Fluctuating Anaemia in Treated HIV Patients: Could be a Pica?

HIV infected patients are frequently exposed to anaemia, due to antiretroviral agents and/or prophylactic treatment of opportunistic infections. Anemia due to PICA, unusually evoked in our western countries, could be a more frequent situation than imagined. We report two cases of fluctuating anemia with no HIV or iatrogenic origin, observed in two HIV infected women, 47 years old and 33 years old respectively, coming from Africa and treated with antiretroviral agents. The anemia was explained by a culturally sanctioned practice of kaolin ingestion, in the broader context of PICA and resolved after the withdrawal of kaolin ingestion. PICA, and in particular kaolin ingestion, must be investigated when HIV infected patients came from Africa and presented significative unexplained anemia

Thymidine analogue mutations in antiretroviral-naive HIV-1 patients on triple therapy including either zidovudine or stavudine

International audienceThe aims of this study were to: (i) determine the incidence of thymidine-associated mutations (TAMs) in an observational clinical cohort of naive HIV-1 patients who stopped first-line therapy including either zidovudine or stavudine; and (ii) assess the immunological and virological responses to subsequent second-line therapy in patients who switched from zidovudine to stavudine or conversely

History of COVID-19 Symptoms and Seroprevalence of SARS-CoV-2 Antibodies in HIV-Infected Patients in Northern France after the First Wave of the Pandemic

To assess the prevalence of COVID-19 in people living with HIV (PLWHIV), we performed an epidemiological survey from 1 April through 1 August 2020 in an HIV reference center in Northern France. PLWHIV completed a questionnaire about risk exposures and symptoms consistent with COVID-19 and performed a SARS-CoV-2 serology. Among the 600 PLWHIV included, 16 have been infected with SARS-CoV-2. Symptoms consistent with COVID-19 were frequent both in SARS-CoV-2 positive and negative patients (67% vs. 32%, p = 0.02). Among SARS-CoV-2 infected patients, one (6%) has been hospitalized and five (31%) have been asymptomatic. Close contact with a confirmed COVID-19 case was the only factor associated with COVID-19 acquisition (40% vs. 13%, p = 0.01). The prevalence of COVID-19 in PLWHIV was 2.5%, half of the overall population estimate after the first wave of the pandemic in France. In conclusion, proportion of asymptomatic COVID-19 was high in PLWHIV. The prevalence of COVID-19 in PLWHIV was two times lower than in the general population

Vaccination Against Hepatitis B Virus (HBV) in HIV-1-Infected Patients With Isolated Anti-HBV Core Antibody: The ANRS HB EP03 CISOVAC Prospective Study.

International audience Although an isolated anti-hepatitis B virus (HBV) core antibody (anti-HBc) serological profile is frequent in human immunodeficiency virus (HIV)-infected patients, data on HBV vaccination in these patients are scarce.  A prospective multicenter study was conducted to assess the immunogenicity of HBV vaccination in 54 patients with an isolated anti-HBc profile and undetectable HIV load. They were vaccinated with 1 dose (20 µg) of recombinant HBV vaccine. Those with an anti-HBV surface antibody (anti-HBs) level of 100 mIU/mL 4 weeks after a single recall dose of HBV vaccine should be further vaccinated with a reinforced triple double-dose scheme

Safety and immunogenicity of double-dose versus standard-dose hepatitis B revaccination in non-responding adults with HIV-1 (ANRS HB04 B-BOOST): a multicentre, open-label, randomised controlled trial

Equipe CHU UB (EA) Pôle MERS CT3 Hors Enjeu ANRS HB04 B-BOOST study group : Hugues Aumaitre (Centre Hospitalier Marechal Joff re, Perpignan, France); Jean-Luc Berger (Centre Hospitalier Universitaire de Reims– Hopital Robert Debre, Reims, France); Alain Devidas (Hopital Gilles de Corbeil–Centre Hospitalier Sud Francilien, Corbeil Essonne, France); Sophie Abgrall (Centre Hospitalier Universitaire Avicenne, Avicenne, France); Olivier Patey (Centre Hospitalier Intercommunal de Villeneuve St Georges, Villeneuve Saint Georges, France); Marie-Christine Drobacheff Thiebaut (Centre Hospitalier Universitaire de Besancon–Hopital Saint Jacques, Besancon, France); Frederic Lucht (Centre Hospitalier Universitaire de St Etienne–Hopital Nord, Saint Etienne, France); Bruno Hoen (Centre Hospitalier Universitaire de Besancon–Hopital Saint Jacques, Besancon, France); Caroline Lascoux-Combe (Hopital Saint Louis, Paris, France); Olivier Lortholary (Hopital Necker, Paris, France); Veronique Delcey (Hopital Lariboisiere, Paris, France); Pierre De Truchis (Hopital Raymond–Poincare, Garches, France); Vincent Jeantils (Hopital Jean Verdier, Bondy, France); Daniel Vittecoq (Le Kremlin Bicetre, France); Laurence Slama (Hopital Tenon, Paris, France); David Zucman (Hopital Foch, Suresnes, France); Yves Levy (Hopital Henri Mondor, Creteil, France); Christine Katlama (Hopital Pitie Salpetriere, Paris, France); Anne Simon (Hopital Pitie Salpetriere, Paris, France); Pierre-Marie Girard (Hopital Saint Antoine, Paris, France); Jean-Michel Molina (CISIH, Hopital Saint Louis, Paris, France); Sandrine Pierre-Francois (Centre Hospitalier Universitaire de Fort de France–Hopital Pierre Zobda Quitman, Fort de France, France); Jean-Marie Chennebault (Centre Hospitalier Universitaire d’Angers–Hopital de l’Hotel Dieu, Angers, France); Rozenn Le Berre (Centre Hospitalier Universitaire de Brest– Hopital de La Cavale Blanche, Brest, France); Didier Neau (Hopital Pellegrin, Bordeaux, France); Jean Michel Livrozet (Hopital Edouard Herriot, Lyon, France); Isabelle Poizot-Martin (Hopital Sainte Marguerite, Marseille, France); Sophie Matheron (Hopital Bichat, Paris, France); Jacques Reynes (Hopital Gui De Chauliac, Montpellier, France); Eric Billaud (Centre Hospitalier Universitaire de Nantes–Hotel Dieu, Nantes, France); Philippe Perre (Centre Hospitalier Departemental de Vendee–Les Oudairies, La Roche sur Yon, France); Jacques Durand (Centre Hospitalier Universitaire de Nice–Hopital de l’Archet, Nice, France); Eric Rosenthal (Centre Hospitalier Universitaire de Nice–Hopital de l’Archet, Nice, France); Cedric Arvieux (Centre Hospitalier Universitaire de Rennes–Hopital Pontchaillou, Rennes, France); Lize Cuzin (Centre Hospitalier Universitaire de Toulouse–Hopital Purpan, Toulouse, France); Renaud Verdon (Centre Hospitalier Universitaire Cote de Nacre, Caen, France); Pascale Leclercq (Centre Hospitalier Universitaire de Grenoble–Hopital Albert Michallon, Grenoble, France); Faiza Ajana (Hopital Gustave Dron, Tourcoing, France); Thierry May (Centre Hospitalier Universitaire Nancy–Hopital Brabois, Nancy, France); Yasmine Debab (Centre Hospitalier Universitaire de Rouen–Hopital Charles Nicolle, Rouen, France); Agnes Lefort (Hopital Beaujon, Clichy, France); Isabelle Delacroix (Centre Hospitalier Intercommunal de Creteil, Creteil, France); Genevieve Beck-Wirth (Hopital du Moenchberg, Mulhouse, France); Yves Poinsignon (Centre Hospitalier Bretagne-Atlantique Vannes, Vannes, France); Thierry Prazuck (Centre Hospitalier Regional–Hopital de La Source, Orleans, France); Patrick Philibert (Hopital Europeen Marseille, Marseille, France); Jean-Paul Viard (Hopital Hotel Dieu, Paris, France).International audienceBACKGROUND:Revaccination with double-dose hepatitis B vaccine has been recommended in HIV-infected patients who do not respond to standard vaccination, but has not yet been assessed. We aimed to compare the safety and immunogenicity of a reinforced hepatitis B revaccination protocol with the standard revaccination schedule in HIV-infected patients not responding to primary vaccination.METHODS:We did this multicentre, open-label, randomised controlled trial, at 53 centres in France. HIV-infected adults (aged ≥18 years), with CD4 counts of 200 cells per μL or more and no response to a previous hepatitis B vaccination or a 20 μg booster dose, were randomly assigned (1:1), according to a computer-generated randomisation list with permuted blocks (block sizes of two to six), to receive either standard-dose (20 μg) or double-dose (40 μg) recombinant hepatitis B vaccine at weeks 0, 4, and 24. Randomisation was stratified by baseline CD4 count (200-349 vs ≥350 cells per μL). Patients and treating physicians were not masked to treatment allocation, but the randomisation list was concealed from the investigators who assigned participants to the vaccination groups. The primary endpoint was the proportion of responders, defined as patients with hepatitis B surface antibody (anti-HBs) titres of 10 mIU/mL or more, at week 28. We did analysis by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00670839.FINDINGS:Between May 19, 2008, and May 8, 2011, 178 participants were randomly assigned to the standard-dose group (n=90) or the double-dose group (n=88), of whom 176 (98%) participants were included in the primary efficacy analysis. At week 28, we recorded a response in 60 patients (67%, 95% CI 57-77) in the standard-dose group versus 64 patients (74%, 63-82) in the double-dose group (p=0·334). Except for more frequent local reactions in the double-dose group than the standard-dose group (13 [15%] vs four [4%] patients; p=0·020), there was no difference in safety between groups.INTERPRETATION:In adults with HIV-1 who have not responded to previous hepatitis B vaccination, double-dose revaccination did not achieve a higher response rate than did revaccination with standard single-dose regimen. However, the safety profile was similar between treatment groups. Our results should be assessed in future studies before double-dose vaccine can be considered for the standard of care of vaccine non-responders.FUNDING:French National Institute for Medical Research-French National Agency for Research on AIDS and Viral Hepatitis

Tenofovir Disoproxil Fumarate and Emtricitabine Maintenance Strategy in Virologically Controlled Adults with Low HIV-1 DNA: 48 Week Results from a Randomized, Open-Label, Non-Inferiority Trial

Abstract Objectives Low HIV reservoirs may be associated with viral suppression under a lower number of antiretroviral drugs. We investigated tenofovir disoproxil fumarate/emtricitabine as a maintenance strategy in people living with HIV (PLHIV) with low HIV-DNA. Methods TRULIGHT (NCT02302547) was a multicentre, open-label, randomized trial comparing a simplification to tenofovir disoproxil fumarate/emtricitabine versus a triple regimen continuation (tenofovir disoproxil fumarate/emtricitabine with a third agent, control arm) in virologically suppressed adults with HIV-DNA <2.7\,log10 copies/106 PBMCs and no prior virological failure (VF). The primary endpoint (non-inferiority margin 12%) was the percentage of participants with a plasma viral load (pVL) <50\,copies/mL in ITT (Snapshot approach) and PP analyses at Week 48 (W48). Results Of the 326 participants screened, 223 (68%) were randomized to the tenofovir disoproxil fumarate/emtricitabine arm (n\,=\,113) or control arm (n\,=\,110). At W48, the tenofovir disoproxil fumarate/emtricitabine and control arms maintained a pVL\,<\,50\,copies/mL in 100/113 (88.5%) and 100/110 (90.9%) participants, respectively (ITT difference 2.4%, 95% CI \textendash 5.9 to 10.7; PP difference 3.4%, 95% CI \textendash 4.2 to 11.0). Six VFs occurred in the tenofovir disoproxil fumarate/emtricitabine arm (two with emerging mutations M184V and K65R) versus two in the control arm (ITT difference 3.5%, 95% CI \textendash 1.9 to 9.4). All VFs were resuppressed after treatment modification. Conclusions Although non-inferiority was shown, simplification to tenofovir disoproxil fumarate/emtricitabine should not be used for most PLHIV because of a low risk of VF with resistance

Improving the evidence for indicator condition guided HIV testing in Europe:Results from the HIDES II Study - 2012 - 2015

BackgroundIt is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries.MethodsIndividuals aged 18-65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015.ResultsOf 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5-3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis.ConclusionThe study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit

Safety and Immunogenicity of a Monovalent 2009 Influenza A/H1N1v Vaccine Adjuvanted With AS03A or Unadjuvanted in HIV-Infected Adults: A Randomized, Controlled Trial

Background. Human immunodeficiency virus (HIV)–infected patients have decreased immune response to vaccines. Few data are available about pandemic flu vaccination in this population