Search

BackgroundThe aim of this study was to evaluate the clinical prognostic value of the CD4+T-cell percentage (%CD4), the CD4+/CD8+T-cell ratio or the CD8+T-cell count, in addition to the CD4+T-cell count and viral load (VL) in antiretroviral-naive HIV- infected patients with CD4+T-cell counts >200 cells/ mm3.MethodsAntiretroviral-naive patients ( n=9,740) who were AIDS-free and had a CD4+T-cell count >200 cells/ mm3at their first visit after January 1997 were followed-up until treatment initiation or clinical progression (mean follow- up 17 months and 13,660 person-years). Poisson regression was used for statistical analyses.ResultsProgression to AIDS-defining events (ADEs), serious ADEs and death occurred in 228 patients (crude rate 1.69 per 100 person-years), 105 patients (0.77 per 100 person-years) and 67 patients (0.49 per 100 person-years), respectively. Regarding progression to ADE, the data fit was improved when the model also included the %CD4 (Akaike's information criteria [AIC] 2,049) and, to a lesser extent, the CD4+/CD8+T-cell ratio (AIC 2,053), in addition to CD4+T-cell count and VL (AIC 2,056). After adjustment for VL and baseline characteristics, patients with CD4+T-cell counts of 350–500 cells/mm3and %CD4+T-cell counts of 200–350 cells/mm3and %CD4>15%. The %CD4 was also significantly associated with the risk of serious ADE. By contrast, %CD4, CD4+/CD8+T-cell ratio or CD8+T-cell count had no additional prognostic value for the risk of death.ConclusionsIn antiretroviral-naive HIV-infected patients with CD4+T-cell counts >200 cells/mm3, the %CD4 was predictive of the risk of clinical progression independently of CD4+T-cell count and VL.

Background The effectiveness of neuraminidase inhibitors to reduce transmission when used as treatment in influenza-infected patients remains debated. Methods In a prespecified analysis of a blinded randomized controlled trial on the efficacy of oseltamivir– zanamivir combination therapy versus oseltamivir and zanamivir monotherapy conducted during the 2008– 2009 seasonal influenza epidemic, we compared the rate of secondary illness in household contacts of influenza-positive index patients between arms. Secondary illness was defined as occurrence in contacts of fever plus cough within 7 days from randomization of index patients. Analyses were conducted according to the delay between patients’ onset of symptoms and intervention. Results A total of 543 household contacts of 267 index patients were included, of which 466 had follow-up assessment. A secondary illness was reported in 58 (12.5%) contacts with no significant difference between arms overall ( P=0.07). When the analysis was limited to the 232 contacts of 136 index patients with first treatment intake within 24 h of onset of symptoms, a lower rate of secondary illness was reported in the combination therapy arm (2 of 56 [4%]) than in the oseltamivir arm (14 of 81 [17%]; P=0.014) and the zanamivir arm (14 of 95 [15%]; P=0.031). Multivariate analysis accounting for intra-household correlation confirmed these findings. Conclusions Our analysis suggests a greater effectiveness of the combination therapy to reduce transmissibility when given to the index patient within 24 h of onset of symptoms. As the finding was obtained from a subgroup analysis, it should be interpreted with caution.

Background The aim of this study was to examine smoking motivation and motivation to quit, and determinants of these motivations among HIV-infected cigarette smokers. Methods We conducted a 1-day cross-sectional survey on cigarette smoking in a representative sample of HIV-infected outpatients of French hospitals. A cluster analysis was used to characterize respondents’ smoking motivation. A logistic regression was performed to study the factors associated with motivation to quit, including the clusters describing smoking motives. Results We found four clusters of smoking motivation. These included intellectual/emotional support (22% of respondents), automatic/stress relief (22%; characterized by heavy smoking and strong dependency); weight control (29%; characterized by frequent symptoms of fat accumulation because of antiretroviral therapy) and pleasure/conviviality (27%; corresponding to ‘lighter’ smokers). In the logistic regression model, among other significant covariates (cigarette consumption level, tobacco dependence and perceived risk of developing a smoking-related disease), the automatic/stress relief cluster was negatively correlated to the motivation to quit (odds ratio 0.39), whereas the weight control cluster was strongly associated to this motivation (odds ratio 2.87). Conclusions The diversity of HIV-infected smokers’ profiles suggests that different types of anti-tobacco measures should be implemented in this population, such as information campaigns on specific risks incurred by HIV-infected smokers, non-specific and comprehensive measures for those for whom smoking is combined with other difficulties, and alternative therapeutic solutions for those who smoke to deal with lipodystrophy.

In patients with extensive HIV resistance, one option is to delay salvage therapy until new drugs become available. We hypothesized that this delay period could be based on a simplified treatment, which would reduce drug toxicity, stabilize resistance, and prevent resurgence of wild-type virus.A prospective 24-week treatment simplification study in HIV-1-infected patients having failed several lines of antiretroviral therapy, with CD4+ T-cell countsor = 100 cells/ml, plasma HIV RNA (viral load [VL])or = 4 log10 copies/ml and a resistance genotype predicting less than two active drugs. Treatment associated ritonavir-boosted low-dose indinavir (200 mg twice daily) and lamivudine (150 mg twice daily). The primary endpoint was a decrease in CD4+ T-cell countsor = 25% or increase in VLor = 0.7 log copies/ml relative to baseline.Twenty-six patients were included. Baseline median VL was 4.5 log10 copies/ml and median CD4+ T-cell count was 290 cells/ml. During the study, 10/26 patients (38%, 95% confidence interval = 20.2-59.4) reached the primary endpoint. No patient had an AIDS-defining event. At week 24, the median change in plasma VL was +0.2 log10 copies/ml (interquartile range (IQR): 0-0.5; P = 0.003). The median change in CD4+ T-cell counts was -49 cells/ml (IQR: -14 to -93, P0.001), with a median decline slope of 10 cells/ml/month, which was not different from that measured under full highly active antiretroviral therapy during the 6 months preceding inclusion. There were no significant changes in HIV-1 protease and reverse transcriptase genotypes during the study.In patients with advanced resistance, treatment simplification prevented resurgence of wild-type HIV, reduced drug burden, but failed to stabilize progression of the immune deficiency.