64 research outputs found
A retrospective, multicentre study on the efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for the treatment of HIV in a real-world setting in Belgium
No full textConclusion • Several RCTs have demonstrated BIC/FTC/TAF to be a first-line option for treatment-naïve and experienced PLWH [1-4]. • Real-world studies provide complementary information to RCTs and ensure that those results can be generalized to broader populations seen in daily practice. • The aim of this study was to describe the Belgian HIV population treated with BIC/FTC/TAF and to evaluate its efficacy, durability, and tolerability in a real-world setting.We would like to thank everyone who contributed to this study including the study participants and investigators. This study was supported by a grant from Gilead International
A retrospective, multicentre study on the efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for the treatment of HIV in a real-world setting in Belgium
No full textConclusion • Several RCTs have demonstrated BIC/FTC/TAF to be a first-line option for treatment-naïve and experienced PLWH [1-4]. • Real-world studies provide complementary information to RCTs and ensure that those results can be generalized to broader populations seen in daily practice. • The aim of this study was to describe the Belgian HIV population treated with BIC/FTC/TAF and to evaluate its efficacy, durability, and tolerability in a real-world setting.We would like to thank everyone who contributed to this study including the study participants and investigators. This study was supported by a grant from Gilead International
Saturnisme après une réduction pondérale volontaire
No full textNous rapportons une observation de fluctuations de la plombémie chez un travailleur exposé et régulièrement suivi, qui a présenté une perte pondérale importante suite à un régime drastique. [...
Efficacité d’interventions de prévention, basées sur une meilleure prise en compte des besoins perçus et vécus des HSH en République Centrafricaine
No full textRésumé français :Problématique :les hommes qui ont des rapports sexuels avec des hommes (HSH) constituent les populations les plus à risque d’infection au VIH dans différents pays d’Afrique subsaharienne. A ce jour, très peu d’interventions sont menées pour réduire le risque d’infection en influant sur les facteurs de risque, en Afrique Centrale et particulièrement en République Centrafricaine. Les objectifs de cette thèse visent à démontrer que les HSH sont identifiables et sont à risque des IST/VIH, que leur simple suivi médical ne permet pas un changement de comportements sexuels et réduire la fréquence des IST/VIH, mais que la combinaison d’interventions comportementale, biomédicale et structurelle permet, même en période de crise humanitaire, le changement de comportement sexuel et la réduction de la fréquence des IST/VIH. Méthodologie :Les HSH ont été enrôlés progressivement depuis 2010 pour atteindre un nombre de 220 en 2014. L’étude préliminaire sur les caractéristiques sociodémographiques et pratiques sexuelles à risque a concerné les 103 premiers HSH enrôlés en 2010. En 2012, la cohorte atteint le nombre de 170 HSH parmi lesquels 99 qui avaient un dossier médical complet ont fait l’objet de la deuxième étude du suivi sur deux ans.En 2013, alors que la cohorte des HSH avait atteint 200, 20 HSH ont été interviewés dans le cadre de l’étude qualitative. En 2014, la cohorte des HSH a atteint le nombre de 220. L’étude d’intervention a concerné 40 HSH sélectionnés sur les 220 et s’est poursuivie jusqu’en 2016.Résultats :L’analyse des caractéristiques socio démographiques des 103 HSH relève la présence de HSH jeunes. L’âge varie entre 15 et 40 ans, avec une médiane à 23 ans. Les pratiques sexuelles à risque sont fréquentes, notamment les premiers rapports sexuels avant 16 ans et sans préservatifs (70%) ;7% n’ont jamais utilisé les préservatifs, 56 % sont bisexuels, 98% pratique la pénétration anale. 31 HSH soit 24 %, étaient séropositifs pour le VIH ;22 soit 17% étaient infectés par le virus de l'hépatite B (VHB), dont 6 cas étaient coinfectés par le VIH et le VHB (M.B. Simaleko, et al.- Médecine d'Afrique Noire 6010 - Octobre 2013 - 409-414).En 2012, après deux ans de suivi médical et de counseling, il n’y a pas eu de changement de comportement et de pratiques sexuelles à risque, notamment en ce qui concerne la fréquence des rapports non protégés et la moyenne du nombre de partenaires occasionnels. La fréquence des principales IST a augmenté. Les prévalences du VIH, de la syphilis et de l’hépatite ont augmenté de manière significative et respectivement de 29% à 41%, de 12% à 21% de 14% à 23%. (Mbeko Simaleko M. et al. Pan Afr Med J. 2018; 29: 132).L’entretien avec les HSH a révélé plusieurs obstacles à l’utilisation des préservatifs, notamment, les ruptures, leur disponibilité, les fausses croyances, les pressions de l’entourage. (Mbeko Simaleko M. et al. Médecine et Santé Tropicale 2018 ;28 :424-429). De 2014 à 2016, l’étude d’interventions sur 40 HSH choisis de manière aléatoire et basée sur la combinaison des interventions comportementale, biomédicale et structurelle a permis d’améliorer le comportement et pratiques sexuelles des HSH par la réduction significative du nombre de partenaires sexuels occasionnels et l’augmentation significative de la fréquence des rapports sexuels protégés. À cet effet, il a été noté un seul cas de nouvelle infection par le VIH parmi les séronégatifs des 40 HSH contre 9 cas dans le groupe témoin. Aucune nouvelle infection au virus de l’hépatite B dans le groupe intervention contre 18, dans le groupe témoin. Il y a une augmentation significative de séropositifs dans le groupe témoin comparativement au groupe intervention en ce qui concerne la sérologie de la syphilis. (Mbeko Simaleko M. et al. Health Sci. Dis. 2020; 21: 94-99). Conclusion :les HSH sont identifiables et à risque. Le simple suivi médical associé au counseling ne permet pas d’améliorer le comportement sexuel et réduire la fréquence des IST. Cependant la combinaison des interventions a permis d’améliorer le comportement et la prise de risques des HSH mais également de réduire la fréquence des IST, même en période de crise humanitaire. Au vu du faible nombre de HSH inclus dans l’étude, il serait nécessaire d’étendre celle-ci, afin de conforter les résultats obtenus.Abstract Issue: Men who have sex with men (MSM) are the most at risk populations of HIV infection in different countries of sub-Saharan Africa. To date, very few interventions have been carried out to reduce the risk of infection by influencing on risk factors in Central Africa and particularly in the Central African Republic. The objectives of this research are to demonstrate that MSM are identifiable and at risk of STI/HIV, that the medical follow-up does not cause a change in sexual behavior and a reduction in the frequency of STI/HIV but that the combination of behavioral, biomedical and structural interventions allows, even in times of humanitarian crisis, behavioral change and reduction in the frequency of STI/HIV. Methodology: MSM have been progressively enrolled since 2010 to reach a number of 220 in 2014. The preliminary study on sociodemographic characteristics and sexual risk practices involved the first 103 MSM recruited until 2011. In 2012, 99 MSM who had a complete medical record were the subject of the second study on a two-year follow-up. In 2013, when the MSM cohort reached 200, 20 MSM were interviewed in the context of the qualitative study. In 2014, the MSM cohort reached 220. The intervention study involved 40 selected MSM out of the 220 and was continued during 2016.Results: MSM are predominantly young Their age varied between 15 and 40 years, with a median of23 years. Risky sexual practices were frequent, including first sexual intercourse before the age of 16 and without condoms (70%); 7% never used condoms, 56% are bisexual, 98% practice anal penetration. 31 MSM, or 24%, were HIV-positive; 22, or 17%, were infected with hepatitis B virus (HBV), of which 6 cases were co-infected with HIV and HBV (M.B. Simaleko, Set al. - Médecine d'Afrique Noire 6010 - Octobre 2013 - 409-414). In 2012, after two years of medical follow-up and counselling, there was no change in risk behavior and sexual practices, including the frequency of unprotected sex and the average number of occasional partners.The incidence of major STIs increased. The prevalence of HIV, syphilis and hepatitis increased significantly and respectively from 29% to 41%, from 12% to 21%, from 14% to 23%, respectively (Mbeko Simaleko M. et al. Pan Afr Med J. 2018; 29: 132). Interviews with MSM revealed several barriers to condom use, including condom breaks, condom availability, false beliefs, and peer pressure (Mbeko Simaleko M. et al. Médecine et Santé Tropicale 2018; 28: 424-429). From 2014 to 2016, the intervention study of 40 randomly selected MSM based on a combination of behavioral, biomedical, and structural interventions improved the sexual behavior and practices of MSM by significantly reducing the number of occasional sexual partners and significantly increasing the frequency of safer sex. Only 1 case of new HIV infection was noted among the 40 HSH HIV-negative compared to 9 cases in the control group. There were no new hepatitis B virus infections in the intervention group versus 18 in the control group. There was a significant increase in seropositivity in the control group compared to the intervention group with respect to syphilis serology (Mbeko Simaleko M. et al. Health Sci. Dis: Vol 21 (7) July 2020 pp 94-99). Conclusion: MSM were identifiable and most of them were at HIV risk. Simple medical follow-up combined with counselling does not allow to improve sexual behavior or to reduce the frequency of STIs. However, the combination of interventions has made it possible to improve the behavior and risk-taking of MSM and also to reduce the frequency of STIs, even in times of humanitarian crisis. In view of the low number of MSM included in the sample study and in order to consolidate the results obtained, it would be necessary to carry out a more in-depth study with a larger sample of MSM.Doctorat en Santé Publiqueinfo:eu-repo/semantics/nonPublishe
Importance of Ethnicity, CYP2B6 and ABCB1 Genotype for Efavirenz Pharmacokinetics and Treatment Outcomes: A Parallel-group Prospective Cohort Study in two sub-Saharan Africa Populations.
No full textWe evaluated the importance of ethnicity and pharmacogenetic variations in determining efavirenz pharmacokinetics, auto-induction and immunological outcomes in two African populations. ART naïve HIV patients from Ethiopia (n = 285) and Tanzania (n = 209) were prospectively enrolled in parallel to start efavirenz based HAART. CD4+ cell counts were determined at baseline, 12, 24 and 48 weeks. Plasma and intracellular efavirenz and 8-hydroxyefvairenz concentrations were determined at week 4 and 16. Genotyping for common functional CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 variant alleles were done. Patient country, CYP2B6*6 and ABCB1 c.4036A>G (rs3842A>G) genotype were significant predictors of plasma and intracellular efavirenz concentration. CYP2B6*6 and ABCB1 c.4036A>G (rs3842) genotype were significantly associated with higher plasma efavirenz concentration and their allele frequencies were significantly higher in Tanzanians than Ethiopians. Tanzanians displayed significantly higher efavirenz plasma concentration at week 4 (p<0.0002) and week 16 (p = 0.006) compared to Ethiopians. Efavirenz plasma concentrations remained significantly higher in Tanzanians even after controlling for the effect of CYP2B6*6 and ABCB1 c.4036A>G genotype. Within country analyses indicated a significant decrease in the mean plasma efavirenz concentration by week 16 compared to week 4 in Tanzanians (p = 0.006), whereas no significant differences in plasma concentration over time was observed in Ethiopians (p = 0.84). Intracellular efavirenz concentration and patient country were significant predictors of CD4 gain during HAART. We report substantial differences in efavirenz pharmacokinetics, extent of auto-induction and immunologic recovery between Ethiopian and Tanzanian HIV patients, partly but not solely, due to pharmacogenetic variations. The observed inter-ethnic variations in efavirenz plasma exposure may possibly result in varying clinical treatment outcome or adverse event profiles between populations
First case of a dog bite wound infection caused by Streptococcus minor in human
No full textAbstractWe report the first case of human infection caused by Streptococcus minor in a 51-year-old immunocompetent woman admitted for dog bite injuries. At present, the role of Streptococcus minor in bite wound infections is unknown. Further studies on virulence factors are needed to elucidate its pathogenicity mechanisms
Acalculous cholecystitis in a patient with Plasmodium falciparum infection: a case report and literature review
No full textThe definitive version is available at www3.interscience.wiley.comThe definitive version is available at www3.interscience.wiley.comAcute acalculous cholecystitis (AAC) can occur without gallstones in critically ill or injured patients and has also been associated with various infectious agents.(1-4) We report here a case of AAC in a patient with Plasmodium falciparum malaria
Late presentation for human immunodeficiency virus HIV diagnosis results of a Belgian single centre
No full textBACKGROUND: Antiretroviral therapy reduces mortality and morbidity in HIVinfected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. Although the international guidelines recommend starting antiretroviral therapy ART with a high CD4 cell count level, in the practice, this is particularly challenging to achieve, especially in late presentation of HIV diagnosis. The aim of this study was to determine the frequency and the demographic features associated with late presentation for HIV diagnosis in our Centre.
METHODS: All newly diagnosed patients with HIV between January 2007 and December 2011 in our AIDS Reference Centre, were included. Late presenter patient was defined as patient with CD4 count 350/mm(3) at the time of diagnosis. Demographic age, sex, ethnicity, migration and clinical characteristics transmission mode, CD4 cell count, viral load were collected. We also collected data on outcome median day of hospitalization, mortality, virological response to ART and lost to followup LTFU. LTFU was defined as patient without any medical contact and viral load measurements during two consecutive years in our centre.
RESULTS: From 2007 to 2011, 154 429 out of 359 patients newly diagnosed with HIV were late presenters. According to univariate analysis, age 50, female gender, migrant from subSaharan Africa and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, age 50, heterosexual contact and migrant status particularly women were the only independent risk factors for late presentation. Late presenters tend to have a worse outcome than nonlate presenters.
CONCLUSION: A considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been clearly identified. Despite high testing rate for HIV in Belgium, highrisk population like migrant, heterosexual contact, remain under tested. In order to be able to detect and treat all patients with high CD4 cell count as recommended by all international guidelines, we recommend developing testing policies specifically focused on these categories at high risk for late presentation
PMMA-cement anterior column reconstruction in surgical treatment of spondylodiscitis.
No full textINTRODUCTION AND RESEARCH QUESTION: This paper explains how antibiotic loaded cement can be used in surgical treatment of spondylodiscitis to reconstruct the anterior column of the spine. MATERIAL AND METHODS: 35 consecutive surgical procedures performed for spondylodiscitis were collected over a 11-year period and charts were reviewed. Most infections were caused mainly by staphylococcus spp (n = 16), streptococcus spp (n = 8) and pseudomonas spp (n = 4). Most patients had long standing but unsuccessful antibiotic therapy (median 42 days). Other indications included instability, neurologic deficit, abscess, and patients were generally in very poor medical condition. RESULTS: Anterior debridement was followed by a partial cavity filling with surgical high viscosity PMMA cement in all cases. Cement was a high viscosity gentamycin loaded cement, that was placed in the cavity created by debridement under the direct eye control. In 25 cases, a part of the cavity was filled with freeze dried cancellous bone allograft rehydrated in rifampicin. Spine was further stabilized with an anterior plate in 15 cases, with short (+1/+1) posterior instrumentation in 5 cases, and a long (≥ +2/+2) posterior instrumentation in 11 cases. In four patients, spine was left un-instrumented. Immediate, unrestricted mobilization was always authorized after surgery. None of the patients were reoperated neither for mechanical failure nor for infection relapse. CONCLUSION: This report supports the idea that surgical bone cement is an efficient gap filler when used through anterior approach. For small as well as for large defects, it can help to reconstruct the anterior column and locally control the infection in combination with additional stabilization and optimal intravenous and oral antibiotic treatment
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