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Efficacy of COVID-19 convalescent plasma (CCP) in COVID-19 pneumonia is uncertain. The CORIPLASM study was an open-label, Bayesian randomised clinical trial evaluating the efficacy of CCP in patients with moderate COVID-19, including immunocompromised patients. Patients hospitalised with COVID-19 and less than 9 days since symptoms onset were assigned to receive 4 units of plasma over 2 days (≈ 840 ml)(CCP) or usual care alone (UC). Primary outcomes were the proportion of patients with a WHO-Clinical Progression Score (CPS) ≥6 on the 10-point scale on day (d) 4 and survival without ventilation or additional immunomodulatory treatment by d14. A total of 120 patients were recruited and assigned to CCP (n=60) or UC (n=60), including 22 (CCP) and 27 (UC) immunocompromised patients. Thirteen (22%) patients with CCP had a WHO-CPS ≥6 at d4 versus 8 (13%) with UC, adjusted odds ratio (aOR) 1.88 [95%CI 0.71 to 5.24]. By d14, 19 (31.6%) patients with CCP and 20 (33.3%) patients with UC had ventilation, additional immunomodulatory treatment or had died. Cumulative incidence of death was 3 (5%) with CCP and 8 (13%) with UC at d14 (aHR 0.40 [95%CI 0·10 -1·53]), and 7 (12%) with CCP and 12 (20%) with UC at d28 (aHR 0.51 [95%CI 0.20-1.32]). Subgroup analysis indicated that CCP might be associated with a lower mortality in immunocompromised patients (HR 0.37 [95%CI 0.14-0.97]). CCP treatment did not improve early outcomes in patients with moderate COVID-19 but was associated with reduced mortality in the subgroup of immunocompromised patients.

There are limited data comparing the efficacy and safety of raltegravir and dolutegravir to that of efavirenz in HIV-1/tuberculosis (TB) coinfected patients.We conducted a 10-year retrospective study in 4 centers in France. We included all HIV-1/tuberculosis coinfected patients starting antiretroviral therapy with a rifampicin-based regimen, with a plasma HIV RNA level (VL)1000 copies/mL. The primary endpoint was the proportion of patients with virological success that is, with VL50 copies/mL at W48 using an Intention-To-Treat analysis, using last-observation-carried-forward to impute missing data. We also assessed antiretroviral therapy safety, analyzing treatment discontinuation for adverse events.Between 2010 and 2020, 117 patients were included. Thirty-nine (33.3%) were treated with raltegravir and 2 nucleoside reverse transcriptase inhibitors (NRTIs), 19 (16.2%) with dolutegravir (and 2 NRTIs) and 59 (50.4%) with efavirenz (and 2 NRTIs). At W48, the primary endpoint was achieved in 24 patients (61.5%) in the raltegravir group, in 12 (63.2%) in the dolutegravir group, and in 41 (69.5%) in the efavirenz group using an Intention-To-Treat analysis ( P = 0.68). Emergence of drug resistance in patients with virological failure, defined as a VL50 copies/mL, was observed in 3 patients with efavirenz and one patient with raltegravir. Rate of treatment discontinuation for drug-related adverse events was 10.3%, 10.6%, 16.9% for raltegravir, dolutegravir and efavirenz respectively ( P = 0.67).In this retrospective cohort study, raltegravir and dolutegravir yielded similar efficacy and safety results to efavirenz for the treatment of HIV-1/TB coinfected patients.

Background CSF Alzheimer's disease (AD) biomarkers allow classifying individuals based on their levels of amyloid and neurodegeneration pathologies. Objective To investigate the distribution of AD biomarker profiles from patients suffering from cognitive disorders. Methods We analyzed 3001 patients with cognitive disorders and referred by 18 French memory clinics located in and around Paris. Patients were classified as normal, amyloidosis (A+/N-), amyloidosis and neurodegeneration (A+/N+) or suspected non-AD pathophysiology (SNAP), according to their CSF levels of biomarkers. Analysis were performed for the overall population and stratified by gender, age quintiles, and Mini-Mental State Examination (MMSE) score quintiles. Results were compared to previous findings in cohorts of healthy elderly adults. Results 37% of the sample were classified as A+/N+, 22% were classified A+/N-, and 15% as SNAP. The A+/N+ profile was associated with female gender, advanced age, and lower MMSE score, while the A+/N-profile was observed more frequently in men and the distribution was stable across age and MMSE. The SNAP profile showed no association with gender or age, was less frequent in patients with lower MMSE, and had a lower repartition than the one previously reported in asymptomatic populations. Conclusions While A+/N+ patients had the clinical characteristics typically observed in AD, A+/N-patients had a different epidemiological pattern (higher frequency in men, no association with advanced age or lower MMSE). The SNAP profile was less frequent than previously reported in the general elderly population, suggesting that this profile is not a frequent cause of memory impairment in this population.

An interaction of drug with food, herbs, and dietary supplements is usually the consequence of a physical, chemical or physiologic relationship between a drug and a product consumed as food, nutritional supplement or over-the-counter medicinal plant. The current educational review aims at reminding to the prescribing physicians that the most clinically relevant drug-food interactions may not be strictly limited to those with grapefruit juice and with the Saint John's Wort herbal extract and may be responsible for changes in drug plasma concentrations, which in turn decrease efficacy or led to sometimes life-threatening toxicity. Common situations handled in clinical practice such as aging, concomitant medications, transplant recipients, patients with cancer, malnutrition, HIV infection and those receiving enteral or parenteral feeding may be at increased risk of drug-food or drug-herb interactions. Medications with narrow therapeutic index or potential life-threatening toxicity, e.g., the non-steroidal anti-inflammatory drugs, opioid analgesics, cardiovascular medications, warfarin, anticancer drugs and immunosuppressants may be at risk of significant drug-food interactions to occur. Despite the fact that considerable effort has been achieved to increase patient' and doctor's information and ability to anticipate their occurrence and consequences in clinical practice, a thorough and detailed health history and dietary recall are essential for identifying potential problems in order to optimize patient prescriptions and drug dosing on an individual basis as well as to increase the treatment risk/benefit ratio.

Nonorgan-specific autoantibodies (AAbs) are used for diagnosing autoimmune diseases but can also be detected in other conditions. We carried out a cross-sectional study with the aim to screen HIV1-infected patients in the era of highly active antiretroviral therapy (HAART) for AAbs and to analyze the association of their presence with hypergammaglobulinemia and immunovirological status. Blood samples from HIV1-infected patients without major concomitant illnesses followed in 2 hospitals in Paris, France were tested for immunovirological status, serum immunoglobulin G (IgG) level, antinuclear antibodies (ANAs), anti-double-stranded DNA (anti-dsDNA), anti-extractable nuclear antigens (anti-ENAs), anticardiolipin (aCL), anti-β2glycoprotein1 (anti-β2GP1), and antineutrophil cytoplasmic antibodies (ANCAs). Clinically relevant AAbs were defined as ANAs with titers ≥1:160, anti-dsDNA or anti-ENA antibodies; aCL or anti-β2GP1 antibodies with a level ≥40 U/ml; and ANCAs reacting with proteinase 3 or myeloperoxidase. We included 92 patients (mean age 47 years, men 55%, sub-Saharan African background 55%, HAART 85%, mean CD4 lymphocyte count 611/mm3, viral load

We report the case of an acute, self-resolving HBV-related hepatitis occurring in a HIV-infected patient carrying isolated anti-HBc antibodies. This acute HBV hepatitis may be considered as a clinical manifestation of a reactivation of HBV during an immune reconstitution inflammatory syndrome. Other hypotheses, even unlikely, are discussed.

Introduction : les infections à pneumocoque sont fréquentes avec une morbi-mortalité importante dans les groupes à risque ; pourtant, il semble que la couverture vaccinale soit faible. En 2013, une actualisation des recommandations est publiée avec deux groupes à risque concernés : les immunodéprimés et les non immunodéprimés à risque. Matériel et méthodes : l’objectif de cette étude est d’évaluer l’application des recommandations vaccinales anti-pneumocoque chez l’adulte, par le taux vaccinal, chez les patients non immunodéprimés à risque et les patients VIH positifs, en médecine de ville après l’actualisation des recommandations. Il s’agit d’une étude épidémiologique, rétrospective avec un recrutement en France en médecine ambulatoire via la base de données GERS Patient Data, CEGEDIM®, via le codage CIM 10 et la notion de prescription d’un vaccin. Quatre populations de patients sont étudiées : BPCO, Diabète, Insuffisance cardiaque, VIH+, pendant la période d’analyse : d’avril 2013 à avril 2017, en comparaison à la période contrôle : de mars 2012 à mars 2013. Le critère de jugement principal est le pourcentage de patients vaccinés (avec une prescription et/ou un remboursement d’un vaccin anti-pneumocoque) dans les différentes populations, toutes périodes confondues après la date minimum de diagnostic. Résultats : 13737 patients BPCO sont inclus avec 2821 patients dans la période contrôle et 10916 dans la période d’analyse. 7622 patients diabétiques sont inclus avec 1628 patients dans la période contrôle et 5994 dans la période d’analyse. 816 patients insuffisants cardiaques sont inclus avec 143 patients dans la période contrôle et 673 dans la période d’analyse. 380 patients VIH+ sont inclus avec 98 patients dans la période contrôle et 282 dans la période d’analyse. Pour la population totale, sur la période contrôle, 267 (6%) des 4690 patients inclus ont eu au moins une vaccination anti-pneumocoque après la date minimum de diagnostic. Sur la période d’analyse, 756 (4%) des 17865 patients inclus ont eu au moins une vaccination anti-pneumocoque après la date minimum de diagnostic. Pour la population BPCO, sur la période contrôle, 213 (7%) des 2821 patients inclus ont eu au moins une vaccination anti-pneumocoque et sur la période d’analyse, 598 (5%) des 10916 patients inclus ont eu au moins une vaccination anti-pneumocoque. Pour la population diabétique, sur la période contrôle, 28 (2%) des 1628 patients inclus ont eu au moins une vaccination anti-pneumocoque et sur la période d’analyse, 95 (2%) des 5994 patients inclus ont eu au moins une vaccination anti-pneumocoque. Pour la population insuffisante cardiaque, sur la période contrôle, 10 (7%) des 143 patients inclus ont eu au moins une vaccination anti-pneumocoque et sur la période d’analyse, 28 (4%) des 673 patients inclus ont eu au moins une vaccination anti-pneumocoque. Pour la population VIH+, sur la période contrôle, 16 (16%) des 98 patients inclus ont eu au moins une vaccination anti-pneumocoque et sur la période d’analyse, 35 (12%) des 282 patients inclus ont eu au moins une vaccination anti-pneumocoque. Conclusion : dans notre large échantillon suivi en médecine ambulatoire et avec les limites d’un recueil rétrospectif des données, les recommandations sont très peu appliquées et sans nette tendance à l’amélioration dans le temps avec un taux vaccinal anti-pneumocoque très faible chez les patients BPCO, diabétiques, insuffisants cardiaques et VIH+ sur notre période d’analyse.