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Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men: real-life experience from three sexual health clinics in France To the Editor Although pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV acquisition in patients exposed to a high risk of infection such as men who have sex with men (MSM),1-3 there are still several uncertainties, including the resurgence of other sexually transmitted infections (STIs).4-6 We conducted a multicenter, retrospective, observational study in three sexual health clinics of north-east France from March 2017 to April 2019 to compare in a real-life setting the non-HIV STI incidence in an MSM patient population treated by PrEP to that of an MSM patient population with no prophylactic treatment. The risk to develop a new STI in MSM/PrEP+ patients during the follow-up (17%) was not significantly reduced compared to the MSM/PrEP- control group (Relative Risk = 0.83; 95% CI = 0.5621-1.223). [Extracted from the article]

The study described Pneumocystis jirovecii (P. jirovecii) multilocus typing in seven AIDS patients living in French Guiana (Cayenne Hospital) and seven immunosuppressed patients living in Brest, metropolitan France (Brest Hospital). Archival P. jirovecii specimens were examined at the dihydropteroate synthase (DHPS) locus using a PCR-RFLP technique, the internal transcribed spacer (ITS) 1 and ITS 2 and the mitochondrial large subunit rRNA (mtLSUrRNA) gene using PCR and sequencing. Analysis of typing results were combined with an analysis of the literature on P. jirovecii mtLSUrRNA types and ITS haplotypes. A wild DHPS type was identified in six Guianese patients and in seven patients from metropolitan France whereas a DHPS mutant was infected in the remaining Guianese patient. Typing of the two other loci pointed out a high diversity of ITS haplotypes and an average diversity of mtLSUrRNA types in French Guiana with a partial commonality of these haplotypes and types described in metropolitan France and around the world. Combining DHPS, ITS and mtLSU types, 12 different multilocus genotypes (MLGs) were identified, 4 MLGs in Guianese patients and 8 MLGs in Brest patients. MLG analysis allows to discriminate patients in 2 groups according to their geographical origin. Indeed, none of the MLGs identified in the Guianese patients were found in the Brest patients and none of the MLGs identified in the Brest patients were found in the Guianese patients. These results show that in French Guiana (i) PCP involving DHPS mutants occur, (ii) there is a diversity of ITS and mtLSUrRNA types and (iii) although partial type commonality in this territory and metropolitan France can be observed, MLG analysis suggests that P. jirovecii organisms from French Guiana may present specific characteristics., (Copyright © 2014 Elsevier B.V. All rights reserved.)

This study examined tap water as a source of Pseudomonas aeruginosa in a medical intensive care setting. We prospectively screened specimens of patients, tap water and hands of healthcare workers (HCWs) over a six-month period in a 16-bed medical intensive care unit. Molecular relatedness of P. aeruginosa strains was investigated by pulsed-field gel electrophoresis. A total of 657 tap water samples were collected from 39 faucets and 127 hands of HCWs were sampled. P. aeruginosa was found in 11.4% of 484 tap water samples taken from patients' rooms and in 5.3% of 189 other tap water samples (P<0.01). P. aeruginosa was isolated from 38 patients. Typing of 73 non-replicate isolates (water samples, hands of HCWs and patients) revealed 32 major DNA patterns. Eleven (52.4%) of the 21 faucets were contaminated with a patient strain, found before isolation from tap water in the corresponding room in nine cases, or from the neighbouring room in two cases. Among seven P. aeruginosa strains isolated from HCW hands, the genotype obtained was the same as that from the last patient they had touched in six cases, and in the seventh with the last tap water sample used. More than half of P. aeruginosa carriage in patients was acquired via tap water or cross-transmission. Carriage of P. aeruginosa by patients was both the source and the consequence of tap water colonisation. These results emphasise the need for studies on how to control tap water contamination.

The role of the police in Western society is undergoing a transformation that reflects the economic social and technological changes in the community and the assertion of individual rights within a democracy. The aim of this study is to evaluate level of stress among a group of French policemen and to examine the association between policing, potential stressors and stress levels. The sample is drawn from a large metropolitan police force (n=617). The population extends from the first line policeman to top senior management. Each policeman is matched for age (more or less five years) and sex, to a control. Policemen and controls complete a self administered questionnaire including demographic, occupational and health characteristics, and a stress level assessment with the help of a visual analogue scale. The average age of the two groups is 40 yr. Eighty-four percent are men. The total score for average sources is not statistically significantly different for policemen and controls. Comparison of a police group with a high stress level to a police population with a low and moderate stress level is made. The comparison is done first only with men, and second with the whole population. Policemen with a high stress level (same results only for men and the whole population) belong to the following groups: more than 15 yr service, sergeant, officer and administrative employee rank, divorced experience, age over 30, no leisure-time activities and no hobbies. Multivariate analysis shows that the two last parameters are bound to the stress level. For the whole population, age over 30 has to be added, and for the group of men, length of service over five years should be noted. Stress at work is an ill-health provoking factor. Police from minority groups such as ageing subjects or police officers have been reported to experience greater stress. This population is adversely affected by lack of available manpower and long working hours. In fact sources of stress in the police population are found both in the weariness of the job and private life planning.

Objectives: To describe and analyze the clinical and biological manifestations of thrombotic microangiopathy (TMA) and evaluate the therapeutic strategies., Methods: A retrospective study was performed in 14 infectious diseases units of southern France. All HIV patients presenting TMA during the last decade were selected (n = 14)., Results: The principle signs observed, aside from defining TMA (association of microangiopathic hemolytic anemia, thrombocytopenia and renal failure), were diarrhea (n = 9) and a high level of lacticodehydrogenase (LDH). Patients were at an advanced stage of HIV infection (median of CD4+ cells counts = 70/mm3). Specific etiology was identified in 7 cases: bacterial infection (n = 5), CMV retinitis associated with Kaposi's sarcoma (n = 1) and intravenous drug use (n = 1). Various treatments were used: plasmatic exchange (5 cases), fresh frozen plasma (6 cases), steroid therapy (4 cases), acetyl salicylic acid (3 cases), adaptation of antiretroviral treatment (3 cases). The global prognostic was poor with 50% mortality within 2 months. A high level of LDH (> 2500 UI/L) was associated with premature death in 5 of the 6 cases observed., Conclusion: Our data confirm the severity of TMA in case of HIV infection. The common treatment remains the use of plasmatic exchange and fresh frozen plasma; an optimal antiretroviral therapy must be associated.