22 research outputs found
Les récidives d’endocardite infectieuse à entérocoque : fréquence et facteurs favorisants
No full textOptimisation de la réponse vaccinale contre le pneumocoque à l’initiation du méthotrexate dans la polyarthrite rhumatoïde (VACIMRA) : un essai randomisé ouvert
No full textInternational audienceIntroductionLe méthotrexate (MTX) est le traitement de première ligne utilisé dans la polyarthrite rhumatoïde (PR), mais peut diminuer la réponse immunitaire à la vaccination anti-pneumococcique chez les patients atteints de PR. Il est recommandé de vacciner avant l’initiation du MTX, mais il est également recommandé de commencer le MTX dès que le diagnostic de PR est posé. Comment gérer la vaccination chez les patients PR débutant du MTX ?Patients et méthodesDes patients atteints de PR (critères ACR/EULAR 2010) ont été vaccinés avec le vaccin conjugué 13 valents (VPC13) lors de la randomisation et deux mois plus tard avec le vaccin polysaccharidique 23-valents (VPP23). Les concentrations d’Ig G des 13 sérotypes contenus dans le VPC13 ont été mesurées à 0, 1, 3, 6 et 12 mois. Après randomisation 1:1, le MTX a été initié immédiatement dans le groupe GI ou après un mois dans le groupe GD. Les corticoïdes oraux étaient autorisés mais pas plus de 10 mg/jour. L’activité de la maladie, les infections et les effets secondaires ont été collectés tout au long de l’étude. Les concentrations spécifiques d’IgG des 13 sérotypes contenus dans le VPC13 ont été mesurées par ELISA et par un test de neutralisation opsonophagocytique (OPA), rapportée sous forme d’indices d’opsonisation (IOs). La réponse anticorps positive était définie comme une augmentation d’au moins 2 fois la concentration d’IgG par ELISA. Pour l’IO, la réponse était définie comme une valeur ≥ au seuil de sérotype fourni par le laboratoire. Le critère de jugement principal était les taux de répondeurs un mois après le VPC13, définis par au moins 3 réponses anticorps positives sur 5 des sérotypes d’intérêt (1, 3, 5, 7F, 19A) par ELISA ou OPA. L’analyse principale a été réalisée sur l’ensemble de l’analyse complète (FAS) avec un modèle logistique mixte.Résultats276 patients atteints de PR ont été randomisés. Pour le critère principal, les données de 249 patients ont été analysées dans le FAS. Les caractéristiques des patients à l’inclusion étaient similaires entre les deux groupes : 70 % de femmes, âge moyen de 55,6 ans, durée de la PR de 2 mois, 69 % ACPA+, 21 % érosive, DAS28-CRP 4,6. Comparé au groupe GI, les taux de répondeurs étaient significativement plus élevés dans le groupe GD : 88 % contre 75 % (p < 0,01) et 96 % contre 88 % (p = 0,02) par ELISA et OPA respectivement. Les proportions de répondeurs à 12 mois étaient encore plus élevées dans le groupe GD en ELISA. L’évolution des concentrations géométriques moyennes au cours de l’année de suivi était plus élevée pour 8 des 13 sérotypes dans le groupe GD par rapport au groupe GI. Dans l’analyse multivariée, appartenir au GD et avoir moins de 8 articulations gonflées étaient des facteurs prédictifs d’un doublement des réponses humorales (GMC et GMT) 1 mois après la vaccination. Les doses cumulées de stéroïdes et le recours à un traitement ciblé étaient similaires entre GI et GD pendant le suivi. Il y avait des proportions similaires d’infections graves entre les groupes à 1 an. Au-delà du premier mois, les scores DAS28 étaient similaires entre les deux groupes.ConclusionCette étude démontre clairement que chez les patients PR, le vaccin VPC13 administré 1 mois avant le début du MTX permet une réponse humorale significativement plus élevée à 1 mois, par rapport aux patients vaccinés simultanément avec le MTX, et cette différence est maintenue à 1 an ; ceci sans aucun impact sur le contrôle de la maladie. Ces résultats soutiennent fortement la vaccination des patients avant l’initiation du MTX
Hepatitis C virus incidence in HIV-infected and in preexposure prophylaxis (PrEP)-using men having sex with men
No full textInternational audienceBACKGROUND & AIMS:HCV incidence still appears on the rise in HIV-infected MSM in France. We assessed the incidence of HCV infection in HIV-positive and in preexposure prophylaxis (PrEP)-using MSM.METHODS:HIV-infected, HCV-negative MSM with serological follow-up in 2016 and HIV-negative, HCV-negative PrEP-using MSM enrolled from January 2016 to May 2017 in the French Dat'AIDS cohort were analyzed to assess the incidence of a primary HCV infection. The incidence of HCV reinfection was also determined in patients having cured a previous infection.RESULTS:Among 10,049 HIV-infected MSM followed in 2016, 681 patients were already HCV-infected when entering the study (prevalence 6.8%). Serological follow-up was available in 2016 for 4,151 HCV-negative patients. Virological follow-up was available for 478 patients who had cured a previous infection. Fifty-seven HCV infections occurred in 2016 (42 primary infections, 15 reinfections). Incidence of primary HCV infection, reinfection and overall HCV infection was respectively 1.0, 3.1 and 1.2/100 person-years (PY). From January 2016 to May 2017, 930 HIV-negative subjects were enrolled for PrEP. Seventeen patients were already HCV-infected (prevalence 1.8%). Twelve HCV infections occurred during follow-up (10 primary infections, 2 reinfections) giving an incidence of primary infection of 1.0/100 PY and an overall incidence of 1.2/100 PY.CONCLUSIONS:The overall incidence of HCV infection and of a primary HCV infection in HIV-positive and in PrEP-using MSM appeared similar in France in 2016-early 2017. HIV-positive and PrEP-using MSM probably share similar at-risk practices and both should be targeted for preventative interventions
Low-level viral loads and virological failure in the integrase strand transfer era
No full textInternational audienceObjectives: To analyse the occurrence of virological failure (VF) in patients starting ART with an integrase strand transfer inhibitor (INSTI)-based regimen in recent years, in relation with previous episodes of low-level viral load (LLVL).Patients and methods: Patients starting a first ART between 1 January 2015 and 31 December 2020 based on two NRTIs and one INSTI were included if after virological control (two measures of VL < 50 copies/mL) they had a minimum of two additional VL measurements. Cox models adjusted for sex, age, acquisition group, hepatitis B or C coinfection, place of birth, year of ART initiation, CD4+ T cells and VL at ART initiation, duration of known HIV infection and of ART regimen were used to assess the association between the time to VF and the occurrence of LLVL. ART regimen was evaluated as time-varying covariate.Results: LLVL was described in 13.7% and VF in 11% of the 3302 patients. LLVL was associated with VF [adjusted HR (aHR) 1.76, 95% CI 1.28-2.41], as well as age (aHR 0.97/year, 95% CI 0.96-0.98), CD4+ T cell count at ART initiation (aHR 0.93, 95% CI 0.87-0.98), heterosexual transmission (aHR 1.76, 95% CI 1.30-2.37) and being born abroad (aHR 1.50, 95% CI 1.17-1.93).Conclusions: LLVL was related to VF. Even in the absence of subsequent failure, LLV episodes have a cost. Thus any VL value above 50 copies/mL should lead to enhanced adherence counselling
cohort between 2010 and 2015
No full textInternational audienceBackground: Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV-infected people.Objective: To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage.Methods: Retrospective study using longitudinal data from 44 642 patients in the French Dat'AIDS multicenter cohort. Patients' characteristics were described at KS diagnosis according to ART exposure and to HIV-plasma viral load (HIV-pVL) (≤50 or >50) copies/mL.Results: Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART-experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV-pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted-PI-based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis.Limitations: Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected.Conclusion: Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV-pVL ≤50 cp/mL remain to be explored
Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients – “En route for eradication”?
No full textIncidence of diabetes in HIV-infected patients treated with first-line integrase strand transfer inhibitors: a French multicentre retrospective study
No full textInternational audienceAbstract Background Integrase strand transfer inhibitors (INSTIs) are increasingly used in patients living with HIV due to their safety, effectiveness and high genetic barrier. However, an association with weight gain has recently been suggested and several cases of diabetes mellitus have been reported with raltegravir and dolutegravir. The long-time metabolic impact of these recent molecules remains unclear. Objectives To assess if an INSTI as a third agent is statistically associated with new-onset diabetes mellitus compared with an NNRTI or a PI. Patients and methods Patients undergoing first-line combined ART (cART) without diabetes at baseline were retrospectively included from the Dat’AIDS French cohort study (ClinicalTrials.gov NCT02898987). Incident diabetes mellitus was defined as a notification of new diabetes in the medical history, a glycated haemoglobin (HbA1c) level superior to 7.5% or the start of a diabetes therapy following the initiation of ART. Results From 2009 to 2017, 19 462 patients were included, among which 265 cases of diabetes mellitus occurred. Multivariate and survival analyses did not highlight an increase in new-onset diabetes in patients undergoing cART with an INSTI as a third agent compared with an NNRTI or a PI. BMI >30 kg/m2, age >37 years old (in survival analysis), black race or Hispanic ethnicity, arterial hypertension and AIDS were associated with a higher proportion of incident diabetes. Conclusions INSTIs were not statistically associated with new-onset diabetes. However, clinicians should remain aware of this possible metabolic comorbidity, particularly in patients with a high BMI and older patients
Reaching the Second and Third Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/AIDS 90-90-90 Targets Is Accompanied by a Dramatic Reduction in Primary HIV Infection and in Recent HIV Infections in a Large French Nationwide HIV Cohort
No full textInternational audienceBackground: In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count.Methods: To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis.Results: During the study period, 61 822 patients were followed in the Dat'AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39-33.47) months in 2007 to 0.77 (IQR, 0.37-1.60) months in 2017. A decrease in PHI (-35.1%) and PRHI (-25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8-2014.4) and 2013.1 (95% CI, 2011.3-2014.8), respectively.Conclusions: Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017.Clinical trials registration: NCT02898987
No increased risk of Kaposi sarcoma relapse in patients with controlled HIV‐1 infection after switching protease inhibitor‐based antiretroviral therapy
No full textInternational audienceObjectives: Our aim was to assess if switching from a protease inhibitors (PI)-based regimen to a PI-free one is associated with an increased risk of Kaposi Sarcoma (KS) relapse among patients living with HIV (PLHIV) with history of KS and controlled HIV replication.Methods: In a retrospective analysis of the prospectively collected Dat'AIDS database we selected patients who both had a past KS history and a HIV-1 viral load below 200 copies/mL while being PI-treated. We searched for KS relapses while persistent virological success was maintained for at least 6 months, whether patients kept taking the PI, or switched to PI-free regimen.Results: Among the 216 patients with past KS event and a history of HIV-1 infection efficiently treated by a PI-based regimen, 148 patients (68.5%) later switched to a PI-sparing regimen. Their baseline characteristics were not different from non-switching patients. We described 7 cases of relapse (3.2% of the 216 patients). Five cases of relapse occurred in switching patients (3.4%). The remaining two relapses occurred in PI-treated patients (2.9%). At KS relapse, CD4 cell count was 459 cells/μL (range 225-560) for switching patients, compared with 362 and 136 cells/μL for the other two patients.Conclusions: In this large cohort of PLHIV with a history of KS and ART-controlled HIV replication, KS relapses were described in 3.2% of the patients, and were not more frequent when a PI-containing ART regimen has been switched to a PI-free regimen. Our results do not support a specific effect of PI on KS
No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study
No full textInternational audienceAbstract Objectives Even in an ‘optimal’ health system, patients’ characteristics may have an impact on their care. We investigated whether age, gender and place of birth have an impact in the HIV care continuum in France, a country with a universal free healthcare system. Methods We estimated differences in the 5 year restricted mean percentage of person-time spent (i) in care, (ii) receiving ART and (iii) on ART and virally suppressed among 2432 (30.2%) women, 3925 MSM (48.7%) and 1709 men who have sex with women (MSW; 21.2%) entering care in the Dat’AIDS French prospective cohort between 1 January 2013 and 31 December 2017. Trial registration: Clinicaltrials.gov reference NCT02898987. Results Men and women spent 85.6% and 82.8% of person-time on ART and 69.9% and 65% suppressed, respectively. MSM, MSW and women spent 86.9%, 82.6% and 82.8% of person-time on ART and 72.5%, 63.7% and 65% suppressed, respectively. Patients born in France (47%) and patients born abroad spent 87.9% and 81.9% of person-time on ART and 74.6% and 62.9% suppressed, respectively. Young men born abroad were found to spend the smallest person-time with non-detectable viral load (53% for MSW and 58.1% for MSM). Conclusions Despite free access to care and universal ART in France, disparities remain in the HIV continuum care across age, country of birth and way of HIV acquisition. Clinical and public health interventions targeting specific patients’ conditions are needed
