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Unlabelled: In France, patients over 50 years represent more than 23.6% of all registered cases in the French Hospital Database for HIV (FHDH), and 18% of newly HIV-diagnosed patients., Objective: To describe the long-term evolution after 4 years of a cohort of HIV infected patients older than 60 years recruited in COREVIH Île-de-France Ouest., Results: One hundred and forty-nine participants, 115 men (77%) and 34 women (23%), were included in the cohort analysis in 2004, and baseline characteristics were: median age 65.4 years (60.3-86.3), CDC stage C: 36%, HBV and HCV co-infections: four (2.7%) and eight (5.4%) patients, median time from first HIV infection diagnosis: 8.5 years (0.25-19.5), ongoing HAART regimen: 88%, median duration of ARV treatment: 7.5 years (0.2-15.5), baseline CD4 cells count: 372/mm(3) (18-1860), HIV viral load less than 200 c/ml: 104 (70%). After a 4-year follow-up, 111 patients were alive, all but one treated with HAART, 17/149 (11.5%) were lost for follow-up, and 21/149 were deceased (14%). Causes of death were acute cardiovascular disease (4/21), neoplasia (11/21), neurological disease 1/21, end stage liver disease 3/21, unknown 2/21. The prevalence of co-morbidities after 4 years of follow-up were: arterial hypertension 40/111 (36%), hypercholesterolemia 48/111 (43%), diabetes 23/111 (21%), kidney disease with renal insufficiency (creatinine clairance<60 ml/min): 36/111 (32%). At the end of follow-up, median CD4 cells count was 494/mm(3), and viral load was undetectable less than 200 c/ml in 107/111 patients (96%). No new opportunistic infection occurred during the 4-year follow-up, but 24 patients had a new diagnosis of neoplasia (incidence 40/1000 person-year). Cancer was the cause of death in 11/24., Conclusion: Clinical and immunological improvement was continuous under HAART in these aged HIV infected patients, but co-morbidities are frequently observed in this population, with high incidence of cardiovascular disease and neoplasia, and related mortality. A multidisciplinary approach, with preventive consultations, oncology and cardiovascular screening, as done in geriatrics, is warranted in the aging HIV population., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: Simplification of combined antiretroviral therapy in HIV-infected patients is possible, but virological success can be compromised by the development or emergence of resistant viruses., Case: Worsening renal functioning in a patient under successful combination antiretroviral therapy resulted led to the replacement of indinavir by abacavir. Eight weeks later, his viral load rose and he developed a mutant virus resistant to all the nucleoside analogs., Discussion: Our case report illustrates the danger of streamlining combined antiretroviral therapy composed only of nucleoside analogs in patients already successfully treated with nucleoside analogs, by exposing them to the risk of the emergence of a mutant virus.

Objectives: Determine possible differences in clinical manifestations, laboratory findings and neuroimaging results in tuberculous meningitis patients with and without HIV infection., Patients and Methods: We retrospectively reviewed data of 38 patients with positive cerebrospinal fluid cultures for Mycobacterium tuberculosis who were hospitalized in 3 university hospitals in Paris over the last 11 years., Results: There were 24 HIV-infected patients and 14 without HIV infection. Mean CD4 lymphocyte count was 103 +/- 180/mm3 in the HIV group. Age (median age = 33 years for the HIV group vs. 53 for the non-HIV group), sex ratio (3 vs. 0.75), and prior history of tuberculosis (46% vs. 43%) were similar in both groups. Clinical presentation was similar for headache (83% in HIV group vs. 50% in non-HIV group; p = 0.02) and confusion (54% vs. 93% in non-HIV group p = 0.05). Serum natremia (mmol/l) (131 +/- 5 vs. 125 +/- 8; p = 0.024), white blood cell count (x 10(9)/l) (5.8 +/- 4.7 vs. 10.7 +/- 1.7; p = 0.37) and erythrocyte sedementation rate (mm/h) (68 +/- 34 vs. 31 +/- 35; p = 0.003) were significantly different in the 2 groups. Median cerebrospinal fluid findings were similar in the 2 groups: leukocytes (x 10(6)/l) (375 +/- 860 vs 218 +/- 250), glucose (mmol/l) (2.3 +/- 0.9 vs 2.7 +/- 1.9) and protein (g/l) (3.8 +/- 7.1 vs. 2.6 +/- 1.6). CT-scans of the brain were similar in the 2 groups. Mortality during hospitalization was similar (42% vs 36%; NS)., Conclusion: HIV infection appears to have little impact on the presentation of tuberculous meningitis.

Objectives: Assess expression of pulmonary toxoplasmosis, the second most frequent localization after brain, in patients infected with the human immunodeficiency virus (HIV)., Methods: Twenty-one HIV-infected patients (18M, 3F) were admitted for pulmonary toxoplasmosis between September 1987 and February 1995. Mode of HIV transmission was unprotected homosexual sexual activity (n = 16), intravenous drug abuse (n = 3) and transfusion (n = 2)., Results: Isolated pulmonary toxoplasmosis was found in 11 patients. In 10 patients pulmonary toxoplasmosis was associated with cerebral (n = 4), bone marrow (n = 2), ocular (n = 1) and multifocal (n = 3) localizations. Seven patients were admitted for acute pulmonary distress. Fever (reported for 20 patients) and nonproductive cough (reported for 16 patients) were the most common clinical symptoms. Chest roentgenogram revealed bilateral pulmonary infiltrates in 16 (76%) patients. Mean absolute CD4 count was 25 +/- 57 (range 0-110). Serologic evidence of past infection was observed in 18 patients. Serology tests were not done for two patients and negative for one. Two patients presented co-infection with Pneumocystis carinii. Fourteen patients had elevated serum lactic dehydrogenase (LDH) concentration. Among those, 4 patients whose LDH concentration was elevated more than ten fold died of respiratory distress. Patients received pyrimethamine and sulfadiazine (n = 13) or clindamycin (n = 8). Seven patients died during the first month after diagnosis was made. For the other patients, mean survival was 8 months. No relapse of toxoplasmosis was observed. All the patients took a secondary prophylaxis., Conclusion: No difference between patient with isolated pulmonary toxoplasmosis and patients with associated extra-pulmonary localization was noted for clinical, biological, radiological presentations and outcome.