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Martin L, Mas R, Vittecoq D, Frank M. Analyse de la qualité des données PMSI pour le suivi des cas de grippe à l’hôpital. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.099] [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: 10/27/2022] Open
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2
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Dinh A, Fessi H, Duran C, Batista R, Michelon H, Bouchand F, Lepeule R, Vittecoq D, Escaut L, Sobhani I, Lawrence C, Chast F, Ronco P, Davido B. Clearance of carbapenem-resistant Enterobacteriaceae vs vancomycin-resistant enterococci carriage after faecal microbiota transplant: a prospective comparative study. J Hosp Infect 2018; 99:481-486. [PMID: 29477634 DOI: 10.1016/j.jhin.2018.02.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 12/07/2017] [Accepted: 02/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant enterococci (VRE) carriage are increasing worldwide. Faecal microbiota transplantation (FMT) appears to be an attractive option for decolonization. This study aimed to evaluate CRE vs VRE clearance by FMT among carriers. METHODS A multi-centre trial was undertaken on patients with CRE or VRE digestive tract colonization who received FMT between January 2015 and April 2017. Adult patients with CRE or VRE colonization, confirmed by three consecutive rectal swabs at weekly intervals, including one in the week prior to FMT, were included in the study. Patients with immunosuppression or concomitant antibiotic prescription at the time of FMT were excluded. Successful decolonization was determined by at least two consecutive negative rectal swabs [polymerase chain reaction (PCR) and culture] on Days 7, 14, 21 and 28, and monthly for three months following FMT. RESULTS Seventeen patients were included, with a median age of 73 years [interquartile range (IQR) 64.3-79.0]. Median duration of carriage of CRE or VRE before FMT was 62.5 days (IQR 57.0-77.5). One week after FMT, three of eight patients were free of CRE colonization and three of nine patients were free of VRE colonization. After three months, four of eight patients were free of CRE colonization and seven of eight patients were free of VRE colonization. Qualitative PCR results were concordant with culture. Six patients received antibiotics during follow-up, three in each group. No adverse events were reported. CONCLUSION CRE and VRE clearance rates were not significantly different in this study, possibly due to the small sample size, but a trend was observed. These data should be confirmed by larger cohorts and randomized trials.
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Affiliation(s)
- A Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
| | - H Fessi
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Batista
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - H Michelon
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Lepeule
- Antimicrobial Stewardship Unit, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - D Vittecoq
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - L Escaut
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Kremlin-Bicêtre, France
| | - I Sobhani
- Gastro-enterology Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - C Lawrence
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Chast
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - P Ronco
- Nephrology Unit, Tenon Teaching Hospital, APHP, Pierre et Marie Curie University, Paris, France
| | - B Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
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Seng R, Mutuon P, Riou J, Duvivier C, Weiss L, Lelievre JD, Meyer L, Vittecoq D, Zak Dit Zbar O, Frenkiel J, Frank-Soltysiak M, Boue F, Rapp C, Sobel A, Brucker G, Goujard C, Salmon D. Hospitalization of HIV positive patients: Significant demand affecting all hospital sectors. Rev Epidemiol Sante Publique 2017; 66:7-17. [PMID: 29233572 DOI: 10.1016/j.respe.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/21/2016] [Revised: 06/16/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In a context of the evolution of severe morbidities in patients living with HIV (PLWH), the aim of this study was to describe reasons for hospitalization and the mode of care for the patients requiring hospitalization. METHODS All admissions (≥24h) of PLWH to 10 hospitals in the south of Paris (COREVIH Ile-de-France Sud) between 1/1/2011 and 12/31/2011 were identified. The hospital database and the file of patients followed in the HIV referral department of each hospital were matched. Detailed clinical and biological data were collected, by returning to the individual medical records, for a random sample (65% of hospitalized patients). RESULTS A total of 3013 hospitalizations (1489 patients) were recorded in 2011. The estimated rate of hospitalized patients was about 8% among the 10105 PLWH routinely managed in COREVIH Ile-de-France Sud in 2011. The majority (58.5%) of these hospitalizations occurred in a unit other than the HIV referral unit. Non-AIDS-defining infections were the main reason for admission (16.4%), followed by HIV-related diseases (15.6%), hepatic/gastrointestinal diseases (12.0%), and cardiovascular diseases (10.3%). The median length of stay was 5 days overall (IQR: 2-11), it was longer among patients admitted to a referral HIV care unit than to another ward. HIV infection had been diagnosed >10 years previously in 61.4% of these hospitalized patients. They often had associated comorbidities (coinfection HCV/HVB 40.5%, smoking 45.8%; hypertension 33.4%, dyslipidemia 28.8%, diabetes 14.8%). Subjects over 60 years old accounted for 15% of hospitalized patients, most of them were virologically controlled under HIV treatment, and cardiovascular diseases were their leading reason for admission. CONCLUSION Needs for hospitalization among PLWH remain important, with a wide variety in causes of admission, involving all hospital departments. It is essential to prevent comorbidities to reduce these hospitalizations, and to maintain a link between the management of PLWH, that becomes rightly, increasing ambulatory, and recourse to specialized inpatient services.
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Affiliation(s)
- R Seng
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France.
| | - P Mutuon
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - J Riou
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - C Duvivier
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Infectious Diseases, Necker-Pasteur Infectious Diseases Center, AP-HP Necker hospital, 75015 Paris, France
| | - L Weiss
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Clinical Immunology, AP-HP Georges-Pompidou hospital, 75015 Paris, France
| | - J D Lelievre
- Department of Clinical Immunology and Infectious Diseases, AP-HP Henri-Mondor hospital, 94010 Creteil, France
| | - L Meyer
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - D Vittecoq
- Department of Infectious and Tropical Diseases, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - O Zak Dit Zbar
- Department of Infectious Diseases, Cognacq-Jay hospital, 75015 Paris, France
| | - J Frenkiel
- Unité d'information médicale, AP-HP Cochin hospital, 75014 Paris, France
| | - M Frank-Soltysiak
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - F Boue
- Department of Internal Medicine, AP-HP Antoine-Beclere hospital, 92140 Clamart, France
| | - C Rapp
- Department of Infectious and Tropical Diseases, Hopital d'Instruction des Armées Bégin, 94160 Saint-Mandé, France
| | - A Sobel
- Department of Infectious Diseases and Immunology, AP-HP Hotel-Dieu hospital, 75004 Paris, France
| | - G Brucker
- Department of Epidemiology and Public Health, AP-HP Bicetre hospital, 94276 Le-Kremlin-Bicêtre cedex, France
| | - C Goujard
- CESP INSERM, Paris-Sud-University, 94276 Le-Kremlin-Bicêtre cedex, France; Department of Internal Medicine, AP-HP Bicetre hospital, 94276 Le Kremlin-Bicêtre cedex, France
| | - D Salmon
- Paris-Descartes University, Sorbonne-Paris-Cité, 75006 Paris, France; Department of Internal Medicine and Infectious Diseases, Diagnosis Center, AP-HP Hotel Dieu hospital, 75004 Paris, France
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4
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Davido B, Batista R, Michelon H, Lepainteur M, Bouchand F, Lepeule R, Salomon J, Vittecoq D, Duran C, Escaut L, Sobhani I, Paul M, Lawrence C, Perronne C, Chast F, Dinh A. Is faecal microbiota transplantation an option to eradicate highly drug-resistant enteric bacteria carriage? J Hosp Infect 2017; 95:433-437. [PMID: 28237504 DOI: 10.1016/j.jhin.2017.02.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 01/13/2017] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) or vancomycin-resistant enterococci (VRE) carriage present a major public health challenge. Decolonization strategies are lacking. We aimed to evaluate the impact of faecal microbiota transplantation (FMT) on a cohort of patients with digestive tract colonization by CRE or VRE. Eight patients were included: six carrying CRE and two colonized by VRE. One month after FMT, two patients were free from CRE carriage, and another patient was free from VRE after three months. In our experience, this strategy is safe.
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Affiliation(s)
- B Davido
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Batista
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - H Michelon
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - M Lepainteur
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Bouchand
- Pharmacy Department, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - R Lepeule
- Antimicrobial Stewardship Unit, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - J Salomon
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - D Vittecoq
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - C Duran
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - L Escaut
- Infectious Diseases Unit, Bicêtre Teaching Hospital, APHP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - I Sobhani
- Gastroenterology Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - M Paul
- Pharmacy Department, Henri Mondor Teaching Hospital, APHP, Paris-Est Créteil-Est University, Créteil, France
| | - C Lawrence
- Microbiology Laboratory, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - C Perronne
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France
| | - F Chast
- Pharmacy Department, Cochin Teaching Hospital, APHP, Paris Descartes University, Paris, France
| | - A Dinh
- Infectious Diseases Unit, Raymond Poincaré Teaching Hospital, APHP, Versailles Saint-Quentin University, Garches, France.
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Askour M, Bernigaud C, Do-Pham G, Hemery F, Mahé E, Caux F, Dupin N, Cury K, Senet P, Belan AG, Hillion B, Méni C, Saiag P, Bellaud G, Bleibtreu A, Lariven S, Bollens D, Girard PM, Descamps V, Molina JM, Bouchaud O, Vittecoq D, Foulet F, Botterel F, Chosidow O. Gales graves hospitalisées en dermatologie et maladies infectieuses en Île-de-France : étude multicentrique rétrospective de 83 patients sur 6 ans. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Bukreyeva I, Tzara L, Derradji O, Gagnard J, Escaut L, Vittecoq D, Wyplosz B. PADS 2-08 - Comment vacciner plus de 500 malades à l’hôpital en moins de 2 ans et demi ? utilisez votre CVI ! Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30489-9] [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: 10/21/2022]
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7
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Teicher E, Boufassa F, Vittecoq D, Antonini TM, Tateo MG, Coilly A, Roque-Afonso AM, Kassis-Chikhani N, Lambotte O, Ichai P, Samuel D, Duclos-Vallee JC. Infectious complications after liver transplantation in human immunodeficiency virus-infected recipients. Transpl Infect Dis 2015; 17:662-70. [PMID: 26192379 DOI: 10.1111/tid.12422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/15/2015] [Accepted: 07/05/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Few studies have investigated infections in human immunodeficiency virus (HIV)-infected liver transplant patients. The aim of this study was to describe the prevalence, time of onset, mortality of infectious complications, other than hepatitis C virus (HCV), and to identify risk factors for their development in a large single-center cohort of HIV-infected liver transplant patients. METHODS We studied 109 consecutive HIV-infected patients who underwent liver transplantation (LT) between 1999 and 2010 and followed until December 2012. RESULTS The median age was 44 years (interquartile range [IQR] 41-49), 82.6% were male, and the median follow-up was 45.7 months (IQR 14-65). The major indications for LT were HCV cirrhosis (61%) and hepatocellular carcinoma (19%). Forty patients (37%) developed at least 1 infection during the first year after LT. Twenty-eight (26%) patients had an episode of bacteremia. Five (4.6%) patients developed a cytomegalovirus infection. Fungal infections occurred in 5 (4.5%) patients. Four (3.6%) patients developed an HIV-related opportunistic infection. A total of 43 (39.4%) patients died during follow-up. Mortality related to infection occurred in 9 (7%) cases, and 20 (42.5%) patients died because of HCV recurrence. No patients died from opportunistic infections. Model for end-stage liver disease (MELD) score >17 was associated with a 2-fold higher risk (hazard ratio 1.96; 95% confidence interval 1.01-3.80) of developing infectious complications. CONCLUSIONS Infections are not a major cause of mortality after LT in HIV patients and opportunistic infections of acquired immunodeficiency syndrome are infrequent. A MELD score >17 increased the risk of developing post-LT infectious complications. Recurrence of HCV infection remains a major cause of mortality.
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Affiliation(s)
- E Teicher
- Service de Médecine Interne Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - F Boufassa
- Centre for research in Epidemiology and Population Health - U1018, Inserm, Le Kremlin-Bicêtre, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France
| | - D Vittecoq
- Service de Médecine Interne Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpital Bicêtre, Le Kremlin-Bicêtre, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France
| | - T M Antonini
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France
| | - M-G Tateo
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France
| | - A Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France
| | - A-M Roque-Afonso
- Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France.,Département de Microbiologie et Virologie, AP-HP Hôpital Paul-Brousse, Villejuif, France
| | - N Kassis-Chikhani
- Département de Microbiologie et Virologie, AP-HP Hôpital Paul-Brousse, Villejuif, France
| | - O Lambotte
- Univ Paris-Sud, Le Kremlin-Bicêtre, France
| | - P Ichai
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France
| | - D Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France
| | - J-C Duclos-Vallee
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Villejuif, France.,DHU Hepatinov, Villejuif, France.,Univ Paris-Sud, Le Kremlin-Bicêtre, France.,Unité 1193, Inserm, Villejuif, France
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8
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Wyplosz B, Derradji O, Hong E, François H, Durrbach A, Duclos-Vallée JC, Samuel D, Escaut L, Launay O, Vittecoq D, Taha M. Low immunogenicity of quadrivalent meningococcal vaccines in solid organ transplant recipients. Transpl Infect Dis 2015; 17:322-7. [DOI: 10.1111/tid.12359] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/27/2014] [Accepted: 01/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- B. Wyplosz
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Centre de Vaccinations Internationales; Service de Maladies Infectieuses et Tropicales; Le Kremlin-Bicêtre France
| | - O. Derradji
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Centre de Vaccinations Internationales; Service de Maladies Infectieuses et Tropicales; Le Kremlin-Bicêtre France
| | - E. Hong
- Institut Pasteur; Invasive Bacterial Infections Unit; Paris France
| | - H. François
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Néphrologie; Le Kremlin-Bicêtre France
- Faculté de Médecine; Université Paris Sud; Paris France
| | - A. Durrbach
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Néphrologie; Le Kremlin-Bicêtre France
- Faculté de Médecine; Université Paris Sud; Paris France
| | - J.-C. Duclos-Vallée
- Faculté de Médecine; Université Paris Sud; Paris France
- Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Paul Brousse; Centre Hépatobiliaire; Villejuif France
| | - D. Samuel
- Faculté de Médecine; Université Paris Sud; Paris France
- Assistance Publique-Hôpitaux de Paris; Hôpital Universitaire Paul Brousse; Centre Hépatobiliaire; Villejuif France
| | - L. Escaut
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Centre de Vaccinations Internationales; Service de Maladies Infectieuses et Tropicales; Le Kremlin-Bicêtre France
| | - O. Launay
- INSERM, CIC BT505, and AP-HP; Paris Descartes University; Cochin Hospital; Paris France
| | - D. Vittecoq
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Centre de Vaccinations Internationales; Service de Maladies Infectieuses et Tropicales; Le Kremlin-Bicêtre France
- Assistance Publique-Hôpitaux de Paris; CHU Bicêtre; Néphrologie; Le Kremlin-Bicêtre France
| | - M.K. Taha
- Institut Pasteur; Invasive Bacterial Infections Unit; Paris France
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9
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Angoulvant A, Stern JB, Wittnebel S, Bourhis JH, Gachot B, Vittecoq D, Wyplosz B. Dyspnea and Fever in an Allogeneic Stem Cell Recipient. Clin Infect Dis 2015. [DOI: 10.1093/cid/ciu841] [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: 11/13/2022] Open
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10
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Cotte L, Braun J, Lascoux-Combe C, Vincent C, Valantin MA, Sogni P, Lacombe K, Neau D, Aumaitre H, Batisse D, de Truchis P, Gervais A, Michelet C, Morlat P, Vittecoq D, Rosa I, Bertucci I, Chevaliez S, Aboulker JP, Molina JM, Aumaitre H, Batisse D, Bernard L, Cheret A, Cotte L, de Truchis P, Dellamonica P, Dominguez S, Gervais A, Girard PM, Lucht F, Metivier S, Michelet C, Molina JM, Morlat P, Neau D, Pageaux GP, Pol S, Rosa I, Rosenthal E, Vittecoq D, Valantin MA, Zucman D. Telaprevir for HIV/Hepatitis C Virus-Coinfected Patients Failing Treatment With Pegylated Interferon/Ribavirin (ANRS HC26 TelapreVIH): An Open-Label, Single-Arm, Phase 2 Trial. Clin Infect Dis 2014; 59:1768-76. [DOI: 10.1093/cid/ciu659] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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11
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Barau C, Braun J, Vincent C, Haim-Boukobza S, Molina JM, Miailhes P, Fournier I, Aboulker JP, Vittecoq D, Duclos-Vallée JC, Taburet AM, Teicher E, Teicher E, Duclos-Vallée JC, Aboulker JP, Braun J, Fournier I, Vincent C, Arulananthan A, Eliette V, Euphrasie F, Guillon B, Ralaimazava P, Haïm-Boukobza S, Roque-Afonso AM, Bonhomme-Faivre L, Rudant E, Taburet AM, Aboulker J, Bonhomme-Faivre L, Braun J, Couffin-Cadiergues S, Delaugerre C, Durand F, Vittecoq D, Flandre P, Garraffo R, Ghosn J, Marraud A, Pageaux G, Derradji O, Bolliot C, Churaqui F, Antonini T, Coilly A, Ichai P, Ogier O, Belnard M, Molina JM, De Lastours V, Gazaignes S, Ponscarme D, Sauvageon H, Miailhes P, Koffi J, Radenne S, Brochier C. Pharmacokinetic Study of Raltegravir in HIV-Infected Patients With End-Stage Liver Disease: The LIVERAL-ANRS 148 Study. Clin Infect Dis 2014; 59:1177-84. [DOI: 10.1093/cid/ciu515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Ruppé E, Armand-Lefèvre L, Estellat C, El-Mniai A, Boussadia Y, Consigny PH, Girard PM, Vittecoq D, Bouchaud O, Pialoux G, Esposito-Farèse M, Coignard B, Lucet JC, Andremont A, Matheron S. Acquisition of carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013. ACTA ACUST UNITED AC 2014; 19. [PMID: 24739981 DOI: 10.2807/1560-7917.es2014.19.14.20768] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthy travellers to countries where carbapenemases-producing Enterobacteriaceae (CPE) are endemic might be at risk for their acquisition, even without contact with the local healthcare system. Here, we report the acquisition of CPE (two OXA-181, one New Delhi metallo-beta-lactamase 1 (NDM-1)) in three healthy travellers returning from India. The duration of CPE intestinal carriage was less than one month. The results indicate that healthy travellers recently returning from India might be considered as at risk for CPE carriage.
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Affiliation(s)
- E Ruppé
- AP-HP, Hopital Bichat, Laboratoire de Bacteriologie, Paris, France
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Wyplosz B, Burdet C, François H, Durrbach A, Duclos-Vallée JC, Mamzer-Bruneel MF, Poujol P, Launay O, Samuel D, Vittecoq D, Consigny PH. Persistence of yellow fever vaccine-induced antibodies after solid organ transplantation. Am J Transplant 2013; 13:2458-61. [PMID: 23834702 DOI: 10.1111/ajt.12338] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 03/20/2013] [Revised: 05/06/2013] [Accepted: 05/13/2013] [Indexed: 01/25/2023]
Abstract
Immunization using live attenuated vaccines represents a contra-indication after solid organ transplantation (SOT): consequently, transplant candidates planning to travel in countries where yellow fever is endemic should be vaccinated prior to transplantation. The persistence of yellow fever vaccine-induced antibodies after transplantation has not been studied yet. We measured yellow-fever neutralizing antibodies in 53 SOT recipients vaccinated prior to transplantation (including 29 kidney recipients and 18 liver recipients). All but one (98%) had protective titers of antibodies after a median duration of 3 years (min.: 0.8, max.: 21) after transplantation. The median antibody level was 40 U/L (interquartile range: 40-80). For the 46 patients with a known or estimated date of vaccination, yellow-fever antibodies were still detectable after a median time of 13 years (range: 2-32 years) post-immunization. Our data suggest there is long-term persistence of antibodies to yellow fever in SOT recipients who have been vaccinated prior to transplantation.
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Affiliation(s)
- B Wyplosz
- Assistance publique-hôpitaux de Paris, CHU Bicêtre, Service de maladies infectieuses et tropicales, Centre de vaccinations internationales, Paris, Le Kremlin-Bicêtre, France
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Saadoun D, Resche Rigon M, Thibault V, Longuet M, Pol S, Blanc F, Pialoux G, Karras A, Bazin-Karra D, Cazorla C, Vittecoq D, Musset L, Decaux O, Ziza JM, Lambotte O, Cacoub P. Peg-IFNα/ribavirin/protease inhibitor combination in hepatitis C virus associated mixed cryoglobulinemia vasculitis: results at week 24. Ann Rheum Dis 2013; 73:831-7. [PMID: 23606708 PMCID: PMC3995244 DOI: 10.1136/annrheumdis-2012-202770] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background The standard-of-care treatment of patients with hepatitis C virus (HCV)-mixed cryoglobulinemia (MC) vasculitis includes pegylated interferon α (PegIFN)-α plus ribavirin and/or rituximab. About 30–40% of patients are non-responders or relapsers to such combination. Objective To analyse the safety and efficacy of Peg-IFNα/ribavirin/protease inhibitor combination in HCV-MC vasculitis. Patients and methods Open-label, prospective, cohort study including 23 patients with HCV-MC vasculitis. Peg-IFNα/ribavirin was associated to telaprevir (375 mg three times daily, for 12 weeks, (n=15)) or boceprevir (800 mg three times daily, for 44 weeks, (n=8)) for 48 weeks. Results The median age was 59 (52.5–66) years, with 48.8% women. Thirteen patients (56.5%) were complete clinical responders, and 10 (43.5%) were partial responders at week 24. The virological response (ie, HCV RNA negativation) was of 69.6% at week 24 (p=0.005). The cryoglobulin level decreased from 0.44 to 0.06 g/l (p=0.0006) and the C4 level increased from 0.09 to 0.15 g/l (p=0.045). Grades 3 and 4 adverse events (mainly anaemia, neutropenia and thrombocytopenia) were observed in 10 cases (43.5%). Twenty patients (87%) received erythropoietin, 9 (39.1%) had red cell transfusion, and 2 (8.7%) had granulocyte stimulating agents. Antiviral therapy discontinuation was required in 8 (34.7%) patients for virological non-response (n=5), virological relapse (n=2) and depression (n=1). Conclusions Peg-IFNα/ribavirin/protease inhibitor combination seems highly effective in HCV-MC. Such therapeutic regimen should be administered cautiously considering the high rate of side effects.
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Affiliation(s)
- David Saadoun
- Department of Internal Medicine, Service de Médecine Interne, AP-HP, Groupe Hospitalier Pitié-Salpétrière, , Paris, France
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M’Garrech M, Gendron G, de Monchy I, Pogorzalek N, Rebaudet S, Vittecoq D, Labetoulle M. Manifestations cornéennes de la rougeole chez l’adulte non vacciné : deux cas typiques en période d’épidémie. J Fr Ophtalmol 2013; 36:197-201. [DOI: 10.1016/j.jfo.2012.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 02/12/2012] [Accepted: 02/22/2012] [Indexed: 10/27/2022]
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Saadoun D, Thibault V, Pol S, Blanc F, Pialoux G, Karras A, Bazin-Karra D, Vittecoq D, Decaux O, Ziza JM, Lambotte O, Cacoub P. Efficacité et tolérance de la trithérapie antivirale (Peg-IFN alpha/ribavirine/inhibiteur de protéase) chez des patients présentant une vascularite cryoglobulinémique associée au VHC : résultats à 24 semaines. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.077] [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: 11/30/2022]
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17
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Charpentier C, Joly V, Larrouy L, Fagard C, Visseaux B, de Verdiere NC, Raffi F, Yeni P, Descamps D, Aumaitre H, Medus M, Neuville S, Saada M, Abgrall S, Bentata M, Bouchaud O, Cailhol J, Cordel H, Dhote R, Gros H, Honore-Berlureau P, Huynh T, Krivitzky A, Mansouri R, Poupard M, Prendki V, Radia D, Rouges F, Touam F, Warde B, de Castro N, Colin de Verdiere N, Delgado J, Ferret S, Gallien S, Kandel T, Lafaurie M, Lagrange M, Lascoux-Combe C, Le D, Molina JM, Pavie J, Pintado C, Ponscarme D, Rachline A, Rozenbaum W, Sereni D, Taulera O, Estavoyer JM, Faucher JF, Foltzer A, Hoen B, Hustache-Mathieu L, Dupon M, Dutronc H, Neau D, Ragnaud JM, Raymond I, Boucly S, Lortholary O, Viard JP, Bechara C, Delfraissy JF, Ghosn J, Goujard C, Kamouh W, Mole M, Quertainmont Y, Bergmann JF, Boulanger E, Castillo H, Parrinello M, Rami A, Sellier P, Lepeu G, Pichancourt G, Bernard L, Berthe H, Clarissou J, Gory M, Melchior JC, Perronne C, Stegman S, de Truchis P, Derradji O, Malet M, Teicher E, Vittecoq D, Chakvetadze C, Fontaine C, Lukiana T, Pialloux G, Slama L, Bonnet D, Boucherit S, El Alami Talbi N, Fournier I, Gervais A, Joly V, Iordache L, Laurichesse JJ, Leport C, Pahlavan G, Phung BC, Yeni P, Bennamar N, Brunet A, Guillevin L, Salmon-Ceron D, Tahi T, Chesnel C, Dominguez S, Jouve P, Lelievre JD, Levy Y, Melica G, Sobel A, Ben Abdallah S, Bonmarchand M, Bricaire F, Herson S, Iguertsira M, Katlama C, Kouadio H, Schneider L, Simon A, Valantin MA, Abel S, Beaujolais V, Cabie A, Liauthaud B, Pierre Francois S, Abgueguen P, Chennebault JM, Loison J, Pichard E, Rabier V, Delaune J, Louis I, Morlat P, Pertusa MC, Brunel-Delmas F, Chiarello P, Jeanblanc F, Jourdain JJ, Livrozet JM, Makhloufi D, Touraine JL, Augustin-Normand C, Bailly F, Benmakhlouf N, Brochier C, Cotte L, Gueripel V, Koffi K, Lack P, Lebouche B, Maynard M, Miailhes P, Radenne S, Schlienger I, Thoirain V, Trepo C, Drogoul MP, Fabre G, Faucher O, Frixon-Marin V, Gastaut JA, Peyrouse E, Poizot-Martin I, Jacquet JM, Le Facher G, Merle de Boever C, Reynes J, Tramoni C, Allavena C, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet-Francois C, Hue H, Mounoury O, Raffi F, Reliquet V, Aubry O, Esnault JL, Leautez-Nainville S, Perre P, Suaud I, Breaud S, Ceppi C, Dellamonica P, De Salvador F, Durant J, Ferrando S, Fuzibet JG, Leplatois A, Mondain V, Perbost I, Pugliese P, Rahelinirina V, Rosenthal E, Sanderson F, Vassalo M, Arvieux C, Chapplain JM, Michelet C, Ratajczak M, Revest M, Souala F, Tattevin P, Cheneau C, Fischer P, Lang JM, Partisani M, Rey D, Bastides F, Besnier JM, Le Bret P, Choutet P, Dailloux JF, Guadagnin P, Nau P, Rivalain J, Soufflet A, Aissi E, Melliez H, Pavel S, Mouton Y, Yazdanpanah Y, Boyer L, Burty C, Letranchant L, May T, Wassoumbou S, Blum L, Danne O, Arthus MA, Dion P, Certain A, Tabuteau S, Beuscart A, Agher N, Frosch A, Couffin-Cadiergues S, Diallo A. Role and evolution of viral tropism in patients with advanced HIV disease receiving intensified initial regimen in the ANRS 130 APOLLO trial. J Antimicrob Chemother 2012; 68:690-6. [DOI: 10.1093/jac/dks455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Chu C, Rudant E, Bonvalet M, Agostini H, Cavalié P, Bonhomme-Faivre L, Frenkiel J, Taillandier J, Boissonnas A, Vittecoq D, Wyplosz B. Generic drug prescriptions following hospital discharge: a prospective study in France. Eur J Intern Med 2011; 22:e45-9. [PMID: 21925042 DOI: 10.1016/j.ejim.2011.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/20/2010] [Accepted: 01/24/2011] [Indexed: 11/16/2022]
Abstract
AIMS Systematic generic prescription at discharge could reduce confusion on drug-name usage, decrease commercial influence on medicine, and reduce drug-related expenditures. This study aimed to analyze generic drug prescriptions at discharge from hospital and to estimate the potential savings associated with a total substitution policy (substitution of every substitutable drug for its cheapest generic counterpart). METHODS Drug prescriptions before admission and at discharge of all patients from three medical units of a university hospital were prospectively collected for five weeks without informing prescribers. RESULTS Prescriptions from 85 patients were analyzed. On admission, 68 patients (80%) received 413 drugs; 141 were substitutable brand-name drugs and 23 (16%), which were directly prescribed as generics. At discharge, 488 drugs were prescribed to the 85 patients; 180 were substitutable drugs but only 5 (2.8%) were written as generics on prescription pads, a decrease of 78% (p<0.0001) compared to admission. In average, generics were 18% less expensive than brand-name drugs. Some common therapeutic classes offered even greater price difference, such as proton-pump inhibitors (42%), statins (32%), or antihypertensive agents (28%). Potential savings from a total substitution policy at discharge were estimated to €1512 per 1000 patients per week; for lifetime drugs, savings amounted to €18,960 per 1000 patients per year. CONCLUSIONS Very few drugs are written as generics on medical forms at discharge in France. Hospital practitioners should be encouraged to prescribe generics, particularly in chronic diseases. A broad generic prescription policy at hospital discharge would result in substantial savings for health insurance.
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Affiliation(s)
- C Chu
- Pharmacy, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paul Brousse, 12-14 avenue Paul Vaillant-Couturier, Villejuif, France
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Antonini TM, Sebagh M, Roque-Afonso AM, Teicher E, Roche B, Sobesky R, Coilly A, Vaghefi P, Adam R, Vittecoq D, Castaing D, Samuel D, Duclos-Vallée JC. Fibrosing cholestatic hepatitis in HIV/HCV co-infected transplant patients-usefulness of early markers after liver transplantation. Am J Transplant 2011; 11:1686-95. [PMID: 21749638 DOI: 10.1111/j.1600-6143.2011.03608.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We characterized fibrosing cholestatic hepatitis (FCH) in a large cohort of HIV/HCV co-infected patients. Between 1999 and 2008, 59 HIV infected patients were transplanted for end-stage liver disease due to HCV. Eleven patients (19%) developed FCH within a mean period of 7 months [2-27] after liver transplantation (LT). At Week 1 post-LT, the mean HCV viral load was higher in the FCH group: 6.13 log(10) IU/mL ± 1.30 versus 4.9 log(10) IU/mL ± 1.78 in the non-FCH group, p = 0.05. At the onset of acute hepatitis after LT, activity was moderate to severe in 8/11 HIV+/HCV+ patients with FCH (73%) versus 13/28 (46%) HIV+/HCV+ non-FCH (p = 0.007) patients. A complete virological response to anti-HCV therapy was observed in 2/11 (18%) patients. Survival differed significantly between the two groups (at 3 years, 67% in non-FCH patients versus 15% in FCH patients, p = 0.004). An early diagnosis of FCH may be suggested by the presence of marked disease activity when acute hepatitis is diagnosed and when a high viral load is present. The initiation of anti-HCV therapy should be considered at this point.
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Affiliation(s)
- T M Antonini
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
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20
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Bommenel T, Launay O, Meynard JL, Gilquin J, Katlama C, Lascaux AS, Mahamat A, Martinez V, Pradier C, Rouveix E, Simon A, Costagliola D, Abgrall S, Abgrall S, Barin F, Bentata M, Billaud E, Boue F, Burty C, Cabie A, Costagliola D, Cotte L, de Truchis P, Duval X, Duvivier C, Enel P, Gasnault J, Gaud C, Gilquin J, Grabar S, Katlama C, Khuong MA, Lang JM, Lascaux AS, Launay O, Mahamat A, Mary-Krause M, Matheron S, Meynard JL, Pavie J, Pialoux G, Pilorge F, Poizot-Martin I, Pradier C, Reynes J, Rouveix E, Simon A, Tattevin P, Tissot-Dupont H, Viard JP, Viget N, Brosseau M, Salomon V, Jacquemet N, Guiguet M, Lanoy E, Lievre L, Selinger-Leneman H, Lacombe JM, Potard V, Bricaire F, Herson S, Desplanque N, Girard PM, Meyohas MC, Picard O, Cadranel J, Mayaud C, Clauvel JP, Decazes JM, Gerard L, Molina JM, Diemer M, Sellier P, Honore P, Jeantils V, Tassi S, Mechali D, Taverne B, Bouvet E, Crickx B, Ecobichon JL, Picard-Dahan C, Yeni P, Berthe H, Dupont C, Chandemerle C, Mortier E, Tisne-Dessus D, Weiss L, Salmon D, Auperin I, Roudiere L, Fior R, Delfraissy JF, Goujard C, Jung C, Lesprit P, Vittecoq D, Fraisse P, Rey D, Beck-Wirth G, Stahl JP, Lecercq P, Gourdon F, Laurichesse H, Fresard A, Lucht F, Bazin C, Verdon R, Chavanet P, Arvieux C, Michelet C, Choutet P, Goudeau A, Maitre MF, Hoen B, Elinger P, Faller JP, Borsa-Lebas F, Caron F, Daures JP, May T, Rabaud C, Berger JL, Remy G, Arlet-Suau E, Cuzin L, Massip P, Thiercelin Legrand MF, Pontonnier G, Yasdanpanah Y, Dellamonica P, Pugliese P, Aleksandrowicz K, Quinsat D, Ravaux I, Delmont JP, Moreau J, Gastaut JA, Retornaz F, Soubeyrand J, Galinier A, Ruiz JM, Allegre T, Blanc PA, Bonnet-Montchardon D, Lepeu G, Granet-Brunello P, Esterni JP, Pelissier L, Cohen-Valensi R, Nezri M, Chapadaud S, Laffeuillade A, Raffi F, Boibieux A, Peyramond D, Livrozet JM, Touraine JL, Trepo C, Strobel M, Bissuel F, Pradinaud R, Sobesky M, Contant M. Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir. J Antimicrob Chemother 2011; 66:1869-77. [DOI: 10.1093/jac/dkr208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Trémolières F, Cohen R, Gauzit R, Vittecoq D, Stahl JP. Save antibiotics! What can be done to prevent a forecasted disaster? Suggestions to promote the development of new antibiotics☆☆☆. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.reaurg.2010.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Mihaila L, Wyplosz B, Clermont O, Garry L, Hipeaux MC, Vittecoq D, Dussaix E, Denamur E, Branger C. Probable intrafamily transmission of a highly virulent CTX-M-3-producing Escherichia coli belonging to the emerging phylogenetic subgroup D2 O102-ST405 clone. J Antimicrob Chemother 2010; 65:1537-9. [DOI: 10.1093/jac/dkq155] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Tricot L, Teicher E, Peytavin G, Zucman D, Conti F, Calmus Y, Barrou B, Duvivier C, Fontaine C, Welker Y, Billy C, de Truchis P, Delahousse M, Vittecoq D, Salmon-Céron D. Safety and efficacy of raltegravir in HIV-infected transplant patients cotreated with immunosuppressive drugs. Am J Transplant 2009; 9:1946-52. [PMID: 19519819 DOI: 10.1111/j.1600-6143.2009.02684.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Solid organ transplantations (SOT) are performed successfully in selected HIV-infected patients. However, multiple and reciprocal drug-drug interactions are observed between antiretroviral (ARV) drugs and calcineurin inhibitors (CNIs) through CYP450 metabolization. Raltegravir (RAL), a novel HIV-1 integrase inhibitor, is not a substrate of CYP450 enzymes. We retrospectively reviewed the outcomes of 13 HIV-infected transplant patients treated by an RAL + two nucleosidic reverse transcriptase inhibitor (NRTI) regimen, in terms of tolerability, ARV efficacy (plasma viral load, CD4 cell count), drug interactions, RAL pharmacokinetics and transplant outcome. Thirteen patients with liver (n = 8) or kidney (n = 5) transplantation were included. RAL was initiated (400 mg BID) either at time of transplantation (n = 6), or after transplantation (n = 7). Median RAL trough concentration was 507 ng/mL (176-890), which is above the in vitro IC95 for wild type HIV-1 strains (15 ng/mL). Target trough levels of CNIs were promptly obtained with standard dosages of tacrolimus or cyclosporine. RAL tolerability was excellent. There was no episode of acute rejection. HIV infection remained controlled. After a median follow-up of 9 months (range: 6-14), all patients were alive with satisfactory graft function. The use of an RAL + two NRTI-based regimen is a good alternative in HIV-infected patients undergoing SOT.
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Escaut L, Kassis-Chikhani N, Rudant E, Ichai P, Couzigou C, Wyplosz B, Vittecoq D. E-10 Évaluation de l’impact économique d’une épidémie d’Enterococcus faecium résistants aux glycopeptides (ERG) dans un service d’infectiologie. Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)74361-6] [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: 10/20/2022]
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Wyplosz B, Escaut L, Mihaila L, Stern J, Couzigou C, Poirier C, Teicher E, Vittecoq D. Tuberculose pulmonaire bacillifère : lever l’isolement après 3 semaines ou 3 examens microscopiques négatifs ? Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.068] [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: 11/27/2022]
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Wyplosz B, Carlotti A, Escaut L, Vignier N, Guettier C, Agbalika F, Vittecoq D, Dupin N. Rash cutané à HHV-8 et maladie de Castelman multicentrique. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.263] [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: 11/16/2022]
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27
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Chu C, Rudant E, Bonvalet M, Zavani A, Leplat J, Pfau V, Bonhomme-Faivre L, Taillandier J, Boissonnas A, Vittecoq D, Wyplosz B. Les médicaments génériques en sortie d’hospitalisation : enquête prospective chez 85malades à l’hôpital Paul-Brousse. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.055] [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: 11/30/2022]
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Couzigou C, Semaille C, Le Strat Y, Pinget R, Pillonel J, Lot F, Cazein F, Vittecoq D, Desenclos JC. Differential improvement in survival among patients with AIDS after the introduction of HAART. AIDS Care 2007; 19:523-31. [PMID: 17453593 DOI: 10.1080/09540120701235628] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 10/23/2022]
Abstract
We explored changes in the survival of patients with AIDS (PWA) according to the availability of antiretroviral drugs (1994-2002). We tested whether changes in the hazard ratio of progression to death (HR) have been homogeneous among various groups of PWA. We included 4158 PWA diagnosed in Paris, notified to the French National Surveillance Institute by 2002. Four calendar periods were defined: monotherapy (1994-95), bitherapy-HAART transition (1996), early HAART (1997-99), late HAART (2000-October 2002). HR were calculated with Cox models, including the calendar period, modelled as a time dependent covariate. Models were stratified by age, transmission category, CD4 cell count, and AIDS-defining illnesses (ADI) group. Cumulative survival at 60 months increased from 44.0% (before July 1996) to 75.6% (after July 1996) and median survival increased from 31.9 months to >76 months. Adjusted HR reached a minimum in the late HAART period (HR 0.22, 95% CI: 0.19-0.26). No difference in the decrease of the HR has been found by age. HR decreased and was marked during the late HAART period across all HIV transmission categories, including intravenous drug use. HR decreased significantly for all ADIs groups, including tumours. Among PWA diagnosed with tuberculosis, the HR decreased significantly only in the late HAART period. HR decrease was stronger for PWA with a CD4 cell count < or =200/mm(3). Substantial improvements in survival after the introduction of HAART were found for all PWA but varied by specific ADIs and the degree of immunosuppression.
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Affiliation(s)
- C Couzigou
- Unité VIH-1ST-VHC, Institut de Veille Sanitaire, Saint Maurice, France.
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Mackowiak PA, Sellier P, Monsuez JJ, Fadel E, Evans J, Vittecoq D. An Unusual Cause of Hemorrhagic Left Pleural Effusion. Clin Infect Dis 2006. [DOI: 10.1086/503576] [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: 11/03/2022] Open
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Couzigou C, Mazeron MC, Escaut L, Merad M, Vittecoq D. [Valganciclovir maintenance therapy in AIDS: treatment failure due to the development of cytomegalovirus resistance to ganciclovir]. Med Mal Infect 2005; 35:98-100. [PMID: 15780901 DOI: 10.1016/j.medmal.2004.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Accepted: 11/24/2004] [Indexed: 11/24/2022]
Affiliation(s)
- C Couzigou
- Service de maladies infectieuses, hôpital Paul-Brousse, 12, avenue Paul-Vaillant-Couturier, 94804 Villejuif, France
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Lastere S, Dalban C, Collin G, Descamps D, Girard PM, Clavel F, Costagliola D, Brun-Vezinet F, Brun-Vezinet F, Clavel F, Costagliola D, Dalban C, Girard PM, Matheron S, Meynard JL, Morand-Joubert L, Peytavin G, Vray M, Beguinot I, Waldner A, Beumont M, Semaille C, Bentata M, Berlureau P, Gérard L, Molina JM, Hor R, Bayol-Honnet G, Lascoux-Combe C, Drobacheff C, Hoen B, Dupon M, Lacut JY, Goujard C, Rousseau C, Vincent V, Diemer M, Lepeu G, Zerazhi H, de Truchis P, Berthé H, Jeantils V, Tazi CT, Vittecoq D, Escaut L, Dupont B, Nait-Ighil L, Rozenbaum W, Nguyen TH, Boué F, Galanaud P, Kazatchkine M, Piketty C, Bernasconi C, Salmon-Ceron D, Michon C, Chandemerle C, Lascaux AS, Magnier JD, Schneider L, Ait-Mohand H, Simon A, Herson S, Bollens D, Picard O, Tangre P, Bonarek M, Morlat P, Trépo C, Cotte L, Gastaut JA, Poizot-Martin I, Moran G, Masson S, Bennai Y, Belarbi L, Prevot MH, Fournier I, Reynes J, Baillat V, Raffi F, Esnault JL, Ceppi C, Cassuto JP, Arvieux C, Chapplain JM, Rey D, Krantz V, Besnier JM, Bastides F, Obadia M, Aquilina C, Bazin C, Verdon R, Piroth L, Grappin M, Sissoko D, Valette M, May T, Burty C, Debab Y, Caron F, Elharrar B, Launay O, Winter C, Chapuis L, Auperin I, Gilquin J. Impact of Insertions in the HIV-1 P6 Ptapp Region on the Virological Response to Amprenavir. Antivir Ther 2004. [DOI: 10.1177/135965350400900215] [Citation(s) in RCA: 7] [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] [Indexed: 11/17/2022]
Abstract
We evaluated the impact of genetic changes within p6Gag gene on the virological response (VR, mean decrease in plasma viral load at week 12) to unboosted amprenavir (APV). Gag-protease fragments, including gag p2, p7, p1, p6 regions and whole protease (PR) were sequenced from baseline plasma specimens of 84 highly pre-treated but APV-naive patients included in the NARVAL (ANRS 088) trial. The correlation between baseline p6Gag polymorphism, PR mutations, baseline characteristics and VR to APV was analysed in univariate analysis. Insertions (P459Ins) within p6 protein, leading to partial or complete duplication of the PTAPP motif, were significantly associated with a decreased VR (P459Ins versus wild-type; –0.3 ±0.8 vs –1.1 ±1.2 log copies/ml, P=0.007) and were more frequent when the V82A/F/T/S PR mutation was present ( P=0.020). In multivariate analysis, after adjustment on the predictive factors of the VR in the NARVAL trial and on the PR mutations linked with response, there was a strong trend to an association ( P=0.058) between the presence of P459Ins and an altered VR. In conclusion, these results suggest that insertions in the p6 region of HIV-1 gag gene may affect the VR, in highly pre-treated patients receiving an unboosted APV-containing regimen.
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Affiliation(s)
| | - Stephane Lastere
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Cecile Dalban
- INSERM EMI0214, Universite Pierre et Marie Curie – Paris 6, Paris, France
| | - Gilles Collin
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Diane Descamps
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Pierre-Marie Girard
- Service des Maladies Infectieuses et Tropicales, Hopital Saint Antoine, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Hor
- Hôpital Saint-Louis, Paris
| | | | | | | | - B Hoen
- Hôpital Saint-Jacques, Besançon
| | | | | | - C Goujard
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | | | | | | | - G Lepeu
- Hôpital Henri Duffaut, Avignon
| | | | | | - H Berthé
- Hôpital Raymond Poincaré, Garches
| | | | | | | | | | - B Dupont
- Institut Pasteur/Hôpital Necker, Paris
| | | | | | | | - F Boué
- Hôpital Antoine Béclère, Clamart
| | | | | | - C Piketty
- Hôpital Européen Georges Pompidou, Paris
| | | | | | | | | | | | | | | | | | - A Simon
- Hôpital Pitié-Salpétrière, Paris
| | - S Herson
- Hôpital Pitié-Salpétrière, Paris
| | | | | | | | | | | | | | | | | | | | - G Moran
- Hôpital Bichat Claude Bernard, Paris
| | - S Masson
- Hôpital Bichat Claude Bernard, Paris
| | - Y Bennai
- Hôpital Bichat Claude Bernard, Paris
| | - L Belarbi
- Hôpital Bichat Claude Bernard, Paris
| | - MH Prevot
- Hôpital Bichat Claude Bernard, Paris
| | | | - J Reynes
- Hôpital Gui de Chauliac, Montpellier
| | - V Baillat
- Hôpital Gui de Chauliac, Montpellier
| | | | | | | | | | | | | | - D Rey
- Centre Hospitalier Universitaire, Strasbourg
| | - V Krantz
- Centre Hospitalier Universitaire, Strasbourg
| | | | | | | | | | - C Bazin
- Centre Hospitalier Universitaire de Caen
| | - R Verdon
- Centre Hospitalier Universitaire de Caen
| | | | | | - D Sissoko
- Centre Hospitalier Univeristaire, Tourcoing
| | - M Valette
- Centre Hospitalier Univeristaire, Tourcoing
| | - T May
- Hôpital de Brabois, Nancy
| | | | - Y Debab
- Hôpital Charles Nicolle, Rouen
| | - F Caron
- Hôpital Charles Nicolle, Rouen
| | - B Elharrar
- Centre Hospitalier Intercommunal, Créteil
| | - O Launay
- Centre Hospitalier Intercommunal, Créteil
| | - C Winter
- Hôpital André Grégoire, Montreuil
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Abstract
The prognosis of HIV infection has been modified by antiretroviral therapy. However, the morbidity and the mortality of HCV co-infection increase and may be a major problem of health service. Up to now co-infected patients are excluded of transplantation due to complexity, the ethical aspects, the immunodeficiency and the co-infection. This study tries to estimate the feasibility in this population. Between December 1999 and March 2002, seven patients were transplanted. The average of CD4 was 332/ml; the viral load was <50 copies/ml. Before transplantation, no patient had experienced opportunist infection and all patients received antiretroviral therapy adapted to their history. The average follow-up is of 14 months: one patient died 3 months after transplantation, the other one presented a candida in oesophagus, the average of CD4 was 280/ml, and viral load was <50 copies/ml in five patients. A relapse of HVC was observed in all patients. Interferon/rivabirine therapy was proposed for four patients. Every patient received tacrolimus and corticoids. HAART were modified four times for toxicity and one time for virological failure. We observed two cases of transient renal insufficiency, two cases of diabetes, two cases of pancreatitis, and abnormalities of the respiratory mitochondrial chain in four patients. Finally, liver transplantation in HIV-HCV co-infected patients seems to be feasible when strict criteria of selection are taken into account. This still experimental strategy requires a multidisciplinary partnership.
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Affiliation(s)
- D Vittecoq
- Service des maladies infectieuses, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.
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Abstract
Enterocytozoon bieneusi is an agent of intestinal microsporidiosis leading to malabsorption syndrome and diarrhea in AIDS patients. Respiratory tract microsporidiosis due to Encephalitozoon spp. has been reported. To date, however, only two cases of pulmonary involvement of E. bieneusi have been documented for patients with intestinal microsporidiosis. We report here another pulmonary localization of E. bieneusi in a human immunodeficiency virus-infected patient. Clinical features of these three cases are reviewed. E. bieneusi can colonize the respiratory tract but could be considered a simple carriage associated with an intestinal infection.
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Affiliation(s)
- F Botterel
- Service de Microbiologie, Unité de Parasitologie-Mycologie, Hôpital de Bicêtre, AP-HP, Université Paris XI, 94275 Kremlin-Bicetre Cedex, France.
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Escaut L, Monsuez J, Vittecoq D. Antiprotéases, lipodystrophies et maladie coronaire. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80136-9] [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: 11/30/2022]
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Barthélémy O, Escaut L, Vayre F, Gallet B, Pulik M, Heloire F, Vittecoq D. [Acute coronary syndromes in patients treated with HIV protease inhibitors]. Presse Med 2002; 31:343-8. [PMID: 11913076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Cardiovascular complications occurring in patients infected by the human immunodeficient virus (HIV) have considerably changed since the appearance, in April 1996, of highly active antiretroviral tri-therapy (HAART), associating reverse transcriptase and protease HIV-1 inhibitors. The spectacular efficacy of anti-proteases has led to the almost complete disappearance of these opportunistic complications. However, in May 1998, acute coronary accidents were reported in the literature, thus questioning the possible responsibility of antiprotease treatment in the occurrence of accelerated atheroma. METHOD We report a series of 8 seropositive patients in whom an acute coronary event had occurred between February 1997 and February 1999. RESULTS The patients were young and all exhibited cardiovascular risk factors (smoking, dyslipidemia) and were treated with HIV-1 protease inhibitors. Six patients presented myocardial infarction, one patient unstable angina and one patient effort angina. COMMENTS A rise in triglycerides was observed principally on ingestion of ritonavir and a rise in cholesterol and LDL-cholesterol with all the antiprotease agents. Glucose intolerance was observed with indinavir. The occurrence of acute coronary events appeared to be related to antiprotease treatment (at the origin of metabolic disorders, endothelial dysfunction...), although it was impossible to say whether the antiprotease agents were responsible for the early atheroma or whether they simply contributed to the event. The coronary lesions were characterized by their number (single artery) and their topography (proximal or median). Nelfinavir may carry less cardiovascular risks than the other antiproteases. Mean term prognosis was relatively good, after therapeutic adjustment (change in antiprotease, strategic measures against cardiovascular risk factors, introduction of anti-anginal treatment...). CONCLUSION Larger and longer studies would help to specify the role of antiproteases in the occurrence of early coronary events. Rigorous monitoring (lipid and glucose measurements, tests to search for myocardial infarction,..) together with the development of new antiretroviral molecules would reduce the number of coronary events in this type of patient.
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Affiliation(s)
- O Barthélémy
- Service de Cardiologie, Hôpital Cochin, 27 rue du Fg Saint-Jacques, F75679 Paris.
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Abstract
PURPOSE Castleman's disease is a polyclonal lymphoplasmacytic and vascular proliferation prominant in lymphoid tissues. It is associated with lymph node enlargement, hepatosplenomegaly and fever. This manifestations could be secondary to hyperproduction of interleukin 6. The prognosis is poor. The opportunistic infections which are characteristic of severe HIV infection worsen the prognosis. Prolonged monochemotherapy with vinblastine or etoposide can control Castleman's disease. CURRENT KNOWLEDGE AND KEY POINTS Recent advances in human herpesvirus 8 (HHV8) knowledge and its predominance in the forms which are linked to the HIV seropositivity have partly explained the clinical manifestations of Castleman's disease. Indeed, HHV8 produce an homologous interleukin 6, the vIL-6, responsible for lymphoplasmacytic proliferation. The presence of other homologues of human cytokines produced by HHV8 could contribute to lymphoplasmacytosis and to endothelial proliferation. FUTURE AND PROSPECTS Taking into account this viral origin, alpha interferon could be an alternative in forms which are less progressive. However, antiviral therapy against HHV8 or HIV and the immunitary restoration do not have any influence on the evolution of Castleman's disease, contrary to opportunistic infections.
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Affiliation(s)
- L Aaron
- Service de maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France
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Monsuez JJ, Dufaux J, Vittecoq D, Flaud P, Vicaut E. Hemorheology in asymptomatic HIV-infected patients. Clin Hemorheol Microcirc 2001; 23:59-66. [PMID: 11214714] [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: 02/19/2023]
Abstract
Although cardiac and vascular complications have been recognized among patients infected with the Human Immunodeficiency Virus-1 (HIV-1), their vascular biology and rheology have not been studied. Rheology of red blood cells (RBC) was assessed with an erythroaggregometer in 22 HIV-1 infected asymptomatic patients (pts) and 17 healthy HIV negative controls (C). All participants were normotensive, nondiabetics, had normal lipid levels and had an hematocrit ranging from 37 to 44% and hemoglobin levels > or = 12 g/100 ml. Patients had a shorter RBC aggregation characteristic time than controls (1.49 +/- 0.17 vs. 2.04 +/- 0.41 s, p = 0.001) and an increased disaggregation shear rate (166 +/- 34.9 vs. 122 +/- 25.4 s(-1), p = 0.001). This hyperaggregation tendancy was associated with increased gamma-globulin (18.3 +/- 3.3 vs. 13.7 +/- 1.9 g/l, p = 0.01) and fibrinogen (3.52 +/- 0.57 vs 3.03 +/- 0.48 g/l, p = 0.003) levels and with an increased erythrocyte sedimentation rate (ESR) (25 +/- 14.3 vs. 12.3 +/- 7.5 mm, p = 0.02). Even in patients with ESRs ranging within normal values (< or = 20 mm), the aggregation characteristic time was found lower in patients than in controls (p = 0.004). There was no correlation between these rheological changes and the CD4+ T-cell count. The 17 patients receiving an antiviral therapy had lower CD4+ T-cell counts than their 5 untreated counterparts (244.7 +/- 167 vs. 410 +/- 106/mm3, p = 0.025), and a higher disaggregation shear rate (177.4 +/- 38.2 vs. 127 +/- 25.4, p = 0.01). Thus, an impairment of rheological characteristics is observed in asymptomatic HIV-I infected patients in association with changes in plasma proteins.
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, H pital Paul Brousse, Villejuif, France.
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39
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Katlama C, Pellegrin JL, Lacoste D, Aquilina C, Raffi F, Pialoux G, Vittecoq D, Raguin G, Lantz O, Mouroux M, Calvez V, Trylesinski A, Montestruc F, Dohin E, Goehrs JM, Delfraissy JF. MIKADO: a multicentre, open-label pilot study to evaluate the antiretroviral activity and safety of saquinavir with stavudine and zalcitabine. HIV Med 2001; 2:20-6. [PMID: 11737372 DOI: 10.1046/j.1468-1293.2001.00046.x] [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: 02/07/2023]
Abstract
BACKGROUND Since eradication of HIV is unlikely, long-term management of the disease necessitates careful evaluation of the combinations of currently available drugs to determine the most potent and useful rational sequencing of regimens. OBJECTIVE To determine the antiretroviral efficacy and tolerability of saquinavir soft gelatin capsule (SQV-SGC) plus zalcitabine (ddC) and stavudine (d4T), as first-line treatment in HIV-infected patients. DESIGN Multicentre, open-label, non-comparative study. PATIENTS AND METHODS Thirty-five asymptomatic, HIV-infected adults with no prior antiretroviral treatment, a CD4 count > or =250 cells/microL and baseline > or = 5000 HIV RNA copies/mL were included in the study. Patients received SQV-SGC 1200 mg three times a day (tid), ddC 0.75 mg tid and d4T 30 or 40 mg twice a day (bid) for 24 weeks. Plasma HIV RNA, CD4 and CD8 cell counts, HIV reverse transcriptase and protease resistance genotypes, SQV plasma concentration and tolerability were evaluated. RESULTS At baseline, median HIV RNA (interquartile range) was 4.99 (4.81-5.48) log10 copies/mL, and median CD4 count was 370 (318-504) cells/microL (n = 35). At week 24, the median decrease in HIV RNA was 3.05 (2.19-3.68) log10 copies/mL. A viral load below the level of quantification (200 copies/mL and 20 copies/mL) was achieved in 63% and 34% of patients, respectively (intent-to-treat analysis). The only mutations detected were L90M substitutions in two patients. At week 24, the median CD4 count increased (P < 0.0001), and CD8 cell counts decreased (P < 0.0001), relative to baseline. In total, there were five cases of peripheral neuropathy (14%). Mean triglyceride and cholesterol levels remained within normal ranges. CONCLUSIONS Triple therapy with SQV-SGC plus ddC and d4T is a reasonably well tolerated regimen that markedly and rapidly reduces viral load with immunological improvement. This combination is an effective additional therapeutic option, with an efficacy that compares favourably to other triple regimens used in HIV treatment.
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Affiliation(s)
- C Katlama
- Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, Paris, France.
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Abstract
BACKGROUND Given that several pathology-based studies reported some degree of coronary and arterial vasculopathy in HIV-infected patients, we investigated whether abnormal vascular reactivity may also be found in these patients. METHODS Vascular reactivity was assessed noninvasively using finger-skin blood-flow monitoring by laser-Doppler flow measurement in 10 HIV-infected-patients (mean CD4 T-cell count, 350+/-84 cells/mm3) with cardiac symptoms (previous myocardial infarction or left-ventricular dysfunction) and/or HIV-related protease inhibitor-induced hyperlipemia (group 1, symptomatic), 19 HIV-infected patients free of cardiac disease, hyperlipemia, and previous opportunistic infections (mean CD4 T-cell count, 333+/-175 cells/mm3; group 2, asymptomatic), and 19 healthy control subjects (group 3). Laser-Doppler flow was measured at baseline, during postocclusive hyperemic response following transient interruption of brachial blood flow (reactive hyperemia), during transcutaneous delivery of acetylcholine (Ach) using iontophoresis (endothelium-dependent dilation) and after sublingual nitroglycerin administration (endothelium-independent dilation). RESULTS During reactive hyperemia, the absolute increase in flow was found to be lower in asymptomatic HIV-infected patients than in controls (median values [25th-75th percentile]: asymptomatic: 300 [200-400]; versus controls: 600 [400-750] arbitrary units [AU]; p< or =.0001). This abnormality was more pronounced in symptomatic patients (100 [100-200]; p< or =.0001). There was also a reduced peak/baseline flow ratio (symptomatic: 1.14 [1.1-1.2]; asymptomatic: 1.40 [1.25-1.5]; versus controls: 1.83 [1.6-2.2]; p<.0001 for both comparisons) and a reduced hyperemic response, as assessed by the curve of area under the flow versus time from deflation to the end of the hyperemic response (symptomatic: 1850 [1100-2225]; asymptomatic: 6000 [2850-7950]; versus controls: 23,735 [16,000-31, 800] AU x sec; p<.0001 for both comparisons). Although there was no statistically significant difference in acetylcholine (Ach)-induced increases in flow between asymptomatic HIV patients and controls (peak/baseline flow ratio: 6 [4.4-10] versus 5.3 [4-8]; p =.47), a trend to lower values was seen in symptomatic patients (4.4 [1.2-5]; p =.06). Administration of 0.4 mg sublingual nitroglycerin resulted in increases in flow without statistically significant difference between patients and controls: peak/baseline flow ratio for symptomatic: 2.4 [1.9-2.7]; asymptomatic: 2.1 [1.75-2.34] versus controls: 1.97 [1.8-2.4]; p =.2 and.83, respectively). CONCLUSIONS Postischemic reactive hyperemia is reduced in HIV-infected patients. In addition, there was is trend for a reduced response to Ach only in those with cardiac disease and/or hyperlipemia.
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Affiliation(s)
- J J Monsuez
- Department of Internal Medicine, Hôpital Paul Brousse, Villejuif, France.
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Monsuez JJ, Gallet B, Escaut L, Vayre F, Charniot JC, Pulik M, Merad M, Minozzi C, Slama M, Weber S, Vittecoq D. Clinical outcome after coronary events in patients treated with HIV-protease inhibitors. Eur Heart J 2000; 21:2079-80. [PMID: 11102259 DOI: 10.1053/euhj.2000.2264] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Dubreuil-Lemaire ML, Gori A, Vittecoq D, Panelatti G, Tharaux F, Palisses R, Gharakhanian S, Rozenbaum W. Lenograstim for the treatment of neutropenia in patients receiving ganciclovir for cytomegalovirus infection: a randomised, placebo-controlled trial in AIDS patients. Eur J Haematol 2000; 65:337-43. [PMID: 11092465 DOI: 10.1034/j.1600-0609.2000.065005337.x] [Citation(s) in RCA: 15] [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
This phase IIa, randomised, single-blind, placebo-controlled study was conducted to determine the dose of recombinant human granulocyte colony-stimulating factor (lenograstim) suitable for use in AIDS patients. The study was conducted at 27 European AIDS/HIV centres, and recruited 69 AIDS patients with an initial episode or relapse of cytomegalovirus infection (neurological site excluded) and an absolute neutrophil count (ANC) < or = 1.0 x 10(9)/L upon diagnosis or between days 1 and 12 of ganciclovir (GCV) treatment. The patients were randomised to placebo (n = 14) or one of four lenograstim arms: 150 microg/m2/d (the standard onco-haematology dose, n = 13) or 100 (n = 13), 50 (n = 15), or 25 microg/m2/d (n = 14). In all groups, the planned dose of GCV was 10 mg/kg/d for 21 d. Median ANC at weeks 2 and 3 was significantly higher in each lenograstim group than in the placebo group (p = 0.05). At week 3, median ANC (x 10(9)/L) was 0.7 in the placebo group, compared with 6.0, 7.4, 4.5, and 2.0 in the 150, 100, 50, and 25 microg2/d lenograstim groups, respectively. Median ANC was not significantly different between the 150, 100, and 50 microg/m2/d lenograstim groups at any time point, but significantly higher in the 50 than in the 25 microg/m2/d group at weeks 2 (p = 0.05) and 3 (p = 0.02). Lenograstim was generally well tolerated, leading to no severe adverse events. In conclusion, lenograstim 50 microg/m2/d is suitable for the treatment of ganciclovir-induced neutropenia and is safe. These results should help the physician choose an optimal and cost-efficient regimen for patients with AIDS-related neutropenia when rHuG-CSF support is indicated.
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Sellier P, Monsuez JJ, Evans J, Minozzi C, Passeron J, Vittecoq D, Dussaix E, Carcelain G, Lacroix-Jousselin C. Human immunodeficiency virus-associated polymyositis during immune restoration with combination antiretroviral therapy. Am J Med 2000; 109:510-12. [PMID: 11184772 DOI: 10.1016/s0002-9343(00)00562-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Monsuez JJ, Gallet B, Escaut L, Vayre F, Pulik M, Charniot JC, Merad M, Slama M, Weber S, Vittecoq D. [Cardiac side effects of anti-HIV agents]. Arch Mal Coeur Vaiss 2000; 93:835-40. [PMID: 10975035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Both nature and prognosis of cardiac complications occurring in patients infected by the Human Immunodeficiency Virus-1 (HIV-1) have changed considerably since the introduction of highly acive and anti-retroviral triple therapy ("HART"). Opportunist cardiac infections have thus been displaced and side effects of drugs now occupy the primary aetiological role. Torsades de pointe may be exceptionally triggered by anti-infectious agents such as pentacarinat or trimethoprime-sulfamethoxazole, as are those induced by the association of ketoconazole and terfenadine or cisapride, the dangers of which are well known and the prevention more effective, especially with the association with HIV antiproteases which inhibit the cytochrome P450. The diagnosis of iatrogenic myocardial dysfunction is more difficult, except when it occurs acutely as with phosphonoformate (Foscarnet), or interleukine-2. Progressive cardiomyopathy caused by -interferon and dideoxynucleosides (zidovudine, didanosine and zalcitabine), reversible on withdrawal of the drug responsible in half the cases, should be distinguished from those due to the HIV itself (therapeutic relay) or to another associated cause (alcohol, coronary artery disease). The coronary complications of diseases treated by antiproteases usually occur in smokers whose cholesterol and triglyceride levels are rapidly increased with HAART. In a series of 9 patients (amongst 700 treated with the antiproteases), after the acute phase of myocardial infarction during which the interventional approach is often preferred, the medium-term prognosis is relatively good, on condition that the patients correct the hyperlipidaemia and give up smoking.
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Affiliation(s)
- J J Monsuez
- Service de médecine interne, hôpital Paul-Brousse, Villejuif
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Sellier P, Monsuez JJ, Lacroix C, Feray C, Evans J, Minozzi C, Vayre F, Del Giudice P, Feuilhade M, Pinel C, Vittecoq D, Passeron J. Recurrent subcutaneous infection due to Scopulariopsis brevicaulis in a liver transplant recipient. Clin Infect Dis 2000; 30:820-3. [PMID: 10816153 DOI: 10.1086/313764] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe a case of recurrent Scopulariopsis brevicaulis subcutaneous infection, which occurred 6 years after the patient underwent liver transplantation. Combined surgery and long-term oral therapy with terbinafine resulted in a favorable outcome, although this is not the rule in the previously reported S. brevicaulis infections in immunocompromised patients.
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Affiliation(s)
- P Sellier
- Service de Médecine Interne, Hôpital Paul Brousse, Villejuif, France.
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Moyle G, Pozniak A, Opravil M, Clumeck N, DelFraissy JF, Johnson M, Pelgrom J, Reynes J, Vittecoq D, DeLora P, Salgo M, Duff F. The SPICE study: 48-week activity of combinations of saquinavir soft gelatin and nelfinavir with and without nucleoside analogues. Study of Protease Inhibitor Combinations in Europe. J Acquir Immune Defic Syndr 2000; 23:128-37. [PMID: 10737427 DOI: 10.1097/00126334-200002010-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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
OBJECTIVES To compare the efficacy and safety of saquinavir soft gelatin capsules (SQV-SGC) and nelfinavir (NFV), with or without two concomitant nucleoside reverse transcriptase inhibitors (NRTIs), in an exploratory objective to identify populations most likely to benefit from quadruple therapy. DESIGN Phase II/III, open-label, randomized, parallel-arm, multicenter trial. PARTICIPANTS Enrollment included 157 protease inhibitor-naive adults (> or = 13 years) with HIV-1 RNA > or = 10,000 copies/ml; 132 participants completed 48 weeks of therapy. INTERVENTIONS SQV-SGC 1200 mg, NFV 750 mg, SQV-SGC 800 mg plus NFV 750 mg, all with two NRTIs, and SQV-SGC 800 mg plus NFV 750 mg alone, all three times daily for 48 weeks. MAIN OUTCOME MEASURES Proportion of participants with HIV-1 RNA <50 copies/ ml (16 and 48 weeks); time to virologic relapse (48 weeks). RESULTS Proportions of patients with HIV RNA <50 copies/ml were not statistically significantly different between arms at 16 or 48 weeks, although trends favored the quadruple-therapy arm. In patients experiencing virologic relapse, time to relapse was statistically significantly longer in the quadruple-therapy arm than in the other three arms (p = .007). Quadruple therapy provided benefit in NRTI-experienced patients and those with viral loads above the median value at baseline. Adverse events were mainly mild gastrointestinal disorders in all treatment arms. CONCLUSIONS Quadruple therapy, including SQV-SGC and NFV, gave a more durable response than triple therapy with either single protease inhibitor. Quadruple therapy might particularly benefit NRTI-experienced patients and those with high baseline viral loads.
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Affiliation(s)
- G Moyle
- The Kobler Clinic, Chelsea and Westminster Hospital, London, UK
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Barry B, Bouchaud O, Vittecoq D, Minozzi C, Coulaud JP, Gehanno P. [Invasive aspergillosis sinusitis in patients infected by the human immunodeficiency virus]. Ann Otolaryngol Chir Cervicofac 1999; 116:237-41. [PMID: 10519013] [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: 04/13/2023]
Abstract
Invasive aspergillus sinusitis invasive is a rare, life threatening infection observed in immunocompromised patients. We report three cases of patients with AIDS. Diagnosis was based on surgical biopsy specimen performed on patients with unilateral sinusitis with facial pain and osteolysis on CT scanning, associated in one patient with neurological disorders. One patient with frontal sinusitis and meningeal involvement died despite therapy. One patient with limited maxillary sinusitis who underwent surgical satisfactory resection and antifungal therapy was successfully treated without relapse 12 months later. One patient with orbital and cavernous sinus extension of ethmoiditis was successfully cured with antifungal therapy by itraconazole. Our results confirm the necessity of early diagnosis when clinical and CTscanning are suggestive and the curability of aspergillus sinusitis.
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Affiliation(s)
- B Barry
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris
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Valeyrie L, Botterel F, Minozzi C, Roger P, Bourrée P, Vittecoq D. Prolonged fever revealing disseminated infection due to Penicillium marneffei in a French HIV-seropositive patient. AIDS 1999; 13:731-2. [PMID: 10397571 DOI: 10.1097/00002030-199904160-00017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pernet P, Vittecoq D, Kodjo A, Randrianarisolo MH, Dumitrescu L, Blondon H, Bergmann JF, Giboudeau J, Aussel C. Intestinal absorption and permeability in human immunodeficiency virus-infected patients. Scand J Gastroenterol 1999; 34:29-34. [PMID: 10048729 DOI: 10.1080/00365529950172790] [Citation(s) in RCA: 15] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired intestinal function could account for diarrhoea and weight loss, which are common features of advanced human immunodeficiency virus (HIV) infection. METHODS We assessed intestinal permeability to lactulose and mannitol and absorption of D-xylose in 96 HIV-infected patients (group I: asymptomatic subjects (CDC-A); group II: symptomatic subjects (CDC-B or C) without body weight loss and/or diarrhoea; group III: 25 acquired immunodeficiency syndrome (AIDS) patients (CDC-C) with severe body weight loss and/or diarrhoea) and 10 healthy subjects as controls. RESULTS An incremental decrease in urinary D-xylose recoveries was observed, with all groups statistically different from each other. Impaired intestinal permeability was only found in patients of group III (statistically different from all other groups). CONCLUSIONS These findings suggest a loss of intestinal functional absorptive surface as HIV disease progresses. This process may be present at the early stage of infection. Impaired intestinal permeability is observed later in AIDS patients when digestive signs are present, particularly diarrhoea.
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Affiliation(s)
- P Pernet
- Biochemistry Dept. A, Hôpital Saint-Antoine, Paris, France
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