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4. [Hepatitis C in a psychiatric setting: A forgotten reservoir?]

Author

Rolland, B, Bailly, F, Cutarella, C, Drevon, O, Carrieri, P, Darque, A, Hallouche, N, Maptue, N, Pol, S, Llorca, P-M, Lang, J-P, Service Universitaire d’Addictologie de Lyon [CH Le Vinatier, Bron] (Pôle MOPHA - SUAL), Centre Hospitalier le Vinatier [Bron], Service d'Hépatologie [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Clinique Saint Barnabé - Ramsay Santé [Marseille] (CSB-RS), Santé basque développement [Bayonne], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), GHU Paris Psychiatrie et Neurosciences, Association nationale pour la promotion des soins somatiques en santé mentale [Paris] (ANP3SM), Centre mutualiste d'addictologie de Saint-Galmier [Saint-Etienne] (Mutualité française Loire - Haute Loire SSAM), Service d'hépatologie médicale [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Immunité Innée - Innate Immunity, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux (NPsy-Sydo), CHU Clermont-Ferrand-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Les Toises Centre de Psychiatrie et Psychothérapie [Lausanne, Suisse], Centre d'information régional sur les drogues et dépendances Alsace [Strasbourg] (CIRDDA), and Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Psychiatry, Public health, Santé publique, [SDV]Life Sciences [q-bio], Quality of Life, Hépatite C, Humans, Hepacivirus, Hepatitis C, Chronic, Antiviral Agents, Hepatitis C, Psychiatrie
Abstract

International audience; Hepatitis C is a transmissible hepatic and extra-hepatic disease caused by the hepatitis C virus (HCV). HCV develops into a chronic infection among approximately 70% of the contaminated subjects. Chronic HCV infection is estimated to affect between 0.5% and 1 % of the general population in France, which causes an important burden of disease, in particular due to the occurrence of cirrhosis and liver cancer. New antiviral drugs now allow to cure more than 95% of patients in just a few weeks of treatment with very limited safety issues. This therapeutic revolution has led the World Health Organization and many national governments to aim for an elimination of HCV, which has been defined as a 90%-reduction of the incidence rate, and a 65%-reduction in the number of HCV-related deaths on the basis of the 2015 figures. In this respect, the French Ministry of Health has recently decided to extend the ability to prescribe the new antiviral drugs to any physician. However, the elimination campaign of HCV will also need to correctly identify, screen, and treat the main target populations. If people who inject drugs (PWIDs) certainly constitute the most important population concerned by the challenge of HCV elimination, more hidden reservoirs in which HCV transmission can insidiously evolve should be identified and specifically targeted as well. Inpatient psychiatric populations might constitute one of these hidden reservoirs. International data suggest that chronic HCV infection affects approximately 5% of psychiatric inpatients in Europe. This very high prevalence estimate can in part be due to the very frequent psychiatric disorders found among the current or former PWIDs. However, a part of the seropositive patients does not report a history of drug use, and other factors could contribute to the increased risk of contamination in this population including atypical routes of transmission related to institutional promiscuity. Exploring the general profile and risk-behaviors of the psychiatric inpatients found infected by the HCV is thus warranted for future studies. Screening and treating HCV in the specific population of psychiatric patients is part of the general public health objective of eliminating HCV at a national level. Moreover, it also directly fits into the individualized psychiatric care. Many recent data suggest that HCV also has a neural tropism, in particular within glial cells, such as astrocytes or oligodendrocytes. As such, HCV foments inflammatory processes in the brain and contributes to cognitive impairments and psychiatric symptoms such as anxiety or depression. At the individual level, treating HCV infection can improve the psychiatric state and increase patients' outcomes in terms of well-being and quality of life. For all these reasons, the field of psychiatry needs local and national actions for informing and training professionals about HCV screening and treating modalities. Patient and family associations also need to be involved in this general effort of micro-elimination. A key role should be assigned to the general practitioners embedded within inpatient psychiatric units. They are the best fitted professionals to screen, treat, and empower patients, to inform and train other caregivers of the psychiatric field, and to act as a relay with hepatology teams if required. Hospital pharmacists are other important stakeholders. In a national context in which the funding of psychiatric care, including medications, is based on predefined funding envelops, innovative initiatives will have to be set up by local or national health authorities, in partnership with pharmacists, to allow for the treatment of psychiatric inpatients. In conclusion, the world of psychiatry is a possible hidden reservoir of HCV and, as such, a part of the challenge for eliminating the virus. Patients, families, and caregivers will have to be correctly sensitized and trained to play their role in the process. Specific investigations will be required to better understand why such an increased prevalence of HCV is observed in this population. Specific adaptations of the cascade of care within psychiatric settings, including access to treatment, will need to be designed, implemented, and evaluated for reaching micro-elimination of HCV in psychiatry.

Published
2019

7. L’évaluation des services publics par la satisfaction des usagers et les valeurs des citoyens : le cas d’un baromètre du service public municipal

Author

Carton, A., Dupuis, Jérôme, Saint-Pol, S., Lille économie management - UMR 9221 (LEM), Université d'Artois (UA)-Université catholique de Lille (UCL)-Université de Lille-Centre National de la Recherche Scientifique (CNRS), and François Meyssonnier (dir.)

Subjects
[SHS.GESTION]Humanities and Social Sciences/Business administration, [SHS]Humanities and Social Sciences
Abstract

Collection Economie et Société.; International audience

Published
2015

17. Prise en charge du risque de réactivation du virus de l’hépatite B chez les patients traités par immunosuppresseurs et immunomodulateurs en médecine interne : données de l’enquête REACTI-B et proposition d’un algorithme de prise en charge

Author

Terrier, B., Pol, S., Thibault, V., Gottenberg, J.-E., and Cacoub, P.

Subjects
*HEPATITIS B virus, *IMMUNOSUPPRESSIVE agents, *IMMUNOLOGICAL adjuvants, *INTERNAL medicine, *ALGORITHMS, *CROSS-sectional method
Abstract

Abstract: Propose: This study aimed to evaluate the screening practices and management of the risk of hepatitis B virus (HBV) reactivation in patients receiving immunosuppressive and immunomodulatory agents in internal medicine departments and to propose a diagnostic and therapeutic algorithm. Methods: Descriptive, cross-sectional survey of the 1350 members of the French Society of Internal Medicine, which took place in France in January 2011 using an electronic questionnaire. Experts in the field of HBV infection proposed a decisional algorithm. Results: The overall response rate was 21.5%. Screening of HBV infection was performed in 44%, 68% and 76% of patients receiving or prior to initiating corticosteroids, immunosuppressive and immunomodulatory agents, respectively. Among participants, 35% had been confronted with one or several cases of HBV reactivation, mainly in patients receiving corticosteroids (54%), cyclophosphamide (34%) or rituximab (33%). Chronic, inactive carriers of HBV were considered to be at risk of reactivation in 89% of cases, while 41% of anti-HBc positive patients were considered at risk. In at-risk patients initiating immunosuppressive and/or immunomodulatory agents, 43% of practitioners consider the use of pre-emptive therapy, whereas 33% treat in case of confirmed reactivation. Systematic HBV vaccination of seronegative patients is planned in less than 50% of cases. Finally, 89% of participants feel they are not sufficiently educated regarding the risks of HBV reactivation and its prevention. Conclusion: This survey highlights the need to improve the education of physicians regarding the risks of HBV reactivation prior to initiating corticosteroids, immunosuppressive and immunomodulatory agents, and to provide more specific guidelines for patients managed in internal medicine departments. [Copyright &y& Elsevier]

Published
2012
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20. Nucleoside analogues resistance in the treatment of chronic hepatitis B virus infection

Author

Halfon, P., Pol, S., Bourlière, M., Courcambeck, J., and Cacoub, P.

Subjects
*HEPATITIS B treatment, *HEPATITIS B virus, *NUCLEOSIDES, *VIRUS diseases, *THERAPEUTICS
Abstract

Subject. – Chronic hepatitis B virus (HBV) infection is usually treated by interferon alpha. However, a sustained response after stopping treatment is only obtained in 30% of patients.Actuality. – New therapeutic nucleosid analogs have been developped, i.e. lamivudine, famciclovir, adefovir, entecavir, clevudine. However, as in HIV infection, clearance of the original hepatitis B virus with emergence of distinct resistant mutants have been observed during or after treatment with most nucleosid analogs. In this review, the underlying mechanisms of resistance and the characterisation of HBV mutants are described to optimize the best therapeutic regimen.Perspectives. – Treatment of chronic HBV infection, as most of other chronic viral infection, should be based on combination therapy with a special search for the appearance of HBV mutant resistant. [Copyright &y& Elsevier]

Published
2003
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43. Hépatite alcoolique aiguë

Author

Trabut, J.-B., Thépot, V., Sogni, P., and Pol, S.

Subjects
*HEPATITIS, *JAUNDICE, *ALCOHOLIC liver diseases, *CIRRHOSIS of the liver, *ADRENOCORTICAL hormones, *LIVER transplantation
Abstract

Abstract: Alcoholic hepatitis is one of the most severe presentations of alcoholic liver disease. It is usually revealed by the recent onset of jaundice in a patient with alcoholic cirrhosis. Maddrey''s discriminant function can help to recognize patients with poor prognosis (the 6-month mortality is above 50% when it exceeds 32). Corticosteroids increase survival in those patients with high risk of death. Other treatments (pentoxifylline, N-acetyl-cysteine or enteral nutrition) need to be investigated further before to recommend their routine use instead of, or in association with, corticoids. Liver transplantation can be proposed to highly selected patients who do not respond to medical therapy. In any case, long-term prognosis will primarily depend on the maintenance of alcohol abstinence. [Copyright &y& Elsevier]

Published
2012
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49. Évaluation de l’efficacité virologique et de la tolérance du traitement antiviral chez les patients porteurs d’une hépatite C chronique, associée à un lymphome B non hodgkinien : étude cas-témoins ANRS HC13 lympho-C

Author

Jeannel, J., Bonnet, D., Cacoub, P., Pol, S., Canioni, D., Leblond, V., Carrat, F., Davi, F., Hermine, O., Besson, C., and Alric, L.

Abstract

Introduction L’infection par le virus de l’hépatite C (VHC) augmente le risque de lymphome B non hodgkinien (LNH-B). La réponse virale soutenue (RVS) améliore le pronostic hématologique, chez les patients porteurs d’un VHC associée à un LNH-B. L’objectif de notre étude était d’évaluer la faisabilité, l’efficacité virologique et la tolérance du traitement antiviral (TAV) chez ces patients. Patients et méthodes étude cas-témoins, ancillaire de l’étude HC-13 Lympho-C qui est une étude multicentrique française descriptive des LNH-B associés au VHC. Nous avons analysé la réponse virologique, les facteurs prédictifs de réponse virale soutenue (RVS) et la tolérance du TAV chez 61 patients avec LNH-B VHC+ qui ont été appariés 94 témoins VHC sans lymphome. L’appariement a été réalisé sur le génotype viral, le score de fibrose, le sexe et pour les génotypes 1, le génotype de l’IL28B et la trithérapie antivirale. Résultats Vingt-trois patients (38 %) avaient un lymphome agressif et 38 (62 %) un lymphome indolent. La prévalence du génotype 2 dans le groupe LNH-B VHC+, était plus élevée que celle habituellement observée dans la population générale, décrite dans la cohorte nationale de l’INVS (21 % vs 11 % p = 0,03). L’efficacité du TAV par bithérapie (interféron-ribavirine) et trithérapie (interféron-ribavirine et inhibiteurs de protéase) était meilleure chez les patients LNH-B VHC + : 31/57 vs 29/94 : OR = 2,81 (1,26, 6,29). Cinq facteurs étaient associés à la RVS en analyse multivariée : le lymphome, les génotypes 2 et 3, le génotype CC de l’IL28B, la trithérapie et des plaquettes > 50 G/L à l’initiation du TAV. La tolérance était moins bonne dans le groupe LNH-B par comparaison au groupe témoin : 19,7 % d’arrêts précoces pour intolérance vs. 6,4 % : OR = 3,97 (1,24, 12,68). Conclusion Ces résultats, montrent que les patients ayant une infection par le VHC et un LNH-B ont une RVS satisfaisante. Même si la tolérance du TAV est moins bonne que chez les témoins appariés, cela n’a pas d’impact sur le RVS. Le TAV doit donc être proposé chez ces patients car il améliore le pronostic hématologique. Cette étude doit être poursuivie en utilisant les nouveaux antiviraux directs. [ABSTRACT FROM AUTHOR]

Published
2014
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