
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Affiliation(s)
- Aleksandra Piotrowski
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France.
| | - Anne-Marie Fillet
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
| | - Philippe Perez
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Philippe Walkowiak
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Denis Simon
- Medical Department of Health Insurance fund, General Direction of Safety and Health, Electricité de France, France
| | - Marie-Jean Corniere
- Prevention and Safety Department, General Direction of Safety and Health, Electricité de France, France
| | - Pierre-André Cabanes
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
| | - Jacques Lambrozo
- Medical Studies Department, General Direction of Safety and Health, Electricité de France, France
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14
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Deback C, Fillet AM, Dhedin N, Barrou B, Varnous S, Najioullah F, Bricaire F, Agut H. Monitoring of human cytomegalovirus infection in immunosuppressed patients using real-time PCR on whole blood. J Clin Virol 2007; 40:173-9. [PMID: 17904901 DOI: 10.1016/j.jcv.2007.08.014] [Citation(s) in RCA: 25] [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] [Received: 02/05/2007] [Revised: 07/30/2007] [Accepted: 08/16/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Quantitative monitoring of human cytomegalovirus (HCMV) is currently used in the follow-up of immunosuppressed patients. OBJECTIVE To investigate whether real-time PCR quantification (QPCR) of HCMV DNA could replace pp65 antigenemia. STUDY DESIGN We compared HCMV QPCR on whole blood (WB) and on plasma with a pp65-antigenemia assay on 192 samples. Afterwards, we tested 1310 samples from 308 immunosuppressed patients both by antigenemia assay and QPCR on WB. RESULTS The first study comparison showed that QPCR results on WB and plasma were significantly correlated with antigenemia. QPCR on WB was more sensitive than QPCR on plasma or antigenemia, detecting 31 and 49 additional positive samples, respectively. During the second comparison, QPCR on WB and antigenemia were again correlated (r=0.70; p<0.0001), but QPCR detected 244 additional positive samples. HCMV DNA was detected earlier than pp65 antigen (median difference: 14 days; range: 7-30). One, 5, 10, 50 and 100 pp65-positive cells/200,000 leukocytes corresponded to 439, 1531, 2623, 9150 and 15,671 HCMV DNA copies/mL of WB, respectively, but this equivalence differed according to the sub-group of patients considered. CONCLUSION QPCR on WB is the most sensitive method for the monitoring of HCMV infection in immunosuppressed patients.
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Affiliation(s)
- C Deback
- Laboratoire de Virologie du CERVI, UPRES EA 2387 Université Pierre et Marie Curie-Paris VI, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France.
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15
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Loparev V, Martro E, Rubtcova E, Rodrigo C, Piette JC, Caumes E, Vernant JP, Schmid DS, Fillet AM. Toward universal varicella-zoster virus (VZV) genotyping: diversity of VZV strains from France and Spain. J Clin Microbiol 2006; 45:559-63. [PMID: 17135433 PMCID: PMC1829061 DOI: 10.1128/jcm.01738-06] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [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: 01/28/2023] Open
Abstract
Thirty-one isolates from France and Spain were genotyped using a published method analyzing DNA sequence variation in open reading frame (ORF) 22, together with an evaluation of three well-characterized single nucleotide polymorphisms (SNP) in ORF 38, 54, and 62. Nineteen were allocated to the European (E) genotype, six were mosaic-1 (M1), and two were mosaic-2 (M2). Four strains were assigned to a new genotype, mosaic-4 (M4). All isolates were wild type, with no Oka vaccine-associated markers. No isolates of the mosaic-3 (M3) or Japanese (J) genotype were observed. We also evaluated 13 selected isolates of E, J, M1, and M2 strains (9 of the 31 described above) using an alternative genotyping method based on the assessment of multiple SNP located in ORF 1, 9, 10, 21, 31, 50, 54, 62, and 68. This method assigns wild-type varicella-zoster virus (VZV) strains to seven genotypes: A1, A2, J1, B1, B2, C, and C1. VZV isolates identified as E (ORF22 method) had the genetic signature of genotype C VZV strains, M1 strains were A1, and M2 were A2. No J strains were detected, but parental Oka and vaccine Oka (genotype J) corresponded to genotype J1. M4 isolates (B) share the SNP array observed for M1 and E viruses, and probably represent recombinants between African-Asian (M1) and European (E) viruses. The two genotyping methods, using entirely different genomic targets, produced identical clusters for the strains examined, suggesting robust phylogenetic linkages among VZV strains circulating in Europe.
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Affiliation(s)
- Vladimir Loparev
- Biotechnology Core Facility, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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16
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Sacre K, Carcelain G, Cassoux N, Fillet AM, Costagliola D, Vittecoq D, Salmon D, Amoura Z, Katlama C, Autran B. Repertoire, diversity, and differentiation of specific CD8 T cells are associated with immune protection against human cytomegalovirus disease. ACTA ACUST UNITED AC 2005; 201:1999-2010. [PMID: 15967826 PMCID: PMC2212029 DOI: 10.1084/jem.20042408] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To determine the correlates of immune recovery from active human CMV (HCMV) disease, we compared the antigenic repertoire, diversity, magnitude, and differentiation of HCMV-specific CD8+ T cells in HIV-HCMV coinfected subjects with no, cured, or active HCMV disease and in healthy HIV-negative HCMV-positive controls. ELISPOT–IFN-γ assays using peptide pools spanning the pp65 and immediate early 1 (IE1) HCMV proteins showed that HCMV-specific CD8+ T cells had a significantly broader antigenic repertoire and greater diversity in HIV-positive patients controlling HCMV replication than in those with active HCMV disease, but the magnitude of the CD8 T cell response did not differ between the different groups. HCMV-specific T cells mainly were focused against IE1 during the short-term recovery from retinitis, and switched toward pp65 during long-term recovery. HCMV-specific T cells displaying an “early” (CD8+CD27+CD28+) and “intermediate” (CD8+CD27−CD28+) differentiation phenotype were increased significantly during long-term recovery compared with other HIV-positive patients and were nearly undetectable during active HCMV disease. HCMV-specific T cells with a “late” (CD8+CD27−28−) differentiation phenotype predominated in all cases. Therefore, restoration of immune protection against HCMV after active HCMV disease in immunodeficient individuals is associated with enlarged repertoire and diversity, and with early differentiation of virus-specific CD8+ T cells, thus defining immune correlates of protection against diseases caused by persistent viruses.
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Affiliation(s)
- Karim Sacre
- Laboratoire d'Immunologie Cellulaire et Tissulaire, INSERM U543, Hôpital Pitié-Salpétrière, Université Pierre et Marie Curie, 75013 Paris, France
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17
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Ducancelle A, Gravisse J, Alain S, Fillet AM, Petit F, Pors MJSL, Mazeron MC. Phenotypic characterisation of cytomegalovirus DNA polymerase: a method to study cytomegalovirus isolates resistant to foscarnet. J Virol Methods 2005; 125:145-51. [PMID: 15794984 DOI: 10.1016/j.jviromet.2005.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2004] [Revised: 12/22/2004] [Accepted: 01/08/2005] [Indexed: 11/26/2022]
Abstract
A phenotypic method was developed to test mutations in the human cytomegalovirus (HCMV) DNA polymerase gene (UL54) suspected to confer resistance to foscarnet. This method was used to determine the biochemical phenotype of wild-type and mutated HCMV DNA polymerases that had been synthesised in vitro as follows. The UL54 genes were amplified from foscarnet-resistant and -sensitive isolates by PCR and the products were cloned into an expression vector under the control of a T7 promoter. Mutations were introduced by site-directed mutagenesis into wild-type gene UL54 and then polymerases were synthesised by using a commercially available coupled transcription/translation system. Polymerase activity was measured with and without foscarnet by detecting the incorporation of digoxigenin-labelled nucleotides into the growing DNA chain. The results of this non-radioactive assay were consistent with those obtained with the conventional radioactive assay. It was found that the activity of polymerases containing the V715M or E756K mutations was inhibited by foscarnet at concentrations 70- and 30-fold higher than that of wild-type polymerase, respectively. Change N495K and a combination of changes K415R and S291P, both observed in foscarnet-resistant isolates, induced a 5- and 10-fold decrease in susceptibility to foscarnet, respectively. This non-radioactive phenotypic assay could be useful for the characterisation of mutations that confer HCMV resistance to foscarnet.
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Affiliation(s)
- Alexandra Ducancelle
- Service de Bactériologie-Virologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris, France
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18
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Hantz S, Michel D, Fillet AM, Guigonis V, Champier G, Mazeron MC, Bensman A, Denis F, Mertens T, Dehee A, Alain S. Early selection of a new UL97 mutant with a severe defect of ganciclovir phosphorylation after valaciclovir prophylaxis and short-term ganciclovir therapy in a renal transplant recipient. Antimicrob Agents Chemother 2005; 49:1580-3. [PMID: 15793144 PMCID: PMC1068598 DOI: 10.1128/aac.49.4.1580-1583.2005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/20/2022] Open
Abstract
We describe the emergence of a new ganciclovir resistance mutation in the UL97 gene of human cytomegalovirus, deletion of codon 601, after valaciclovir and short-term ganciclovir therapy following kidney transplantation. Its role in ganciclovir resistance was supported by decreased ganciclovir phosphorylation in a recombinant vaccinia virus system.
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Affiliation(s)
- Sébastien Hantz
- Department of Bacteriology-Virology-Hygiene, EA 3175, Teaching Hospital Dupuytren, Limoges cedex, France
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19
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Tran THC, Rozenberg F, Fillet AM, Bodaghi B. Diagnostic and therapeutic management of a severe acyclovir-resistant acute retinal necrosis in a young child. Graefes Arch Clin Exp Ophthalmol 2004; 243:266-8. [PMID: 15378385 DOI: 10.1007/s00417-004-0985-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 06/12/2004] [Accepted: 06/21/2004] [Indexed: 11/27/2022] Open
Affiliation(s)
- T H C Tran
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
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20
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Fillet AM, Auray L, Alain S, Gourlain K, Imbert BM, Najioullah F, Champier G, Gouarin S, Carquin J, Houhou N, Garrigue I, Ducancelle A, Thouvenot D, Mazeron MC. Natural polymorphism of cytomegalovirus DNA polymerase lies in two nonconserved regions located between domains delta-C and II and between domains III and I. Antimicrob Agents Chemother 2004; 48:1865-8. [PMID: 15105145 PMCID: PMC400574 DOI: 10.1128/aac.48.5.1865-1868.2004] [Citation(s) in RCA: 31] [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] Open
Abstract
We described the natural polymorphism of cytomegalovirus DNA polymerase in 42 unrelated isolates susceptible to ganciclovir, foscarnet, and cidofovir. All variations, including an eight-amino-acid deletion, were located between domains delta-C and II and between domains III and I, suggesting that these specific residues are not involved in enzymatic functions.
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Affiliation(s)
- Anne-Marie Fillet
- Virology Laboratories, Hospital AP-HP Pitié-Salpêtrière and University Paris VI, Paris, France.
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21
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Cotto E, Neau D, Cransac-Neau M, Auriacombe M, Pellegrin JL, Ragnaud JM, Fillet AM, Belnard M, Fleury H, Lafon ME. Borna disease virus RNA in immunocompromised patients in southwestern France. J Clin Microbiol 2004; 41:5577-81. [PMID: 14662943 PMCID: PMC308971 DOI: 10.1128/jcm.41.12.5577-5581.2003] [Citation(s) in RCA: 6] [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: 11/20/2022] Open
Abstract
Borna disease virus (BDV) is a neurotropic RNA virus with a wide host range. Human infections, although controversial, have been described in Europe, Asia, and the United States. The present study investigated the existence of BDV infections in immunocompromised human beings, namely, 82 human immunodeficiency virus (HIV)-infected and 80 therapeutically immunosuppressed patients. BDV p40 RNAs were detected in peripheral white blood cells with reverse transcription-nested PCR and hybridization in, respectively, 11 (13.41%) and 1 (1.25%) of the two groups of patients. BDV p24 RNAs were identified in only one of those. BDV RNA was detected in the absence of any neuropsychiatrical illness, suggesting that BDV infections may occur in asymptomatic carriers. The severity and particularity of cellular immunosuppression could explain the significantly increased detection of BDV RNA in HIV-infected patients.
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Affiliation(s)
- Emmanuelle Cotto
- Laboratoire de Virologie, Université Bordeaux 2, and Centre Hospitalier Régional de Bordeaux, France.
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22
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Hausfater P, Fillet AM, Rozenberg F, Arthaud M, Trystram D, Huraux JM, Lebon P, Riou B. Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department. J Med Virol 2004; 73:137-46. [PMID: 15042661 DOI: 10.1002/jmv.20068] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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: 11/07/2022]
Abstract
Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Base Sequence
- Biomarkers/cerebrospinal fluid
- DNA, Viral/cerebrospinal fluid
- DNA, Viral/genetics
- Emergency Service, Hospital
- Female
- Humans
- Interferon-alpha/blood
- Interferon-alpha/cerebrospinal fluid
- Male
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/immunology
- Meningitis, Aseptic/virology
- Meningitis, Viral/diagnosis
- Meningitis, Viral/immunology
- Meningitis, Viral/virology
- Middle Aged
- Polymerase Chain Reaction
- Prospective Studies
- Spinal Puncture
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Affiliation(s)
- Pierre Hausfater
- Service d'Accueil des Urgences, CHU Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie, Paris, France.
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23
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Alain S, Hantz S, Scieux C, Karras A, Mazeron MC, Szelag JC, Imbert BM, Fillet AM, Gouarin S, Mengelle C, De Wilde A, Cogne N, Champier G, Rogez S, Legendre C, Denis F. Detection of ganciclovir resistance after valacyclovir-prophylaxis in renal transplant recipients with active cytomegalovirus infection. J Med Virol 2004; 73:566-73. [PMID: 15221901 DOI: 10.1002/jmv.20127] [Citation(s) in RCA: 28] [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: 11/10/2022]
Abstract
Whether valaciclovir (VCV) prophylaxis could be responsible for ganciclovir (GCV)-resistance of Human cytomegalovirus (HCMV) in transplantation has never been documented. A multicentric retrospective pilot study was undertaken to detect GCV-resistance through mutations within the UL97 gene in renal transplant recipients who experienced active HCMV infection and received valacyclovir prophylaxis. Twenty-three patients who experienced HCMV antigenaemia or DNAemia during or at the end of prophylaxis were included. UL97 genotyping was carried out on peripheral blood samples, using a nested in-house PCR, which amplified the full-length UL97 gene. One patient has a resistance-related mutation (M460I); the major risk factor for emergence of resistance in this patient was the presence of early and persistent antigenaemia. GCV-resistance during VCV-prophylaxis was rare after renal transplantation. However, special attention must be paid to patients developing early active HCMV infection under prophylaxis.
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Affiliation(s)
- S Alain
- Department of Bacteriology-Virology-Hygien, EA, Teaching Hospital Dupuytren, Limoges, France.
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24
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Sénéchal M, Dorent R, du Montcel ST, Fillet AM, Ghossoub JJ, Dubois M, Pavie A, Gandjbakhch I. Monitoring of human cytomegalovirus infections in heart transplant recipients by pp65 antigenemia. Clin Transplant 2003; 17:423-7. [PMID: 14703924 DOI: 10.1034/j.1399-0012.2003.00064.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/23/2022]
Abstract
BACKGROUND Rapid diagnostic techniques offer the opportunity of early diagnosis of human cytomegalovirus (CMV) infection in immunocompromized patients at risk of developing CMV disease and syndrome. The use of CMV pp65 antigenemia as a predictor of CMV syndrome and disease in heart transplant recipient after induction therapy was studied retrospectively. METHODS One hundred and nineteen consecutive heart transplant recipients treated with induction therapy who survived more then 14 d were monitored for CMV infection. Ninety-four recipients were seropositive for CMV. Twenty-five recipients were seronegative for CMV and received grafts from seropositive donors. Pre-emptive therapy was used in seropositive patients when CMV pp65 antigenemia was greater than 50 antigen-positive cells per 2 x 10(5) peripheral blood leukocytes (PBL); prophylactic therapy was done only in seronegative recipient matched with seropositive donor. RESULTS High-level CMV pp65 antigenemia (50 antigen-positive cells 2 x 10(5) PBL) occurred in 34% (41 of 119) of patients at a median of 44 d following transplantation. In seropositive recipients, 16% (15 of 94) of patients developed CMV invasive disease or syndrome, and in seronegative recipients 20% (5 of 25) of patients developed CMV disease or syndrome. Sixty-six per cent (62 of 94) of CMV seropositive patients were identified as not requiring pre-emptive therapy. In seropositive and seronegative recipients, the sensibility and negative predictive value of the cut-off level of 50 antigen positive cell for CMV disease and syndrome was 100%. The specificity was 79% and positive predictive value was 49%. CONCLUSION Because of the excellent sensibility and negative predictive value of the cut-off level of 50 antigen positive cell per 2 x 10(5) PBL, application of pre-emptive therapy guided by high level of CMV pp65 antigenemia in the context of induction therapy allow to omit antiviral therapy in many at risk patients. In the context of pre-emptive and prophylactic therapy, the cut-off level of 50 antigen positive cell do not allow to predict with accuracy the development of CMV disease or syndrome.
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Affiliation(s)
- Mario Sénéchal
- Service de Chirurgie Cardio-Vasculaire et Thoracique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
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25
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Mazeron MC, Fillet AM, Salmon D, Boukli N, Houhou N, Sénéchal B, Matheron S, Gozlan J, Leport C, Katlama C, Scieux C, Imbert BM, Deny P, Bour JB, Freymuth F, Chanzy B, Chaput S, Costagliola D. Quantitative markers for cytomegalovirus disease in HIV-infected patients receiving highly active antiretroviral therapy. AIDS 2003; 17:784-6. [PMID: 12646814 DOI: 10.1097/00002030-200303280-00029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Gourlain K, Salmon D, Gault E, Leport C, Katlama C, Matheron S, Costagliola D, Mazeron MC, Fillet AM. Quantitation of cytomegalovirus (CMV) DNA by real-time PCR for occurrence of CMV disease in HIV-infected patients receiving highly active antiretroviral therapy. J Med Virol 2003; 69:401-7. [PMID: 12526052 DOI: 10.1002/jmv.10303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/08/2022]
Abstract
In HIV-infected patients treated with highly active antiretroviral therapy (HAART) included in the Predivir cohort, we have evaluated the usefulness of CMV DNA quantitation by a TaqMan PCR assay from peripheral blood leukocytes (PBLs) to predict CMV disease occurrence. In parallel with the immune restoration after treatment by HAART, the percentage of positive samples decreased progressively from 7.3% at Day 0 to 3.5% at Month 12. Among the CMV markers, the smallest concordance with PBL CMV TaqMan PCR, as evaluated by kappa, was observed with pp65 antigenemia, whereas concordance with all other CMV markers was high. Among the 16 patients with CMV DNA copies at least once >100/150,000 cells, CMV disease occurred in six during follow-up, whereas among the 159 patients with CMV DNA copies always <10/150,000 cells, CMV disease occurred in three and among the seven patients with CMV DNA copies >10 and <100 occurred in only one. In univariate Cox models, all the CMV markers including PBL CMV TaqMan PCR >10/150,000 cells (RR: 27.6, IC95: 7.1-107.2), the CD4 cell count <75 cells/mm(3) and the HIV viral load >100,000 copies/ml were predictive for CMV disease. In a stepwise multivariate analysis, which should be interpreted with caution due to the small number of events (n = 10), three covariates were associated independently with CMV disease: pp65 antigenemia >100 nuclei/200,000, PBL CMV TaqMan PCR >10 copies/150,000 cells and HIV viral load remaining or increasing >100,000 copies/ml.
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Affiliation(s)
- Karine Gourlain
- Department of Virology, Pitié-Salpêtrière Hospital, Paris, France
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27
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Abstract
In older patients, prophylaxis of herpesvirus infections mainly involves preventing the recurrence of herpes simplex virus (HSV) and complications of herpes zoster in immunocompetent patients, while in immunocompromised patients it is more concerned with the prevention of opportunistic virus reactivation. HSV ocular infection is the most frequent cause of corneal blindness in the US. The effectiveness of aciclovir 400mg twice daily in preventing the recurrence of HSV eye disease in immunocompetent patients has been well demonstrated. The issue of treatment duration for patients with highly recurrent ocular herpes remains unresolved. Post-herpetic neuralgia (PHN) is one of the most common neuralgic illnesses worldwide. Some progress in prevention of PHN has been made with a combination of antiviral therapy (famciclovir or valaciclovir), started within 72 hours of onset of the rash, and analgesic treatment. However, the best prevention of PHN is the prevention of herpes zoster disease, and the varicella vaccine is an option which over the next few years will be tested in clinical trials. For immunocompromised patients of any age, restoring immunity prevents herpesvirus disease, as demonstrated for cytomegalovirus (CMV) in AIDS patients receiving highly active antiretroviral therapy. Specific antiviral therapy during the initial period after transplantation could prevent reactivation of HSV or CMV in seropositive recipients. Whether pre-emptive therapy or prophylaxis with ganciclovir is the optimal approach against CMV remains controversial, and the relative merits and limitations of each approach may guide the choice. In stem cell transplantation, pre-emptive therapy with foscarnet avoids the neutropenia and related complications associated with ganciclovir. In renal transplant recipients, universal prophylaxis of CMV infection with valaciclovir has the same efficacy as ganciclovir. Although it is relatively toxic, cidofovir should be further evaluated because of its in vitro activity against most DNA viruses.
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Affiliation(s)
- Anne-Marie Fillet
- Virology Department, Pitié-Salpêtrière Hospital and University, 83 Boulevard de l'Hôpital, 75651 Paris, Cédex 13, France.
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28
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Challine D, Buisson M, Cadilhac M, Germanidis G, Joab I, Eliaszewicz M, Caumes E, Flahault A, Fillet AM, Pawlotsky JM, Seigneurin JM. Hepatitis C virus-Epstein-Barr virus interaction in patients with AIDS. J Med Virol 2002; 67:510-5. [PMID: 12115996 DOI: 10.1002/jmv.10130] [Citation(s) in RCA: 6] [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: 01/29/2023]
Abstract
Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads to B-cell non-Hodgkin's lymphoma in immunocompromised patients. The role of hepatitis C virus (HCV) in B-cell non-Hodgkin's lymphoma has recently been raised, and an interaction between HCV and EBV is supported by recent in vitro experiments. The aim of this study was to investigate in vivo interactions between HCV and EBV in patients with AIDS, i.e., patients exposed to the risk of EBV-related B-cell non-Hodgkin's lymphoma. A total of 135 patients were prospectively studied. Serological and molecular markers of HCV, EBV, and human immunodeficiency virus (HIV) infection were sought. All the patients harbored latent EBV infection, and 20% had detectable HCV RNA in serum. No significant relationship was found between HIV, HCV, and EBV viral load in peripheral blood mononuclear cells or plasma. There was no difference between anti-HCV-positive and -negative patients or between HCV RNA-positive and -negative patients with regard to the prevalence of EBV markers, especially EBV replication markers. The presence of EBV replication markers was not related to HCV RNA seropositivity or to HCV viral load. Five patients subsequently developed B-cell non-Hodgkin's lymphoma, none of whom had markers of EBV or HCV replication. These results argue against an in vivo interaction between HCV and EBV in patients with AIDS, and against a role of HCV infection in the occurrence of B-cell non-Hodgkin's lymphoma in these patients.
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Affiliation(s)
- Dominique Challine
- Department of Virology (EA 3489), Hôpital Henri Mondor, Université Paris XII, Créteil, France
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Gautheret-Dejean A, Manichanh C, Thien-Ah-Koon F, Fillet AM, Mangeney N, Vidaud M, Dhedin N, Vernant JP, Agut H. Development of a real-time polymerase chain reaction assay for the diagnosis of human herpesvirus-6 infection and application to bone marrow transplant patients. J Virol Methods 2002; 100:27-35. [PMID: 11742650 DOI: 10.1016/s0166-0934(01)00390-1] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [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: 12/01/2022]
Abstract
A quantitative real-time PCR assay was developed for human herpesvirus-6 (HHV-6) genome based on TaqMan technology. After choosing a region of interest into the U65-U66 genes of HHV-6 genome, its nucleotide sequence was determined among four HHV-6 strains (one variant A and three variants B) to exclude a variability of sensitivity due to interstrain sequence differences. A plasmid containing HHV-6 target sequences identical to those of reference type viruses was constructed with the aim of standardisation. This HHV-6 genomic quantitation assay has a threshold sensitivity of ten copy equivalents (EqCop) per reaction. In order to test the feasibility of this assay directly on human samples, the technique was applied to the quantitation of HHV-6 genome in 30 blood samples from healthy subjects as well as 31 blood samples and three samples of cerebrospinal fluid (CSF) from 21 bone marrow transplant (BMT) recipients and four patients with a haematological disease but not treated by bone marrow transplantation. HHV-6 load ranged between 0.00015 and 0.0008 equivalent DNA copy number (EqCop) per 100 peripheral blood mononuclear cells (PBMCs) in healthy subjects whereas it ranged from <10 to 7500 EqCop per 100 PBMCs, and from <10 to 415,820 EqCop per 100 microl of whole CSF in patients. The efficacy of treatment with antiherpetic drug was associated with a decrease of the viral load in the CSF of one patient. This method leads to relevant results in term of range of quantitation, sensitivity, and safety against contamination by amplicons, and might constitute a useful tool for the follow-up of BMT recipients particularly in the presence of antiherpetic therapy.
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Affiliation(s)
- Agnès Gautheret-Dejean
- Laboratoire de Virologie, UPRES EA 2387, Groupe Hospitalier Pitié-Salpêtrière, 83 boulevard de l'Hôpital, 75013 Paris, France.
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Abstract
BACKGROUND We report three new cases of cutaneous Destombes-Rosai-Dorfman disease (DRDD). Two were skin-limited, and one was associated with systemic involvement. In all cases typical large S100 positive macrophages with emperipolesis were present, but different patterns were seen. A viral etiology has long been suspected in DRDD. METHODS Thus, all cases were investigated for presence of HHV-6 major capsid protein gene by polymerase chain reaction (PCR), and for presence of HHV-8 latency-associated nuclear antigen 1 by immunohistochemistry. RESULTS All results were negative. HHV-6 antibody tests were positive for IgG but not for IgM in one case. With regard to HHV-6, previous studies supplied inconclusive results while, to our knowledge, HHV-8 has never been investigated in DRDD. CONCLUSION This study suggests that HHV-8 is not involved in the pathogenesis of cutaneous DRDD. However, this should be confirmed by further studies. We can postulate three hypotheses in regard to HHV-6 role in DRDD pathogenesis: 1) its presence in lesionnal tissues is fortuitous, 2) HHV-6 plays a role in promoting more aggressive diseases and 3) various causes, including HHV-6, are implicated in the pathogenesis of DRDD.
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Affiliation(s)
- N Ortonne
- Department of Pathology, Hôpital Henri Mondor, Créteil, France
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31
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Saint-Léger E, Caumes E, Breton G, Douard D, Saiag P, Huraux JM, Bricaire F, Agut H, Fillet AM. Clinical and virologic characterization of acyclovir-resistant varicella-zoster viruses isolated from 11 patients with acquired immunodeficiency syndrome. Clin Infect Dis 2001; 33:2061-7. [PMID: 11702291 DOI: 10.1086/324503] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 04/11/2001] [Revised: 07/19/2001] [Indexed: 11/04/2022] Open
Abstract
We studied the clinical resistance to acyclovir of infections with varicella-zoster viruses (VZV) in patients with acquired immunodeficiency syndrome, and we correlated it to virologic analyses. Eleven patients with VZV infections (treated with acyclovir, 30 mg/kg/day, given intravenously, or 4 g/day, given orally) were included in the study because of the failure of 10 days of acyclovir therapy. Susceptibility of VZV isolates to acyclovir was tested using a plaque reduction assay to determine the 50% inhibitory concentration (IC(50)) of acyclovir and the SI(50) (IC(50) of the patient isolate/IC(50) of the reference strain) to acyclovir. The thymidine kinase (TK) gene, which supports the resistance, was sequenced on amplified products. Only 3 patients had a significant increase in the IC(50), as compared with the IC(50) of the reference strain (SI(50) of > or =4), and a mutation in the TK gene. For the other 8 patients, the clinical resistance was not confirmed by the virologic results: the SI(50) was < 4, and no mutation was detected in the TK gene. Because no acyclovir-resistant strain appeared during a shorter period of time, we suggest an increase in the duration of the treatment to 21 days before acyclovir resistance is suspected.
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Affiliation(s)
- E Saint-Léger
- Department of Virology, La Pitie-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), 75651 Paris Cedex, France
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Arnulf B, Chebbi F, Lefrere F, Ait Arkoub Z, Varet B, Fillet AM. Multiple herpes simplex virus infections with various resistance patterns in a matched unrelated donor transplant recipient. Bone Marrow Transplant 2001; 28:799-801. [PMID: 11781635 DOI: 10.1038/sj.bmt.1703233] [Citation(s) in RCA: 5] [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] [Received: 04/06/2001] [Accepted: 07/27/2001] [Indexed: 11/09/2022]
Abstract
A 45-year-old matched unrelated BMT recipient had sequential mucocutaneous herpes simplex virus (HSV) type 2 infections. Five months after BMT, a penile lesion occurred and was cured using acyclovir, as expected from in vitro susceptibility results. The same lesion recurred 1 month later but worsened with acyclovir. The HSV isolate was resistant to acyclovir (IC(50) = 105 microM), and a nucleotide (G) was added to the thymidine kinase gene leading to a premature stop codon. The lesion improved markedly with foscarnet. During this treatment a second HSV infection occurred on the buttocks 2 weeks after the first one and healed completely with acyclovir. This course correlated with in vitro results of the buttock HSV isolate which was foscarnet-resistant (IC(50) = 300 microg/ml) and acyclovir-sensitive. Surprisingly, no mutation gene of the foscarnet-resistant isolate was detected in the DNA polymerase gene. This case shows that an HSV acyclovir-resistant infection may be followed by an acyclovir-sensitive one. Determination of antiviral susceptibility is needed to monitor the treatment of various HSV infections in immunocompromised BMT recipients.
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Affiliation(s)
- B Arnulf
- Hematology Department, Necker Hospital, Paris, France
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33
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Saint-Léger E, Fillet AM, Malvy D, Rabanel B, Caumes E. [Efficacy of cidofovir in an HIV infected patient with an acyclovir and foscarnet resistant herpes simplex virus infection]. Ann Dermatol Venereol 2001; 128:747-9. [PMID: 11460038] [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: 02/20/2023]
Abstract
BACKGROUND We report the case of an AIDS patient, whose persistant HSV2 ulceration was clinically and phenotypically resistant to acyclovir and foscarnet. Only five clinical isolates of simultaneous acyclovir and foscarnet resistance have been previously described. CASE REPORT This patient, without history of opportunistic infection, was hospitalized for a recurrent scrotal ulceration resistant to several antiviral treatment such as acyclovir, valacyclovir or foscarnet. The CD4 count was stable at 150/mm(3) and the HIV viral load was below detection level. The last recurrence appeared rapidly under valacyclovir therapy which had been introduced after 65 days of foscarnet therapy. Thus, the patient received a new dose of foscarnet. After initial efficacy, the ulceration increased once again. HSV2 phenotypic determination was done and detected, at that time, a double resistance to acyclovir and foscarnet. Healing was obtained with intravenous cidofovir. DISCUSSION Foscarnet and acyclovir resistance in an HSV2 isolate is rare. This report presents several particularities. First, whereas the earlier published patients with an acyclovir and foscarnet resistant strain were widely immunocompromised, this was not the case for our patient. Secondly, in contrast with most precedent observations in which acyclovir-resistant strain disappeared after foscarnet therapy, in our case the acyclovir resistant strain remained after foscarnet therapy. Finally, few reports concerned the clinical efficacy of cidofovir in HSV infection. In this case, we proved that intravenously cidofovir was highly and rapidly effective on acyclovir and foscarnet resistant strains.
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Affiliation(s)
- E Saint-Léger
- Service de Virologie CERVI (Professeur Huraux), Groupe Hospitalier Pitié-Salpêtrière, Paris
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Descamps V, Valance A, Edlinger C, Fillet AM, Grossin M, Lebrun-Vignes B, Belaich S, Crickx B. Association of human herpesvirus 6 infection with drug reaction with eosinophilia and systemic symptoms. Arch Dermatol 2001; 137:301-4. [PMID: 11255328] [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: 02/19/2023]
Abstract
BACKGROUND There is a current debate regarding the association of human herpesvirus 6 (HHV-6) infection and drug reaction with eosinophilia and systemic symptoms (DRESS). METHODS Seven consecutive patients hospitalized with DRESS were enrolled in a prospective study to evaluate evidence of active HHV-6 infection. OBSERVATIONS The imputable drugs were carbamazepine (5 patients), ibuprofen (1 patient), and sulfasalazine (1 patient). All patients were seropositive for anti-HHV-6 IgG antibodies. Anti-HHV-6 IgM antibodies were detected in 4 of the 7 patients with a seroconversion in 2 patients. Neither anti-cytomegalovirus nor anti-Epstein-Barr virus early antigen IgM antibody was detected. Human herpesvirus 6 genome was not detected by polymerase chain reaction in the first serum sample of all patients. It was weakly detected in skin lesions in the last patient tested by polymerase chain reaction but was not found in uninvolved skin. CONCLUSIONS The results suggest an association between HHV-6 active infection (primo-infection or reactivation) and severe DRESS. Absence of anti-cytomegalovirus or anti-Epstein-Barr virus early antigen IgM antibodies argues against a nonspecific viral reactivation. Human herpesvirus 6 infection may play a role in the development of DRESS in susceptible patients. Some drugs with reactive metabolites could favor reactivation and propagation of HHV-6.
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Affiliation(s)
- V Descamps
- Dermatology Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France.
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Généreau T, Charlotte F, Fillet AM, Poynard T, Herson S, Di Martino V. [Cytomegalovirus hepatitis is never chronic and may hide another!]. Rev Med Interne 2001; 22:196-7. [PMID: 11234680 DOI: 10.1016/s0248-8663(00)00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
MESH Headings
- Acute Disease
- Adult
- Chronic Disease
- Cytomegalovirus Infections/complications
- Cytomegalovirus Infections/diagnosis
- Cytomegalovirus Infections/enzymology
- Diagnosis, Differential
- Female
- Fever/etiology
- Hepatitis, Autoimmune/complications
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Hepatitis, Autoimmune/enzymology
- Hepatitis, Viral, Human/complications
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/enzymology
- Humans
- Jaundice/etiology
- Liver Function Tests
- Pruritus/etiology
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Abstract
Borna disease virus (BDV), a noncytolytic neurotropic nonsegmented negative-stranded RNA virus with a wide geographic distribution, infects several vertebrate animal species and causes an immune-mediated central nervous system (CNS) disease with various manifestations, depending on both host and viral factors. In animal infections, BDV can persist in the CNS and induce alterations in brain cell functions, neurodevelopmental abnormalities and behavioral disturbances. An association between BDV and psychiatric disorders (essentially schizophrenia and affective disorders) has been suggested by some serologic and molecular studies but further investigations are required to substantiate the possible contribution of this virus to the pathogenesis of these disorders.
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Affiliation(s)
- O Taieb
- Department of Virology, CERVI, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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37
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Jouan M, Savès M, Tubiana R, Carcelain G, Cassoux N, Aubron-Olivier C, Fillet AM, Nciri M, Sénéchal B, Chêne G, Tural C, Lasry S, Autran B, Katlama C. Discontinuation of maintenance therapy for cytomegalovirus retinitis in HIV-infected patients receiving highly active antiretroviral therapy. AIDS 2001; 15:23-31. [PMID: 11192865 DOI: 10.1097/00002030-200101050-00006] [Citation(s) in RCA: 67] [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
OBJECTIVE To study the safety of discontinuing cytomegalovirus (CMV) maintenance therapy among patients with cured CMV retinitis receiving highly active antiretroviral therapy (HAART). METHODS Patients with a history of CMV retinitis who were receiving anti-CMV maintenance therapy and who had a CD4 cell count > 75 x 10(6) cells/l and a plasma HIV RNA level < 30000 copies/ml while on HAART were included in a multicentre prospective study. Maintenance therapy for CMV retinitis was discontinued at enrolment and all the patients were monitored for 48 weeks by ophthalmological examinations and by determination of CMV markers, CD4 cell counts and plasma HIV RNA levels. T helper-1 anti-CMV responses were assessed in a subgroup of patients. The primary study endpoint was recurrence of CMV disease. RESULTS At entry, the 48 assessable patients had been taking HAART for a median of 18 months. The median CD4 cell count was 239 x 10(6) cells/l and the median HIV RNA load was 213 copies/ml. Over the 48 weeks, 2 of the 48 patients had a recurrence of CMV disease. The cumulative probability of CMV retinitis relapse was 2.2% at week 48 (95% confidence interval, 0.4-11.3) and that of all forms of CMV disease 4.2%. CMV blood markers remained negative throughout follow-up. The proportion of patients with CMV-specific CD4 T cell reactivity was 46% at baseline and 64% at week 48. CONCLUSIONS CMV retinitis maintenance therapy may be safely discontinued in patients with CD4 cell counts above 75 x 10(6) cells/l who have been taking HAART for at least 18 months.
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Affiliation(s)
- M Jouan
- Department of Infectious Diseases, H pital Pitié-Salpêtrière, Paris, France
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38
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Cassoux N, Bodaghi B, Fillet AM, Carcelain G, Katlama C, Lehoang P. Relapses of CMV retinitis after 2 years of highly active antiretroviral therapy. Br J Ophthalmol 2000; 84:1203. [PMID: 11202913 PMCID: PMC1723278 DOI: 10.1136/bjo.84.10.1203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Salmon-Céron D, Mazeron MC, Chaput S, Boukli N, Senechal B, Houhou N, Katlama C, Matheron S, Fillet AM, Gozlan J, Leport C, Jeantils V, Freymuth F, Costagliola D. Plasma cytomegalovirus DNA, pp65 antigenaemia and a low CD4 cell count remain risk factors for cytomegalovirus disease in patients receiving highly active antiretroviral therapy. AIDS 2000; 14:1041-9. [PMID: 10853987 DOI: 10.1097/00002030-200005260-00017] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [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: 11/25/2022]
Abstract
OBJECTIVE To study the natural history and the current risk factors for cytomegalovirus (CMV) disease in the context of highly active antiretroviral therapy (HAART). SETTING Prospective multicentre cohort in 15 university hospitals in France. METHODS A group of 198 patients with CD4 cell count < 100 x 10(6) cells/l (or < 200 x 10(6) cells/l under HAART for at least 2 months), no previous CMV disease and CMV-positive serology were followed every 4 months clinically and for virological testing including HIV RNA and CMV blood markers (culture, pp65 antigenaemia, plasma CMV DNA and CMV late mRNA by the polymerase chain reaction). RESULTS At inclusion, median CD4 was 77 x 10(6) cells/l (0-308) and 85% of the patients received protease inhibitors. The percentage of patients receiving HAART reached 99% at 12 months. After a follow-up of 23.6 months, the incidence of CMV disease was 3.2/100 patient-years [95% confidence interval (CI) 1.3-5.0]. In univariate Cox models, all the CMV markers, a CD4 cell count remaining < 75 x 10(6) cells/l and an HIV viral load > 100,000 copies/ml were predictive for CMV disease. The hazard ratios for CMV disease were 11 for blood culture; 14 and 70 for pp65 antigenaemia of > or = 1 and > or = 100 nuclei/200,000 cells, respectively; 35 for plasma CMV DNA; 6 for CMV mRNA; 29 for CD4 < 75 x 10(6) cells/l; and 12 for HIV RNA > 100,000 copies/ml. In a stepwise multivariate analysis, only three covariates were independently associated with the occurrence of a disease: plasma CMV DNA, pp65 antigenaemia > or = 100 nuclei/200,000 cells and a CD4 count < 75 x 10(6) cells/l. CONCLUSION CMV blood markers and CD4 count < 75 x 10(6) cells/l remain risk factors for CMV disease in patients receiving HAART. Analysis of plasma CMV DNA by the polymerase chain reaction is a reproducible and standardized tool that could be used as a decision marker for initiating CMV pre-emptive therapy.
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Affiliation(s)
- D Salmon-Céron
- Department of Internal Medicine, Hospital Cochin, Paris, France
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Huraux JM, Fillet AM, Calvez V, Blanchier H, Huraux-Rendu C. [Maternal-fetal viral infections: preventive treatment of maternal-fetal transmission during pregnancy, delivery and after birth]. Arch Pediatr 2000; 6 Suppl 2:411s-413s. [PMID: 10370553 DOI: 10.1016/s0929-693x(99)80485-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J M Huraux
- Service de virologie, Groupe hospitalier Pitié-Salpêtrière, Paris, France
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Anduze-Faris BM, Fillet AM, Gozlan J, Lancar R, Boukli N, Gasnault J, Caumes E, Livartowsky J, Matheron S, Leport C, Salmon D, Costagliola D, Katlama C. Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients. AIDS 2000; 14:517-24. [PMID: 10780714 DOI: 10.1097/00002030-200003310-00007] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the foscarnet-ganciclovir combination in induction therapy (IT) and maintenance therapy (MT) for cytomegalovirus (CMV) central neurological disorders in HIV-infected patients. DESIGN An open pilot non-comparative multicentre study. METHODS Thirty-one patients with acute CMV encephalitis (CMVe) (n = 17) or CMV myelitis (CMVm) (n = 14) during the era before highly active antiretroviral therapy (HAART) received intravenous IT with foscarnet 90 mg/kg plus ganciclovir 5 mg/kg twice a day followed by MT. The primary endpoint was clinical efficacy, assessed at the end of the induction phase. RESULTS The foscarnet-ganciclovir combination in IT resulted in a 74% (23 out of 31 patients) clinical improvement or stabilization. Eight patients did not respond clinically. Side-effects leading to drug discontinuation occurred in 10 patients during IT. Among the 23 patients who qualified for the maintenance phase, CMV disease progressed in 10, with a median time to the first relapse of 126 days (range 64-264 days). Overall, the median survival time was 3 months [95% confidence interval (CI), 2-4 months]. CONCLUSION The combination of foscarnet and ganciclovir can safely be used for CMV central nervous system (CNS) infection, with an improvement or stabilization in 74% of patients. Life-long MT with this combination is recommended as long as the immune system is profoundly impaired.
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Affiliation(s)
- B M Anduze-Faris
- Department of Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, Paris, France
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Saint-Léger E, Fillet AM. [Varicella-zoster virus]. Rev Prat 1999; 49:2208-16. [PMID: 10731804] [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: 02/15/2023]
Abstract
Varicella-zoster virus, an ubiquitous human pathogen, causes vesicular rash during varicella, the primary infection of the host and zoster corresponding to reactivation. The symptoms could be various, nervous systems and lung being involved. Usually mild, varicella could be severe in immunocompromised patients, during pregnancy for the mother and the foetus, for the newborn and also for adults. Post herpetic neuralgia in old patient is the main complication of zoster. Various methods for virological diagnosis (culture, cytology, serology, PCR) with different sensibilities and specificities depending mainly of sample type are available. Various antiviral drugs are available, acyclovir being the reference one.
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Affiliation(s)
- E Saint-Léger
- Service de virologie Groupe hospitalier La Pitié-La Salpêtrière, Paris
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Visse B, Huraux JM, Fillet AM. Point mutations in the varicella-zoster virus DNA polymerase gene confers resistance to foscarnet and slow growth phenotype. J Med Virol 1999; 59:84-90. [PMID: 10440813] [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: 02/13/2023]
Abstract
Seven independent laboratory mutants were derived from seven distinct wild-type varicella-zoster virus (VZV) isolates after exposure to increasing concentrations of foscarnet (PFA) and were found to be resistant to this drug. Single base changes resulting in amino acid substitutions were observed in the nucleotide sequence of the DNA polymerase gene of each PFA-resistant mutant. The mutations were found to occur within the domain II (Arg-665 --> Gly for strains vrMOR and vrVER; Val-666 --> Leu for vrLEB; Gln-692 --> Arg for vrOLI) and domain III (Arg-806 --> Ser for vrABD; Leu-809 --> Ser for vrALI and vrCHA) of DNA polymerase gene. In addition, the PFA-resistant mutants exhibited a phenotype characterized by slow growth, the strains showing a marked delay in immediate-early antigen plaque formation compared with the wild-type VZV from which they were derived. These results may have implications for successful isolation and characterization of PFA-resistant strains from clinical samples containing mixed viral populations.
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Affiliation(s)
- B Visse
- Laboratoire de Virologie, CERVI, Hôpital Pitié-Salpêtrière, Paris, France
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Li TS, Tubiana R, Fillet AM, Autran B, Katlama C. Negative result of cytomegalovirus blood culture with restoration of CD4+ T-cell reactivity to cytomegalovirus after HAART in an HIV-1-infected patient. J Acquir Immune Defic Syndr Hum Retrovirol 1999; 20:514-5. [PMID: 10225236 DOI: 10.1097/00042560-199904150-00016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salmon-Céron D, Fillet AM, Aboulker JP, Gérard L, Houhou N, Carrière I, Ostinelli J, Vildé JL, Brun-Vézinet F, Leport C. Effect of a 14-day course of foscarnet on cytomegalovirus (CMV) blood markers in a randomized study of human immunodeficiency virus-infected patients with persistent CMV viremia. Agence National de Recherche du SIDA 023 Study Group. Clin Infect Dis 1999; 28:901-5. [PMID: 10825058 DOI: 10.1086/515223] [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: 11/03/2022] Open
Abstract
A randomized open-label phase 2 trial compared the virological and clinical effects on cytomegalovirus (CMV) infection of a 14-day course of intravenous foscarnet (100 mg/[kg x 12 h]) or no treatment in 42 HIV-infected patients with < 100 CD4 cells/mm3 and persistent asymptomatic CMV viremia. All CMV markers (blood culture, pp65 antigenemia, plasma and leukocyte DNA) either became negative or decreased significantly at day 14 in the foscarnet group. CMV blood culture results at day 14 were positive in 14% of those receiving foscarnet versus 60% of control patients (P = .004). However, after the end of treatment, all markers reappeared or the virus load rapidly increased. The probability of CMV disease at 6 months was 43% in both groups. Patients who had or who achieved a negative blood culture at any time had a reduced risk of CMV disease (RR = 2.64; 95% CI = 1.24-5.62; P = .02). This study suggests that sequential courses of intravenous foscarnet might not be a good strategy for preemptive therapy in this population and that in patients with a positive blood marker, treatment able to induce and maintain negative CMV blood cultures could constitute an effective intervention.
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Affiliation(s)
- D Salmon-Céron
- Department of Internal Medicine, Cochin Hospital, Paris, France.
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47
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Fillet AM. Predictive value of peripheral blood leukocytes (PBL) cytomegalovirus (CMV) quantification by PCR assay on occurrence of CMV disease as compared to others CMV blood markers in HIV infected patients under HAART included in the predivir cohort (ANRS EP7). J Clin Virol 1999. [DOI: 10.1016/s1386-6532(99)90557-7] [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: 10/26/2022]
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Breton G, Fillet AM, Katlama C, Bricaire F, Caumes E. Acyclovir-resistant herpes zoster in human immunodeficiency virus-infected patients: results of foscarnet therapy. Clin Infect Dis 1998; 27:1525-7. [PMID: 9868672 DOI: 10.1086/515045] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [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: 11/03/2022] Open
Abstract
We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.
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Affiliation(s)
- G Breton
- Department of Infectious and Tropical Diseases, Hôpital Pitié Salpétrière, Paris, France
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Visse B, Dumont B, Huraux JM, Fillet AM. Single amino acid change in DNA polymerase is associated with foscarnet resistance in a varicella-zoster virus strain recovered from a patient with AIDS. J Infect Dis 1998; 178 Suppl 1:S55-7. [PMID: 9852975 DOI: 10.1086/514257] [Citation(s) in RCA: 33] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The genetic characterization of a foscarnet-resistant strain of varicella-zoster virus (VZV) that was isolated from a patient with AIDS is reported. Compared with the sequence of the Dumas reference strain, this strain, which was isolated from a patient in whom foscarnet treatment failed, had two point mutations. The emergence of one of the mutations, which includes a change from a glutamic acid to a lysine at position 512 in the DNA polymerase, suggests that this mutation is implicated in the VZV foscarnet resistance. The other mutation, which replaces serine 863 by a glycine, is also present in 2 susceptible strains--Oka and a wild-type isolate.
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Affiliation(s)
- B Visse
- Laboratoire de Virologie, CERVI, Hôpital Pitié-Salpêtrière, Paris, France
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