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Mother-to-child transmission of chikungunya virus was reported during the 2005-2006 outbreak on Reunion Island, France. To determine the effects of this virus on pregnancy outcomes, we conducted a study of pregnant women in Reunion in 2006. The study population was composed of 1,400 pregnant women (628 uninfected, 658 infected during pregnancy, 27 infected before pregnancy, and 87 infected on unknown dates). We compared pregnancy outcomes for 655 (628 + 27) women not infected during pregnancy with 658 who were infected during pregnancy. Infection occurred during the first trimester for 15% of the infected women, the second for 59%, and the third for 26%. Only hospital admission during pregnancy differed between infected and uninfected women (40% vs. 29%). Other outcomes (cesarean deliveries, obstetric hemorrhaging, preterm births, stillbirths after 22 weeks, birthweight, congenital malformations, and newborn admissions) were similar. This virus had no observable effect on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016.Methods: Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area.Results: Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%).Conclusion: With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access. [ABSTRACT FROM AUTHOR]

Background: In January 2016, the French Medicine Agency initiated a Temporary Recommendation for Use (TRU) to allow the use of oral intake of tenofovir disoproxil fumarate and emtricitabine for pre-exposure prophylaxis (PrEP) in adults at high risk of HIV. We report the results of the first year of PrEP implementation in France.Methods: Data were collected by physicians using a secured web subject-monitoring interface, with two forms: an initiation form, with patients' baseline characteristics, and an HIV seroconversion form. Univariate and adjusted multivariate analysis using a logistic regression model were performed to identify baseline factors associated with on-demand PrEP regimen prescription.Results: From 4 January 2016 to 28 February 2017, 3405 subjects were enrolled, with 2774 initiation forms completed; 98.1% were male and 96.9% were MSM. An on-demand regimen was prescribed to 57% of subjects. Older age (OR for participants older than 50 years = 1.76, 95% CI 1.35-2.3, P < 0.001) and site of prescription (OR of former IPERGAY sites = 2.28, 95% CI 1.84-2.83, P < 0.001) were associated with on-demand prescription. Those reporting sexually transmitted infection (STI) and condomless anal sex with at least two different partners were less likely to receive on-demand PrEP (OR = 0.68, 95% CI 0.57-0.82 and 0.75, 95% CI 0.57-0.98, respectively; P < 0.05 for all). Four breakthrough HIV infections were reported during the study, in the context of PrEP interruption or acute infection at the time of PrEP initiation.Conclusions: In a real-life setting in France, PrEP was used, either daily or on-demand, mostly by MSM, with breakthrough infections being rare. [ABSTRACT FROM AUTHOR]

• We aimed to describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 as well as patients' characteristics related to the use of protease inhibitors in 2015. We extracted data from 15,897 patients who started a first antiretroviral therapy between 2005 and 2015. Before 2014, 60% of initial treatment regimens were based on boosted protease inhibitors. The use of integrase strand transfer inhibitors as first-line treatments was recommended in 2014, and they have since been gradually replacing boosted protease inhibitors in the first-line treatment setting. In 2015, boosted protease inhibitors were still more frequently prescribed to young women, patients with high viral loads, and patients low CD4 cell counts. To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015. We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load ˃5 log copies/mL were less likely to receive NNRTI (OR = 0.08) or INSTI regimens (OR = 0.69) than bPIs. Patients with initial CD4+ T cell count ˂200/mm3 were less likely to receive an NNRTI (OR = 0.28) or an INSTI regimen (OR = 0.52) than a bPI. Women were less likely to receive an NNRTI (OR = 0.79) or an INSTI regimen (OR = 0.71) than a bPI; although this depended on age. The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4+ T cell count, and in women. [ABSTRACT FROM AUTHOR]

Objectives: Studies evaluating the efficacy and safety of the fixed‐dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV‐1 and hepatitis C virus (HCV) have mainly included treatment‐naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment‐experienced patients with and without cirrhosis. Methods: We conducted a multicentre, open‐label, double‐arm, nonrandomized study in patients coinfected with HIV‐1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first‐generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed‐dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient‐reported outcomes. Results: Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty‐five patients [95.6%; 95% confidence interval (CI): 87.6–99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient‐reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14–0.96; P = 0.04]. Mean tenofovir area under the plasma concentration–time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified. Conclusions: LDV/SOF provided a high SVR rate in PI‐experienced subjects coinfected with HCV genotype 1 and HIV‐1, including patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to determine whether there is a relationship between social deprivation and time of HIV diagnosis in France. Methods: Prospectively collected data from a multicentre database were used in the study. Patients with a first HIV diagnosis between 1 January 2014 and 31 December 2015 were selected from the database. Deprivation was measured using the European Deprivation Index (EDI), which is an ecological index constructed from the address of residence and based on the smallest geographical census unit, in which individuals are classified so as to be comparable with national quintiles. Time of diagnosis was classified as being at an early, intermediate, late, or advanced stage of disease. Age, gender, distance from home to HIV centre, most probable route of infection, and hepatitis B or C coinfection were considered in the analysis. Because of a strong interaction between gender and most probable route of infection, we constructed a ‘population’ variable: men who have sex with men (MSM), heterosexual men and women. Results: Of 1421 newly diagnosed patients, 44% were diagnosed either late or at an advanced stage of disease, and 46.3% were in the highest deprivation quintile. Using multivariate logistic regression, ‘population’ [odds ratio (OR) 0.62 (95% confidence interval (CI) 0.48–0.78) for MSM compared with women] and age [OR 1.39 (95% CI 1.07–1.80), 1.72 (1.32–2.23) and 1.86 (1.40–2.47) for the second, third and fourth quartiles, respectively, compared with the first quartile] were found to be related to late diagnosis. EDI level was not related to late HIV diagnosis. Conclusions: ‘Population’ seems to be more relevant than EDI to define evidence‐based interventions to limit late diagnosis. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral preexposure prophylaxis has been shown to reduce the risk of human immunodeficiency virus type 1 (HIV-1) infection in some studies, but conflicting results have been reported among studies, probably due to challenges of adherence to a daily regimen.Methods: We conducted a double-blind, randomized trial of antiretroviral therapy for preexposure HIV-1 prophylaxis among men who have unprotected anal sex with men. Participants were randomly assigned to take a combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) or placebo before and after sexual activity. All participants received risk-reduction counseling and condoms and were regularly tested for HIV-1 and HIV-2 and other sexually transmitted infections.Results: Of the 414 participants who underwent randomization, 400 who did not have HIV infection were enrolled (199 in the TDF-FTC group and 201 in the placebo group). All participants were followed for a median of 9.3 months (interquartile range, 4.9 to 20.6). A total of 16 HIV-1 infections occurred during follow-up, 2 in the TDF-FTC group (incidence, 0.91 per 100 person-years) and 14 in the placebo group (incidence, 6.60 per 100 person-years), a relative reduction in the TDF-FTC group of 86% (95% confidence interval, 40 to 98; P=0.002). Participants took a median of 15 pills of TDF-FTC or placebo per month (P=0.57). The rates of serious adverse events were similar in the two study groups. In the TDF-FTC group, as compared with the placebo group, there were higher rates of gastrointestinal adverse events (14% vs. 5%, P=0.002) and renal adverse events (18% vs. 10%, P=0.03).Conclusions: The use of TDF-FTC before and after sexual activity provided protection against HIV-1 infection in men who have sex with men. The treatment was associated with increased rates of gastrointestinal and renal adverse events. (Funded by the National Agency of Research on AIDS and Viral Hepatitis [ANRS] and others; ClinicalTrials.gov number, NCT01473472.). [ABSTRACT FROM AUTHOR]

Bien que l'épidémiologie des uvéites dans les pays occidentaux soit bien connue, peu de données sont disponible concernant leurs caractéristiques et leur épidémiologie lorsqu'elles affectent les patients vivants avec le VIH (PVVIH). L'objectif principal de cette étude était d'évaluer la fréquence relative des étiologies d'uvéites chez les PVVIH. Il s'agit d'une étude rétrospective multicentrique, incluant les patients âgés de plus de 18 ans, vivants avec le VIH, et ayant présenté une uvéite active entre janvier 2000 et décembre 2020 au sein des CHU de Nancy, Dijon, de l'Hôpital de la Pitié Salpêtrière (Assistance Publique–Hôpitaux de Paris) et de l'Hôpital de la Croix-Rousse (Hospices Civils de Lyon). Les patients présentant des séquelles d'uvéites passées sans signe d'inflammation active étaient exclus. Un total de 83 PVVIH ont été inclus, dont 56 hommes et 27 femmes (sex ratio = 2,07), avec un âge moyen de 43,2 ± 11,1 ans au diagnostic de l'uvéite. Les uvéites étaient avant tout infectieuses (61,4 %), puis idiopathiques (21,7 %), d'origine systémiques (8,4 %), médicamenteuses (4,8 %), et enfin correspondaient à des entités ophtalmologiques pures (3,6 %). Parmi les uvéites infectieuses, l'agent infectieux le plus fréquemment en cause était la syphilis (15/51, exclusivement des hommes), suivi du VIH (12/51), du CMV (7/51), de l'HSV5/51) et du ZVZ (5/51), la toxoplasmose (4/51), la tuberculose (2/51), EBV (1/51) et Borrelia burgdorferi (1/51). Parmi les 7 uvéites d'origines systémiques, 4 étaient liée à l'antigène HLA-B27 (avec spondylarthropathie), 2 à une sarcoïdose et 1 à une maladie inflammatoire chronique de l'intestin. Toutes les uvéites médicamenteuses étaient liées à la rifabutine. Deux patients présentaient des ophtalmies sympathiques et une maladie de Eales. Après comparaison à une cohorte de patients non VIH avec uvéites, il était noté une augmentation significative de la proportion d'uvéites infectieuses et d'uvéites médicamenteuses (61,4 % vs. 12,7 %, p < 0,001, et 4,8 % vs. 0,3 %, p = 0,001, respectivement) et une diminution significative d'uvéites idiopathiques et d'origine systémique (21,7 % vs. 59,7 %, p < 0,001, et 8,8 % vs. 20,8 %, p = 0,005, respectivement). Au sein des patients ayant bénéficié d'une évaluation du taux de lymphocytes T (LT) CD4 au moment du diagnostic de l'uvéite, la proportion d'uvéites infectieuses était de 85,7 % lorsque le taux de LT CD4 était inférieur à 50/mm3, de 64,7 % lorsque le taux de LT CD4 était entre 50 et 200/mm3, de 58,8 % lorsque le taux de LT CD4 était entre 200 et 500/mm3, et de 48,1 % lorsque le taux de LT CD4 était supérieur à 500/mm3. Cette proportion chez les patients ayant plus de 500 LT CD4/mm3 restait significativement supérieure à celle retrouvée chez les patients non atteints par le VIH (48,1 % vs. 12,7 %, p < 0,001). Les uvéites infectieuses sont la première cause d'uvéite chez les PVVIH, avec une forte proportion d'uvéites syphilitiques. Cette fréquence et significativement augmentée par rapport à celle retrouvée dans la population générale, et ce, même après normalisation du taux de LT CD4. Cette étude souligne d'une part l'impact majeure du VIH sur le profil étiologique des uvéites, justifiant de réaliser une sérologie VIH au cours du bilan étiologique de toute uvéite, et d'autre part, l'importance d'envisager une enquête infectieuse exhaustive et rapide chez les PVVIH présentant une uvéite. [ABSTRACT FROM AUTHOR]

We aimed to compare the evolution of estimated glomerular filtration rate ( eGFR) in HIV-, HIV-HBV- and HBV-infected patients treated with tenofovir disoproxil fumarate (TDF). Three groups of patients receiving TDF > 12 months were recruited: 194 HIV-infected patients, 85 HIV-HBV-coinfected patients and 50 HBV-infected patients. eGFR was estimated using the Modification of the Diet in Renal Disease ( MDRD) equation. Multivariate regression models were constructed to estimate factors associated with eGFR decrease from baseline. A total of 329 patients were studied. Median follow-up was 2.7 years. Median eGFR decrease was −4.9 (−16.6 to +7.2) mL/min/1.73 m2. After multivariate stepwise regression analysis, age ( P = 0.0002), non- African origin ( P < 0.0001), baseline eGFR ( P < 0.0001) and TDF duration ( P = 0.02) were associated with eGFR decrease in the whole population, while hypertension, diabetes and type of infection were not. Age ( P < 0.0001), non-African origin ( P = 0.0004), baseline eGFR ( P < 0.0001) and TDF duration ( P = 0.007) remained associated with eGFR decline in HIV and HIV-HBV-infected patients, while other variables including HIV risk factor, CDC stage, CD4 and HIV-RNA levels were not. Age ( P = 0.03), non- African origin ( P = 0.004), baseline eGFR ( P < 0.0001) and baseline HBV-DNA > 2000 IU/ mL ( P = 0.04) were associated with eGFR decline in HBV and HIV-HBV-infected patients, while other variables including HBV risk factor and fibrosis stage were not. Estimated glomerular filtration rate decline under TDF therapy appears mainly associated with older age, non- African origin, higher baseline eGFR and longer TDF administration but not with the type of viral infection. Regular follow-up of renal function, especially tubular function is recommended during TDF therapy. [ABSTRACT FROM AUTHOR]

Transient elastography (TE) is a noninvasive technique to evaluate liver fibrosis. We compared the performance of TE with liver biopsy (LB) in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection. Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was calculated using receiver operating characteristic (ROC) curves for different stages of fibrosis, and optimal cut-off values were defined. A sequential algorithm combining TE with biochemical score (Fibrotest®) is proposed. Fifty-seven patients had both TE and LB (median time: 3 days) and two with proven cirrhosis, only TE. Forty-six (78%) were under antiretroviral therapy with anti-HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase (ALT). A significant correlation was observed between liver stiffness measurement (LSM) and METAVIR fibrosis stages ( P < 0.0001). Patients with elevated ALT tended to have higher LSM than those with normal ALT. The areas under the ROC curves were 0.85 for significant fibrosis (≥F2), 0.92 for advanced fibrosis (≥F3) and 0.96 for cirrhosis. Using a cut-off of 5.9 kPa for F≥2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%, respectively. With an algorithm combining TE and Fibrotest®, 97% of patients were well classified for significant fibrosis. Using this algorithm, the need for LB can be reduced by 67%. In HIV/HBV-coinfected patients, most of them with normal ALT under antiretroviral treatment including HBV active drugs, TE was proficient in discriminating moderate to severe fibrosis from minimal liver disease. [ABSTRACT FROM AUTHOR]

Objectives The effect of starting highly active antiretroviral therapy (HAART) early after the onset of acute retroviral syndrome (ARS) on CD4 and HIV-RNA trends was studied over a 2-year follow-up period. Methods Four groups of HIV-infected patients stratified according to the time interval from ARS onset to HAART initiation and a control group of untreated patients were compared. Results The results indicated that the earlier the start of HAART, the faster was the rate of CD4 increase and HIV-RNA decrease. However, this difference did not seem to persist at 24 months. Conclusions The optimal treatment strategy for HIV-infected patients needs to be explored further. [ABSTRACT FROM AUTHOR]

The rate of human immunodeficiency virus (HIV) disease progression or death of individuals coinfected with hepatitis C virus (HCV) is conflicting. The complete-case analysis systematically used, excludes patients unscreened for HCV. Our objective was to assess if rate of survival differed between HIV-infected patients screened and unscreened for HCV in a hospital-based prospective cohort study. Patients were enrolled in the Lyon section of the French Hospital Database on HIV between 1 July 1992 and 31 May 2005. A multivariate Cox regression model was used to analyse the association of HCV screening with survival. Of 3244 patients, 299 (9.2%) were not screened for HCV. The populations screened and unscreened differed by the proportion of acquired immune deficiency syndrome at baseline, presumed route of infection, CD4 cell count category at baseline, mean duration of follow-up, mean number of visits per year, type of antiretroviral therapy and survival. The rate of progression to death was higher for non-HCV-screened vs HCV-screened patients: the incidence rate among HCV-screened patients was 22.9/1000 patient-years; the incidence rate among HCV-unscreened patients was 52.4/1000 patient-years. The adjusted hazards ratio of death was 2.48 [95% confidence interval (1.83–3.35); P < 0.001] for patients with unknown HCV status compared with others. In conclusion, unscreened or unknown HCV status was associated with an increased risk of death in our hospital cohort. Important prognostic factors are related to, or confounded by the practice of HCV screening. [ABSTRACT FROM AUTHOR]

Background Alovudine inhibits replication of highly nucleoside reverse transcriptase inhibitor (NRTI)-resistant HIV strains in vitro. However, dose-dependent safety concerns resulted in its initial development being halted. Recently, a 4-week course of alovudine 7.5 mg/day added to a stavudine-free failing regimen yielded a significant decrease in viral load by −1.88 log10 HIV-1 RNA copies/mL. The magnitude of the reduction in viral load suggested that lower doses might still be effective while offering adequate safety during long-term use. Objective To determine whether lower dosages of alovudine still provide significant antiviral activity in patients with broad NRTI resistance. Methods A randomized, double-blind, placebo-controlled trial investigating three doses of alovudine (0.5, 1 and 2 mg) or placebo added for 4 weeks to a failing regimen in patients with evidence of NRTI-resistant HIV strains [≥2 thymidine-associated mutations (TAMs)]. The primary endpoint was the mean viral load reduction between baseline and week 4. Results Seventy-two patients were enrolled in the study: 21, 13, 18 and 20 in the placebo and 0.5, 1 and 2 mg arms, respectively. Baseline median CD4 count and viral load were 298 cells/μL (range 44–692 cells/μL) and 3.9 log10 copies/mL (range 2.5–5.2 log10 copies/mL), respectively. Baseline viral isolates harboured a median of four TAMs. Alovudine was added to a median four-drug failing regimen. At week 4, compared with placebo, mean viral load changes were −0.42 log10 [95% confidence interval (CI) −0.67 to −0.18] and −0.30 log10 (−0.55 to −0.06) in the 2 and 1 mg arms, respectively. There was no significant change in CD4 cell count. Alovudine was well tolerated. Conclusion: A 4-week course of alovudine 2 mg/day provided a modest but significant viral load reduction in patients harbouring viruses with a median of four TAMs. [ABSTRACT FROM AUTHOR]

The article describes three symptomatic cases of neurologic syphilis that occurred after the administration of the usual therapy for primary or secondary syphilis in human immunodeficiency virus-infected patients. The difficulty of diagnosing neurosyphilis, the need for lumbar puncture and risk factors of relapse were discussed.

Background A 36% increase in the incidence of AIDS was observed in 2002/2003 compared with 2000/2001 at Lyon University Hospitals. Objectives We compared the characteristics of these patients with the characteristics of those diagnosed previously with AIDS. Methods Data for all patients with AIDS diagnosed at Lyon University Hospitals were analyzed. The data were collected prospectively. Multiple logistic regression was used for analysis. Results The variables independently associated with an AIDS diagnosis in 2002/2003 compared with the 1985–1989 period were: homosexual exposure [odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2–0.8]; heterosexual exposure in an endemic area (OR 22.5; 95% CI 6.8–74.8), compared with other exposure to HIV; lymphoma as initial AIDS event (OR 10.3; 95% CI 2.7–39.1) compared with Pneumocystis carinii pneumonia; and age at first AIDS event aged 34–38 years (OR 2.5; 95% CI 1.0–6.4), aged 39–46 years (OR 5.1; 95% CI 2.2–11.8), and aged 47–84 years (OR 10.6; 95% CI 4.5–25.1) compared with aged <30 years. The variables independently associated with an AIDS diagnosis in 2002/2003 compared with the 1997/2001 period were age at first AIDS event aged 34–38 years (OR 0.4; 95% CI 0.2–0.9) compared with aged <30 years. Conclusion Recently diagnosed AIDS patients differed from those diagnosed previously, showing an epidemic switch in different populations. The characteristics of the AIDS population in 2002/2003 might reflect public health messages disseminated around 10 years ago or more for the prevention of HIV transmission. Anticipation of populations affected by the AIDS epidemic is difficult. [ABSTRACT FROM AUTHOR]

A diagnosis of AIDS shortly after the detection of HIV antibodies suggests a long-lasting course of the disease without care. The factors associated with a short delay between the initial HIV-1-positive test and the first AIDS-defining event were identified in 1901 patients from 1985 to 2001 in Lyon University hospitals. A total of 576 individuals (30.3%) had an interval of ≤3 months between the detection of HIV infection and AIDS. The factors independently associated with a delay of ≤3 months were: age from 30 to 44 years [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.9–3.2]; age from 45 to 59 years (OR 5.6; 95% CI 3.9–7.8); age ≥60 years (OR 4.5; 95% CI 2.5–8.1), compared to those<30 years old; heterosexuality (OR 2.4; 95% CI 1.6–3.4); injection drug use (OR 2.1; 95% CI 1.5–2.7); and other exposures (OR 2.4; 95% CI 1.6–3.4), compared to homosexual exposure; two opportunistic infections at AIDS (OR 1.8; 95% CI 1.4–2.4) compared to one; and Pneumocystis carinii pneumonia as initial AIDS event (OR 2.6; 95% CI 1.8–3.7), compared to Kaposi's sarcoma. These results provide opportunities to refocus local public health interventions to reduce delayed access to care. [ABSTRACT FROM AUTHOR]

Cyclooxygenase-2 inhibitors appear to have two advantages compared to classical non-steroidal anti-inflammatory drugs (NSAIDs): they do not often cross-react with aspirin and other anti-inflammatory drugs in patients with NSAID and/or aspirin-induced asthma, and they do not cause adverse gastrointestinal effects in most patients. Cross-reactions between cyclooxygenase-2 inhibitors, aspirin and other NSAIDs are uncommon and not often reported. Here we describe two patients who presented with a history of adverse effects to classical NSAIDs and aspirin. During the course of an in-hospital oral challenge test, both patients developed angioedema when they were given a cyclooxygenase-2 inhibitor. We conclude that, from the allergist’s point of view, tolerance to cyclooxygenase-2 inhibitors is not absolute. [Copyright &y& Elsevier]

In order to study the humoral immune defences in the respiratory tract during HIV-I infection, we measured the levels, local productions and anti-HIV and antibacterial activities of IgG and IgA in the bronchoalveolar lavage fluid (BALF) and serum of 61 adult patients with severe HIV infection and of 56 HIV- controls. Albumin was used as the serum transudation factor. The increase of immunoglobulin levels in the serum of HIV-infected patients was confirmed. The IgG level was also increased in epithelial lining fluid (ELF), whereas the total IgA level was unchanged and secretory IgA (SIgA) level was decreased. The ELF/serum immunoglobulin ratios suggested that the IgG present in ELF resulted mainly from transudation. in contrast to SIgA, which was synthesized locally in controls but greatly diminished in HIV-infected patients. IgG to HIV-1 could be detected in BALF of all the patients, but IgA to HIV-1 only in 30% of patients. BAL IgG reacted more consistently and with a broader array of HIV-1 antigens than did IgA. BAL IgA, when present in samples, reacted primarily with viral envelope antigens. Because IgA specificities to some HIV-1 antigens were detected more intensively by BAL than by serum immunoglobulins, we conclude that the mucosal immune response is distinct from that in serum. IgG antibody activity lo Streptococcus pneumoniae was decreased in HIV-infected patients" sera, and IgA antibody activities to S. pneumoniae and to Pseudomonas aeruginosa were decreased in ELF in HIV infected patients. [ABSTRACT FROM AUTHOR]

En France, l'enquête nationale OBEPI 2012 a rapporté une prévalence de surpoids et d'obésité respectivement de 32 % et 15 %, avec un gradient décroissant Nord/Sud. L'objectif de l'étude est de comparer la prévalence du surpoids et de l'obésité au sein de la cohorte Dat'AIDS par rapport à la population générale, de façon globale, selon l'âge, le sexe et la zone géographique de résidence. Etude rétrospective observationnelle réalisée à partir des données recueillies en 2018 dans la cohorte Dat'AIDS (NCT02898987), regroupant 23 centres de prise en charge des personnes vivant avec le VIH (PVVIH) répartis sur tout le territoire français. Les caractéristiques démographiques, épidémiologiques, immuno-virologiques et thérapeutiques des PVVIH avec au moins une valeur disponible d'Indice de Masse Corporelle (IMC) ont été collectées au dernier suivi et réparties en trois groupes : IMC < 25 kg/m2, IMC ≥ 25 kg/m2 et ≤ 29,9 kg/m2 (surpoids) et IMC ≥ 30 kg/m2 (obésité). La comparaison avec la population générale française a été effectuée après standardisation sur la population 2018 sur l'âge, le sexe et la zone géographique de résidence déterminées selon la Zone d'Etudes et d'Aménagement du Territoire (ZEAT 9). Sur les 32153 patients analysés, 68 % sont des hommes, d'âge médian 51,5 ans [42,9 ; 58,5], suivis en médiane depuis 15 ans [7,6 ; 24], 97 % sous ARTdepuis 12 ans en médiane [6,1 ; 20,2], avec une charge virale < 50 copies/ml chez 93 % et une médiane CD4 de 650/mm3 [466 ; 861]. Comparée à la population générale, la prévalence du surpoids (n = 9719) et de l'obésité (n = 4566) est plus faible en global chez les PVVIH (29 % versus 32 % ; 13 % versus 15 %, p < 0,001), avec un gradient nord-sud pour l'obésité qui se maintient à un taux plus bas (Nord :15,7 % vs 21,8 % ; Sud : 8 % vs 13 %, p < 0,001), mais est supérieure chez les femmes VIH+ (surpoids : 29,5 % vs 28,7 %, p = 0,03 ; obésité :22,2 % vs 8,5 %, p < 0,001), et ne progresse plus avec l'âge au-delà de 45 ans. Chez les PVVIH, la prévalence du surpoids et de l'obésité est plus élevée chez les hommes et les femmes nés en Afrique subsaharienne et aux Caraïbes (Hommes : 41,6 % vs 28,7 % et 14,7 % vs 8,5 %, p < 0,001 ; Femmes : 36,5 % vs 22,8 % et 34,6 % vs 15,1 %, p < 0,001). La prévalence du surpoids et de l'obésité est élevée chez les PVVIH mais cependant plus faible qu'en population générale et se répartit différemment selon l'âge, le sexe et le lieu de résidence, facteurs qui devront être pris en compte dans l'analyse des facteurs associés [ABSTRACT FROM AUTHOR]

Objectives: The impact of the systematic screening of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men having sex with men (MSM) on these pathogens' epidemiology remains unclear. We conducted a modelling study to analyse this impact in French MSM., Methods: We modelled NG and CT transmission using a site-specific deterministic compartmental model. We calibrated NG and CT prevalence at baseline using results from MSM enrolled in the Dat'AIDS cohort. The baseline scenario was based on 1 million MSM, 40 000 of whom were tested every 90 days and 960 000 every 200 days. Incidence rate ratios (IRRs) at steady state were simulated for NG, CT, NG and/or CT infections, for different combinations of tested sites, testing frequency and numbers of frequently tested patients., Results: The observed prevalence rate was 11.0%, 10.5% and 19.1% for NG, CT and NG and/or CT infections. The baseline incidence rate was estimated at 138.2 per year per 100 individuals (/100PY), 86.8/100PY and 225.0/100PY for NG, CT and NG and/or CT infections. Systematically testing anal, pharyngeal and urethral sites at the same time reduced incidence by 14%, 23% and 18% (IRR: 0.86, 0.77 and 0.82) for NG, CT and NG and/or CT infections. Reducing the screening interval to 60 days in frequently tested patients reduced incidence by 20%, 29% and 24% (IRR: 0.80, 0.71 and 0.76) for NG, CT and NG and/or CT infections. Increasing the number of frequently tested patients to 200 000 reduced incidence by 29%, 40% and 33% (IRR: 0.71, 0.60 and 0.67) for NG, CT and NG and/or CT infections. No realistic scenario could decrease pathogens' incidence by more than 50%., Conclusions: To curb the epidemic of NG and CT in MSM, it would not only be necessary to drastically increase screening, but also to add other combined interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: No direct-acting antiviral is currently approved for acute HCV infection, delaying treatment. We investigated the effectiveness and safety of 8-week glecaprevir/pibrentasvir (G/P) in patients with acute HCV infection., Approach and Results: This noninterventional, single-arm, retrospective chart review was designed to enroll adults/adolescents with acute HCV infection. Analyses were conducted on a full analysis set (FAS; all enrolled) and modified FAS (FAS excluding nonvirologic failures). The primary end point (modified FAS) was sustained virologic response at posttreatment week 12 (SVR12) with superiority to 92.6% threshold determined by historic chronic HCV G/P SVR12 rates. Secondary end points (FAS) included SVR12, on-treatment virologic failure, posttreatment relapse, and reinfection. Adverse events and safety laboratory values were assessed.Overall, 202 adults were enrolled; in the modified FAS, 150/151 (99.3%; 95% CI: 96.3-99.9) achieved SVR12, demonstrating superiority to efficacy threshold. In the FAS, the SVR12 rate was 74.3% and the on-treatment virologic failure rate was 0%. Relapse and reinfection rates after the final treatment visit (FAS) were 0.5% and 3%, respectively; 39 patients had missing SVR12 data. No on-treatment alanine aminotransferase elevations > 3 × upper limit of normal with total bilirubin > 2 × upper limit of normal were reported. All 53 patients with alanine aminotransferase Grade ≥ 2 at baseline improved to Grade 0/1 on treatment. No adverse eventss of hepatic decompensation/failure or leading to G/P discontinuation occurred. Two patients had serious adverse events unrelated to G/P., Conclusions: Eight-week G/P therapy was effective and well-tolerated in patients with acute HCV infection. Data support further investigation of G/P in acute HCV to shorten care cascades, reduce transmission, and support HCV elimination., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Our objective was to identify missed opportunities for the use of pre-exposure prophylaxis (PrEP) in people with recently acquired HIV, factors associated with PrEP knowledge, and reasons for not using PrEP., Design: This was a French national cross-sectional multicentre study enrolling people diagnosed with recent HIV (incomplete Western blot or negative HIV test in the previous 6 months) in 28 HIV clinical centres. Data were gathered using a self-administered questionnaire (SAQ)., Method: We analysed missed opportunities for PrEP use via a retrospective prep cascade. Factors associated with prior knowledge of PrEP and reasons for PrEP non-use among those who knew about PrEP were described using univariate and multivariate logistic regression models., Results: Of the 224 eligible patients, 185 completed the SAQ and 168 (91%) were eligible for PrEP. Of these, 90% reported seeing at least one physician during the previous year, 26% received information about PrEP, and 5% used PrEP. Factors independently associated with a higher probability of knowing about PrEP were being a man who has sex with men, being aged 25-30 years (vs older), undergoing HIV screening at least once every semester (vs less often; odds ratio [OR] 4.11; 95% confidence interval [CI] 2.00-8.45), and practicing chemsex (OR 3.19; 95% CI 1.12-9.10). Fear of side effects and a low perceived risk of HIV infection were the two most common reasons for not using PrEP (N = 40 [33.33%] and N = 34 [28.3%], respectively)., Conclusions: We found two gaps in the retrospective PrEP cascade: insufficient provision of PrEP information by healthcare providers (mainly general practitioners) and low PrEP acceptability by informed, eligible patients. More diverse healthcare providers need to be involved in PrEP prescription, and at-risk people need to be sensitized to the risk of HIV infection., (© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Modified vaccinia virus Ankara vaccine (MVA-BN; Bavarian Nordic) is recommended to contacts of mpox cases up to 14 days post-exposure but the effectiveness of this strategy is unknown. Among 108 adults (≥ 18 years old) who received one dose of MVA-BN after exposure to mpox, 11 (10%) cases of breakthrough mpox were observed. Sexual exposure was associated with the risk of breakthrough mpox (p = 0.0179). Samples taken from vaccinated breakthrough mpox cases had similar rates of infectious virus isolation than unvaccinated mpox cases.