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Background Children with HIV will be on antiretroviral therapy (ART) longer than adults, and therefore the durability of first-line ART and timing of switch to second-line are key questions. We assess the long-term outcome of protease inhibitor and non-nucleoside reverse transcriptase inhibitor (NNRTI) first-line ART and viral load switch criteria in children. Methods In a randomised open-label factorial trial, we compared effectiveness of two nucleoside reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor versus two NRTIs plus an NNRTI and of switch to second-line ART at a viral load of 1000 copies per mL versus 30,000 copies per mL in previously untreated children infected with HIV from Europe and North and South America. Random assignment was by computer-generated sequentially numbered lists stratified by age, region, and by exposure to perinatal ART. Primary outcome was change in viral load between baseline and 4 years. Analysis was by intention to treat, which we defined as all patients that started treatment. This study is registered with ISRCTN, number ISRCTN73318385. Findings Between Sept 25, 2002, and Sept 7, 2005, 266 children (median age 6.5 years; IQR 2.8-12.9) were randomly assigned treatment regimens: 66 to receive protease inhibitor and switch to second-line at 1000 copies per mL (PI-low), 65 protease inhibitor and switch at 30,000 copies per mL (PI-higher), 68 NNRTI and switch at 1000 copies per mL (NNRTI-low), and 67 NNRTI and switch at 30,000 copies per mL (NNRTI-higher). Median follow-up was 5.0 years (IQR 4.2-6.0) and 188 (71%) children were on first-line ART at trial end. At 4 years, mean reductions in viral load were -3.16 log(10) copies per mL for protease inhibitors versus -3.31 log(10) copies per mL for NNRTIs (difference -0.15 log(10) copies per mL, 95% CI -0.41 to 0.11; p=0.26), and -3.26 log(10) copies per mL for switching at the low versus -3.20 log(10) copies per mL for switching at the higher threshold (difference 0.06 log(10) copies per mL, 95% CI -0.20 to 0.32; p=0.56). Protease inhibitor resistance was uncommon and there was no increase in NRTI resistance in the PI-higher compared with the PI-low group. NNRTI resistance was selected early, and about 10% more children accumulated NRTI mutations in the NNRTI-higher than the NNRTI-low group. Nine children had new CDC stage-C events and 60 had grade 3/4 adverse events; both were balanced across randomised groups. Interpretation Good long-term outcomes were achieved with all treatments strategies. Delayed switching of protease-inhibitor-based ART might be reasonable where future drug options are limited, because the risk of selecting for NRTI and protease-inhibitor resistance is low. Funding Paediatric European Network for Treatment of AIDS (PENTA) and Pediatric AIDS Clinical Trials Group (PACTG/IMPAACT).

Background. The authors studied the relationship between the dynamics of Epstein-Barr virus (EBV) load, CD8 + T-cell activation and differentiation, and EBV-associated symptoms in 25 children after kidney transplantation (Tx). Methods. Twenty-two patients were enrolled at the time of Tx and three at diagnosis of EBV-induced posttransplant lymphoproliferative disease (PTLD). EBV load was serially measured by a semiquantitative method of DNA amplification in blood cells. The percentages of activated (human leukocyte antigen-DR + ) and of effector-memory (CD28 - ) CD8 + circulating cytolytic T lymphocytes (CTL) were serially evaluated by flow cytometry. The cytotoxic potential of CTL was assessed by a CD3-redirected cytotoxic assay. Results. For three children with post-Tx uncomplicated primary EBV infection, EBV load peaked by months 1 to 2 after Tx and declined spontaneously by months 3 to 6, whereas expansion of activated and effector-memory CTL was absent (one case) or transient and moderate (two cases). In 15 patients who were EBV-seropositive before Tx and who did not develop EBV-PTLD, transient elevation of EBV load but no noticeable changes in CTL phenotype were observed. In contrast, in one child who was also EBV-seropositive before Tx but who developed EBV-PTLD, a major and sustained elevation of EBV load and of activated and effector-memory CTL was observed. In three patients retrospectively enrolled at diagnosis of EBV-PTLD, sustained elevation of both viral load and activated T cells was also noticed. Finally, increased cytotoxic activity correlated with increased level of activated CTL. Conclusions. An association between high and sustained T-cell activation, EBV load, and the occurrence of EBV-PTLD was observed. Furthermore, intense cytotoxic activity was observed in EBV-PTLD, with favorable outcome.

BACKGROUND: Quantifying pediatric immunologic recovery by highly active antiretroviral therapy (HAART) initiation at different CD4 percentage (CD4%) and age thresholds may inform decisions about timing of treatment initiation. METHODS: HIV-1-infected, HAART-naive children in Europe and the Americas were followed from 2002 through 2009 in PENPACT-1. Data from 162 vertically infected children, with at least World Health Organization “mild” immunosuppression and CD4% RESULTS: Seventy-two percent of baseline immunosuppressed children recovered to normal within 4 years. Compared with “severe” immunosuppression, more children with “mild” immunosuppression (difference 36%, 95% confidence interval [CI]: 22% to 49%) or “advanced” immunosuppression (difference 20.8%, 95% CI: 5.8% to 35.9%) recovered a normal CD4%. For each 5-year increase in baseline age, the proportion of children achieving a normal CD4% declined by 19% (95% CI: 11% to 27%). Combining baseline CD4% and age effects resulted in >90% recovery when initiating HAART with “mild” immunosuppression at any age or “advanced” immunosuppression at age CONCLUSIONS: Initiating HAART at higher CD4% and younger ages maximizes potential for immunologic recovery. Guidelines should weigh immunologic benefits against long-term risks.

Post-transplant lymphoproliferative disorder (PTLD) after haemopoietic stem cell transplantation is a serious complication that occurs in 8–22% of patients with high-risk factors. We retrospectively investigated tolerance and efficacy of humanized anti-CD20 monoclonal antibody (rituximab) as first-line treatment in 12 children with B-cell PTLD. At diagnosis, eight patients had tumoral involvement. The other four patients had fever, associated with raised Epstein–Barr virus (EBV) viral load and monoclonal gammopathy. Rituximab was given at the dose of 375 mg/m2 once a week by intravenous infusion (1–9 infusions). Only 1/48 infusions was associated with a grade 2 clinical adverse event. Eight out of 12 (66%) patients responded to the treatment and were in complete remission. All patients without tumoral involvement responded to the treatment. A rapid decrease in fever within 1 week was observed in all responders. Non-responders did not show any clinical response during the first week. Tumoral involvement and immunodepression seemed to be more marked in non-responders. Rituximab was an effective and well-tolerated treatment of B-cell PTLD. Early treatment before tumoral involvement seemed to be the most effective approach. Lack of rapid response should lead to intensification of PTLD treatment. Pre-emptive treatment should be considered and evaluated in further longitudinal multicentre studies.

We have tested the value of maternal plasma creatine kinase activity for diagnosing ectopic pregnancies obtained after in-vitro fertilization and embryo transfer. Plasma creatine kinase was assayed in 57 patients: 20 normal, 23 miscarriages and 14 ectopic pregnancies, for a total of 240 samples. All values were in the lower part of the normal range except only one in a miscarrying patient. A statistically significant difference was observed for a cut-off value of 45 IU/l between normal and ectopic pregnancies. However, for this cut-off point, the measurement of plasma creatine kinase activity had a sensitivity of 0.50 and a specificity of 0.76 for the diagnosis of ectopic pregnancy. The positive predictive value was 0.69. Creatine kinase activity measurements are thus of no practical value in this particular population, in which an early and specific marker of ectopic implantation would be of paramount interest. The association of human chorionic gonadotrophin (HCG) determinations and ultrasound scanning of the pelvis still remain the best paraclinical support for an early diagnosis of ectopic implantation.

Ouvrage collectif sous la direction de Laurent Creton, Yannick Dehée, Sébastien Layerle et Caroline Moine; International audience; Figure-clé du cinéma, le producteur est longtemps resté ignoré par les historiens. Cet ouvrage élabore une cartographie des recherches, au carrefour de l’économique, du politique et du culturel. À l’exemple de la France, mais aussi d’autres pays, on examine une profession aux frontières floues et mouvantes, des origines du cinéma à nos jours. Parce que les stratégies financières et éditoriales sont étroitement imbriquées, ce recueil mêle les approches économiques, stratégiques et sociologiques pour mieux cerner le rôle et l’influence du producteur dans la culture contemporaine. Plusieurs « grands témoins », professionnels reconnus, apportent leur éclairage et leur expérience (notamment, Nicolas Seydoux sur Daniel Toscan du Plantier, Alain Goldman, Philippe Martin, Alain Rocca et Thomas Schmitt).

International audience

Group A rotaviruses (RV), members of the Reoviridae family, are a major cause of infantile acute gastroenteritis. The RV genome consists of 11 double-stranded RNA segments. In some cases, an RNA segment is replaced by a rearranged RNA segment, which is derived from its standard counterpart by partial sequence duplication. We report here a reverse genetics system for RV based on the preferential packaging of rearranged RNA segments. Using this system, wild-type or in vitro -engineered forms of rearranged segment 7 from a human rotavirus (encoding the NSP3 protein), derived from cloned cDNAs and transcribed in the cytoplasm of COS-7 cells with the help of T7 RNA polymerase, replaced the wild-type segment 7 of a bovine helper virus (strain RF). Recombinant RF viruses (i.e., engineered monoreassortant RF viruses) containing an exogenous rearranged RNA were recovered by propagating the viral progeny in MA-104 cells, with no need for additional selective pressure. Our findings offer the possibility to extend RV reverse genetics to segments encoding nonstructural or structural proteins for which no potent selective tools, such as neutralizing antibodies, are available. In addition, the system described here is the first to enable the introduction of a mutated gene expressing a modified nonstructural protein into an infectious RV. This reverse genetics system offers new perspectives for investigating RV protein functions and developing recombinant live RV vaccines containing specific changes targeted for attenuation.

Un dictionnaire sans equivalent pour comprendre les grands succes du cinema populaire : les films-phares de chaque epoque ; les grandes figures : acteurs, realisateurs, scenaristes, producteurs, mediateurs, musiciens ; les cles de lecture : themes, personnages, lieux. Et aussi : l'economie, la technique, l'exploitation. Une somme d'informations jamais reunies auparavant. Ce dictionnaire veut donner a comprendre les succes du cinema et l'evolution de ses modes, faire revivre l'engouement pour ses stars, decouvrir ses artisans meconnus. Ce faisant, il eclaire l'Histoire de la France et des Francais au XXe siecle. Cette deuxieme edition entierement mise a jour comporte une cinquantaine de nouvelles entrees : acteurs (tels que Marion Cotillard, Jean Dujardin, Guillaume Canet, Cecile de France) et films (Mesrine, Bienvenue chez les Ch'tis). Le box-office des entrees en salles et des diffusions televisees est egalement actualise. Date de premiere edition : 2004.

Quel point commun entre Leon Zitrone et PPDA, Casimir et Kermit la grenouille, le commissaire Navarro et Jack Bauer ? Beaucoup font partie de notre memoire intime, car nous sommes tous, ou presque, des « enfants de la tele ». Pourquoi certaines figures ou emissions passent-elles a la posterite ? Ce dictionnaire reconstitue le puzzle des programmes et personnalites populaires qui ont marque chaque generation de telespectateurs depuis 60 ans. Cette « somme » a l'erudition souriante deroule les grandes emissions d'information et de divertissement, les fictions comiques et dramatiques francaises, mais aussi etrangeres, et "croque" les grandes figures qui ont anime nos apres-midi et nos soirees. Sans oublier les reperes economiques et politiques essentiels pour comprendre la television. Les textes sont illustres de tres nombreux documents, souvent rares ou surprenants. Un ouvrage unique en son genre qui nous invite a revisiter, entre nostalgie et surprise, notre memoire televisuelle...

The authors studied the relationship between the dynamics of Epstein-Barr virus (EBV) load, CD8 T-cell activation and differentiation, and EBV-associated symptoms in 25 children after kidney transplantation (Tx).Twenty-two patients were enrolled at the time of Tx and three at diagnosis of EBV-induced post-transplant lymphoproliferative disease (PTLD). EBV load was serially measured by a semiquantitative method of DNA amplification in blood cells. The percentages of activated (human leukocyte antigen-DR) and of effector-memory (CD28) CD8 circulating cytolytic T lymphocytes (CTL) were serially evaluated by flow cytometry. The cytotoxic potential of CTL was assessed by a CD3-redirected cytotoxic assay.For three children with post-Tx uncomplicated primary EBV infection, EBV load peaked by months 1 to 2 after Tx and declined spontaneously by months 3 to 6, whereas expansion of activated and effector-memory CTL was absent (one case) or transient and moderate (two cases). In 15 patients who were EBV-seropositive before Tx and who did not develop EBV-PTLD, transient elevation of EBV load but no noticeable changes in CTL phenotype were observed. In contrast, in one child who was also EBV-seropositive before Tx but who developed EBV-PTLD, a major and sustained elevation of EBV load and of activated and effector-memory CTL was observed. In three patients retrospectively enrolled at diagnosis of EBV-PTLD, sustained elevation of both viral load and activated T cells was also noticed. Finally, increased cytotoxic activity correlated with increased level of activated CTL.An association between high and sustained T-cell activation, EBV load, and the occurrence of EBV-PTLD was observed. Furthermore, intense cytotoxic activity was observed in EBV-PTLD, with favorable outcome.

WBC depletion by filtration may prevent the transmission of HTLV-I, which requires cell-to-cell contact. The removal of HTLV-I-infected cells in routinely filtered blood cell components was measured.The study was conducted in Martinique where systematic screening for HTLV-I and -II and universal leukoreduction are mandatory. HTLV-I was quantified by use of real-time PCR in 8 RBC units and 4 PLT concentrates before and after filtration. HTLV-I proviral load in PBMNCs was determined in five of the eight HTLV-I-infected blood donors.The amount of MNC-associated HTLV-I DNA in RBC units before filtration was 21 x 10(6)+/- 29 x 10(6) copies (mean +/- SD). HTLV-I was detected in 4 of 8 RBC units after filtration, with a number of copies in the MNC fraction ranging from 20 to 140, following a 4.9 to 5.8 log reduction. Flow cytometry analysis performed in 2 of the filtered RBC units containing detectable HTLV-I showed suboptimal and out-of-range leukoreduction (0.56 x 10(6) and 1.22 x 10(6) residual WBCs). HTLV was not detected in filtered RBCs from the blood donor with the highest percentage of HTLV-I-infected PBMCs (9%).This study confirms that HTLV-I-infected cells can be detected in filtered blood cell components and shows that optimal leukoreduction is critical for HTLV-I removal.

A quantitative real-time PCR assay was developed to measure the proviral load of human T-lymphotropic virus type I (HTLV-I) in peripheral blood mononuclear cells (PBMCs). The HTLV-I copy number was referred to the actual amount of cellular DNA by means of the quantitation of the albumin gene. Ten copies of HTLV-I DNA could be detected with 100% sensitivity, and the assay had a wide range of at least 5 log(10). Intra- and inter-assay reproducibility was evaluated using independent extractions of PBMCs from an HTLV-I-infected patient (coefficients of variation, 24 and 7% respectively). The performance of this TaqMan PCR assay, coupled with its high throughput, thus allows reliable routine follow-up of HTLV-I proviral load in infected patients. Preliminary results using clinical samples indicate a higher proviral load in patients with HTLV-I-associated myelopathy/tropical spastic paraparesis than in asymptomatic carriers, and also suggest the usefulness of this quantitative measurement to assess the etiological link between HTLV-I and adult T-cell leukaemia/lymphoma-like syndromes.

Post-transplant lymphoproliferative disorder (PTLD) after haemopoietic stem cell transplantation is a serious complication that occurs in 8-22% of patients with high-risk factors. We retrospectively investigated tolerance and efficacy of humanized anti-CD20 monoclonal antibody (rituximab) as first-line treatment in 12 children with B-cell PTLD. At diagnosis, eight patients had tumoral involvement. The other four patients had fever, associated with raised Epstein-Barr virus (EBV) viral load and monoclonal gammopathy. Rituximab was given at the dose of 375 mg/m2 once a week by intravenous infusion (1-9 infusions). Only 1/48 infusions was associated with a grade 2 clinical adverse event. Eight out of 12 (66%) patients responded to the treatment and were in complete remission. All patients without tumoral involvement responded to the treatment. A rapid decrease in fever within 1 week was observed in all responders. Non-responders did not show any clinical response during the first week. Tumoral involvement and immunodepression seemed to be more marked in non-responders. Rituximab was an effective and well-tolerated treatment of B-cell PTLD. Early treatment before tumoral involvement seemed to be the most effective approach. Lack of rapid response should lead to intensification of PTLD treatment. Pre-emptive treatment should be considered and evaluated in further longitudinal multicentre studies.

A quantitative study of the T cell receptor repertoire was performed ex vivo on CD4 and CD8 T cell subsets of human T cell leukemia virus type I (HTLV-I)‐infected asymptomatic carriers and patients with HTLV-I‐associated myelopathy/tropical spastic paraparesis (HAM/ TSP). Indexes of oligoclonality that compiled all repertoire modifications were calculated for peripheral blood mononuclear cells and for CD4 and CD8 T cell subsets. Both patients with HAM/TSP and asymptomatic carriers had greater T lymphocyte expansions than did uninfected donors, which was independent of age and at least twice higher in the CD8 than in the CD4 cell compartment. Some expanded CD8 T cells corresponded to cytotoxic T lymphocytes directed against various epitopes of the immunodominant Tax protein. Patients with HAM/TSP had significantly higher CD8 cell expansions than did asymptomatic carriers. These results highlight the prognostic value of measuring CD8 T cell expansions during follow-up of HTLV-I infection. Human T cell leukemia virus type I (HTLV-I) is a persistent virus that infects 10‐20 million people worldwide. Although HTLV-I infection is asymptomatic in a majority of infected persons, in 1%‐5% of infected persons it is associated with the de

Le President, Z, Mourir d'aimer, Emmanuelle, L'Aile ou la Cuisse, Pour la peau d'un flic, Le Professionnel, Le Bon Plaisir, Les Ripoux, Tchao Pantin, L 627, Une epoque formidable, Marius et Jeannette… La plupart des Francais connaissent ces succes du box-office. Ces films ont une portee politique, et, s'ils ne sont pas tous des chefs-d'œuvre et expriment rarement une doctrine claire et affirmee, ils vehiculent cependant des representations dominantes de la societe, de ses jeux et enjeux de pouvoir. Le projet de cet ouvrage est de tracer une histoire de l'imaginaire politique des Francais, du debut des annees 1960 au debut des annees 2000. En quarante ans, on est passe des certitudes aux doutes, d'une societe hierarchisee a une societe desorganisee, en quete de nouveaux modeles. Les heros de l'ere gaullienne (Gabin, de Funes) ont ete remplaces par de nouvelles stars (Belmondo, Delon) qui a leur tour ont connu le declin avec l'ascension de nouvelles figures (Coluche, Depardieu). C'est l'histoire de ces mutations dont on tentera ici de poser les jalons.

Epstein-Barr Virus (EBV) is the prototype member of the human herpesvirus subfamily Gammaherpesviridae. EBV establishes a latent infection in lymphoïd cell and replicates in epithelial cells. Infection of individuals with EBV is widespread in all human populations, as shown by the high proportion of individual with specific antibodies in their serum. EBV is the etiological agent of the infectious mononucleosis and has been implicated in the pathogenesis of an increasing number of human malignancies, the best characterized being endemic Burkitt's lymphomas, nasopharyngeal carcinomas (NPC), and polyclonal lymphomas in immunocompromised patients. EBV infection in vivo is a complex mixture of latent, reactivated, transforming, or replicative type of infection. EBV infection is characterized by sporadic viral excretion in the oropharynx and persistent latent infection in the bone marrow and peripheral blood lymphocytes. EBV infection includes an intense immune response. During primary infection, the humoral response is primarily directed toward antigens of the lytic cycle, membrane antigen complex, early antigen (EA), viral capsid antigen (VCA) while the antibodies response to EBNAs is delayed. The cell mediated response controls the proliferation of EBV-infected lymphocytes through two classes of cytotoxic cells, namely, natural killer and T8 cytotoxic cells. Laboratory diagnosis of EBV infection is recently based upon molecular biology techniques which provides a useful tool for direct identification of EBV and may allow to better understand the role of the virus in the pathogenesis of EBV associated disorders.

Epstein-Barr virus has been associated to several forms of neoplasia including Burkitt's lymphoma, B lymphomas in immuno-compromised patients and undifferentiated nasopharyngeal carcinoma. Immunodepression, genetic and/or environmental factors and the expression of several viral genes (latent genes mainly) may contribute to these pathologies. In vitro, several latent proteins (EBNA 1, 2, 3A, 3C, 5 et LMP-1) directly or indirectly contribute to the initiation and maintenance of the transformation process. The role of these proteins is discussed in the present article.