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Chawki S, Goldwirt L, Mouhebb ME, Gabassi A, Taouk M, Bichard I, Loze B, Amara A, Brand R, Siegel A, McGowan I, Costagliola D, Assoumou L, Molina JM, Delaugerre C. Ex-vivo rectal tissue infection with HIV-1 to assess time to protection following oral preexposure prophylaxis with tenofovir disoproxil/emtricitabine. AIDS 2024; 38:455-464. [PMID: 37976073 PMCID: PMC10906210 DOI: 10.1097/qad.0000000000003789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/07/2023] [Revised: 09/21/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES We wished to assess time to protection from HIV-1 infection following oral tenofovir disoproxil and emtricitabine (TDF/FTC) as preexposure prophylaxis (PrEP), using ex-vivo rectal tissue infections and drug concentration measures in blood and rectal tissue. DESIGN/METHODS Participants from the ANRS PREVENIR study (NCT03113123) were offered this sub-study after a 14-day wash-out. We used an ex-vivo model to evaluate rectal tissue HIV-1 susceptibility before and after PrEP, 2 h after two pills or 7 days of a daily pill of TDF/FTC. PrEP efficacy was expressed by the difference (after-before) of 14-day cumulative p24 antigen levels. TFV-DP and FTC-TP levels were measured in rectal tissue and PBMCs and correlated with HIV-1 infection. RESULTS Twelve and 11 men were analyzed in the 2 h-double dose and 7 days-single dose groups, respectively. Cumulative p24 differences after-before PrEP were -144 pg/ml/mg (IQR[-259;-108]) for the 2 h-double dose group ( P = 0.0005) and -179 pg/ml/mg (IQR [-253;-86]) for the 7 days-single dose group ( P = 0.001), with no differences between groups ( P = 0.93). Rectal TFV-DP was below quantification after a double dose, but FTC-TP levels were similar to levels at 7 days. There was a significant correlation between rectal FTC-TP levels and p24 changes after a double dose ( R = -0.84; P = 0.0001). CONCLUSION Oral TDF/FTC provided similar protection against HIV-1 infection of rectal tissue 2 h after a double dose or 7 days of a daily dose. At 2 h, this protection seems driven by high FTC-TP concentrations in rectal tissue. This confirms the importance of combining TDF and FTC to achieve early protection.
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Affiliation(s)
- Sylvain Chawki
- Université de Paris Cité, INSERM U-944, Institut Recherche Saint Louis
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Maladies Infectieuses
| | - Lauriane Goldwirt
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Laboratoire de Pharmacologie Biologique
| | - Mayssam El Mouhebb
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique
| | - Audrey Gabassi
- Université de Paris Cité, INSERM U-944, Institut Recherche Saint Louis
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Virologie
| | - Milad Taouk
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Gastro-entérologie, Paris, France
| | - Iris Bichard
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Maladies Infectieuses
| | - Bénédicte Loze
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Maladies Infectieuses
| | - Ali Amara
- Université de Paris Cité, INSERM U-944, Institut Recherche Saint Louis
| | - Rhonda Brand
- University of Pittsburgh, Magee-Women's Research Institute and Foundation, Pittsburgh, Pennsylvania, USA
| | - Aaron Siegel
- University of Pittsburgh, Magee-Women's Research Institute and Foundation, Pittsburgh, Pennsylvania, USA
| | - Ian McGowan
- University of Pittsburgh, Magee-Women's Research Institute and Foundation, Pittsburgh, Pennsylvania, USA
- Orion Biotechnology, Ottawa, Ontario, Canada
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique
| | - Jean-Michel Molina
- Université de Paris Cité, INSERM U-944, Institut Recherche Saint Louis
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Maladies Infectieuses
| | - Constance Delaugerre
- Université de Paris Cité, INSERM U-944, Institut Recherche Saint Louis
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Saint Louis, Service de Virologie
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Aslan A, Lessard D, Lebouché B, Bichard I, Loze B, Laussat E, Molina JM. Harm reduction and multidisciplinary consultations for gay, bisexual, and other men who have sex with men practising chemsex based in a French infectious disease unit: patients' characteristics and perceptions. Sex Health 2024; 21:SH23165. [PMID: 38467162 DOI: 10.1071/sh23165] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Chemsex, a type of sexualised drug use, is expanding among gay, bisexual, and other men who have sex with men (GBMSM), with physical and mental health risks. Health-seeking behaviours of GBMSM practising chemsex is not clear. METHODS Harm reduction (HR) consultations for GBMSM engaging in chemsex and seeking comprehensive services including HR were offered in a Parisian infectious disease unit. From December 2021 to January 2022, HR consultation patients completed an online survey on their consumption, health, used services, and perspective on consultations. We generated descriptive statistics, and tested (χ 2 ) the relationship between reporting a specialised follow-up and perceived usefulness of intervention. RESULTS Of 172 patients, a total of 96 GBMSM (55.2%) completed the survey. Most ever consumed substance was 3-methylmethcathinone (3MMC; 92/96; 95.8%). Before consultations, about half consumed at least once a week (50/96; 52%), most reported negative impacts of chemsex on their social (60/96, 62.5%), professional (56/96, 58.3%), intimate (53/96; 55.21%), or sexual life (52/96; 54.17%). Also, more than two-thirds (n =57; 69.38%) had received a follow-up in specialised services: one-third had been followed in addictology (28/96, 29.2%) and/or psychotherapy (32/96, 33.3%), and one-fourth (24/96, 25.0%) had used emergency services. After consultations, three-quarters perceived the intervention as useful (n =74; 77.08%); we found no significant relationship with receiving a specialised follow-up; and most were satisfied with professionals' listening (90/96; 93.8%), and reported reduced risks (80/96; 83.3%). DISCUSSION Multidisciplinary HR, preventive, diagnostical, and therapeutic sexological and psychiatric interventions are greatly needed among GBMSM practising chemsex. HR interventions accessible in services already attended by GBMSM are a valuable option.
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Affiliation(s)
- Alexandre Aslan
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; and Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; and Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Iris Bichard
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Bénédicte Loze
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Eleonore Laussat
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France
| | - Jean-Michel Molina
- Unité des maladies infectieuses et tropicales, Hôpital Saint-Louis (Hopitaux de Paris - Assistance Publique de Paris), Paris, France; and Université Paris Cité, Paris, France
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Liegeon G, Brun A, Hamet G, Zeggagh J, Pintado C, Loze B, Ponscarme D, Rozenbaum W, Molina JM. Brief Report: Incidence and Management of Complex Kidney Situations Among On-Demand and Daily HIV Pre-Exposure Prophylaxis Users. J Acquir Immune Defic Syndr 2024; 95:255-259. [PMID: 37977193 DOI: 10.1097/qai.0000000000003346] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND We evaluated complex pre-exposure prophylaxis (PrEP) situations linked to kidney issues in a cohort of on-demand and daily PrEP users. SETTING We conducted a single-center retrospective cohort study in France including all PrEP users who received a tenofovir disoproxil (TD)-emtricitabine (FTC) prescription between January 1, 2012 and December 31, 2019 with at least 1 creatinine measurement available before and after PrEP initiation. METHODS A complex kidney situation (CKS) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m 2 on 2 consecutive measurements. We estimated the incidence of this event, described case management, and identified associated factors using a Cox model. RESULTS Three thousand one hundred and fourteen individuals were included in this study. Almost all were men (99%) with a median age of 35 years, 25% had an eGFR <90 mL/minute/1.73m 2 at baseline, and 65% used on-demand PrEP. Nine users (0.29%) had a CKS at baseline; 8/9 initiated on-demand PrEP without renal function worsening after a median (interquartile range [IQR]) follow-up time of 14 months (7-31). Thirteen cases of CKS occurred during the follow-up for a 0.25 per 100 person-years incidence (95% confidence interval [CI]: [0.14; 0.45]). On-demand PrEP was used in 7/13 participants with no further episode of confirmed eGFR <60 mL/minute/1.73m 2 after a 17-month median follow-up (IQR 4-18). CKS was associated with an age ≥50 years (hazard ratio [HR] 13, 95% CI: [4-39]) or with a baseline eGFR <90 mL/minute/1.73m 2 (HR 34, 95% CI: [4-261]). 9/22 CKS were linked to high-protein intake for weight training. CONCLUSIONS CKS were rare in our cohort. On-demand PrEP did not result in subsequent renal function worsening in these few situations.
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Affiliation(s)
- Geoffroy Liegeon
- Department of Infectious Diseases and Global Health, University of Chicago, Chicago, IL
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Jeremy Zeggagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Claire Pintado
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
- Service de Prévention et Santé Communautaire, Hôpital Intercommunal de Créteil, Créteil, France
| | - Bénédicte Loze
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Diane Ponscarme
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Willy Rozenbaum
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Jean-Michel Molina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
- Paris Cité University, Paris, France
- INSERM UMR 944, Paris, France
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Molina JM, Ghosn J, Assoumou L, Delaugerre C, Algarte-Genin M, Pialoux G, Katlama C, Slama L, Liegeon G, Beniguel L, Ohayon M, Mouhim H, Goldwirt L, Spire B, Loze B, Surgers L, Pavie J, Lourenco J, Ben-Mechlia M, Le Mestre S, Rojas-Castro D, Costagliola D. Daily and on-demand HIV pre-exposure prophylaxis with emtricitabine and tenofovir disoproxil (ANRS PREVENIR): a prospective observational cohort study. The Lancet HIV 2022; 9:e554-e562. [DOI: 10.1016/s2352-3018(22)00133-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
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Noret M, Balavoine S, Pintado C, Siguier M, Brun A, Bauer R, Loze B, Leplatois A, Aslan A, Moudachirou K, Delaugerre C, Rozenbaum W, Molina JM. Daily or on-demand oral tenofovir disoproxil fumarate/emtricitabine for HIV pre-exposure prophylaxis: experience from a hospital-based clinic in France. AIDS 2018; 32:2161-2169. [PMID: 30212403 DOI: 10.1097/qad.0000000000001939] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND On-demand oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) has been approved for pre-exposure prophylaxis (PrEP) in MSM in France following the results of clinical studies, but data are limited on real-world experience. DESIGN A single-center, open-label, prospective cohort study that recruited people at high risk of HIV infection in Paris. METHODS Participants were enrolled in a single hospital-based outpatient clinic and were proposed to start PrEP with daily or on demand TDF/FTC. At baseline and every 3 months thereafter, patients were tested for HIV and creatinine plasma levels, and data on sexual behavior, other sexually transmitted infections (STIs), and tolerability were collected. RESULTS From 10 November 2015 to 30 April 2017, 1069 patients were screened and 1049 (98.1%) started PrEP. Median age was 36 years, 99.4% were MSM with a median number of partners of 10, and 793 (75.6%) opted for on demand PrEP. Over 486 person-years of follow-up, four HIV-infections were diagnosed in poorly or nonadherent patients (incidence 0.82/100 person-years). Rate of condomless sex at last intercourse increased from 53.3% at baseline to 79% at month 12 (P < 10), but increase in bacterial STI rates was modest (14.6% at baseline vs. 19.2% at month 12; P < 10). Most adverse events were gastrointestinal and did not lead to PrEP discontinuation. CONCLUSIONS Most PrEP users were high-risk MSM and opted for on-demand PrEP. PrEP use was associated with a low HIV incidence and a high rate of condomless sex with a modest increase in bacterial STIs.
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Loze B, Lohro F, Niedbalski L, Parlier S, Chereau S, Veron R, Delgado J, Dalle E, Aloccio B, Molina J. Mise en place et prise en charge des consultations PreP par l’équipe paramédicale. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.384] [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: 11/25/2022]
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Fonsart J, Saragosti S, Taouk M, Peytavin G, Bushman L, Charreau I, Hance A, Goldwirt L, Morel S, Mammano F, Loze B, Capitant C, Clavel F, Mahjoub N, Meyer L, Anderson PL, Delaugerre C, Molina JM. Single-dose pharmacokinetics and pharmacodynamics of oral tenofovir and emtricitabine in blood, saliva and rectal tissue: a sub-study of the ANRS IPERGAY trial. J Antimicrob Chemother 2016; 72:478-485. [PMID: 28073964 DOI: 10.1093/jac/dkw412] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/20/2016] [Accepted: 08/28/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In the ANRS IPERGAY pre-exposure prophylaxis (PrEP) trial, a single dose of tenofovir disoproxil fumarate and emtricitabine was taken orally 2-24 h before sexual intercourse. A sub-study was conducted to assess the pharmacokinetics of tenofovir and emtricitabine in blood, saliva and rectal tissue following this initial oral intake. METHODS Plasma, PBMC, saliva and rectal tissue sampling was performed over 24 h in 12 seronegative men before enrolment in the ANRS IPERGAY trial, following a single dose of 600 mg tenofovir disoproxil fumarate/400 mg emtricitabine. Ex vivo HIV infectibility of rectal biopsies was also assessed. RESULTS The median plasma Tmax of tenofovir (median Cmax: 401 μg/L) and emtricitabine (median Cmax: 2868 μg/L) was obtained 1 h (range: 0.5-4) and 2 h (range: 1-4) after dosing, respectively. The median C24 of tenofovir and emtricitabine was 40 and 63 μg/L, respectively. The median PBMC tenofovir diphosphate and emtricitabine triphosphate levels were 12.2 and 16.7 fmol/106 cells and 2800 and 2000 fmol/106 cells at 2 and 24 h after dosing, respectively. Saliva/plasma AUC0-24 ratios were 2% and 17% for tenofovir and emtricitabine, respectively. Emtricitabine was detected in rectal tissue 30 min after dosing, whereas tenofovir was only detectable at 24 h. Ex vivo HIV infectibility assays of rectal biopsies showed partial protection after dosing (P < 0.07). DISCUSSION A single high dose of oral tenofovir disoproxil fumarate/emtricitabine provides rapid and high blood levels of tenofovir and emtricitabine, with rapid diffusion of emtricitabine in saliva and rectal tissue.
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Affiliation(s)
- Julien Fonsart
- Department of Biochemistry, AP-HP, Hôpital Saint-Louis, Paris, France
| | | | - Milad Taouk
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP and University of Paris Diderot, Paris Sorbonne Cité, France
| | - Gilles Peytavin
- Department of Pharmacology, Hôpital Bichat Claude Bernard, Paris, France
| | | | | | | | - Lauriane Goldwirt
- Department of Pharmacology, AP-HP, Hôpital Saint-Louis, Paris, France
| | | | | | - Bénédicte Loze
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP and University of Paris Diderot, Paris Sorbonne Cité, France
| | | | | | - Nadia Mahjoub
- Department of Virology, AP-HP, Hôpital Saint-Louis, University of Paris Diderot, Paris, France
| | | | | | - Constance Delaugerre
- INSERM U941, Paris, France.,Department of Virology, AP-HP, Hôpital Saint-Louis, University of Paris Diderot, Paris, France
| | - Jean-Michel Molina
- INSERM U941, Paris, France .,Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP and University of Paris Diderot, Paris Sorbonne Cité, France
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Lafaurie M, Dolivo M, Girard PM, May T, Bouchaud O, Carbonnel E, Madelaine I, Loze B, Porcher R, Molina JM. Polylactic acidvs.polyacrylamide hydrogel for treatment of facial lipoatrophy: a randomized controlled trial [Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS) 132 SMILE]. HIV Med 2013; 14:410-20. [DOI: 10.1111/hiv.12021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - T May
- Department of Infectious Diseases; Brabois Hospital; Vandoeuvre les Nancy; Paris; France
| | - O Bouchaud
- Department of Infectious Diseases; Avicenne Hospital; Bobigny Cedex; France
| | - E Carbonnel
- Department of Dermatology; E. Herriot Hospital; Lyon Cedex; France
| | - I Madelaine
- Pharmacy; Saint-Louis Hospital; Paris; France
| | | | - R Porcher
- Department of Biostatistics; Saint-Louis Hospital; Paris; France
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Pavie J, Rachline A, Loze B, Niedbalski L, Delaugerre C, Laforgerie E, Plantier JC, Rozenbaum W, Chevret S, Molina JM, Simon F. Sensitivity of five rapid HIV tests on oral fluid or finger-stick whole blood: a real-time comparison in a healthcare setting. PLoS One 2010; 5:e11581. [PMID: 20657834 PMCID: PMC2906506 DOI: 10.1371/journal.pone.0011581] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [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] [Received: 01/13/2010] [Accepted: 05/27/2010] [Indexed: 11/24/2022] Open
Abstract
Background Health authorities in several countries recently recommended the expansion of human immunodeficiency virus (HIV) antibody testing, including the use of rapid tests. Several HIV rapid tests are now licensed in Europe but their sensitivity on total blood and/or oral fluid in routine healthcare settings is not known. Methods and Findings 200 adults with documented HIV-1 (n = 194) or HIV-2 infection (n = 6) were prospectively screened with five HIV rapid tests using either oral fluid (OF) or finger-stick whole blood (FSB). The OraQuick Advance rapid HIV1/2® was first applied to OF and then to FSB, while the other tests were applied to FSB, in the following order: Vikia HIV 1/2®, Determine HIV 1–2®, Determine® HIV-1/2 Ag/Ab Combo® and INSTI HIV-1/HIV-2®. Tests negative on FSB were repeated on paired serum samples. Twenty randomly selected HIV-seronegative subjects served as controls, and the results were read blindly. Most patients had HIV-1 subtype B infection (63.3%) and most were on antiretroviral therapy (68.5%). Sensitivity was 86.5%, 94.5%, 98.5%, 94.9%, 95.8% and 99% respectively, with OraQuick OF, OraQuick FSB, Vikia, Determine, Determine Ag/Ab Combo and INSTI (p<0.0001). OraQuick was less sensitive on OF than on FSB (p = 0.008). Among the six patients with three or more negative tests, two had recent HIV infection and four patients on antiretroviral therapy had undetectable plasma viral load. When patients positive in all the tests were compared with patients who had at least one negative test, only a plasma HIV RNA level <200 cp/ml was significantly associated with a false-negative result (p = 0.009). When the 33 rapid tests negative on FSB were repeated on serum, all but six (5 negative with OraQuick, 1 with INSTI) were positive. The sensitivity of OraQuick, Determine and Determine Ag/Ab Combo was significantly better on serum than on FSB (97.5%, p = 0.04; 100%, p = 0.004; and 100%, p = 0.02, respectively). Conclusion When evaluated in a healthcare setting, rapid HIV tests were less sensitive on oral fluid than on finger-stick whole blood and less sensitive on finger-stick whole blood than on serum.
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Affiliation(s)
- Juliette Pavie
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Anne Rachline
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Bénédicte Loze
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Laurence Niedbalski
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Constance Delaugerre
- Service de Microbiologie, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Eric Laforgerie
- Agence Française de Sécurité Sanitaire et des Produits de Santé, Saint Denis, France
| | - Jean-Christophe Plantier
- Laboratoire Associé du Centre National de Référence sur le VIH, CHU Charles Nicolle, Rouen, France
| | - Willy Rozenbaum
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Sylvie Chevret
- Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - Jean-Michel Molina
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
| | - François Simon
- Service de Microbiologie, Hôpital Saint-Louis, Université Paris Diderot, Paris, France
- * E-mail:
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Fournier S, Chaffaut C, Maillard A, Loze B, Lascoux C, Gérard L, Timsit J, David F, Bergmann JF, Oksenhendler E, Sereni D, Chevret S, Molina JM. Factors associated with virological response in HIV-infected patients failing antiretroviral therapy: a prospective cohort study. HIV Med 2005; 6:129-34. [PMID: 15807719 DOI: 10.1111/j.1468-1293.2005.00275.x] [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: 11/28/2022]
Abstract
OBJECTIVES To assess the antiviral response to optimized therapy following genotypic resistance testing and to identify factors associated with virological response in HIV-1-infected patients failing antiretroviral therapy. METHODS A prospective cohort study was conducted in 344 HIV-1-infected patients who underwent genotypic resistance testing because of virological failure. Virological response was defined as a plasma HIV RNA level below 200 HIV-1 RNA copies/mL or a drop of plasma viral load from baseline of more than 1 log10. A multivariate logistic regression analysis was performed to identify factors associated with virological response. RESULTS The median age of the patients was 40 years, with a male to female ratio of 4:1. Fifty-one per cent of patients had received the three major classes of antiretrovirals and the median duration of previous antiretroviral therapy was 4.6 years. At baseline, the median plasma HIV RNA level was 4.4 log10 copies/mL and the median CD4 cell count was 274 cells/microL. At 3 months, 55% of patients (188 of 344) had a virological response, which was sustained at 6 months (53%). Predictors of virological response were exposure to two or fewer protease inhibitors [odds ratio (OR) 1.8; P=0.046], and use in optimized therapy of a new class of antiretrovirals (OR 2.9; P=0.006), of more than two new drugs (OR 3.0; P<0.0001), of abacavir (OR 1.9; P=0.03), or of lopinavir/ritonavir (OR 3.7; P=0.0002). CONCLUSIONS A high proportion of patients achieved a short-term virological response in this cohort study. Patients with the least experience of protease inhibitor treatment and in whom a new class of antiretroviral, more than two new drugs, abacavir or lopinavir/ritonavir was used in optimized therapy had the best virological outcome.
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Affiliation(s)
- S Fournier
- Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique, Hopitaux de Paris, Paris, France.
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