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39. Les patients infectés par le virus de l'immunodéficience humaine sous traitement antirétroviral ont-ils un risque cardiovasculaire accru ?

Author

Michel Duong, Jean-Eric Wolf, Marianne Zeller, Chavanet P, A. Fargeot, Lionel Piroth, M Froidure, Portier H, M Mahrousseh, Yves Cottin, Jean-Michel Petit, and Isabelle L’Huillier

Subjects
medicine.medical_specialty, business.industry, Disease, medicine.disease, Surgery, Coronary artery disease, Acquired immunodeficiency syndrome (AIDS), Diabetes mellitus, Internal medicine, Epidemiology, medicine, Risk factor, Family history, Cardiology and Cardiovascular Medicine, business, Dyslipidemia
Abstract

There is a growing concern about an increased risk for cardiovascular disease in HIV infected patients receiving antiretroviral therapy (ART). This risk could be related to metabolic abnormalities associated with long-term use of antiretroviral drugs. In fact, well recognized cardiovascular risk factors such as hypertension, dyslipidaemia, diabetes mellitus and central fat deposition are increasingly seen in HIV patients on ART. These factors can also be associated with non reversible risk factors, such as male sex, age greater than 40 years and family history of premature coronary artery disease. In addition, cigarette smoking and sedentary lifestyle may predispose these patients to significant cardiovascular disease. A direct atherogenic effect of HIV infection itself or antiretroviral drugs is unlikely. Epidemiological studies have suggested an increased risk for coronary artery disease in HIV infected persons; nevertheless, only long term follow-up could confirm this statement. Despite these uncertainties, it seems reasonable to identify and manage cardiovascular risk factors in HIV infected patients.

Published
2003

42. Sparfloxacin as alternative treatment to standard therapy for community-acquired bacteremic pneumococcal pneumonia

Author

Lode, H. Aubier, M. Portier, H. Ortqvist, A. Garau, J. Grassi, C. Hosie, J. Huchon, G. Legakis, N. Segev, S. Wijnands, G. Regamey, C. Verster, R. May, T. Valtonen, M. Cars, O. Wahl, M. Saikku, P. Jean, C. Richard, M.P.

Abstract

Objective: To assess the effectiveness of a single daily dose of sparfloxacin in comparison with standard antibacterial therapy for the treatment of pneumococcal bacteremic community-acquired pneumonia (CAP). Methods: The results were analyzed of four comparative trials in CAP, in which 107 adult patients with CAP confirmed by blood cultures positive for Streptococcus pneumoniae were included. Sparfloxacin was given at a loading dose of 400 mg followed by 200 mg daily, Comparator drugs included amoxycillin 3 g/day, amoxycillin/clavulanate 1.5/0.375 g/day and erythromycin 2 g/day. Dosing was for 7-14 days (mean 10 days). Success was determined by a combination of clinical and microbiological assessment and radiologic changes, Results: Sparfloxacin was as effective as the comparator drugs, with an overall success rate of 80% at the end of treatment (comparators 78%), and a 79% success rate at follow-up (76% for comparators). There were no pneumococcal isolates resistant to sparfloxacin, but eight of 56 were either resistant (four) or had reduced susceptibility to penicillin G, and two strains were resistant to erythromycin. Tolerance to sparfloxacin was good, with fewer patients reporting drug-related adverse events (15.8%) than with the comparator drugs (33.3%). Conclusions: This analysis suggests that sparfloxacin would be an alternative candidate for empirical therapy in moderately severe CAP.

Published
1998

45. Infraclinical neuropathies related to immunodeficiency virus infection associated with higher T-helper cell counts

Author

Chavanet, P., Solary, E., Giroud, M., Waldner, A., Beuriat, P., Nordman, P., and Portier, H.

Subjects
Peripheral nerve diseases -- Demographic aspects, AIDS (Disease) -- Complications, T cells -- Measurement, HIV (Viruses) -- Physiological aspects, Virus-induced immunosuppression -- Demographic aspects, Peripheral nerve diseases -- Causes of, Health
Abstract

Neurological symptoms occur in approximately 40 percent of patients with AIDS, affecting both the brain and the peripheral nerves. The conduction of nerve impulses was examined in patients who were grouped according to Centers for Disease Control (CDC) classifications. CDC II-III was defined as those infected with human immunodeficiency virus (HIV), but without clinical symptoms (infraclinical), and those who had persistent abnormalities of the lymph nodes (lymphadenopathy). This group was compared with those who were CDC IV, having ARC (AIDS-related complex) or AIDS, and with individuals who were not infected. Of the 57 patients with an HIV classification, 20 (35 percent) had decreased conduction of nerve impulses. More patients (10 out of 17) who were classified as CDC IV had decreased conduction than those in stage CDC II-III (10 out of 40). More of the patients in the CDC IV group (9 out of 10) had two or more abnormalities compared with those in the CDC II-III group (4 out of 10). Patients in the CDC II-III group with neural abnormalities had higher numbers of helper T cells and lower numbers of T cell suppressor cells, along with a higher T-helper/T-suppressor ratio than those without neural abnormalities. This indicates less immunosuppression in those with neural abnormalities compared with those without. The reason for is not understood, but it is thought that different strains of HIV might cause different symptoms of disease. Thus, abnormalities in conduction of peripheral nerve impulses are often seen in patients who are infected with HIV. These abnormalities may occur early in HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1989

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