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1. Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France

Author

A. Becker, L. Kreitmann, C. Triffaut-Fillit, F. Valour, E. Mabrut, E. Forestier, O. Lesens, C. Cazorla, S. Descamps, B. Boyer, C. Chidiac, S. Lustig, E. Montbarbon, C. Batailler, and T. Ferry

Subjects
Orthopedic surgery, RD701-811
Abstract

Introduction: In patients undergoing a « debridement, antibiotics, and implant retention » (DAIR) procedure for acute staphylococcal prosthetic joint infection (PJI), post-operative treatment with rifampin has been associated with a higher probability of success.(1,2) However, it is not known whether it is the total dose, delay of introduction or length of therapy with rifampin that is most strongly associated with the observed improved outcomes.Methods: A multicentric, retrospective cohort study of patients with acute staphylococcal hip and knee PJI treated with DAIR between January 2011 and December 2016. Failure of the DAIR procedure was defined as persistent infection, need for another surgery or death. We fitted logistic and Cox regression multivariate models to identify predictors of DAIR failure. We compared Kaplan-Meier estimates of failure probability in different levels of the 3 variables of interest - total dose, delay of introduction or length of therapy with rifampin - with the log-rank test.Results: 79 patients included (median age 71 years [63.5-81]; 55 men [70%]), including 54 (68%) DAIR successes and 25 (32%) DAIR failures. Patients observed for a median of 435 days [IQR 107.5-834]. Median ASA score significantly lower in DAIR successes than in DAIR failures (2 vs. 3, respectively p = 0.011). Bacterial cultures revealed 65 (82.3%) S. aureus and 16 (20.3%) coagulase negative staphylococci, with 2 patients being infected simultaneously with S. aureus and CNS. Among S. aureus isolates, 7 (10.8%) resistant to methicillin; 2 (3.1 %) resistant to rifampin. Median duration of antimicrobial therapy was 85 days [IQR 28.5-97.8]. Fifty-eight patients (73.4%) received rifampin at a median dose of 14.6 mg/kg/day |IQR 13-16.7], started at a median delay of 8.5 days [IQR, 4-7.5] after debridement surgery. Twenty-one patients (26.6%) developed a drug-related adverse event, leading to rifampin interruption in 6 of them (7.6% of total cohort). Determinants of DAIR failure were rifampin use (HR 0.17, IC [0.06, 0.45], p-value p = 0.0017).Conclusion: Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with DAIR.

Published
2020
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3. Dolutegravir-based dual maintenance regimens combined with lamivudine/emtricitabine or rilpivirine: risk of virological failure in a real-life setting

Author

Caroline Lions, N Biezunski, Sophie Matheron, Romain Guery, Pierre-Marie Roger, Caroline Charlier, Mathieu Dupont, Line Meddeb, Philippe Van de Perre, V Joly, R Lecomte, Matthieu Revest, Claudine Duvivier, B Lefèvre, M Delestan, H Laurichesse, H Marty, F Lemaitre, Martine Valette, Marc-Antoine Valantin, A S Ritleng, A Ménard, Eric Cua, M. Alvarez, A Raoux, M P Bouillon, A Sève, A Brebion, Claire Triffault-Fillit, Sylvie Bregigeon, M Carles, O. Aubry, S Hénard, P. Dellamonica, A Charmillon, E Alidjinou, V Brodard, M Tetart, F Raffi, Paul-Henri Consigny, O Lesens, C Brunet-Cartier, I Lamaury, S Giaché, Amandine Gagneux-Brunon, Jacques Reynes, Karine Sauné, Clotilde Allavena, Q Lepiller, Véronique Reliquet, C Louisin, I Perbost, Jean-Luc Berger, B Prouvost-Keller, Eric Delaporte, Isabelle Lamaury, C Gubavu, L Fagour, Laurent Cotte, G Gaube, Elina Teicher, Faouzi Souala, C Blanc, Dominique Merrien, Isabelle Poizot-Martin, C Drobacheff-Thiébaut, T May, P Richard, M A Trabaud, M Bistoquet, C Klotz, Samira Fafi-Kremer, M Marcel, Charlotte Charpentier, L Lelièvre, K Risso, Sandrine Pierre-François, S Ferrando, S Breaud, S Bevilacqua, A Montoya Ferrer, T Rojas-Rojas, D Boucher, Yazdan Yazdanpanah, Olivier Lortholary, Philippe Colson, Anne-Sophie Brunel, F-Xavier Lescure, Christelle Tomei, M Martin-Degioanni, Eric Rosenthal, Philippe Bossi, Patrick Miailhes, Kevin Bouiller, Lise Cuzin, A Foltzer, F Boulard, Michel Vidal, V Mondain, H Colson, J Pasquier, I Kmiec, F Alby-Laurent, R Agher, A Cabié, Guillaume Martin-Blondel, L Hocqueloux, M Colin, A Madrid, Faiza Ajana, J M Livrozet, V Rio, Karima Amazzough, C Merle de Boever, M Digumber, Thomas Perpoint, A Cheret, Laurence Bocket, Z Julia, Virginie Ferré, M Pradier, M Poisson-Vannier, A Legoff, M J Soavi, Y Quertainmont, Marine Morrier, Christian Chidiac, F Touam, O Zaegel-Faucher, A Marquise, G Benabdelmoumen, Florence Ader, T Guimard, M C Receveur, J C Tardy, P Morineau, K Guitteaud, D. Rey, S Leautez, Catherine Chirouze, Benoit Tressières, A. Ivanova, C Charre, J Reynes, Christian Pradier, Catherine Dhiver, Laurent Boyer, E Frentiu, David Rey, C Allavena, Anne Motte, Tristan Ferry, C Pronier, M. Hentzien, C Rouzaud, O Cabras, K Jidar, F Najioullah, C Clavel, M Orticoni, S Patrat-Delon, M Cavellec, Cécile Herrmann-Storck, V Baclet, Jade Ghosn, M Perry, S Wehrlen-Pugliese, J. M. Chapplain, R Palich, Laurent Hocqueloux, A Maillard, C Deschanvres, O Deradji, F. Lucht, A Grégoire, Veronique Joly, R Ouissa, C Daniel, N Mrozek, D Chirio, O Bollangier, J Bavay, P. Le Turnier, A Maka, C Rioux, Colin Deschanvres, C Brochier, Elisabeth Botelho-Nevers, A Meybeck, C Ceppi, J Lourenco, François Bénézit, Thomas Jovelin, G Zouzou, N Tissot, N. Viget, F Brunel-Dalmas, Brigitte Montes, N Chellum Rungen, K Rome, David Boutoille, B Bigeard, I Fabre, N Oran, M Lefebvre, P Point, C Etienne, Diane Descamps, G Thomas, S Le Gac, Cyrille Delpierre, Pierre Tattevin, M Godinot, P Fischer, C Aumeran, C Boulard, Elisabeth André-Garnier, J Sinteff, V Ronat, F Goehringer, Romain Palich, Luminita Schneider, I Touitou, Eric Billaud, P Thill, Catherine Varache, Olivier Robineau, I Jaquet, Roland Landman, Cédric Arvieux, B. Bonnet, V Rzepecki, Olivier Grossi, Christian Rabaud, L Laine, F Louni, C Cheneau, S Markowicz, Hélène Laroche, A Gervais, C Bernard-Henry, E Goncalvez, N Lerolle, M André, D Lambert, André Boibieux, L. Porte, S Bouchez, E Paredes, E Aïssi, V. Le Moing, S Degroodt, Sylvie Abel, André Cabié, B Lafon-Desmurs, O Babre, M Baldeyrou, C Debreux, A Rodallec, Pierre Delobel, V Icard, Agathe Becker, Edouard Tuaillon, Hervé Tissot-Dupont, M Mokhtari, C Morlat, I Alcaraz, Anne Frésard, O Cannesson, Elodie Curlier, P Chiarello, S. Roux, F Bani-Sadr, François Raffi, Florent Valour, M Piffaut, M Priester, A. Belkhir, J Romaru, Cécile Goujard, A Castro, G Cessot, A Mirand, C Pouderoux, A Brunet, C Michelangeli, Y N’guyen, Patrice Muret, Elisa Demonchy, Christine Jacomet, D Makhloufi, E Jeanmaire, Marialuisa Partisani, Véronique Obry-Roguet, J Turmel, C Mélounou, J. Durant, Christine Katlama, P Parize, O Robineau, S Seang, F. Bozon, S Galie, Alexa Debard, E de Mautort, C Duvivier, Fanny Lanternier, Alain Makinson, A Barrail-Tran, C Aguilar, A Naqvi, Rodolphe Garraffo, N Meftah, C Biron, A de Monte, Pascal Pugliese, V Corbin, S Jaureguiberry, E Lafont, L Hustache Mathieu, R Colarino, Isabelle Ravaux, C Henquell, Benoit Pilmis, M Grégoire, P Lansalot, E Ressiot, T. Huleux, Olivier Baud, S Sécher, R Dupin de Majoubert, J Leporrier, L Cuzin, E Chevalier, M Poinot, R Tubiana, S Lariven, A Boucher, N Atoui, Firouzé Bani-Sadr, T Prazuck, M Ducassou, Gilles Peytavin, A Soria, B J Gaborit, Service des maladies infectieuses et tropicales [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Dat’AIDS Study Group, Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Pointe-à-Pitre/Abymes [Guadeloupe], Les Hôptaux universitaires de Strasbourg (HUS), CHU Strasbourg, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Gustave Dron [Tourcoing], Institut Pasteur [Paris] (IP), Centre Hospitalier Régional d'Orléans (CHRO), Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU de la Martinique [Fort de France], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], CHU Clermont-Ferrand, and Université Clermont Auvergne (UCA)

Subjects
Microbiology (medical), medicine.medical_specialty, Anti-HIV Agents, Pyridones, MESH: Piperazines, HIV Infections, Emtricitabine, Piperazines, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, MESH: Pyridones, Oxazines, MESH: Emtricitabine, Humans, Medicine, Pharmacology (medical), MESH: Anti-HIV Agents, Pharmacology, MESH: Heterocyclic Compounds, 3-Ring, MESH: Humans, business.industry, Rilpivirine, Lamivudine, MESH: HIV Infections, Viral Load, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Virological failure, Regimen, Infectious Diseases, chemistry, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Dolutegravir, Cohort, MESH: Rilpivirine, business, MESH: Viral Load, Heterocyclic Compounds, 3-Ring, MESH: Oxazines, medicine.drug, MESH: Lamivudine
Abstract

Background Maintenance ART with dolutegravir-based dual regimens have proved their efficacy among HIV-1-infected subjects in randomized trials. However, real-life data are scarce, with limited populations and follow-up. Objectives We assessed virological failure (VF) and resistance-associated mutations (RAMs) on dolutegravir maintenance regimens in combination with rilpivirine or with lamivudine or emtricitabine (xTC) and analysed the factors associated with VF. Methods Between 2014 and 2018, all HIV-1-infected adults included in the Dat’AIDS cohort and starting dolutegravir/rilpivirine or dolutegravir/xTC as a maintenance dolutegravir-based dual regimen were selected. VF was defined as two consecutive HIV RNA values >50 copies/mL or a single value >400 copies/mL. We compared cumulative genotypes before initiation of a maintenance dolutegravir-based dual regimen with genotype at VF. Results We analysed 1374 subjects (799 on dolutegravir/rilpivirine and 575 on dolutegravir/xTC) with a median follow-up of 20 months (IQR = 11–31) and 19 months (IQR = 11–31), respectively. VF occurred in 3.8% (n = 30) of dolutegravir/rilpivirine subjects and 2.6% (n = 15) of dolutegravir/xTC subjects. Among subjects receiving dolutegravir/rilpivirine, two genotypes harboured emerging RAMs at VF: E138K on NNRTI (n = 1); and E138K+K101E on NNRTI and N155H on INSTI (n = 1). Among subjects receiving dolutegravir/xTC, no new RAM was detected. The only predictive factor of VF on dolutegravir/rilpivirine was the history of failure on an NNRTI-based regimen (adjusted HR = 2.97, 95% CI = 1.28–6.93). No factor was associated with VF on dolutegravir/xTC. Conclusions In this large real-life cohort, dolutegravir/rilpivirine and dolutegravir/xTC sustained virological suppression and were associated with a low rate of VF and RAM emergence. Careful virological screening is essential before switching to dolutegravir/rilpivirine in virologically suppressed patients with a history of NNRTI therapy.

Published
2022
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4. The vaccination coverage in dispensaries on Mayotte Island is lacking for natives and migrants alike

Author

O. Lesens and C. Pascal

Subjects
Adult, Male, Meningitides, Vaccination Coverage, Adolescent, Comoros, 03 medical and health sciences, Vaccination status, Humans, Medicine, Prospective Studies, Child, Indigenous Peoples, Transients and Migrants, 0303 health sciences, 030306 microbiology, business.industry, Vaccination, Infant, Hepatitis B, medicine.disease, Infectious Diseases, Child, Preschool, Vaccination coverage, Female, business, Demography
Abstract

Objective Assessing the vaccination coverage rate in Mayotte dispensaries. Patients and methods Prospective study in three dispensaries from June to July 2019. Results Of the 162 patients included, 78% (126/162) were natives of the island and 19% (30/162) were from the Comoros Islands. Twenty-three percent (37/162) were up-to-date on their mandatory vaccinations, 45% (73/162) were not and 32% (52/162) had unknown vaccination status. There was no difference in relation to their origin. Some vaccinations were strictly followed (MMR, Hepatitis B…) others were not (HiB, meningitides…). The vaccination coverage rate and its traceability are altogether lacking whatever the age or origin of patients. Efforts must be made in order to increase the vaccination coverage rate among people who, from our experience, do not oppose vaccination in any way.

Published
2021
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5. E-learning versus face-to-face training: Comparison of two learning methods for Lyme borreliosis

Author

B. Jaulhac, M. Kelly, Y. Hansmann, G. Tanguy, L. Ouchchane, M. Gaudin, O. Lesens, M. Plagne, A. Saussac, Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, Université de Strasbourg (UNISTRA), and The expert group for the teaching of Lyme disease

Subjects
medicine.medical_specialty, 020205 medical informatics, E-learning (theory), Concordance, education, 02 engineering and technology, 03 medical and health sciences, Face-to-face, 0302 clinical medicine, Lyme disease, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, Learning, 030212 general & internal medicine, Lyme Disease, business.industry, Internship and Residency, medicine.disease, 3. Good health, Test (assessment), LYME, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Family medicine, Learning methods, Population study, Clinical Competence, business, Computer-Assisted Instruction
Abstract

OBJECTIVES To compare two learning methods for Lyme disease (e-learning versus face-to-face training) to assess knowledge and know-how. METHODS The study population was volunteer general medicine residents and family physicians (FP). Face-to-face training on Lyme disease was offered to each group. E-learning training was then offered to those who had not attended the face-to-face training. Theoretical knowledge was assessed by an identical pre- and post-test questionnaire and know-how by a script concordance test. RESULTS Seventy learners (47 FPs and 23 general medicine residents) were included in the face-to-face training group and 61 (33 FPs and 28 general medicine residents) in the e-learning group. The pre- and post-test scores were significantly improved in the FP group (difference of 29.3±1.9 [P

Published
2021
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6. E-Learning versus Classroom Learning for Acquiring Knowledge about Precarity in Medicine

Author

Gosgnach M, Dessene P, Hersart De La Villemarque A, Clement G, O. Lesens, Laurenson C, Doly L, G. Tanguy, Rude M, and L. Ouchchane

Subjects
Precarity, E-learning (theory), Mathematics education, Psychology
Abstract

The effect on knowledge levels immediately after a course on precarity in family medicine was assessed by comparing online learning against classroom learning, both followed by time for face-to-face discussion. Of 87 family medicine interns of the same class, 65 took part in the study and were evaluated, 34 being assigned to classroom learning and 31 to online learning. The increase in knowledge after the course was significantly higher in the online learning group (+27.8 points±11.2) than in the classroom group (+9.1 points±9.0) (p

Published
2021
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7. Incidence of diabetes in HIV-infected patients treated with first-line integrase strand transfer inhibitors: a French multicentre retrospective study

Author

P Fischer, C Aumeran, V Ronat, L Laine, S Bouchez, André Cabié, D Lambert, Eric Cua, J Pasquier, F Touam, Laurent Hocqueloux, A Maillard, O Deradji, Charlotte Charpentier, Véronique Avettand-Fenoel, Catherine Tamalet, Anne Frésard, Elodie Curlier, M Batard, S Ferrando, S Breaud, Philippe Bossi, C Pronier, C Gubavu, M Martin-Degiovani, Samira Fafi-Kremer, A. Duréault, Christian Pradier, A Montoya Ferrer, M Piffaut, Faiza Ajana, V Rio, A Maka, C Biron, Pierre Delobel, A de Monte, P Choisy, L Lelièvre, K Risso, N. Viget, Q Lepiller, Véronique Reliquet, I Perbost, Laurence Bocket, C Rioux, G Thomas, O. Aubry, L. Porte, Cédric Arvieux, Thomas Jovelin, Elisabeth Botelho-Nevers, Pierre-Marie Roger, C Etienne, David Boutoille, S Le Gac, Caroline Charlier, Virginie Ferré, M Pradier, M C Receveur, Isabelle Ravaux, Philippe Colson, K Rome, O Lesens, C Brunet-Cartier, A Meybeck, Romain Palich, P Martinet, V. Le Moing, C Ceppi, Hélène Laroche, I Lamaury, V Brodard, N Oran, M Lefebvre, P Morineau, K Guitteaud, M Bistoquet, Diane Descamps, O Cabras, Amandine Gagneux-Brunon, Brigitte Montes, Olivier Robineau, I Jaquet, Roland Landman, C Cheneau, V Mondain, Caroline Lions, Olivier Grossi, Laurent Boyer, C Debreux, M André, A Rodallec, Philippe Van de Perre, Jade Ghosn, Clotilde Allavena, Sylvie Abel, Karine Sauné, F Louni, F Boulard, Luminita Schneider, Dominique Merrien, D Chirio, S Pillet, Mathieu Dupont, A Motte, F Lemaitre, C Guennoun, Benoît Henry, S Sausse, Michel Vidal, M Mokhtari, O Zaegel-Faucher, Eric Rosenthal, Isabelle Poizot-Martin, Faouzi Souala, Matthieu Revest, M Baldeyrou, S Patrat-Delon, Jacques Reynes, M Cavellec, Laurent Cotte, C Michelangeli, François Danion, M Priester, Axel Ursenbach, C Mackoumbou-Nkouka, Thomas Perpoint, A Cheret, P Geneau de Lamarlière, Christian Rabaud, Agathe Becker, Tristan Ferry, A. Ivanova, Elina Teicher, T Bonijoly, F-Xavier Lescure, O Bollangier, A S Ritleng, Patrick Miailhes, A Gervais, Y N’guyen, Patrice Muret, Elisa Demonchy, Vincent Max, I Alcaraz, N Meftah, M P Bouillon, S Degroodt, A Foltzer, Laurent Hustache-Mathieu, Jean-Luc Berger, A Ménard, J Prouteau, B. Bonnet, Kevin Bouiller, Lise Cuzin, Christian Chidiac, R Agher, S Leautez, Catherine Chirouze, M Poinot, R Tubiana, E Aïssi, O Babre, J Lourenco, Benoit Tressières, C Clavel, Cécile Goujard, A Brunet, Claire Triffault-Fillit, F Raffi, E Sidani, Anne-Sophie Brunel, A Madrid, B Prouvost-Keller, Eric Delaporte, M J Soavi, J. M. Chapplain, M Orticoni, Pascal Pugliese, V Corbin, Pierre Tattevin, C Boulard, Véronique Obry-Roguet, P. Loubet, Paul-Henri Consigny, Elisabeth André-Garnier, J Sinteff, S Lariven, A Boucher, N Lerolle, C Blanc, Y Quertainmont, Sylvie Bregigeon, Bruno Hoen, André Boibieux, S Casanova, N Atoui, C Dhiver, N Biezunski, R Ouissa, M. Hentzien, C Bernard-Henry, Sophie Matheron, Cécile Herrmann-Storck, Firouzé Bani-Sadr, I Touitou, Eric Billaud, I Kmiec, Benoit Pilmis, T Prazuck, Romain Guery, Karima Amazzough, C Merle de Boever, Marine Morrier, T Guimard, M Poisson-Vanier, H Laurichesse, Catherine Varache, J Goesch, Guillaume Martin-Blondel, Z Julia, M Ducassou, F. Lucht, B Lafon-Desmurs, Martine Valette, A Sève, Marc-Antoine Valantin, G Zouzou, A Barrail-Tran, M Delestan, M. Alvarez, A Naqvi, Colin Deschanvres, A Raoux, L Meddeb, Rodolphe Garraffo, C Daniel, T May, A. Galinier, François Bénézit, Yazdan Yazdanpanah, Veronique Joly, Olivier Lortholary, C Louisin, K Jidar, I Fabre, Cyrille Delpierre, Christine Katlama, P Parize, S Galie, Claudine Duvivier, P. Dellamonica, L Osei, C Drobacheff-Thiébaut, Sandrine Pierre-François, G Cessot, C. Tomei, F. Biron, Christine Jacomet, G Benabdelmoumen, Florence Ader, David Rey, Marialuisa Partisani, J Turmel, J. Durant, S Seang, F. Bozon, M Illiaquer, N Hall, Edouard Tuaillon, S. Roux, Florent Valour, A. Belkhir, Marine Maurel, V Baclet, N Mrozek, Olivier Baud, S Sécher, P Letertre-Gibert, Alexa Debard, E de Mautort, Fanny Lanternier, Alain Makinson, H. Tissot Dupont, P Lansalot, E Ressiot, T. Huleux, S Wehrlen-Pugliese, M Landon, C Brochier, C Bernaud, Gilles Peytavin, A Soria, Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Pathogénèse et contrôle des infections chroniques (PCCI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier ), Service de pharmacologie, Hôpital Pasteur [Nice] (CHU)-Centre Hospitalier Universitaire de Nice (CHU Nice), Centre Hospitalier Universitaire de Reims (CHU Reims), Laboratoire de Virologie Médicale et Moléculaire - EA 4684 (CardioVir), Université de Reims Champagne-Ardenne (URCA)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre Hospitalier Universitaire de Reims (CHU Reims), Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Université Jean Monnet [Saint-Étienne] (UJM), School of Civil and Environmental Engineering [Sydney], University of New South Wales [Sydney] (UNSW), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Laboratoire Chrono-environnement - CNRS - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), and Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
0301 basic medicine, Microbiology (medical), Adult, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Integrase inhibitor, HIV Infections, HIV Integrase, Diabetes Therapy, Cohort Studies, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Pharmacology (medical), 030212 general & internal medicine, HIV Integrase Inhibitors, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, Pharmacology, Integrases, business.industry, Incidence, Retrospective cohort study, Raltegravir, medicine.disease, Comorbidity, 3. Good health, 030104 developmental biology, Infectious Diseases, chemistry, Dolutegravir, business, medicine.drug, Cohort study
Abstract

BackgroundIntegrase 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.ObjectivesTo 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 methodsPatients 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.ResultsFrom 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.ConclusionsINSTIs 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.

Published
2020
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8. Épidémiologie des infections urinaires récidivantes : une enquête transversale départementale auprès des patients sujets aux infections urinaires

Author

C. Cornille, O. Lesens, and F. Buron

Subjects
Infectious Diseases
Abstract

Introduction Les infections urinaires (IU) sont la premiere cause d’infection bacterienne en medecine ambulatoire. Chez certains patients, ces infections sont recidivantes et ont pour consequences une consommation de soins importante et une alteration de la qualite de vie. Materiels et methodes Nous avons realise une enquete transversale en partenariat avec la caisse primaire d’assurance maladie du departement (CPAM). Les assures ayant fait un ECBU en 2020 etaient invites a repondre a un questionnaire en ligne. Les mineurs et les femmes enceintes etaient exclus. Suivant le nombre d’IU declare en 2020, les sujets etaient repartis en deux groupes : infections urinaires recidivantes (IUR) si ≥ 3 episodes ou infections urinaires non recidivantes si 1 ou 2 episodes. L’objectif principal etait d’estimer la proportion de patients sujets aux IUR selon le sexe parmi la population protegee par la CPAM. Les objectifs secondaires etaient : etudier les caracteristiques de ces patients selon le sexe, les facteurs associes aux recidives, les recours medicaux, les traitements, et evaluer la qualite de vie avec la Leicester Impact Scale. Resultats Sur les 15 825 mails d’invitation envoyes par la CPAM, 466 femmes et 95 hommes ont repondu aux questionnaires. La proportion de patients sujets aux IUR parmi la population etudiee etait de 50,2 % (234/466) IC95 %[45,5–54,9] pour les femmes et 27,4 % (26/95) IC95 %[18,7–37,5 %] pour les hommes. L’âge moyen etait respectivement de 50,4 ± 15,8 ans et 59,9 ± 14,8 ans. Les femmes du groupe IUR rapportaient plus souvent un antecedent de pyelonephrite (OR 1,70 IC95 %[1,10 ; 2,62] p = 0,017) ou de chirurgie uterine complexe (OR 2,00 IC95 %[1,05–3,83] p = 0,036). Elles etaient plus sujettes aux diarrhees (OR 1,75 IC95 %[1,11–2,78] p = 0,017) et plus nombreuses a avoir identifie les rapports sexuels comme facteur declenchant les episodes d’IU (OR 1,74 IC95 %[1,05–2,90] p = 0,032). Elles ont eu plus souvent recours a un medecin specialiste (54,3 % (126/232) contre 28,4 % (65/229) p Conclusion Les patients sujets aux IUR representent une part importante de la population. Cette etude retrouve des facteurs de risque d’IUR deja connus et en identifie de nouveaux. Le caractere recidivant a un retentissement important sur la consommation de soins et la qualite de vie des patients. Cette etude permet de faire un etat des lieux sur les modalites de prise en charge des IUR dans le departement.

Published
2021
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9. Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study

Author

O, Lesens, T, Ferry, E, Forestier, E, Botelho-Nevers, P, Pavese, E, Piet, B, Pereira, E, Montbarbon, B, Boyer, S, Lustig, S, Descamps, Florence, Ader, Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS)-Université d'Auvergne - Clermont-Ferrand I (UdA), Service des Maladies Infectieuses et Tropicales [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Hospices Civils de Lyon (HCL), Service de Maladies Infectieuses CH Métropole Savoie, Service des maladies infectieuses [Saint-Etienne], CHU Saint-Etienne, Department of Infectious Diseases, University Hospital, Service d’Infectiologie CH Annecy Genevois, CHU Clermont-Ferrand, Service d’Orthopédie-Traumatologie CH Metropole Savoie, Service Orthopédie, CRIOAc Saint-EtienneHôpital Nord–CHU Saint-Etienne, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)

Subjects
0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Staphylococcus aureus, Prosthetic joint infection, Prosthesis-Related Infections, Combination therapy, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030106 microbiology, Kaplan-Meier Estimate, medicine.disease_cause, Prosthesis, 03 medical and health sciences, 0302 clinical medicine, Medical microbiology, medicine, antibiotic therapy, Humans, Treatment Failure, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, Debridement, business.industry, Hazard ratio, and implant retention), Retrospective cohort study, General Medicine, DAIR procedure (debridement, Middle Aged, Staphylococcal Infections, Rifampin Biofilm, 3. Good health, Surgery, Anti-Bacterial Agents, Infectious Diseases, Treatment Outcome, Lavage, Female, Implant, Rifampin, business
Abstract

International audience; To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan–Meier method was 76.2 [95% CI 68–83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69–0.88]; p 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.

Published
2018
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10. TIBOLA : une rickettsiose en expansion, cliniquement polymorphe

Author

O. Lesens, E. Rigal, Michel D'Incan, D. Dorcier, and C. Texier

Subjects
Dermatology
Abstract

Resume Introduction Le TIBOLA est une rickettsiose due principalement a R. slovaca, inoculee par une tique du genre Dermacentor. Nous en rapportons cinq observations, rappelant les caracteristiques de ce syndrome. Observations Dans trois cas, le diagnostic a ete porte au stade initial inflammatoire (œdeme cutane, escarre d’inoculation, adenites, fievre) et chez deux patients, au stade des sequelles (asthenie persistante, alopecie cicatricielle). Dans un seul cas, la preuve microbiologique de l’infection a pu etre apportee. Discussion Le TIBOLA est une rickettsiose en expansion en Europe. Le diagnostic clinique est souvent tardif du fait de symptomes peu bruyants et de la meconnaissance des cliniciens. Les tests microbiologiques (serologie, PCR et culture a partir de l’escarre ou du sang circulant) sont mis en defaut dans plus d’un tiers des cas. Le traitement de reference fait appel aux antibiotiques efficaces sur les germes intracellulaires, cyclines et macrolides.

Published
2014
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11. Happy@feet application for the management of diabetic foot osteomyelitis

Author

I. Tauveron, F. Desbiez, O. Lesens, M. Vidal, S. Fiquet, and N. Mrozek

Subjects
medicine.medical_specialty, 030209 endocrinology & metabolism, Day care, 03 medical and health sciences, Nursing care, User-Computer Interface, 0302 clinical medicine, Multidisciplinary approach, medicine, Humans, 030212 general & internal medicine, Medical prescription, Medical History Taking, Referral and Consultation, Data collection, business.industry, Osteomyelitis, Data Collection, Disease Management, medicine.disease, University hospital, Diabetic foot, Correspondence as Topic, Mobile Applications, Diabetic Foot, Infectious Diseases, Prescriptions, Physical therapy, Medical emergency, business, Day Care, Medical, Follow-Up Studies
Abstract

Objective We aimed to develop and implement an application that could improve the management of patients presenting with diabetic foot osteomyelitis. Patients and methods Physicians from the multidisciplinary diabetic foot infection team and a software engineer first assessed the needs required for the infection management and application. An experimental version was then designed and progressively improved. A final version was implemented in clinical practice in 2013 by the multidisciplinary diabetic foot infection team of our university hospital. Results The application, known as Happy@feet, helps gather and allows access to all required data for patient management, dispenses prescriptions (antibiotics, nursing care, blood tests), and helps follow the evolution of the wound. At the end of the consultation, a customizable letter is generated and may be directly sent to the persons concerned. This application also facilitates clinical and economic research. In 2014, Happy@feet was used to follow 83 patients during 271 consultations, 88 of which were day care hospitalizations. Conclusion The Happy@feet application is useful to manage these complex patients. Once the learning period is over, the time required for data collection is compensated by the rapid dispense of prescriptions and letters. Happy@feet can be used for research projects and will be used in a remote patient management project.

Published
2016

12. L’Entérocoque résistant à la vancomycine (ERV)

Author

O. Lesens

Subjects
Colonisation, biology, Nephrology, Multi drug resistant bacteria, Vancomycin-Resistant Enterococci, biology.organism_classification, Enterococcus faecium, Microbiology
Abstract

Resume L’enterocoque resistant a la vancomycine (ERV) a recemment fait son apparition en France et en Europe alors qu’il est deja present a l’etat endemique aux Etats-Unis depuis une vingtaine d’annees. Bien que peu pathogene, il peut donner des infections severes, particulierement difficiles a traiter, chez l’immunodeprime. La colonisation notamment digestive precede l’infection et est a l’origine de la dissemination a bas bruit de l’ERV. En cas d’epidemie, des mesures de controle doivent etre rapidement mises en oeuvre pour eviter le passage a l’endemicite.

Published
2009
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13. Place du traitement endovasculaire des sténoses symptomatiques d’artères digestives chez les sujets infectés par le VIH : trois cas

Author

A. Vacher, L. Boyer, P. Chabrot, L. Cassagnes, H. Laurichesse, E. Buc, D. Pezet, and O. Lesens

Subjects
medicine.medical_specialty, Abdominal pain, Radiological and Ultrasound Technology, medicine.diagnostic_test, Vascular disease, business.industry, medicine.medical_treatment, Angioscopy, Thrombolysis, Bowel resection, medicine.disease, Surgery, Mesenteric ischemia, Angioplasty, medicine, Vascular Patency, Radiology, Nuclear Medicine and imaging, Radiology, medicine.symptom, business
Abstract

Patients with HIV or AIDS frequently present with GI symptoms, sometimes due to early and diffuse atherosclerosis. We report 3 cases of HIV patients with abdominal pain due to severe splanchnic arterial stenosis. Only one patient presented typical clinical findings of mesenteric ischemic. Endovascular treatment was performed in all three cases. Good clinical outcome was immediate in 2 cases. In the third case, subsequent bowel resection was required due to irreversible ischemic injury in spite of local thrombolysis and endovascular revascularization in a patient presenting with acute severe mesenteric ischemia. In all three cases, vascular patency was demonstrated at follow-up. Mesenteric ischemia is a severe complication requiring early diagnosis in HIV patients, especially those with vascular risk factors, especially since endovascular treatment is a valid therapeutic option.

Published
2009
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14. Comparison of microbiological results of needle puncture vs. superficial swab in infected diabetic foot ulcer with osteomyelitis

Author

R. Meyer, Y. Piemont, J. Gaudias, C. Averous, Y. Hansmann, C. Boeri, F. Ortega, O Lesens, Laurence Kessler, Michel Pinget, and D. Christmann

Subjects
Adult, Male, Staphylococcus aureus, medicine.medical_specialty, Microbiological culture, Endocrinology, Diabetes and Metabolism, Staphylococcal infections, Endocrinology, Diabetes mellitus, Biopsy, Internal Medicine, medicine, Humans, Prospective Studies, Aged, Bacteriological Techniques, medicine.diagnostic_test, business.industry, Osteomyelitis, Biopsy, Needle, Streptococcus, Middle Aged, Staphylococcal Infections, medicine.disease, Diabetic foot, Diabetic Foot, Surgery, Diabetic foot ulcer, Female, Osteitis, business
Abstract

Aim To study prospectively two methods for the bacteriological diagnosis of osteomyelitis related to diabetic foot ulcer: needle puncture performed across normal skin surrounding the foot ulcer and superficial swabbing of the ulcer. Patients and methods Diabetic patients with a foot ulcer complicated by bone or joint infection, as detected by X-ray imaging, were included in the study. Ulcer swabbing and needle puncture were performed in each patient. To reach the tissue nearest the bone surface, needle puncture was guided by X-ray imaging and the drop of fluid obtained by aspiration was used for both aerobic and anaerobic bacterial culture. Results Twenty-one diabetic patients were included. The mean number of microorganisms isolated by needle puncture was significantly lower compared with that obtained by superficial swabbing: 1.09 vs. 2.04 (P

Published
2006
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16. Prescriptions liées à la prise en charge alternative de patients suspects de maladie de Lyme

Author

O. Lesens, O. Baud, and E. Mabru

Subjects
Infectious Diseases
Abstract

Introduction Le diagnostic et le traitement de la maladie de Lyme (ML) sont actuellement au centre d’une polemique qui oppose une attitude basee sur les recommandations existantes a une conception alternative de la physiopathologie et de la prise en charge de la maladie. L’objectif de cette etude de decrire les prescriptions (examens complementaires, antibiotherapie) liees a la prise en charge alternative de patients suspects de maladie de Lyme. Materiels et methodes Analyse en double insu de 16 dossiers anonymises (le medecin responsable des prescriptions etant egalement anonyme) par deux medecins de maladies infectieuses et une pharmacienne. Resultats Il s’agissait de 9 femmes et 7 hommes, d’âge median 43,5 ans. Une affection comorbide susceptible d’etre un diagnostic differentiel etait retrouvee dans 11 cas (69 %). La symptomatologie comprenait essentiellement des arthralgies (12/16), une fatigue (12/16), des douleurs musculo-squelettiques (10/16), des troubles du sommeil (6/16). Les autres symptomes etaient des cephalees (4/16), des troubles de memoire (3/16), de concentration (2/16), des malaises (2/16) et des troubles psychiatriques (1/16). Une moyenne de 16 serologies (dont maladie de Lyme) etaient realisees (extremes : 2–27 ; mediane : 19). Deux PCR babesiose et bartonelle etaient realisees (negatives). Les autres examens comprenaient les sous-populations lymphocytaires (14/16), les IgE specifiques (8/16), les AC antitransglutaminases (10/16). Les 16 patients ont donne lieu a la prescription d’en moyenne 7 molecules par patient (extremes : 4–12 ; cout moyen par patient : 287 euros) pour un total de 113 molecules et un cout total de 4604,30 euros. Les molecules les plus utilisees etaient le metronidazole et le fluconazole (13/16), l’hydroxychloroquine (11/16), la doxycycline et l’azythromycine (10/16). Les autres molecules prescrites etaient le pyrantel (9/16), la clarithromycine (8/16), l’albendazole (7/16), la roxythromycine (7/16), l’amoxicilline, le cotrimoxazol, la disulone (4/16), l’amoxicilline-acide clavulanique, la ceftriaxone, la rovamycine, le fenticonazole (3/16), l’atovaquone et le flubendazole (1/16). La prise en charge ne modifiait pas ou peu la symptomatologie chez 12/16 patients (2 etaient non evaluables). Conclusion On constate une inadequation entre les symptomes et les serologies demandees et une repetition inutile des serologies. Les resultats ne semblent pas influer sur la prise en charge. L’utilisation d’un nombre important de molecules sans qu’on puisse detecter une logique de prescription, tant sur la nature de la molecule que sur la duree doit alerter sur les derives de telles pratiques, ce d’autant qu’elles paraissent ici peu efficaces. Un point reste a nuancer toutefois : le medecin a manifestement pris le temps de l’ecoute avec une volonte de prendre en charge des patients qui se sentent rejetes par le systeme de soin classique. C’est sans doute un des points qui doit alimenter notre reflexion.

Published
2017
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18. [TIBOLA: an emerging clinically polymorphous rickettsiosis]

Author

E, Rigal, D, Dorcier, O, Lesens, C, Texier, and M, D'Incan

Subjects
Infant, Rickettsia Infections, Middle Aged, Communicable Diseases, Emerging, Diagnosis, Differential, Scalp Dermatoses, Lymphadenitis, Tick-Borne Diseases, Animals, Humans, Female, France, Skin Diseases, Infectious, Child, Facial Dermatoses, Dermacentor
Abstract

TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases.Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case.TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.

Published
2013

19. Syndrome oculo-rénal et syphilis

Author

Jean-Louis Kémény, F. Chiambaretta, O. Lesens, O. Bons, Anne-Elisabeth Heng, N. Bonnin, J. Albaret, and J. Aniort

Subjects
Nephrology
Abstract

Introduction La syphilis est en recrudescence en France depuis l’annee 2000. Avec elle reapparaissent les complications renales de cette infection. Nous rapportons un cas d’atteinte oculo-renale. Patients et methodes Un homme de 43 ans est hospitalise pour chorioretinite bilaterale confirmee par angiographie a la fluoresceine, avec decouverte concomitante d’un syndrome nephrotique pur (protidemie a 52 g/L, l’albuminemie a 15,6 g/L, et la proteinurie de 3,5 g/24 h). Le bilan etiologique objective une syphilis tertiaire (TPHA = 1/5120, VDRL = 1/64, meningite lymphocytaire a culture sterile). Les bilans immunologiques et infectieux complementaires sont sans particularite (chaines legeres libres seriques, electrophorese des proteines seriques, fractions C3 et C4 du complement, ANCA, FAN, cryoglobulinemie et anticorps anti-recepteur de la phospholipase A2, serologies VIH 1 et 2, VHB, VHC et PCR Chlamydiae, serologie de Lyme). L’histologie renale permet le diagnostic de glomerulonephrite extra-membraneuse (GEM) de stade 1. Le traitement de la syphilis tertiaire par Penicilline ® G IV 20 MUI/jour permet une remission partielle du syndrome nephrotique des la fin du traitement (14 jours) : protidemie = 58 g/L, albuminemie = 22 g/L, proteinurie = 0,7 g/24 h, suivie d’une remission complete a 3 mois avec une proteinurie a 0,17 g/24 h, parallelement a la guerison de la syphilis, sans rechute a 6 mois. Sur le plan ophtalmologique, on constate a 6 mois une faible recuperation visuelle droite, consequence d’une atrophie de l’epithelium pigmentaire sequellaire. Discussion et conclusion La GEM est l’atteinte renale la plus frequente de la syphilis. Son incidence actuelle, inconnue, est de 1 cas sur 51 biopsies de GEM depuis 10 ans dans notre hopital. Elle est la consequence de depots d’immuns complexes composes d’antigenes treponemiques et de leurs anticorps. Le mecanisme exact (anticorps plantes ou depots de complexes immuns preformes) n’est pas connu, il differe au niveau ophtalmique ou l’epithelium pigmentaire chorioretinien est infecte directement par le treponeme. Notre observation demontre la rapide remission du syndrome nephrotique avec la guerison de l’infection, rare avant 3 mois dans les GEM primitives.

Published
2014
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20. Water access and attendance for diarrhea in primary health care centers, Gaza strip

Author

F. Robin, O. Lesens, F. El Yaagoubi, A. Kamel, A. Abouteir, I. Bioh-Johnson, N. Godard, L. Cormerais, Médecins du monde, CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Institut National de la Recherche Agronomique (INRA), Faculté de Médecine, Université d'Auvergne - Clermont-Ferrand I (UdA), and ECHO, European Commission DG for Humanitarian Aid, Brussels Belgium [B-1049]

Subjects
Male, Pediatrics, Palestine, Multivariate analysis, Sanitation, [SDV]Life Sciences [q-bio], Primary health care, 010501 environmental sciences, 01 natural sciences, Feces, 0302 clinical medicine, Infectious diarrhea, Risk Factors, Medicine, 030212 general & internal medicine, Prospective Studies, Gaza strip, Child, Refugees, Attendance, General Medicine, 3. Good health, Diarrhea, Infectious Diseases, Matched, Animals, Domestic, Child, Preschool, Female, medicine.symptom, Adult, medicine.medical_specialty, Warfare, Adolescent, 03 medical and health sciences, Middle East, Young Adult, Water Supply, Environmental health, Animals, Humans, 0105 earth and related environmental sciences, Primary Health Care, business.industry, Public Health, Environmental and Occupational Health, Case-control study, Infant, Newborn, Water, Infant, case control, Case-Control Studies, Housing, Parasitology, business
Abstract

International audience; Water access and sanitation has worsened in Gaza strip since the conflict between Israel and Palestine in January 2009. This study aimed to investigate the relationship between attendance for diarrhea to a Primary Health Care Center (PHCC) in Gaza strip and several potential risk factors including water access. A matched case control study with prospective data record was performed. Cases were patients attending a PHCC for diarrhea, and controls were patients attending for any other cause with no diarrhea within the previous three months or since birth. We matched 133 cases and 133 controls, for date of inclusion, age, gender. All patients attended PHCC and were included in January/February 2010. A stool analysis for bacteria and parasites was performed for cases. Of the 266 patients, 62% (166) have to buy water from a private provider. In multivariate analysis, four variables were independently predictive of diarrhea: public water access (OR: 0.046; 95% CI: 0.005-0.454; P=0.0083), poultry or rabbits at home, and presence of cooker at home. A bacterial cause was found in 5.5% (7) and Giardia duodenalis in 20% (26). Treatments did not comply with WHO recommendations. Efforts should be made to improve water access and to implement guidelines for a better management of diarrhea in Gaza strip. (C) 2011 Royal Society of Tropical Medicine and Hygiene

Published
2010
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21. [Prognostic value of the LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis) in soft tissue infections: a prospective study at Clermont-Ferrand University hospital]

Author

V, Corbin, M, Vidal, J, Beytout, H, Laurichesse, M, D'Incan, P, Souteyrand, and O, Lesens

Subjects
Adult, Aged, 80 and over, Male, Fever, Soft Tissue Infections, Bacteremia, Middle Aged, Prognosis, Severity of Illness Index, Shock, Septic, Abscess, Anti-Bacterial Agents, Hospitals, University, Young Adult, Early Diagnosis, Debridement, Humans, Female, Fasciitis, Necrotizing, France, Lymphedema, Prospective Studies, Aged
Abstract

The LRINEC score was developed in a retrospective study in order to distinguish necrotizing fasciitis from severe soft tissue infections using laboratory data.To evaluate the prognostic value of the LRINEC score in infectious cellulitis.A prospective study was performed at the departments of infectious diseases and dermatology of the Clermont-Ferrand University Hospital. The three evaluation criteria were: time from initiation of antibiotics to regression of erythema, duration of fever and occurrence of complications (abscess, surgery, septic shock, necrotizing fasciitis, death, transfer to intensive care). Potential predictive variables were: LRINEC score6 at admission, comorbidities, local appearance, clinical presentation and soft tissue ultrasound results.Fifty patients were included. The rate of complications was higher for patients with a LRINEC score6 (54%) than for patients with a score6 (12%, P=0.008). However, a LRINEC score6 on admission was not significantly associated with increased duration of erythema or of fever. Prior lymphoedema was associated with a better prognosis.The LRINEC score may be a useful tool for the detection of complicated forms of soft tissue infections. Patients with a LRINEC score6 on admission should be carefully evaluated (hospitalization, surgical assessment, close monitoring).

Published
2010

22. [Vancomycin resistant Enterococci (VRE)]

Author

O, Lesens

Subjects
Europe, Cross Infection, Immunocompromised Host, Infection Control, Vancomycin, Enterococcus faecium, Humans, Vancomycin Resistance, France, Gram-Positive Bacterial Infections, Anti-Bacterial Agents
Abstract

Vancomycin resistant enteroccoci (VRE) has recently emerged in France and in Europe whereas it has been endemic in the United States for two decades. Despite its little pathogenicity, VRE may be responsible for severe, difficult to treat infections in immunocompromised host. Intestinal colonization precedes infection and is responsible for VRE silent dissemination. In case of epidemy, infection control measures should be quickly implemented to avoid endemicity.

Published
2009

23. [Potential nosocomial disseminated infection due to Nocardia asteroides after a prosthesis insertion in an immunocompetent patient]

Author

N, Mrozek, S, Hamizi, F, Gourdon, H, Laurichesse, J, Beytout, and O, Lesens

Subjects
Male, Cross Infection, Time Factors, Arthroplasty, Replacement, Hip, Brain Abscess, Nocardia Infections, Middle Aged, Magnetic Resonance Imaging, Anti-Bacterial Agents, Postoperative Complications, Treatment Outcome, Nocardia asteroides, Humans, Psoas Abscess, Drug Therapy, Combination, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

Nocardia infections are rare and usually occurred in immunocompromised patients with systemic dissemination from a lung infection. We report a case of an immunocompetent patient in whom Nocardia asteroides had cause psoas and cerebral abcess without pulmonary infection, a short period after a hip prosthesis insertion. The clinical history is highly suggestive of a hospital-acquired infection.

Published
2008

24. [Kawasaki disease is also a disease of adults: report of six cases]

Author

C, Dauphin, P, Motreff, G, Souteyrand, H, Laurichesse, F, Gourdon, O, Lesens, D, Lamaison, J, Beytout, J, Cassagnes, and J-R, Lusson

Subjects
Adult, Male, Decision Trees, Coronary Aneurysm, Immunoglobulins, Middle Aged, Mucocutaneous Lymph Node Syndrome, Coronary Angiography, Pericardial Effusion, Diagnosis, Differential, Electrocardiography, Myocarditis, Echocardiography, Humans, Immunologic Factors, Pericarditis, Female
Abstract

Kawasaki disease is an inflammatory arterial disease of unknown cause usually affecting young children, the principal complication of which is coronary artery aneurysm. Early treatment with immunoglobulins and aspirin prevents this complication. The diagnosis requires expert clinical criteria and, in atypical forms, a more recent decisional diagnostic tree has to be used. The authors report 6 cases of adult Kawasaki disease. As in the other sixty or so cases in the literature, hepatic forms were the commonest (5/6). Only three of the six cases met the classical clinical criteria and the diagnosis was made by the decisional tree or after coronary complications in the oldest subject. The five treated patients progressed favourably after a course of immunoglobulins. Echocardiography detected 100% of children with coronary disease but it was more difficult in adults in whom new non-invasive methods of coronary imaging (fast CT and MRI) and stress testing should complete the investigations. The association of prolonged pyrexia, clinical criteria and a biological inflammatory syndrome should, after exclusion of the differential diagnoses, suggest a diagnosis of Kawasaki disease in the adult as in the child. The possibility of coronary disease, even though extremely rare, should be recognised by the cardiologist and lead to diagnostic and therapeutic managements as aggressive as in children.

Published
2007

25. [Thromboembolic events at the time of highly active antiretroviral therapies against human immunodeficiency virus]

Author

L, Lyonne, C, Magimel, L, Cormerais, S, Trouillier, B, Bocquier, M, Zenut, C, Jacomet, H, Laurichesse, J, Beytout, and O, Lesens

Subjects
Adult, Male, Venous Thrombosis, Ritonavir, Anti-HIV Agents, HIV Protease Inhibitors, Pyrimidinones, Middle Aged, Lopinavir, Cohort Studies, Antiretroviral Therapy, Highly Active, HIV Seropositivity, Humans, Female, France, Pulmonary Embolism, Follow-Up Studies, Retrospective Studies
Abstract

Vein thrombosis risk and pulmonary embolism seem to be more important among human immunodeficiency virus (HIV) infected patients.We performed a retrospective study including 780 HIV positive patients followed-up between January 2000 and June 2005 at the University Hospital of Clermont-Ferrand.Among the 780 HIV-infected patients, six cases of thromboembolic events were identified including, four with pulmonary embolism. All the patients were receiving lopinavir/ritonavir combination.Although uncommon, pulmonary embolism occurs more frequently among HIV positive patients than in general population. Clinicians must remain aware about the possibility of the occurrence of a thromboembolic event especially during the first few months after introduction of the antiretroviral therapy.

Published
2007

26. [Invasive Streptococcus agalactiae infections in non-pregnant adults]

Author

N, Lefebvre, E, Forestier, M, Mohseni-Zadeh, V, Remy, O, Lesens, C, Kuhnert, V, Poindron, P, Riegel, Y, Piémont, D, Christmann, and Y, Hansmann

Subjects
Adult, Diabetes Complications, Male, Neoplasms, Streptococcal Infections, Humans, Female, Middle Aged, Medical Records, Aged, Retrospective Studies, Streptococcus agalactiae
Abstract

Streptococcus agalactiae (Group B streptococcus) is a major cause of invasive diseases in non-pregnant adults, particularly in the elderly and those with underlying conditions. We describe these conditions and clinical characteristics of patients followed in our teaching hospital.We retrospectively reviewed clinical records of 64 patients with S. agalactiae-related invasive infection, hospitalized between January 1997 and January 2006.The mean age of patients was 59 (+/-17 years). The H:F sex ratio was 1.06. At least one underlying condition was found in 90.6%. Diabetes mellitus (43.7%), peripheral vascular disease (34.4%), myocardial ischemia (20.3%) and malignant neoplasms (20.3%) were among the most frequent conditions. The mean index of comorbidity (Charlson) was 2.5 (+/-2). Common clinical manifestations included infection of the urinary tract (32.8%), skin and soft-tissue (25%), and osteoarthritis (21.9%). Bacteremia occurred in 31.2% with no identified source in 2 patients. During the first month, 2 cases of endocarditis, 1 case of meningitis, and 4 deaths occurred.We confirm the importance of underlying diseases in the emergence of S. agalactiae infections.

Published
2007

27. [Should presumptive meningoencephalitis treatment in adults be active against Mycoplasma pneumoniae?]

Author

S, Trouillier, E, Dionet, B, Bocquier, J-M, Constantin, D, Guelon, R, Bonnet, J-P, Romaszko, H, Laurichesse, J, Beytout, and O, Lesens

Subjects
Adult, Male, Treatment Outcome, Meningoencephalitis, Pneumonia, Mycoplasma, Humans, Female, Middle Aged, Aged, Anti-Bacterial Agents, Mycoplasma pneumoniae
Abstract

Meningoencephalitis is the most common central nervous system complication caused by Mycoplasma pneumoniae. Its frequency is probably underestimated.The study's aim was to determine the retrospectively incidence of M. pneumoniae meningoencephalitis among other cases of encephalitis diagnosed in infectiology, neurology and ICU at the Clermont-Ferrand University hospital in 2004 and 2005.A case of meningoencephalitis was defined by encephalopathy (altered level of consciousness and/or change in personality), with one or more of the following symptoms: fever, seizure, focal neurological findings, meningitis, electroencephalography or neuroimaging findings consistent with encephalitis. Tumor and hematoma diagnosed by scan were excluded. M. pneumoniae was considered as a possible cause when patients had positive serological test (IgM Elisa) and/or positive PCR results for the CSF.Four (8.3%) patients among 48 cases of encephalitis could have been caused by M. pneumoniae. All except one convulsed initially. Pneumopathy was found in two patients. All received a specific treatment later. Antibiotics seemed to influence evolution in only two patients. These 4 cases appeared during an epidemic between November 2004 and August 2005: 48 hospitalized adults had positive serological test for M. pneumoniae in 2005 and 15 in 2004, whereas the number of tests was the same in 2004 and in 2005.M. pneumoniae should be investigated as a cause of meningoencephalitis if initial tests are negative, if patients have respiratory symptoms and in case of epidemic. Presumptive treatment of meningoencephalitis should include an antibiotic active against M. pneumoniae.

Published
2006

28. [MRSA bacteremia: recent epidemiological and therapeutical trends]

Author

E, Forestier, V, Rémy, M, Mohseni-Zadeh, O, Lesens, B, Jauhlac, D, Christmann, and Y, Hansmann

Subjects
Europe, Cross Infection, Staphylococcus aureus, Bacterial Proteins, Risk Factors, Humans, Penicillin-Binding Proteins, Bacteremia, Methicillin Resistance, France, Microbial Sensitivity Tests, Staphylococcal Infections
Abstract

Staphylococcus aureus is the first agent responsible for nosocomial bacteremia in France. About 40% of the strains are resistant to methicillin (MRSA). The epidemiology of these infections has changed in the last fifteen years whereas therapeutics options have slightly progressed.Hospital-acquired MRSA bacteremia are more and more frequent while community-acquired strains recently appeared. Factors influencing the emergence of these infections were identified thanks to numerous clinical studies, as well as patients risk factors for developing these infections and their complications. At the same time, intermediate sensitive and resistant MRSA strains to glycopeptides appeared. Conversely, the best antibiotic strategy is still unclear in absence of good clinical studies. The interest of antibiotics combinations and of glycopeptides serum-concentrations control is still a matter of debate. Finally, the number of new active molecules remains limited.The frequency and severity of MRSA bacteremia are quite worrying in our country. The epidemiology of these infections must be known by every clinicians in order to prevent them. The therapeutic strategy has to be better define and need for new anti-infectious agents is critic.

Published
2006

29. [Carcinoma cuniculatum: an uneasy diagnosis to suspect in case of chronic osteomyelitis with unsuccessful outcome despite appropriate antibiotic therapy]

Author

V, Corbin, M, Vidal, P, Souteyrand, M, D'Incan, S, Amarger, H, Laurichesse, S, Terver, O, Nohra, and O, Lesens

Subjects
Time Factors, Biopsy, Middle Aged, Toes, Amputation, Surgical, Anti-Bacterial Agents, Diagnosis, Differential, Radiography, Treatment Outcome, Recurrence, Chronic Disease, Humans, Wounds and Injuries, Female, Carcinoma, Verrucous, Osteitis
Abstract

The clinical and histological features of cuniculatum carcinoma (CC) are often misleading.We report a case of CC of the foot, which was misdiagnosed as osteomyelitis for a two year period and which relapsed 2 months after complete resection.The CC has to be evoked in patients with chronic osteomyelitis and torpid wound. The anatomopathologist needs to be aware of the suspected diagnosis.

Published
2005

30. [Cryptococcal meningitis disclosed by visual loss in HIV negative patient with ventriculo-atrial shunting]

Author

X, Gibold, A, Husson, V, Corbain, M, Vidal, F, Gourdon, H, Laurichesse, J, Beytout, P, Irthum, A, Ferrier, and O, Lesens

Subjects
Male, Antifungal Agents, Time Factors, Hydrocortisone, Sarcoidosis, Prednisolone, Anti-Inflammatory Agents, Flucytosine, Meningitis, Cryptococcal, Middle Aged, Blindness, Cerebrospinal Fluid Shunts, Diagnosis, Differential, Treatment Outcome, Amphotericin B, Fludrocortisone, HIV Seronegativity, Humans, Drug Therapy, Combination, Eye Infections, Fungal, Fluconazole, Follow-Up Studies, Hydrocephalus
Abstract

HIV infection is the main cause of cryptococcal neuromeningitis but other diseases may be associated with this infection.We report a case of cryptococcal neuromeningitis in a patient with sarcoidosis and ventriculoatrial shunting. The patient was successfully treated by effective therapy without device withdrawal.The relationship between cryptococcosis and sarcoïdosis has been already described and may be not fortuitous. However it remains a very rare complication of sarcoidosis. Because of its potential severity (mortality rate of 40%), the diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

Published
2005

31. [VCA agar (bioMérieux) for selective isolation of vancomycin-resistant Enterococci (VRE) from fecal specimens]

Author

J, Delmas, F, Robin, J-P, Romaszko, R, Baraduc, O, Lesens, J, Sirot, and R, Bonnet

Subjects
Cross Infection, Feces, Enterococcus faecium, Humans, Vancomycin Resistance, Sensitivity and Specificity, Enterococcus, Gram-Positive Bacterial Infections
Abstract

Screening for Vancomycin Resistant Enterococci (VRE) is recommended for preventing nosocomial infections with VRE. The aim of this study was to assess the performance of VCA3 agar (bioMérieux) in VRE isolation from fecal specimens. 220 specimens were cultured on VCA3 agar, which contains vancomycin and in parallel, on CAP agar (Oxoid), which is vancomycin-free. 36 vancomycin resistant enterococci were isolated: 24 isolates of Enterococcus faecium expressed a high-level resistance to vancomycin and 12 isolates of E. gallinarum/casseliflavus exhibited resistance at low-level. The sensitivity of VCA3 appeared greater than that of CAP for VRE isolation: 92% (22/24) vs 79% (19/24) for E. faecium (NS, P0.05) ; 83% (10/12) vs 50% (6/12) for E. gallinarum/casselliflavus (NS, P0.05). As expected, initial cultures of multiple gram positive organisms were far more frequent on CAP agar than on VCA3 agar. The isolation rate of vancomycin susceptible gram positive strains was impressively lower on VCA3 medium than on CAP medium. VCA3 agar avoided therefore additional subcultures, useless identification and susceptibility tests. In conclusion, VCA3 medium could be useful for the direct, rapid and selective isolation of VRE from fecal specimens.

Published
2005

32. [Infections associated to severe thrombotic events and antiphospholipid antibodies]

Author

M, Vidal, V, Corbin, V, Chanet, M, Ruivard, F, Gourdon, H, Laurichesse, J, Beytout, and O, Lesens

Subjects
Adult, Male, Cytomegalovirus Infections, Antibodies, Antiphospholipid, Humans, Thrombosis, Middle Aged, Q Fever, Severity of Illness Index
Abstract

The authors present 2 cases of infections in which the presence of antiphospholipid antibodies (APL), anticardiolipin and anti-beta2-GP1, was associated to the occurrence of significant thrombotic events: 1) a 55-year-old male patient whose serology (indirect immunofluorescence) revealed Coxiella burnetii infection (phase 2 antigens) with IgG at 1,600 and IgM at 50 (significant titer: IgGor=200 and IgMor=50); 2) and a 20-year-old male patient with a CMV infection confirmed by serology (IgG: 44 U/ml, significant threshold 6, IgM: 2.1 U/ml, significant threshold 0.9).

Published
2005

33. Suspected SARS patients hospitalised in French isolation units during the early SARS epidemic: the French experience

Author

B, Issartel, O, Lesens, C, Chidiac, Y, Mouton, D, Christmann, and D, Peyramond

Subjects
Adult, Male, Travel, Incidence, Severe Acute Respiratory Syndrome, Risk Assessment, Hospitalization, Patient Isolation, Risk Factors, Population Surveillance, Humans, Female, France, Disease Notification, Retrospective Studies
Abstract

During the SARS epidemic, many patients were screened according to WHO criteria but never went on to develop SARS. In May 2003, early in the epidemic, we conducted a retrospective study to describe suspected SARS patients hospitalised in France and compared them with documented cases of patients with SARS to evaluate the screening strategy. A total of 117 patients were studied. Only 3.4% had been in close contact with a SARS patient but 73.5% came from an affected area. 67.5% had fever and respiratory symptoms on their admission to hospital. 49.6% had fever and non specific symptoms. Clinical symptoms that were significantly more common among patients with SARS were fever, myalgia, dyspnoea, and nausea or vomiting. Presumed viral fever and respiratory tract infection were the most common diagnosis. Symptoms cannot be distinguished from an early stage of SARS confirming the usefulness of the WHO case definitions in isolation decision to avoid further transmission.

Published
2005

34. [Cogan's syndrome revealed by haemorrhagic glairous diarrhoea]

Author

A-C, Bursztejn, O, Lesens, Y, Hansmann, T, Methlin, A-E, Perrin, F, Veillon, and D, Christmann

Subjects
Adult, Diarrhea, Keratitis, Time Factors, Labyrinth Diseases, Anti-Inflammatory Agents, Syndrome, Prognosis, Magnetic Resonance Imaging, Diagnosis, Differential, Hearing Loss, Bilateral, Treatment Outcome, Audiometry, Vestibulocochlear Nerve Diseases, Humans, Prednisone, Female, Cochlear Nerve, Meniere Disease
Abstract

Cogan's syndrome is defined by the combination of non syphilitic interstitial keratitis and inner ear dysfunction, similar to Meniere's disease.Cogan's syndrome was revealed by haemorrhagic glaireous diarrhoea in a 21 year-old woman whose medical history included Hirschsprung's disease. Cerebral MRI revealed viral-like bilateral neuritis of the eighth cranial nerve, never described in the literature before. The auditory and visual disorders regressed after treatment with corticosteroids.The early diagnosis of Cogan's syndrome permits the cure of the visual and auditory and notably inner ear symptoms with corticosteroid therapy.

Published
2005

35. [Non Hodgkin's and Hodgkin's lymphomas and HIV: frequency, outcome and immune response under HAART; Clermont-Ferrand University Hospital, 1991-2003]

Author

C, Jacomet, O, Lesens, B, Villemagne, C, Darcha, O, Tournilhac, C, Henquell, L, Cormerais, F, Gourdon, H, Peigue-Lafeuille, P, Travade, J, Beytout, and H, Laurichesse

Subjects
Adult, Male, AIDS-Related Opportunistic Infections, Incidence, Lymphoma, Non-Hodgkin, Remission Induction, HIV Infections, Middle Aged, Hodgkin Disease, Survival Analysis, CD4 Lymphocyte Count, Cohort Studies, Hospitals, University, Treatment Outcome, Antiretroviral Therapy, Highly Active, Antineoplastic Combined Chemotherapy Protocols, HIV-1, Humans, Female, France, Lymphoma, AIDS-Related, Retrospective Studies
Abstract

The authors had for aim to identify cases of non Hodgkin's (NHL) and Hodgkin's (HL) lymphomas in HIV1-infected patients to assess 1) their incidence, before and after 1996, 2) the clinical features and outcome under treatment together with the survival rate of the patients, 3) the immune reconstitution of lymphoma-free patients under HAART.A retrospective study was made of HIV1-infected patients managed at the Clermont-Ferrand University Hospital from 1991 to 2003 for the diagnosis and treatment of HIV1-related lymphomas.Forty-one patients were included: 35 NHL and 6 HL giving a cumulative incidence rate estimate from 2.4% between 1991 and 1996 to 3.4% between 1997 and 2003 while other opportunistic diseases were decreasing. A high proportion of aggressive and disseminated disease was observed among NHL cases. Complete remission was achieved in 17 (49%) and 5 (83%) NHL and HL cases respectively. The mean survival was 109+/-54 months and was correlated with CD4 cell count at lymphoma diagnosis (univariate analysis). Among responding patients, 5 died: 3 from opportunistic infections, 1 commited suicide, and 1 from hepatic carcinoma. For responding patients, the mean increase of CD4 cell count under HAART was 58/mm3 over a 2 year-period and 192/mm3 over a 5 year-period of follow-up.The incidence of lymphomas in HIV-infected patients has not decreased since the introduction of HAART. The immune status assessed by CD4 cell count on diagnosis is correlated with survival. Immune restoration in lymphoma-free patients under HAART is poor.

Published
2005

36. [Prevention and infection in adults patients with hyposplenism]

Author

V, Chanet, O, Lesens, H, Laurichesse, and J, Beytout

Subjects
Adult, Risk Factors, Humans, Bacterial Infections, France, Spleen, Splenic Diseases
Abstract

People with asplenia are at risk for infections due to many causative agents, mainly Streptococcus pneumoniae. Among adults, splenectomy is the most frequent etiology of hyposplenism followed with chronic hematological and connective diseases. Physiopathology of the immunologic impairment due to hyposplenia is multifactorial. Physicians and even patients must be aware of overwhelming sepsis occurring on these conditions. The prognosis of these life-threatening infections is related to the precocity of the treatment onset. These infections, mainly due to S. pneumoniae (50-90% of cases) could be prevented with appropriate precautions. Patients presenting with asplenia must be largely vaccinated against these infectious agents: S. pneumoniae, Haemophilus influenzae b, and possibly Neisseiria meningitidis. Oral phenoxymethylpenicillin seems to be the simplest chemoprophylaxis (despite the global increase of pneumococcal strains with reduced susceptibility). Duration of treatment following splenectomy is discussed: The French medicine agency (AFSSAPS) recommends a 2-year treatment after surgery and for patients having functional hyposplenism (persistency of Howell-Jolly bodies) and/or associated immunodeficiency. Despite these prevention policies, the patient must be informed of the risk of very severe infection.

Published
2004

37. [Severe acute respiratory syndrome (SARS). The questions raised by the management of a patient in Besançon and Strasbourg]

Author

O, Lesens, L, Hustache-Mathieu, Y, Hansmann, V, Remy, B, Hoen, and D, Christmann

Subjects
Male, China, Travel, Aircraft, Hydrocortisone, Anti-Inflammatory Agents, Middle Aged, Severe Acute Respiratory Syndrome, Antiviral Agents, Patient Readmission, Polymerase Chain Reaction, Disease Outbreaks, Coronavirus, Diagnosis, Differential, Patient Isolation, Ribavirin, Humans, Drug Therapy, Combination, France, Coronavirus Infections, Tomography, X-Ray Computed, Lung
Abstract

In mid-June 2003, 8500 probable cases of Severe Acute respiratory Syndrome (SARS) responsible for 800 deaths in 29 countries were reported by the World Health Organization (WHO). In France, 5 probable cases of SARS were diagnosed until May 2003. We report the case of one of the 5 French cases, hospitalized successively in Besançon then in Strasbourg.This 54 year-old man was infected during the Air France flight from Hanoi to Paris via Bangkok by the index case, who himself had been contaminated at the French hospital in Hanoi and who was hospitalized in a critical state in the Tourcoing hospital shortly after his arrival in France. The first clinical signs (fever and dry cough) appeared 4 days after contact with the index case. The chest X-ray showed a pulmonary consolidation 6 days after the first clinical symptoms. Blood test revealed deep lymphopenia and elevated LDH. The patient finally recovered with a treatment combining ribavirin and steroids.The clinical symptoms of SARS are unspecific and its evolution may be misleading. The epidemiological context (contact with the index case) is a key point for the diagnosis. The management of such a patient requires the careful protection of contacts, the adequation between medical and paramedical staff and excess work and communication to the general public.

Published
2003

38. [Tick-borne neurological diseases]

Author

D, Christmann, Y, Hansmann, V, Remy, and O, Lesens

Subjects
Lyme Disease, Rickettsia conorii, Tick-Borne Diseases, Ehrlichiosis, Animals, Humans, Louping Ill, Rickettsia Infections, Q Fever, Encephalitis, Tick-Borne
Abstract

Some microorganisms transmitted to man via tick bite are responsible for infections, which can be associated with neuro-meningeal complications. TBE virus is the most frequent virus associated with potentially severe neurological lesions. No treatment is available so far. The most frequent bacterial diseases in which neurological complications may appear are Lyme borreliosis, Q fever and some rickettsial infections. More recently ehrlichiosis have emerged as new infections that may be associated with neuro-meningeal complications. Appropriate antibiotic therapy may be used for the treatment of these bacterial infections, but no vaccine is available so far.

Published
2002

39. [Procalcitonin in pyelonephritis and acute community-acquired pneumonia in adults]

Author

M, Martinot, Y, Hansmann, S, De Martino, O, Lesens, G, Coumaros, E, Pencreach, M, Bertrand, and D, Christmann

Subjects
Adult, Calcitonin, Inflammation, Male, Pyelonephritis, Calcitonin Gene-Related Peptide, Fibrinogen, Blood Sedimentation, Middle Aged, Community-Acquired Infections, Leukocyte Count, C-Reactive Protein, Reference Values, Pneumonia, Bacterial, Humans, Female, Protein Precursors
Abstract

Procalcitonin (PCT) is an acute-phase protein involved in the specific inflammatory reaction to severe bacterial or fungal infections. This protein does however lack sensitivity in focal infections.In this study, we investigated PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocytosis, and fibrinogen levels at admission among adult patients hospitalized for community-acquired pneumonia (n = 33) or pyelonephritis (n = 30) and in a control population (n = 27) of patients with viral infections and non-infectious inflammatory diseases.Median serum PCT in the control group (0.21 ng/ml) was significantly lower than in the pyelonephritis group (0.46 ng/ml, p0.0005) or the pneumonia group (0.88 ng/ml, p0.0005). In the control group, median CRP was 51.4 ng/l reaching 220 mg/l in the pyelonephritis and 198 mg/l in the pneumonia group (p0.0005 in both cases). The other markers of inflammation investigated (leukocytosis, ESR, fibrinogen) did not show such differences between the control group and the sepsis groups. The sensitivity of PCT (threshold 0.5 ng/ml) was 61% for the diagnosis of pneumonia and 44% for the diagnosis of pyelonephritis. Specificity was 92% in both cases. In comparison, the sensitivity of CRP (threshold 50 mg/l) was 94% and 91% for pyelonephritis and pneumonia respectively with a 33% specificity in both cases.PCT is a specific but poorly sensitive marker of community-acquired pneumonia and pyelonephritis among adults hospitalized in medical wards.

Published
2001

41. [Use in Mozambique of WHO diagnostic strategies in HIV infection]

Author

F J, Louis, J L, Perret, M, Morillon, J J, Pina, O, Lesens, A B, de Vaucouleurs, and G, Martet

Subjects
Adult, Male, Adolescent, Blotting, Western, AIDS Serodiagnosis, HIV Infections, Middle Aged, World Health Organization, Sensitivity and Specificity, Immunoenzyme Techniques, HIV Seropositivity, HIV-2, HIV-1, Humans, False Positive Reactions, Female, Child, Algorithms, Mozambique, Aged
Abstract

The lack of expensive equipment and well-trained laboratory technicians in developing countries makes it difficult to use standard methods (2 EIA confirmed by western blotting) to diagnose HIV infection. This led the WHO to develop simplified algorithms based on sequential screening tests, with no confirmation by immunoblotting. These algorithms were tested in the normal diagnosis conditions of a medical unit in Maputo, Mozambique. We tested 402 sera, collected with the consent of the patients concerned. The sera were first tested for HIV according to French regulations (2 EIA with western blot if at least one EIA was positive). This strategy identified 53 sera as positive for HIV1 and 1 serum as positive for HIV2. We then tested who algorithms, one for a predicted rate of prevalence10% and the other for a predicted rate of prevalence10%. Neither algorithm performed adequately for diagnostic purposes. Further evaluation with a panel of local sera is required to select the most suitable algorithm in terms of specificity and sensitivity, and algorithms should be throughly tested before inclusion in national AIDS control strategies.

Published
1999

43. THU0435 Performance of the Usual Clinical and Biological Signs for the Diagnosis of Septic Arthritis

Author

F. Al juhani, R. Bonnet, S. Malochet-guinamant, Sylvain Mathieu, M. Vayssade, Bruno Pereira, O. Lesens, Marion Couderc, Martin Soubrier, Jeannot Schmidt, Anne Tournadre, J.-J. Dubost, and B. Glace

Subjects
medicine.medical_specialty, Univariate analysis, medicine.diagnostic_test, business.industry, Immunology, Arthritis, medicine.disease, Gastroenterology, General Biochemistry, Genetics and Molecular Biology, Rheumatology, Surgery, Erythrocyte sedimentation rate, Internal medicine, Immunology and Allergy, Synovial fluid, Medicine, Chills, Septic arthritis, medicine.symptom, business, Prospective cohort study
Abstract

Objectives To study the sensibility (Se) and specificity (Sp) of clinical and biological signs for the diagnosis of septic arthritis (SA). Methods This prospective study included all adult patients with a suspicion of SA seen in the emergency department or rheumatology service at the University Hospital of Clermont-Ferrand during a period of 18 months. The sensibility and specificity of the clinical and biological signs for the diagnosis of SA were calculated. A univariate analysis followed by a logistic regression analysis for SA diagnosis was conducted. Results In total, 105 patients with a suspected SA were included, 38 (36%) presenting with SA (29 with a bacteriologically documented SA). In univariate analysis, chills (Se 39%; Sp 82%, p=0.015) but not fever (Se 53%; Sp 53%, p=0.6), a slow onset duration (Se 54%; Sp 72%, p=0.04), local redness (Se 53%, Sp 72%, p=0.01), as well as an infection entry-site (Se 7%; Sp 54%, p=0.01) were found most often in the SA cases. Microcrystalline antecedents (Se 5%, Sp 72%, 95% CI 0-0.6) and involvement of the knee were more frequent in non-septic arthritis (non-SA) cases. An erythrocyte sedimentation rate (ESR) >50 mm (Se 72%; Sp 60%, p=0.005), a C-reactive protein level >100mg/L (Se 58%; Sp 66%, p=0.019) and, above all, suggestive radiological signs (Se 30%; Sp 95%, p=0.001) were more frequent in the SA cases. The clear (Se 0; Sp 81%, p=0.007) and purulent (Se 57%, Sp 88, p 50000/μL (Se 57%; Sp 82%, p 90% (Se 42%; Sp 82%, p=0.02), but not the presence of microcrystals (Se 24%, Sp 58% p=0.09). In multivariate analysis, only chills (OR=4.1, 95% CI: 1.4-12.2), microcrystalline antecedents (OR=0.08, 95% CI: 0.01-0.5), and radiological signs (OR=11, 95% CI: 2.4-50.1) remained significant. The parameters chills, microcrystalline antecedents, infection entry-site, risk factors for SA, the aspect and cellularity of synovial fluid, and radiological signs permitted the elaboration of two logistic regression models for the diagnosis of SA (AUC: 0.85 and 0.87). Conclusions No clinical or biological (excluding bacteriological) sign, taken alone, is conclusive for the differentiation between SA and non-SA pathology, but the association of several signs, notably chills, microcrystalline antecedents, radiological signs of SA, and the aspect and cellularity of joint liquid may be conclusive. Disclosure of Interest None Declared

Published
2013
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46. No increased risk of Kaposi sarcoma relapse in patients with controlled HIV‐1 infection after switching protease inhibitor‐based antiretroviral therapy

Author

Lajaunie, Rébecca, Cuzin, Lise, Palich, Romain, Makinson, Alain, Bani-Sadr, Firouzé, Duvivier, Claudine, Arvieux, Cedric, Rey, David, Poizot-Martin, Isabelle, Delpierre, Cyril, Delobel, Pierre, Martin-Blondel, Guillaume, Chirouze, C., Drobacheff-Thiébaut, C., Foltzer, A., Bouiller, K., Hustache- Mathieu, L., Lepiller, Q., Bozon, F., Babre, O, Brunel, As., Muret, P., Chevalier, E., Jacomet, C., Laurichesse, H., Lesens, O., Vidal, M., Mrozek, N., Aumeran, C., Baud, O., Corbin, V., Goncalvez, E., Mirand, A, Brebion, A, Henquell, C, Lamaury, I., Fabre, I., Curlier, E., Ouissa, R., Herrmann-Storck, C., Tressieres, B., Receveur, Mc., Boulard, F., Daniel, C., Clavel, C., Roger, Pm., Markowicz, S., Chellum Rungen, N., Merrien, D., Perré, P., Guimard, T., Bollangier, O., Leautez, S., Morrier, M., Laine, L., Boucher, D., Point, P., Cotte, L., Ader, F., Becker, A., Boibieux, A., Brochier, C., Brunel-Dalmas, F., Cannesson, O., Chiarello, P., Chidiac, C., Degroodt, S., Ferry, T., Godinot, M., Livrozet, J.M., Makhloufi, D., Miailhes, P., Perpoint, T., Perry, M., Pouderoux, C., Roux, S., Triffault-Fillit, C., Valour, F., Charre, C., Icard, V., Tardy, J.C., Trabaud, M.A., Ravaux, I., Ménard, A., Belkhir, Ay., Colson, P., Dhiver, C., Madrid, A., Martin-Degioanni, M., Meddeb, L., Mokhtari, M., Motte, A., Raoux, A., Toméi, C., Tissot-Dupont, H., Poizot-Martin, I., Brégigeon, S., Zaegel-Faucher, O., Obry-Roguet, V., Laroche, H, Orticoni, M., Soavi, M.J., Ressiot, E., Ducassou, M.J., Jaquet, I., Galie, S., Colson, H., Ritleng, A.S., Ivanova, A., Debreux, C., Lions, C., Rojas-Rojas, T, Cabié, A., Abel, S., Bavay, J., Bigeard, B., Cabras, O., Cuzin, L., Dupin de Majoubert, R., Fagour, L., Guitteaud, K., Marquise, A., Najioullah, F., Pierre-François, S., Pasquier, J., Richard, P., Rome, K., Turmel, Jm, Varache, C., Atoui, N., Bistoquet, M., Delaporte, E, Le Moing, V., Makinson, A., Meftah, N., Merle de Boever, C., Montes, B., Montoya Ferrer, A., Tuaillon, E., Reynes, J., Lefèvre, B., Jeanmaire, E., Hénard, S., Frentiu, E., Charmillon, A., Legoff, A., Tissot, N., André, M., Boyer, L., Bouillon, Mp., Delestan, M., Goehringer, F., Bevilacqua, S., Rabaud, C., May, T., Raffi, F., Allavena, C., Aubry, O., Billaud, E., Biron, C., Bonnet, B., Bouchez, S., Boutoille, D., Brunet-Cartier, C., Deschanvres, C., Gaborit, B.J., Grégoire, A., Grégoire, M., Grossi, O., Guéry, R., Jovelin, T., Lefebvre, M., Le Turnier, P., Lecomte, R., Morineau, P., Reliquet, V., Sécher, S., Cavellec, M., Paredes, E., Soria, A., Ferré, V., André-Garnier, E., Rodallec, A., Pugliese, P., Breaud, S., Ceppi, C., Chirio, D., Cua, E., Dellamonica, P., Demonchy, E., de Monte, A., Durant, J., Etienne, C., Ferrando, S., Garraffo, R., Michelangeli, C., Mondain, V., Naqvi, A., Oran, N., Perbost, I., Carles, M., Klotz, C., Maka, A., Pradier, C., Prouvost-Keller, B., Risso, K., Rio, V., Rosenthal, E., Touitou, I., Wehrlen-Pugliese, S., Zouzou, G., Hocqueloux, L., Prazuck, T., Gubavu, C., Sève, A., Giaché, S., Rzepecki, V., Colin, M., Boulard, C., Thomas, G., Cheret, A., Goujard, C., Quertainmont, Y., Teicher, E., Lerolle, N., Jaureguiberry, S., Colarino, R., Deradji, O., Castro, A., Barrail-Tran, A., Yazdanpanah, Y., Landman, R., Joly, V., Ghosn, J., Rioux, C., Lariven, S., Gervais, A., Lescure, Fx., Matheron, S., Louni, F., Julia, Z., Le Gac, S., Charpentier, C., Descamps, D., Peytavin, G., Duvivier, C., Aguilar, C., Alby-Laurent, F., Amazzough, K., Benabdelmoumen, G., Bossi, P., Cessot, G., Charlier, C., Consigny, P.H., Jidar, K., Lafont, E., Lanternier, F., Leporrier, J., Lortholary, O., Louisin, C., Lourenco, J., Parize, P., Pilmis, B., Rouzaud, C., Touam, F., Valantin, Ma., Tubiana, R., Agher, R., Seang, Sophie, Schneider, L., Palich, R., Blanc, C., Katlama, C., Bani-Sadr, F., Berger, Jl., N’guyen, Y., Lambert, D., Kmiec, I., Hentzien, M., Brunet, A., Romaru, J., Marty, H., Brodard, V., Arvieux, C., Tattevin, P., Revest, M., Souala, F., Baldeyrou, M., Patrat-Delon, S., Chapplain, J.M., Benezit, F., Dupont, M., Poinot, M., Maillard, A., Pronier, C., Lemaitre, F., Morlat, C., Poisson-Vannier, M., Sinteff, Jp., Gagneux-Brunon, A., Botelho-Nevers, E., Frésard, A., Ronat, V., Lucht, F., Rey, D., Fischer, P., Partisani, M., Cheneau, C., Priester, M., Batard, Ml., Mélounou, C, Bernard-Henry, C., de Mautort, E., Fafi-Kremer, S., Delobel, P., Alvarez, M., Biezunski, N., Debard, A., Delpierre, C., Gaube, G., Lansalot, P., Lelièvre, L., Marcel, M., Martin-Blondel, G., Piffaut, M., Porte, L., Saune, K., Robineau, O., Ajana, F., Aïssi, E., Alcaraz, I., Alidjinou, E., Baclet, V., Bocket, L., Boucher, A., Digumber, M., Huleux, T., Lafon-Desmurs, B., Meybeck, A., Pradier, M., Tetart, M., Thill, P., Viget, N., Valette, M., Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU de la Martinique [Fort de France], Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Reims (CHU Reims), Service des Maladies infectieuses et tropicales [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Centre Médical de l'Institut Pasteur (CMIP), Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité), CHU Pontchaillou [Rennes], CHU Strasbourg, 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), Université Toulouse III Paul Sabatier - Faculté de médecine Purpan (UTPS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), And The Dat’AIDS study group: C Chirouze, C Drobacheff-Thiébaut, A Foltzer, K Bouiller, L Hustache-Mathieu, Q Lepiller, F Bozon, O Babre, A S Brunel, P Muret, E Chevalier, C Jacomet, H Laurichesse, O Lesens, M Vidal, N Mrozek, C Aumeran, O Baud, V Corbin, E Goncalvez, A Mirand, A Brebion, C Henquell, I Lamaury, I Fabre, E Curlier, R Ouissa, C Herrmann-Storck, B Tressieres, M C Receveur, F Boulard, C Daniel, C Clavel, P M Roger, S Markowicz, N Chellum Rungen, D Merrien, P Perré, T Guimard, O Bollangier, S Leautez, M Morrier, L Laine, D Boucher, P Point, L Cotte, F Ader, A Becker, A Boibieux, C Brochier, F Brunel-Dalmas, O Cannesson, P Chiarello, C Chidiac, S Degroodt, T Ferry, M Godinot, J M Livrozet, D Makhloufi, P Miailhes, T Perpoint, M Perry, C Pouderoux, S Roux, C Triffault-Fillit, F Valour, C Charre, V Icard, J C Tardy, M A Trabaud, I Ravaux, A Ménard, A Y Belkhir, P Colson, C Dhiver, A Madrid, M Martin-Degioanni, L Meddeb, M Mokhtari, A Motte, A Raoux, C Toméi, H Tissot-Dupont, I Poizot-Martin, S Brégigeon, O Zaegel-Faucher, V Obry-Roguet, H Laroche, M Orticoni, M J Soavi, E Ressiot, M J Ducassou, I Jaquet, S Galie, H Colson, A S Ritleng, A Ivanova, C Debreux, C Lions, T Rojas-Rojas, A Cabié, S Abel, J Bavay, B Bigeard, O Cabras, L Cuzin, R Dupin de Majoubert, L Fagour, K Guitteaud, A Marquise, F Najioullah, S Pierre-François, J Pasquier, P Richard, K Rome, J M Turmel, C Varache, N Atoui, M Bistoquet, E Delaporte, V Le Moing, A Makinson, N Meftah, C Merle de Boever, B Montes, A Montoya Ferrer, E Tuaillon, J Reynes, B Lefèvre, E Jeanmaire, S Hénard, E Frentiu, A Charmillon, A Legoff, N Tissot, M André, L Boyer, M P Bouillon, M Delestan, F Goehringer, S Bevilacqua, C Rabaud, T May, F Raffi, C Allavena, O Aubry, E Billaud, C Biron, B Bonnet, S Bouchez, D Boutoille, C Brunet-Cartier, C Deschanvres, B J Gaborit, A Grégoire, M Grégoire, O Grossi, R Guéry, T Jovelin, M Lefebvre, P Le Turnier, R Lecomte, P Morineau, V Reliquet, S Sécher, M Cavellec, E Paredes, A Soria, V Ferré, E André-Garnier, A Rodallec, P Pugliese, S Breaud, C Ceppi, D Chirio, E Cua, P Dellamonica, E Demonchy, A De Monte, J Durant, C Etienne, S Ferrando, R Garraffo, C Michelangeli, V Mondain, A Naqvi, N Oran, I Perbost, M Carles, C Klotz, A Maka, C Pradier, B Prouvost-Keller, K Risso, V Rio, E Rosenthal, I Touitou, S Wehrlen-Pugliese, G Zouzou, L Hocqueloux, T Prazuck, C Gubavu, A Sève, S Giaché, V Rzepecki, M Colin, C Boulard, G Thomas, A Cheret, C Goujard, Y Quertainmont, E Teicher, N Lerolle, S Jaureguiberry, R Colarino, O Deradji, A Castro, A Barrail-Tran, Y Yazdanpanah, R Landman, V Joly, J Ghosn, C Rioux, S Lariven, A Gervais, F X Lescure, S Matheron, F Louni, Z Julia, S Le Gac, C Charpentier, D Descamps, G Peytavin, C Duvivier, C Aguilar, F Alby-Laurent, K Amazzough, G Benabdelmoumen, P Bossi, G Cessot, C Charlier, P H Consigny, K Jidar, E Lafont, F Lanternier, J Leporrier, O Lortholary, C Louisin, J Lourenco, P Parize, B Pilmis, C Rouzaud, F Touam, M A Valantin, R Tubiana, R Agher, S Seang, L Schneider, R Palich, C Blanc, C Katlama, F Bani-Sadr, J L Berger, Y N'Guyen, D Lambert, I Kmiec, M Hentzien, A Brunet, J Romaru, H Marty, V Brodard, C Arvieux, P Tattevin, M Revest, F Souala, M Baldeyrou, S Patrat-Delon, J M Chapplain, F Benezit, M Dupont, M Poinot, A Maillard, C Pronier, F Lemaitre, C Morlat, M Poisson-Vannier, T Jovelin, J P Sinteff, A Gagneux-Brunon, E Botelho-Nevers, A Frésard, V Ronat, F Lucht, D Rey, P Fischer, M Partisani, C Cheneau, M Priester, M L Batard, C Mélounou, C Bernard-Henry, E de Mautort, S Fafi-Kremer, P Delobel, M Alvarez, N Biezunski, A Debard, C Delpierre, G Gaube, P Lansalot, L Lelièvre, M Marcel, G Martin-Blondel, M Piffaut, L Porte, K Saune, O Robineau, F Ajana, E Aïssi, I Alcaraz, E Alidjinou, V Baclet, L Bocket, A Boucher, M Digumber, T Huleux, B Lafon-Desmurs, A Meybeck, M Pradier, M Tetart, P Thill, N Viget, M Valette, Malbec, Odile, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Toulouse (UT)-Université de Toulouse (UT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Rennes (CHU Rennes), Laboratoire de Physique des Lasers (LPL), Université Paris 13 (UP13)-Centre National de la Recherche Scientifique (CNRS)-Université Sorbonne Paris Nord, Service d'Immuno-hématologie clinique [Hôpital Sainte Marguerite - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Institut des sciences de la santé publique [Marseille] (ISSPAM), European Infective Endocarditis Registry (Euro-Endo), EMERGEN consortium, Stratégies thérapeutiques contre l'infection VIH et les maladies virales associées [iPLesp] (THERAVIR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Laboratoire Microorganismes : Génome et Environnement (LMGE), and Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)

Subjects
medicine.medical_specialty, MESH: CD4 Lymphocyte Count, [SDV]Life Sciences [q-bio], antiretroviral therapy, Human immunodeficiency virus (HIV), protease inhibitors, HIV Infections, medicine.disease_cause, MESH: HIV-1, Acquired immunodeficiency syndrome (AIDS), MESH: Neoplasm Recurrence, Local / complications, Internal medicine, medicine, Humans, HHV8, MESH: HIV Infections* / complications, MESH: Protease Inhibitors / adverse effects, Pharmacology (medical), Protease inhibitor (pharmacology), Sarcoma, Kaposi, Retrospective Studies, MESH: Humans, business.industry, Health Policy, Kaposi sarcoma, MESH: Retrospective Studies, Viral Load, MESH: HIV Infections* / drug therapy, medicine.disease, Antiretroviral therapy, switch, CD4 Lymphocyte Count, AIDS, [SDV] Life Sciences [q-bio], Regimen, Infectious Diseases, Increased risk, MESH: Sarcoma, Kaposi* / drug therapy, HIV-1, Sarcoma, Neoplasm Recurrence, Local, business, MESH: Viral Load, Viral load
Abstract

International audience; Objectives: 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.

Published
2022
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47. Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012-2018

Author

Pradat, Pierre, Chirouze, C, Drobacheff-Thiébaut, C, Foltzer, A, Bouiller, K, Hustache-Mathieu, L, Lepiller, Q, Bozon, F, Babre, O, Brunel, A, Muret, P, Chevalier, E, Jacomet, C, Laurichesse, H, LESENS, O, Vidal, M, Mrozek, N, Aumeran, C, Baud, O, Corbin, V, Goncalvez, E, Mirand, A, brebion, A, Henquell, C, Lamaury, I, Fabre, I, Curlier, E, Ouissa, R, Herrmann-Storck, C, Tressieres, B, Receveur, M, Boulard, F, Daniel, C, CLAVEL, C, Roger, P, Markowicz, S, Chellum Rungen, N, Merrien, D, Perré, P, Guimard, T, Bollangier, O, Leautez, S, Morrier, M, Laine, L, Boucher, D, Point, P, Cotte, Laurent, Ader, F, Becker, A, Boibieux, A, Brochier, C, Brunel-Dalmas, F, Cannesson, O, Chiarello, P, Chidiac, C, Degroodt, S, FERRY, T, Godinot, M, Livrozet, J, Makhloufi, D, Miailhes, P, Perpoint, T, Perry, M, Pouderoux, C, Roux, Stéphane, Triffault-Fillit, C, Valour, F, Charre, C, Icard, V, Tardy, J, Trabaud, M, Ravaux, I, Ménard, A, Belkhir, A, Colson, P, Dhiver, C, Madrid, A, Martin-Degioanni, M, Meddeb, L, Mokhtari, M, Motte, A, Raoux, A, Toméi, C, Tissot-Dupont, H, Poizot-Martin, Isabelle, Brégigeon, S, Zaegel-Faucher, O, Obry-Roguet, V, Laroche, H, Orticoni, M, Soavi, M, Ressiot, E, Ducassou, M, Jaquet, I, Galie, S, Colson, H, Ritleng, A, Ivanova, A, Debreux, C, Lions, C, Rojas-Rojas, T, Cabié, André, Abel, S, Bavay, J, Bigeard, B, Cabras, O, Cuzin, L, Dupin de Majoubert, R, Fagour, L, Guitteaud, K, Marquise, A, Najioullah, F, Pierre-François, S, Pasquier, J, Richard, P, Rome, K, Turmel, J, Varache, C, Atoui, N, Bistoquet, M, Delaporte, E, Le Moing, V, Makinson, A, Meftah, N, Merle de Boever, C, Montes, B, Montoya Ferrer, A, Tuaillon, E, Reynes, J, Lefèvre, B, Jeanmaire, E, Hénard, S, Frentiu, E, Charmillon, A, Legoff, A, Tissot, N, André, M, Boyer, L, Bouillon, M, Delestan, M, Goehringer, F, Bevilacqua, S, Rabaud, C, May, T, Raffi, F, Allavena, C, Aubry, O, Billaud, E, Biron, C, Bonnet, B, Bouchez, S, Boutoille, D, Brunet-Cartier, C, Deschanvres, C, Gaborit, B, Grégoire, A, Grégoire, M, Grossi, O, Guéry, R, Lefebvre, Maeva, Le Turnier, P, Lecomte, R, Morineau, P, Reliquet, V, Sécher, S, Cavellec, M, Paredes, E, Soria, A, Ferré, V, André-Garnier, E, Rodallec, A, Pugliese, Pascal, Breaud, S, Ceppi, C, Chirio, D, Cua, E, Dellamonica, P, Demonchy, E, De Monte, A, Durant, J, Etienne, C, Ferrando, S, Garraffo, R, Michelangeli, C, Mondain, V, Naqvi, A, Oran, N, Perbost, I, Carles, M, Klotz, C, Maka, A, Pradier, C, Prouvost-Keller, B, Risso, K, Rio, V, Rosenthal, E, Touitou, I, Wehrlen-Pugliese, S, Zouzou, G, Hocqueloux, Laurent, Prazuck, T, Gubavu, C, Sève, A, Giaché, S, Rzepecki, V, Colin, M, Boulard, C, Thomas, G, Cheret, A, Goujard, C, Quertainmont, Y, Teicher, E, Lerolle, N, Jaureguiberry, S, Colarino, R, Deradji, O, Castro, A, Barrail-Tran, A, Yazdanpanah, Y, Landman, R, Joly, V, Ghosn, J, Rioux, C, Lariven, S, gervais, a, Lescure, F, Matheron, S, Louni, F, Julia, Z, Le Gac, S, Charpentier, c, Descamps, D, Peytavin, G, Duvivier, C, Aguilar, C, Alby-Laurent, F, Amazzough, K, Benabdelmoumen, G, Bossi, P, Cessot, G, Charlier, C, Consigny, P, Jidar, K, Lafont, E, Lanternier, F, Leporrier, J, Lortholary, O, Louisin, C, Lourenco, J, Parize, P, Pilmis, B, Rouzaud, C, Touam, F, Valantin, M, Tubiana, R, Agher, R, Seang, S, Schneider, L, PaLich, R, Blanc, C, Katlama, C, Bani-Sadr, Firouze, Berger, J, N’Guyen, Y, Lambert, D, Kmiec, I, Hentzien, M, Brunet, A, Romaru, J, Marty, H, Brodard, V, Arvieux, C, Tattevin, P, Revest, M, Souala, F, Baldeyrou, M, Patrat-Delon, S, Chapplain, J, Benezit, F, Dupont, M, Poinot, M, MAILLARD, A, Pronier, C, Lemaitre, F, Morlat, C, Poisson-Vannier, M, Jovelin, T, Sinteff, J, Gagneux-Brunon, A, Botelho-Nevers, E, Frésard, A, Ronat, V, Lucht, F, Rey, David, Fischer, P, Partisani, M, Cheneau, C, Priester, M, Mélounou, C, Bernard-Henry, C, de Mautort, E, Fafi-Kremer, S, Delobel, P, Alvarez, M, Biezunski, N, Debard, A, Delpierre, C, Gaube, G, Lansalot, P, Lelièvre, L, Marcel, M, Martin-Blondel, G, Piffaut, M, Porte, L, Saune, K, Robineau, O, Ajana, F, Aïssi, E, Alcaraz, I, Alidjinou, E, Baclet, V, Bocket, L, Boucher, A, Digumber, M, Huleux, Thomas, Lafon-Desmurs, B, Meybeck, A, Pradier, M, Tetart, M, Thill, P, Viget, N, Valette, M, Pathogenesis and Control of Chronic and Emerging Infections (PCCEI), Université des Antilles (UA)-Etablissement français du don du sang [Montpellier]-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional d'Orléans (CHRO), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital universitaire Robert Debré [Reims], Centre Hospitalier Gustave Dron [Tourcoing], Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Aix Marseille Université (AMU), 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), Centre Hospitalier Universitaire de Nice (CHU Nice), Hôpital l'Archet, Les Hôpitaux Universitaires de Strasbourg (HUS), Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Université des Antilles (UA), Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Dat’AIDS Study Group Besançon: C. Chirouze, C. Drobacheff-Thiébaut, A. Foltzer, K. Bouiller, L. Hustache- Mathieu, Q. Lepiller, F. Bozon, O. Babre, AS. Brunel, P. Muret, E. Chevalier. Clermont-Ferrand: C. Jacomet, H. Laurichesse, O. Lesens, M. Vidal, N. Mrozek, C. Aumeran, O. Baud, V. Corbin, E. Goncalvez, A Mirand, A brebion, C Henquell. Guadeloupe: I. Lamaury, I. Fabre, E. Curlier, R. Ouissa, C. Herrmann-Storck, B. Tressieres, MC. Receveur, F. Boulard, C. Daniel, C. Clavel, PM. Roger, S. Markowicz, N. Chellum Rungen. La Roche sur Yon: D. Merrien, P. Perré, T. Guimard, O. Bollangier, S. Leautez, M. Morrier, L. Laine, D. Boucher, P. Point. Lyon: L. Cotte, F. Ader, A. Becker, A. Boibieux, C. Brochier F, Brunel-Dalmas, O. Cannesson, P. Chiarello, C. Chidiac, S. Degroodt, T. Ferry, M. Godinot, J.M. Livrozet, D. Makhloufi, P. Miailhes, T. Perpoint, M. Perry, C. Pouderoux, S. Roux, C. Triffault-Fillit, F. Valour, C. Charre, V. Icard, J.C. Tardy, M.A. Trabaud. Marseille IHU Méditerrannée: I. Ravaux, A. Ménard, AY. Belkhir, P. Colson, C. Dhiver, A. Madrid, M. Martin-Degioanni, L. Meddeb, M. Mokhtari, A. Motte, A. Raoux, C. Toméi, H. Tissot-Dupont. Marseille Ste Marguerite: I. Poizot-Martin, S. Brégigeon, O. Zaegel-Faucher, V. Obry-Roguet, H Laroche, M. Orticoni, M.J. Soavi, E. Ressiot, M.J. Ducassou, I. Jaquet, S. Galie, H. Colson, A.S. Ritleng, A. Ivanova, C. Debreux, C. Lions, T Rojas-Rojas. Martinique: A. Cabié, S. Abel, J. Bavay, B. Bigeard, O. Cabras, L. Cuzin, R. Dupin de Majoubert, L. Fagour, K. Guitteaud, A. Marquise, F. Najioullah, S. Pierre-François, J. Pasquier, P. Richard, K. Rome, JM Turmel, C. Varache. Montpellier: N. Atoui, M. Bistoquet, E Delaporte, V. Le Moing, A. Makinson, N. Meftah, C. Merle de Boever, B. Montes, A. Montoya Ferrer, E. Tuaillon, J. Reynes. Nancy: B. Lefèvre, E. Jeanmaire, S. Hénard, E. Frentiu, A. Charmillon, A. Legoff, N. Tissot, M. André, L. Boyer, MP. Bouillon, M. Delestan, F. Goehringer, S. Bevilacqua, C. Rabaud, T. May. Nantes: F. Raffi, C. Allavena, O. Aubry, E. Billaud, C. Biron, B. Bonnet, S. Bouchez, D. Boutoille, C. Brunet-Cartier, C. Deschanvres, B.J. Gaborit, A. Grégoire, M. Grégoire, O. Grossi, R. Guéry, T. Jovelin, M. Lefebvre, P. Le Turnier, R. Lecomte, P. Morineau, V. Reliquet, S. Sécher, M. Cavellec, E. Paredes, A. Soria, V. Ferré, E. André-Garnier, A. Rodallec. Nice: P. Pugliese, S. Breaud, C. Ceppi, D. Chirio, E. Cua, P. Dellamonica, E. Demonchy, A. De Monte, J. Durant, C. Etienne, S. Ferrando, R. Garraffo, C. Michelangeli, V. Mondain, A. Naqvi, N. Oran, I. Perbost, M. Carles, C. Klotz, A. Maka, C. Pradier, B. Prouvost- Keller, K. Risso, V. Rio, E. Rosenthal, I. Touitou, S. Wehrlen-Pugliese, G. Zouzou. Orléans: L. Hocqueloux, T. Prazuck, C. Gubavu, A. Sève, S. Giaché, V. Rzepecki, M. Colin, C. Boulard, G. Thomas. Paris APHP Bicètre: A. Cheret, C. Goujard, Y. Quertainmont, E. Teicher, N. Lerolle, S. Jaureguiberry, R. Colarino, O. Deradji, A. Castro, A. Barrail-Tran. Paris APHP Bichat: Y. Yazdanpanah, R. Landman, V. Joly, J. Ghosn, C. Rioux, S. Lariven, A. Gervais, FX. Lescure, S. Matheron, F. Louni, Z. Julia, S. Le GAC, C. Charpentier, D. Descamps, G. Peytavin. Paris APHP Necker Pasteur: C. Duvivier, C. Aguilar, F. Alby-Laurent, K. Amazzough, G. Benabdelmoumen, P. Bossi, G. Cessot, C. Charlier, P.H. Consigny, K. Jidar, E. Lafont, F. Lanternier, J. Leporrier, O. Lortholary, C. Louisin, J. Lourenco, P. Parize, B. Pilmis, C. Rouzaud, F. Touam. Paris APHP Pitié Salpetrière: MA. Valantin, R. Tubiana, R. Agher, S. Seang, L. Schneider, R. PaLich, C. Blanc, C. Katlama. Reims: F. Bani-Sadr, JL. Berger, Y. N’Guyen, D. Lambert, I. Kmiec, M. Hentzien, A. Brunet, J. Romaru, H. Marty, V. Brodard. Rennes: C. Arvieux, P. Tattevin, M. Revest, F. Souala, M. Baldeyrou, S. Patrat-Delon, J.M. Chapplain, F. Benezit, M. Dupont, M. Poinot, A. Maillard, C. Pronier, F. Lemaitre, C. Morlat, M. Poisson-Vannier, T. Jovelin, JP. Sinteff. St Etienne: A. Gagneux-Brunon, E. Botelho-Nevers, A. Frésard, V. Ronat, F. Lucht. Strasbourg: D. Rey, P. Fischer, M. Partisani, C. Cheneau, M. Priester, C. Mélounou, C. Bernard-Henry, E. de Mautort, S. Fafi-Kremer. Toulouse: P. Delobel, M. Alvarez, N. Biezunski, A. Debard, C. Delpierre, G. Gaube, P. Lansalot, L. Lelièvre, M. Marcel, G. Martin-Blondel, M. Piffaut, L. Porte, K. Saune. Tourcoing: O. Robineau, F. Ajana, E. Aïssi, I. Alcaraz, E. Alidjinou, V. Baclet, L. Bocket, A. Boucher, M. Digumber, T. Huleux, B. Lafon-Desmurs, A. Meybeck, M. Pradier, M. Tetart, P. Thill, N. Viget, M. Valette., CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française]-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Institut National de la Santé et de la Recherche Médicale (INSERM)-Université des Antilles et de la Guyane (UAG), and Malbec, Odile

Subjects
Microbiology (medical), Male, medicine.medical_specialty, Hepatitis C virus, [SDV]Life Sciences [q-bio], Population, men having sex with men, HIV Infections, Hepacivirus, medicine.disease_cause, Antiviral Agents, Men who have sex with men, 03 medical and health sciences, Sexual and Gender Minorities, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Human Immunodeficiency virus, Homosexuality, Male, education, Retrospective Studies, Hepatitis, education.field_of_study, business.industry, Coinfection, Mortality rate, Incidence (epidemiology), microelimination, virus diseases, HIV, Hepatitis C, Chronic, medicine.disease, Hepatitis C, digestive system diseases, 3. Good health, [SDV] Life Sciences [q-bio], Infectious Diseases, Cohort, 030211 gastroenterology & hepatology, epidemiology, France, business
Abstract

Background The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort. Methods This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors. Results From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018. Conclusions A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM. Clinical Trials Registration. NCT02898987.

Published
2020
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48. Post-exposure prophylaxis completion and condom use in the context of potential sexual exposure to HIV

Author

Claudine Duvivier, André Cabié, Sylvie Bregigeon, Alain Makinson, David Rey, C Allavena, Jacques Reynes, Laurent Cotte, Isabelle Ravaux, Pierre Gantner, Les Hôptaux universitaires de Strasbourg (HUS), CHU Strasbourg, Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôtel-Dieu de Nantes, Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Médical de l'Institut Pasteur (CMIP), Institut Pasteur [Paris] (IP), Infection à VIH, réservoirs, diversité génétique et résistance aux antirétroviraux (ARV) (EA 7327), Université Paris Descartes - Paris 5 (UPD5), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Maladies infectieuses et tropicales dans la Caraïbe (MAITC EA 4537), CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de la Martinique [Fort de France]-Université des Antilles (UA), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Dat'AIDS Study Group: Besançon: C. Drobacheff-Thiébaut, A. Foltzer, K. Bouiller, L. Hustache-Mathieu, C. Chirouze, F. Bozon, O. Babre, P. Muret, Clermont-Ferrand: H. Laurichesse, O. Lesens, M. Vidal, N. Mrozek, C. Aumeran, O. Baud, V. Corbin, P. Letertre, S. Casanova, C. Jacomet, Guadeloupe: B. Hoen, I. Lamaury, I. Fabre, E. Curlier, R. Ouissa, K. Schepers, C. Herrmann-Storck, N. Dournon, La Roche sur Yon: D. Merrien, P. Perré, T. Guimard, O. Bollangier, S. Leautez, M. Morrier, Lyon: F. Ader, F. Biron, A. Boibieux, L. Cotte, T. Ferry, P. Miailhes, T. Perpoint, S. Roux, S. Degroodt, C. Brochier, F. Valour, C. Chidiac, Marseille (IHU): C. Dhiver, M. Saadia Mokhtari, A. Ménard, H. Tissot Dupont, C. Toméi, L. Meddeb, A.Y. Belkhir, I. Ravaux, Marseille (Ste Marguerite): S. Brégigeon, O. Zaegel-Faucher, V. Obry-Roguet, H. Laroche, M. Orticoni, M.J. Soavi, P. Geneau de Lamarlière, E. Ressiot, M.J. Ducassou, I. Jaquet, S. Galie, A. Galinier, P. Martinet, M. Landon, A.S. Ritleng, A. Ivanova, C. Debreux, C. Lions, I. Poizot-Martin, Martinique: S. Abel, R. Césaire, L. Cuzin, G. Dos Santos, L. Fagour, M. Illiaquer, F. Najioullah, D. Nguyen, M. Ouka, S. Pierre-François, J. Pasquier, M. Pircher, B. Rozé, A. Cabié, Montpellier: N. Atoui, V. Le Moing, A. Makinson, N. Meftah, C. Merle de Boever, B. Montes, A. Montoya Ferrer, J. Reynes, Nancy: M. André, L. Boyer, M.P. Bouillon, M. Delestan, T. May, Nantes: C. Allavena, C. Bernaud, E. Billaud, C. Biron, B. Bonnet, S. Bouchez, D. Boutoille, C. Brunet-Cartier, C. Deschanvres, N. Hall, T. Jovelin, P. Morineau, V. Reliquet, H. Hue, S. Sécher, M. Cavellec, A. Soria, V. Ferré, E. André-Garnier, A. Rodallec, M. Lefebvre, O. Grossi, O. Aubry, F. Raffi, Nice: P. Pugliese, S. Breaud, C. Ceppi, J. Courjon, E. Cua, J. Cottalorda, P. Dellamonica, E. Demonchy, A. De Monte, J. Durant, C. Etienne, S. Ferrando, J.G. Fuzibet, R. Garraffo, A. Joulie, K. Risso, V. Mondain, A. Naqvi, N. Oran, I. Perbost, S. Pillet, B. Prouvost-Keller, C. Pradier, S. Wehrlen-Pugliese, V. Rio, E. Rosenthal, S. Sausse, G. Zouzou, Orléans: L. Hocqueloux, T. Prazuck, C. Gubavu, A. Sève, M. Niang, C. Boulard, Paris (Bicêtre): A. Cheret, C. Goujard, Y. Quertainmont, E. Teicher, N. Lerolle, D. Vittecoq, O. Deradji, F. Fourreau, C. Pallier, A. Barrail-Tran, Paris (Bichat): R. Landman, V. Joly, C. Rioux, S. Lariven, A. Gervais, F.X. Lescure, S. Matheron, F. Louni, C. Godard, Z. Julia, M. Chansombat, D. Rahli, C. Mackoumbou-Nkouka, C. Charpentier, D. Descamps, G. Peytavin, Y. Yazdanpanah, Paris (Pasteur-Necker): P.H. Consigny, G. Cessot, P. Bossi, J. Goesch, J. Benabdelmoumen, F. Lanternier, C. Charlier, K. Amazzough, B. Henry, B. Pilmis, C. Rouzaud, M. Morgand, F. Touam, C. Louisin, C. Duvivier, O. Lortholary, R. Guery, F. Danion, J. Lourenco, P. Parize, M. Launay, V. Avettand-Fenoel, Paris (Pitié): M.A. Valantin, F. Caby, R. Tubiana, R. Agher, S. Seang, L. Schneider, R. Palich, C. Blanc, C. Katlama, Reims: J.L. Berger, Y. N'Guyen, D. Lambert, D. Lebrun, I. Kmiec, M. Hentzien, V. Brodard, F. Bani-Sadr, Saint-Etienne: E. Botelho-Nevers, A. Gagneux-Brunon, A. Frésard, F. Lucht, Strasbourg: P. Fischer, M. Partisani, C. Cheneau, M. Priester, M.L. Batard, C. Bernard-Henry, E. de Mautort, P. Gantner, D. Rey, Toulouse: M. Alvarez, N. Biezunski, A. Debard, C. Delpierre, P. Lansalot, L. Lelièvre, G. Martin-Blondel, M. Piffaut, L. Porte, K. Saune, P. Delobel, and Tourcoing: F. Ajana, I. Alcaraz, V. Baclet, A. Boucher, P. Choisy, T. Huleux, B. Lafon-Desmurs, H. Melliez, A. Meybeck, A. Pasquet, M. Pradier, O. Robineau, N. Viget, M. Valette.

Subjects
0301 basic medicine, Male, HIV Infections, law.invention, Men who have sex with men, Condoms, 0302 clinical medicine, MESH: Tenofovir, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Emtricitabine, MESH: Sexual Partners, Emtricitabine, Pharmacology (medical), 030212 general & internal medicine, Condom use, Health Policy, MESH: HIV Infections, Infectious Diseases, Sexual Partners, Cohort, cardiovascular system, Female, France, Post-Exposure Prophylaxis, circulatory and respiratory physiology, medicine.drug, Adult, medicine.medical_specialty, Unprotected Sexual Intercourse, MESH: Unsafe Sex, Treatment discontinuation, education, Context (language use), MESH: Multivariate Analysis, Medication Adherence, MESH: Homosexuality, Male, 03 medical and health sciences, MESH: Condoms, Condom, Internal medicine, medicine, Humans, Homosexuality, Male, Tenofovir, Retrospective Studies, MESH: Humans, Unsafe Sex, business.industry, HIV, MESH: Adult, MESH: Retrospective Studies, Odds ratio, MESH: Medication Adherence, 030112 virology, MESH: Male, Discontinuation, Sexual exposure, MESH: France, Multivariate Analysis, business, MESH: Female, MESH: Post-Exposure Prophylaxis
Abstract

International audience; ObjectivesPost-exposure prophylaxis (PEP) care remains a challenge for individuals with potential sexual exposure to HIV in terms of PEP completion and ongoing risk behaviours.MethodsA retrospective analysis was carried out on data from the French Dat’AIDS prevention cohort (NCT03795376) for individuals evaluated for PEP between 2004 and 2017. A multivariable analysis was performed of predictors of both PEP completion and condom use [odds ratios (ORs)] and their associated probabilities (P, with P > 95% being clinically relevant).ResultsOverall, 29 060 sexual exposures to HIV were evaluated for PEP [36% in men who have sex with men (MSM) and 64% in heterosexuals]. Overall, 12 different PEP regimens were offered in 19 240 cases (46%). Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) was the preferred backbone (n = 14 304; 74%). We observed a shift from boosted protease inhibitor-based regimens to nonnucleoside reverse transcriptase inhibitor- or integrase inhibitor-based regimens in recent years. Overall, 20% of PEP prescriptions were prematurely discontinued. Older age, MSM, intercourse with a sex worker, rape and intercourse with a known HIV-infected source patient were factors associated with increased rates of PEP completion (OR > 1; P > 98%). None of the 12 PEP regimens was associated with premature discontinuation. We also found 12 774 cases of unprotected sexual intercourse (48%). Condom use decreased (OR < 1; P > 99%) with the year of exposure, and was lower in MSM and rape victims. Condom use increased (OR > 1, P > 99%) with age, and was higher in those who had intercourse with a sex worker or with a female partner and in those with knowledge of the partner’s HIV status.ConclusionsWe provide new insights into how rates of condom use and PEP completion might be improved in those receiving PEP by targeting certain groups of individuals for interventions. In particular, youth and MSM at risk should be linked in a prevention-to-care continuum.

Published
2020
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49. Kaposi sarcoma among people living with HIV in the French DAT'AIDS cohort between 2010 and 2015

Author

Obry-Roguet, Véronique, Duvivier, Claudine, Lions, Caroline, Huleux, Thomas, Jacomet, Christine, Ferry, Tristan, Cheret, Antoine, Allavena, Clotilde, Bani-Sadr, Firouzé, Palich, Romain, Cabié, André, Pugliese, Pascal, Delobel, Pierre, Lamaury, Isabelle, Hustache-Mathieu, Laurent, Bregigeon, Sylvie, Makinson, Alain, Rey, David, Poizot-Martin, Isabelle, Hustache‐Mathieu, Laurent, Drobacheff‐Thiébaut, C., Foltzer, A., Bouiller, K., Hustache‐ Mathieu, L., Chirouze, C., LEPILLER, Q., Bozon, F., Babre, O, Brunel, A.S., Muret, P., Laurichesse, H., Lesens, O., Vidal, M., Mrozek, N., Aumeran, C., Baud, O., Corbin, V., Letertre‐Gibert, P., Casanova, S., Prouteau, J., Fabre, I., Curlier, E., Ouissa, R., Herrmann‐Storck, C., Tressieres, B., Bonijoly, T., Receveur, M.C., Boulard, F., Daniel, C., Clavel, C., Merrien, D., Perré, P., Guimard, T., Bollangier, O., Leautez, S., Morrier, M., Laine, L., Ader, F., Becker, A., Biron, F., Boibieux, A., Cotte, L., Miailhes, P., Perpoint, T., Roux, S., Triffault‐Fillit, C., Degroodt, S., Brochier, C., Valour, F., Chidiac, C., Ménard, A., Belkhir, A.Y., Colson, P., Dhiver, C., Madrid, A., Martin‐Degioanni, M., Meddeb, L., Mokhtari, M., Motte, A., Raoux, A., Ravaux, I., Tamalet, C., Tomei, C., Tissot Dupont, H., Zaegel‐Faucher, O., Obry‐Roguet, Véronique, Laroche, H, Orticoni, M., Soavi, M.J., Geneau de Lamarlière, P, Ressiot, E, Ducassou, M.J., Jaquet, I., Galie, S., Galinier, A., Martinet, P., Landon, M., Ritleng, A.S., Ivanova, A., Debreux, C., Poizot‐Martin, I., Abel, S., Cabras, O., Cuzin, L., Guitteaud, K., Illiaquer, M., Pierre‐François, S., Osei, L., Pasquier, J., Rome, K., Sidani, E., Turmel, JM, Varache, C., Atoui, N., Bistoquet, M., Delaporte, E., Le Moing, V., Meftah, N., Merle de Boever, C., Montes, B., Montoya Ferrer, A., Tuaillon, E., Reynes, J., André, M., Boyer, L., Bouillon, MP., Delestan, M., Rabaud, C., May, T., Hoen, B., Bernaud, C., Billaud, E., Biron, C., Bonnet, B., Bouchez, S., Boutoille, D., Brunet‐Cartier, C., Deschanvres, C., Hall, N., Morineau, P., Reliquet, V., Sécher, S., Cavellec, M., Soria, A., Paredes, E., Ferre, V., André‐Garnier, E., Rodallec, A., Lefebvre, M., Grossi, O., Aubry, O., Raffi, F., Breaud, S., Ceppi, C., Chirio, D., Cua, E., Dellamonica, P., Demonchy, E., De Monte, A., Durant, J., Etienne, C., Ferrando, S., Garraffo, R., Michelangeli, C., Mondain, V., Naqvi, A., Oran, N., Perbost, I., Pillet, S., Pradier, C., Prouvost‐Keller, B., Risso, K., Rio, V., Roger, PM., Rosenthal, E., Sausse, S., Touitou, I., Wehrlen‐Pugliese, S., Zouzou, G., Hocqueloux, L., Prazuck, T., Gubavu, C., Sève, A., Maka, A., Boulard, C., Thomas, G., Lerolle, N., Landman, R., Joly, V., Ghosn, J., Rioux, C., Lariven, S., Gervais, A., Lescure, F.X., Matheron, S., Louni, F., Julia, Z., Mackoumbou‐Nkouka, C., Le Gac, S., Charpentier, C., Descamps, D., Peytavin, G., Yazdanpanah, Y., Amazzough, K., Benabdelmoumen, G., Bossi, P., Cessot, G., Charlier, C., Consigny, P.H., Danion, F., Dureault, A., Goesch, J., Guery, R., Henry, B., Jidar, K., Lanternier, F., Loubet, P., Lortholary, O., Louisin, C., Lourenco, J., Parize, P., Pilmis, B., Touam, F, Valantin, M.A., Tubiana, R., Agher, R, Seang, S., Schneider, L., Blanc, C., Katlama, C., Berger, J.L., N'guyen, Y., Lambert, D., Kmiec, I., Hentzien, M., Brunet, A., Brodard, V., Bani‐Sadr, Firouze, Tattevin, P., Revest, M., Souala, F., Baldeyrou, M., Patrat‐Delon, S., Chapplain, J.M., Bénézit, F., Dupont, M., Poinot, M., Maillard, A., Pronier, C., Lemaitre, F., Guennoun, C., Poisson‐Vanier, M., Jovelin, T., Sinteff, J.P., Arvieux, C., Botelho‐Nevers, E., Gagneux‐Brunon, A., Frésard, Anne, Ronat, V., Lucht, F., Fischer, P., Partisani, M., Cheneau, C., Priester, M, Batard, ML, Bernard‐Henry, C, de Mautort, E, Fafi‐Kremer, S., Alvarez, M., Biezunski, N., Debard, A., Delpierre, C., Lansalot, P., Lelievre, L., Martin‐Blondel, G., Piffaut, M., Porte, L., Saune, K., Ajana, F., Aïssi, E., Alcaraz, I., Baclet, V., Bocket, L., Boucher, A., Choisy, P., Lafon‐Desmurs, B., Meybeck, A., Pradier, M., Robineau, O., Viget, N., Valette, M., Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Centre d'infectiologie Necker-Pasteur [CHU Necker], CHU Necker - Enfants Malades [AP-HP], 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), Centre Hospitalier Tourcoing, Département des Maladies Infectieuses et Tropicales [CHU Gabriel-Montpied, Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], Pathogénie des Staphylocoques – Staphylococcal Pathogenesis, Centre International de Recherche en Infectiologie - UMR (CIRI), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Services des maladies infectieuses [CH Turcoing], Centre Hospitalier de Tourcoing, Service de maladies infectieuses et tropicales [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire de Reims (CHU Reims), Alliance for International medical Action (ALIMA), Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique], CHU de la Martinique [Fort de France]-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France]-Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Service de Maladies Infectieuses [Nice], Centre de Physiopathologie Toulouse Purpan ex IFR 30 et IFR 150 (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Pointe-à-Pitre/Abymes [Guadeloupe], service de maladies infectieuses CHU J Minjoz Besancon, Hôpital Jean Minjoz, Service d'Immuno-hématologie clinique [Hôpital Sainte Marguerite - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Universtié Yaoundé 1 [Cameroun]-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Laboratoire d'Ingénierie Circulation Transport (LICIT), Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR)-École Nationale des Travaux Publics de l'État (ENTPE)-Université de Lyon, Laboratoire Chrono-environnement - CNRS - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Universitaire de Besançon (CHU Besançon), Université libre de Bruxelles (ULB), Hôpital Gabriel Montpied, Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Clermont-Ferrand, Laboratoire Microorganismes : Génome et Environnement - Clermont Auvergne (LMGE), Université Clermont Auvergne (UCA)-Centre National de la Recherche Scientifique (CNRS), CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, CCLIN Sud-Est – Centre de Coordination de la Lutte contre les Infections Nosocomiales Sud-Est, Montpellier Research in Management (MRM), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Perpignan Via Domitia (UPVD)-Groupe Sup de Co Montpellier (GSCM) - Montpellier Business School-Université de Montpellier (UM), Laboratoire Traitement et Communication de l'Information (LTCI), Télécom ParisTech-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS), Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250 (P3CELL), Université de Reims Champagne-Ardenne (URCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hosp Civils Lyon, Serv Malad Infect, Lyon, France, Institut de biologie et chimie des protéines [Lyon] (IBCP), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Equipe 15, Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon], Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Institut Hospitalier Universitaire Méditerranée Infection (IHU AMU), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Neurobiologie, plasticité tissulaire et métabolisme énergétique (NPTME), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), CECIL, Space Research Institute of the Russian Academy of Sciences (IKI), Russian Academy of Sciences [Moscow] (RAS), Système membranaires, photobiologie, stress et détoxication (SMPSD), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre IRD de Montpellier (IRD), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Bell Labs (BELL), Lucent Technologies, Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Centre hospitalier universitaire de Nantes (CHU Nantes), Unité de Nutrition Humaine - Clermont Auvergne (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne (UCA), Service des maladies infectieuses et tropicales [CHU Nantes], Plant Biomechanics Group, Botanischer Garten, Albert-Ludwigs-Universität Freiburg, Service de virologie [CHU Nantes], Centre de recherche en neurosciences de Lyon (CRNL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service des maladies infectieuses, Centre Hospitalier Universitaire de Nice (CHU Nice)-University Hospital, CHU Nice [Cimiez], Hôpital Cimiez [Nice] (CHU), Centre Hospitalier Universitaire de Nice (CHU Nice), Hopital l'Archet, Centre d'Information et de Soins de I'Immunodéficience Humaine (CISIH). Hôpital l'Archet 1, Hôpital l'Archet, Public Health Department, Hôpital de l'Archet, Institut de génétique humaine (IGH), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Infectious Diseases Department, Université Montpellier 1 (UM1), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre Régional de recherche et de Formation à la prise en charge Clinique de Fann (CRCF), CHNU Fann, Registre EPIMAD, CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Amiens-Picardie-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre d'Etudes Lasers Intenses et Applications (CELIA), Centre National de la Recherche Scientifique (CNRS)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université de Bordeaux (UB), Pharmacie de l'Hôpital Bichat, UMR CNRS 8179, Université de Lille, Sciences et Technologies-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Paris 5 (UPD5), Service de rhumatologie [Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Pathogénie des infections systémiques (UMR_S 570), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses [CHU Pitié-Salêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], Laboratoire d'aérologie (LA), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Centre National de la Recherche Scientifique (CNRS), McGill University = Université McGill [Montréal, Canada], Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Les Hôpitaux Universitaires de Strasbourg (HUS), Service de pneumologie, Hôpital Pontchaillou-CHU Pontchaillou [Rennes], CHU Pontchaillou [Rennes], SEV, Groupe d'Etudes et de Contrôle des Variétés et des Semences (GEVES), Service de virologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), University Hospital and University Jean Monnet, Institut de pharmacologie moléculaire et cellulaire (IPMC), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Génomique métabolique (UMR 8030), Genoscope - Centre national de séquençage [Evry] (GENOSCOPE), Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Université d'Évry-Val-d'Essonne (UEVE)-Centre National de la Recherche Scientifique (CNRS), Virologie et pathogenèse virale (VPV), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Imagine - Institut des maladies génétiques (IHU) (Imagine - U1163), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Institut Pasteur [Paris] (IP), Centre Hospitalier Gustave Dron [Tourcoing], Infection à VIH, réservoirs, diversité génétique et résistance aux antirétroviraux (ARV) (EA 7327), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Département d'Hématologie Clinique [CHU Nantes] (Hôtel-Dieu), Hôtel-Dieu de Nantes-Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], Maladies infectieuses et tropicales dans la Caraïbe (MAITC EA 4537), CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de la Martinique [Fort de France]-Université des Antilles (UA), Centre d'Investigation Clinique Antilles-Guyane (CIC - Antilles Guyane), Université des Antilles et de la Guyane (UAG)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pointe-à-Pitre/Abymes [Guadeloupe] -CHU de Fort de France-Centre Hospitalier Andrée Rosemon [Cayenne, Guyane Française], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Centre de Physiopathologie Toulouse Purpan (CPTP), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Dermatologie et Maladies infectieuses [Pointe-à-Pitre], CHU Pointe-à-Pitre/Abymes [Guadeloupe] -Centre de Gestion du Risque Infectieux Nosocomial [Pointe-à-Pitre] (CGRIN), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Infectious and Tropical Diseases Department [Montpellier], Institut de Recherche pour le Développement (IRD)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dat'AIDS study group: C Drobacheff-Thiébaut, A Foltzer, K Bouiller, C Chirouze, Q Lepiller, F Bozon, O Babre, A S Brunel, P Muret, H Laurichesse, O Lesens, M Vidal, N Mrozek, C Aumeran, O Baud, V Corbin, P Letertre-Gibert, S Casanova, J Prouteau, I Fabre, E Curlier, R Ouissa, C Herrmann-Storck, B Tressieres, T Bonijoly, M C Receveur, F Boulard, C Daniel, C Clavel, D Merrien, P Perré, T Guimard, O Bollangier, S Leautez, M Morrier, L Laine, F Ader, A Becker, F Biron, A Boibieux, L Cotte, P Miailhes, T Perpoint, S Roux, C Triffault-Fillit, S Degroodt, C Brochier, F Valour, C Chidiac, A Ménard, A Y Belkhir, P Colson, C Dhiver, A Madrid, M Martin-Degioanni, L Meddeb, M Mokhtari, A Motte, A Raoux, I Ravaux, C Tamalet, C Toméi, H Tissot Dupont, O Zaegel-Faucher, H Laroche, M Orticoni, M J Soavi, P Geneau de Lamarlière, E Ressiot, M J Ducassou, I Jaquet, S Galie, A Galinier, P Martinet, M Landon, A S Ritleng, A Ivanova, C Debreux, S Abel, O Cabras, L Cuzin, K Guitteaud, M Illiaquer, S Pierre-François, L Osei, J Pasquier, K Rome, E Sidani, J M Turmel, C Varache, N Atoui, M Bistoquet, E Delaporte, V Le Moing, N Meftah, C Merle de Boever, B Montes, A Montoya Ferrer, E Tuaillon, J Reynes, M André, L Boyer, M P Bouillon, M Delestan, C Rabaud, T May, B Hoen, C Bernaud, E Billaud, C Biron, B Bonnet, S Bouchez, D Boutoille, C Brunet-Cartier, C Deschanvres, N Hall, T Jovelin, P Morineau, V Reliquet, S Sécher, M Cavellec, A Soria, E Paredes, V Ferré, E André-Garnier, A Rodallec, M Lefebvre, O Grossi, O Aubry, F Raffi, S Breaud, C Ceppi, D Chirio, E Cua, P Dellamonica, E Demonchy, A De Monte, J Durant, C Etienne, S Ferrando, R Garraffo, C Michelangeli, V Mondain, A Naqvi, N Oran, I Perbost, S Pillet, C Pradier, B Prouvost-Keller, K Risso, V Rio, P M Roger, E Rosenthal, S Sausse, I Touitou, S Wehrlen-Pugliese, G Zouzou, L Hocqueloux, T Prazuck, C Gubavu, A Sève, A Maka, C Boulard, G Thomas, C Goujard, Y Quertainmont, E Teicher, N Lerolle, O Deradji, A Barrail-Tran, R Landman, V Joly, J Ghosn, C Rioux, S Lariven, A Gervais, F X Lescure, S Matheron, F Louni, Z Julia, C Mackoumbou-Nkouka, S Le Gac, C Charpentier, D Descamps, G Peytavin, Y Yazdanpanah, K Amazzough, G Benabdelmoumen, P Bossi, G Cessot, C Charlier, P H Consigny, F Danion, A Dureault, J Goesch, R Guery, B Henry, K Jidar, F Lanternier, P Loubet, O Lortholary, C Louisin, J Lourenco, P Parize, B Pilmis, F Touam, M A Valantin, R Tubiana, R Agher, S Seang, L Schneider, C Blanc, C Katlama, J L Berger, Y N'Guyen, D Lambert, I Kmiec, M Hentzien, A Brunet, V Brodard, P Tattevin, M Revest, F Souala, M Baldeyrou, S Patrat-Delon, J M Chapplain, F Benezit, M Dupont, M Poinot, A Maillard, C Pronier, F Lemaitre, C Guennoun, M Poisson-Vanier, T Jovelin, J P Sinteff, C Arvieux, E Botelho-Nevers, A Gagneux-Brunon, A Frésard, V Ronat, F Lucht, P Fischer, M Partisani, C Cheneau, M Priester, M L Batard, C Bernard-Henry, E de Mautort, S Fafi-Kremer, M Alvarez, N Biezunski, A Debard, C Delpierre, P Lansalot, L Lelièvre, G Martin-Blondel, M Piffaut, L Porte, K Saune, F Ajana, E Aïssi, I Alcaraz, V Baclet, L Bocket, A Boucher, P Choisy, B Lafon-Desmurs, A Meybeck, M Pradier, O Robineau, N Viget, M Valette., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut Pasteur [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Institut Pasteur [Paris], Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-CHU Amiens-Picardie, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université d'Évry-Val-d'Essonne (UEVE)-Centre National de la Recherche Scientifique (CNRS), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Université Paul-Valéry - Montpellier 3 (UPVM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Université de Perpignan Via Domitia (UPVD)-Université Montpellier 1 (UM1)-Groupe Sup de Co Montpellier (GSCM) - Montpellier Business School-Université de Montpellier (UM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Centre National d'Études Spatiales [Toulouse] (CNES)-Météo France-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, and Dupuis, Christine

Subjects
0301 basic medicine, Pediatrics, medicine.medical_specialty, MESH: Sarcoma, Kaposi* / epidemiology, [SDV]Life Sciences [q-bio], 030106 microbiology, HIV Infections, Dermatology, Skin Infectiology, Venereology and Sexual Health, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, MESH: HIV Infections* / complications, 030212 general & internal medicine, Sarcoma, Kaposi, Retrospective Studies, Response rate (survey), MESH: Acquired Immunodeficiency Syndrome, MESH: Herpesvirus 8, Human, Acquired Immunodeficiency Syndrome, MESH: Humans, business.industry, Kaposi sarcoma, HIV, Retrospective cohort study, MESH: Retrospective Studies, MESH: HIV Infections* / drug therapy, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], medical dermatology, Regimen, Infectious Diseases, Clinical research, clinical research, Herpesvirus 8, Human, Cohort, oncology, Original Article, Sarcoma, business, Viral load, MESH: HIV Infections* / epidemiology, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background - 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.

Published
2020
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50. Reappraising Cladophialophora bantiana phaeohyphomycosis in France: retrospective nation-based study.

Author

Lortholary O, Garcia-Hermoso D, Sturny-Leclère A, Sitbon K, Nourrisson C, Letscher-Bru V, Desbois-Nogard N, Bani-Sadr F, Bastides F, Bienvenu B, Cordier C, Coste A, Danion F, Dégot T, Delarbre D, Fekkar A, Garcie C, Garrouste C, Gits-Muselli M, Guemas E, Huguenin A, Janvier F, Kamar N, Kervinio C, Le Gal S, Lesens O, Machouart M, Persat F, Picot S, Rouze A, Ranque S, Ruch Y, Saada M, Stabler S, Alanio A, Lanternier F, and Desoubeaux G

Subjects
Humans, Retrospective Studies, France epidemiology, Male, Middle Aged, Female, Adult, Aged, Phaeohyphomycosis drug therapy, Phaeohyphomycosis microbiology, Phaeohyphomycosis epidemiology, Phaeohyphomycosis mortality, Phaeohyphomycosis diagnosis, Antifungal Agents therapeutic use, Young Adult, Adolescent, Aged, 80 and over, Ascomycota isolation & purification, Ascomycota drug effects
Abstract

Background: Cladophialophora bantiana is one of the most virulent phaeohyphomycetes, typically causes non-angiogenic single (or sometimes multiple) cystic brain lesions, and has resulted in a mortality rate of up to 70%. Most C bantiana cases are described either in a series of isolated reports or in very small cohorts. The aim of this retrospective nation-based study was to share the data on C bantiana phaeohyphomycosis cases reported in France and French overseas territories over the past two decades to improve understanding of this disease., Methods: Patients with C bantiana infection were processed through the active surveillance programme of invasive fungal infections launched by the National Reference Center for Mycoses and Antifungals, Institut Pasteur (Paris, France), and the French Surveillance Network of Invasive Fungal Infections, which involved 29 hospitals from mainland France and overseas French territories. Only proven and probable cases of infection, according to the revised and updated consensus definitions from the European Organization for Research and Treatment of Cancer and Mycoses Study Group, were included in the study. Patients were diagnosed or confirmed, or both, using a polyphasic approach at the Institut Pasteur between 2002 and 2022. Patients were separated into two groups: those with CNS involvement and those with no CNS involvement. The primary outcome was the survival rate., Findings: A total of 23 patients with a C bantiana invasive infection were included during the study period (Jan 1, 2002, to Dec 31, 2022). The median age was 56 years in the CNS involvement group and 65 years in the non-CNS involvement group. Until 2021, the annual number of cases varied between zero and two, with six cases observed in 2022, the warmest year recorded in France since 1900. CNS involvement was observed in 15 (65%) patients, including three disseminated cases; skin and soft tissue involvement in seven (30%) patients and an isolated lung infection in one case. Diabetes was observed in five patients, and any immunodepression factor was observed in 14 (61%) of 23 patients. When considering only patients with CNS involvement, 9-month survival appeared higher in patients who underwent exeresis or large drainage (three [75%] of four patients vs three [27%] of 11 patients; p=0·24) and significantly higher in those treated for 2 or more weeks with triple antifungal therapy (liposomal amphotericin B plus posaconazole and flucytosine; seven [78%] of nine patients vs one [17%] of six patients; p=0·040). Two patients were treated with excision surgery alone (one patient with success, and the other patient lost to follow-up)., Interpretation: This study shows that the clinical presentations and underlying medical conditions of C bantiana infections are more diverse than previously described. It also emphasises a significant difference in mortality rate between those with and without CNS involvement. The prognosis improved when surgery was performed and triple antifungal therapy was administered. Such rare and devastating invasive fungal infections should be managed by a multidisciplinary team., Funding: Santé Publique France., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

Published
2024
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