Incidence of Herpes Zoster in HIV-Infected Adults in the Combined Antiretroviral Treatment (cART) Era: Results from the FHDH-ANRS CO4 Cohort

International audienceBackground: Recent studies have shown a decrease in the incidence of herpes zoster (HZ) among HIV-infected patients since the cART era, but more data are needed on a possible increase in the risk early after cART initiation.Methods: We studied the HZ incidence and risk factors among patients followed in the French Hospital Database on HIV (FHDH) between 1992 and 2011. Standardized incidence ratios (SIR) were used for comparison with the general population between 2005 and 2008. The risk of HZ following cART initiation (0-6, ≥6 months) was studied with Poisson regression models.Results: 7167 cases of incident HZ were diagnosed among 91 044 individuals (583 125 person-years). The incidence declined significantly from 2955 per 100 000 person-years in 1992-1996 to 628 in 2009-2011. This decline was mainly explained by cART (RR=0.60; 95%CI, 0.57-0.64). The risk of HZ was associated with low CD4 cell counts, high HIV-RNA levels, low CD4/CD8 ratios and prior AIDS. Compared to the general population, the risk of HZ was higher in HIV-infected patients (overall SIR=2.7; 95%CI, 2.6-2.9), particularly between ages 15 and 45 years (SIR=4-6). In ART-naive patients a moderate increase in the HZ risk was observed during the first 6 months of cART, with a peak at 3 months (RR=1.47 95%CI, 1.26-1.73) a finding that disappeared after adjustment for the current CD4 cell count (RR=1.03; 95%CI, 0.81-1.32). Conclusions: The risk of HZ has declined markedly among HIV-infected patients in the cART era but remains 3 times higher than in the general population. The risk increases moderately during the first 6 months of cART

Four-days-a-week antiretroviral maintenance therapy in virologically controlled HIV-1-infected adults: the ANRS 162-4D trial

International audienceBackground:Intermittent treatment could improve the convenience, tolerability and cost of ART, as well as patients' quality of life. We conducted a 48 week multicentre study of a 4-days-a-week antiretroviral regimen in adults with controlled HIV-1-RNA plasma viral load (VL).Methods:Eligible patients were adults with VL  90%, with a power of 87% and a 5% type 1 error. The study was registered with ClinicalTrials.gov (NCT02157311) and EudraCT (2014-000146-29).Results:One hundred patients (82 men), median age 47 years (IQR 40-53), were included. They had been receiving ART for a median of 5.1 (IQR 2.9-9.3) years and had a median CD4 cell count of 665 (IQR 543-829) cells/mm3. The ongoing regimen included PI/r in 29 cases and NNRTI in 71 cases. At 48 weeks, 96% of participants (95% CI 90%-98%) had no failure while remaining on the 4-days-a-week regimen. Virological failure occurred in three participants, who all resumed daily treatment and became resuppressed. One participant stopped the strategy. No severe treatment-related events occurred.Conclusions:Antiretroviral maintenance therapy 4 days a week was effective for 48 weeks in 96% of patients, leading to potential reduction of long-term toxicities, high adherence to the antiretroviral regimen and drug cost saving

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence