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Summary: Background: No study has compared the virological and immunological status of young people with perinatally-acquired HIV infection (P-HIV) with that of people with HIV adulthood (A-HIV) having a similar duration of infection. Methods: 5 French cohorts of P-HIV and A-HIV patients with a known date of HIV-infection and receiving antiretroviral treatment (ART), were used to compare the following proportions of: virological failure (VF) defined as plasma HIV RNA ≥ 50 copies/mL, CD4 cell percentages and CD4:CD8 ratios, at the time of the most recent visit since 2012. The analysis was stratified on time since infection, and multivariate models were adjusted for demographics and treatment history. Findings: 310 P-HIV were compared to 1515 A-HIV (median current ages 20.9 [IQR:14.4–25.5] and 45.9 [IQR:37.9–53.5] respectively). VF at the time of the most recent evaluation was significantly higher among P-HIV (22.6%, 69/306) than A-HIV (3.3%, 50/1514); p ≤ 0.0001. The risk of VF was particularly high among the youngest children (2–5 years), adolescents (13–17 years) and young adults (18–24 years), compared to A-HIV with a similar duration of infection: adjusted Odds-Ratio (aOR) 7.0 [95% CI: 1.7; 30.0], 11.4 [4.2; 31.2] and 3.3 [1.0; 10.8] respectively. The level of CD4 cell percentages did not differ between P-HIV and A-HIV. P-HIV aged 6–12 and 13–17 were more likely than A-HIV to have a CD4:CD8 ratio ≥ 1: 84.1% vs. 58.8% (aOR = 3.5 [1.5; 8.3]), and 60.9% vs. 54.7% (aOR = 1.9 [0.9; 4.2]) respectively. Interpretation: P-HIV were at a higher risk of VF than A-HIV with a similar duration of infection, even after adjusting for treatment history, whereas they were not at a higher risk of immunological impairment. Exposure to viral replication among young patients living with HIV since birth or a very early age, probably because of lower adherence, could have an impact on health, raising major concerns about the selection of resistance mutations and the risk of HIV transmission. Funding: Inserm - ANRS MIE.

Leptospirosis is a worldwide zoonosis with higher incidence in tropical areas and is a neglected disease in the Pacific region. French Polynesia (FP) is a French overseas territory located in the South Pacific. Data on the epidemiology in FP are scarce. In this study, we describe our understanding of leptospirosis epidemiology in FP and discuss the prospects concerning this disease and its surveillance to better address preventive actions. We report 11 years of surveillance data between 1 January 2007 and 31 December 2017. Over the study period, 1356 confirmed and probable leptospirosis cases were reported. The mean annual incidence rate was 46.0 (95% confidence interval, 43.6–48.5) cases per 100 000 inhabitants. We registered 864 (63.7%) hospitalizations; of these, at least 270 (19.9%) were in the intensive care unit, and 24 patients (1.8%) died. Even if the incidence of leptospirosis is lower in FP compared to most of other Pacific countries and territories, our data confirm that the disease is highly endemic in FP. Despite all the preventive measures taken, leptospirosis remains a major public health concern in FP, thus highlighting the need to maintain intensive leptospirosis surveillance, medical staff training and provision of information to the general population. Keywords: Epidemiology, incidence, leptospirosis/epidemiology, polynesia/epidemiology, public health/epidemiology, zoonoses

Objectives: Errors are frequently made in the prescription of antiretroviral medication for hospitalized HIV-infected patients. We had for aim to evaluate the prescription of antiretroviral drug regimens at hospital admission and the impact of a strategy implemented to prevent errors., Methods: HIV-infected patients managed by our hospital as outpatients and admitted between January 1, 2010, and December 31, 2010 (first period) and between February 1, 2011, and January 31, 2012 (second period) were included in the study. We retrospectively identified errors made in the prescription of antiretrovirals by comparing the drugs prescribed during hospitalization and the treatment documented in the outpatient file. During the second period, we implemented a strategy involving the pharmacist and the infectious disease specialist to reduce the number of errors., Results: Thirty-five patients were treated during the first period for 56 admissions, and 43 patients for 77 admissions during the second one. We identified 39% of medication-related errors during the first period and 42% during the second one. The most common errors were drug omission, inappropriate dosage, or failure to adjust dosage for renal insufficiency. Our intervention, during the second period, allowed correcting 36% of errors., Conclusion: In our study, errors made in the prescription of antiretroviral medication were frequent and our intervention allowed correcting 36% of errors. Other strategies, such as consulting a clinical pharmacist on admission, or training prescribers should be considered., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Since the onset of the human immunodeficiency virus (HIV) epidemic, the care of infected patients improved dramatically. Whereas the disease was almost always fatal, the development of new drugs and new therapeutic strategies now allow a prolonged survival. However, the complexity of patient care is increasing and physicians face new clinical events and treatment toxicities. Recent molecules and follow-up according to the recent French recommendations will be presented here. The objectives of the treatment is to decrease mortality and morbidity of the HIV infection, by restoring near normal CD4+ T cell counts and qualitative T CD4+ responses, associated with a sustained reduction in viral replication. This objective must be reached by minimizing toxicity of antiretroviral drugs. Newly developed drugs that are better-tolerated and new therapeutic classes should improve outcome at all stages of HIV infection. Whereas viral eradication remains unrealistic and protective vaccines will not be soon available, direct consequences of long term HIV infection and issues related to an ageing HIV infected population raise up new research topics. Prevention of new infections, improvement in the precocity of care by a better-targeted screening and assessment of therapy before an established immune deficiency appear as the main priorities for the coming years.