Dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d’un syndrome de reconstitution immune avec tuberculose

Un homme de 35 ans, VIH-1, sans antécédents médicaux et chirurgicaux particuliers, a été hospitalisé à Abidjan, Côte d'Ivoire, dans un contexte fébrile, toux, dyspnée, douleurs thoraciques et à la radiographie pulmonaire, un déroulement de la crosse de l'aorte une semaine après avoir débuté les antirétroviraux (ARV). Les scanners angiothoraciques réalisés ont mis en évidence une ectasie aortique globale étendue avec thrombus mural. Une échocardiographie transoesophagienne conclut à une dissection aortique, type A de Stanford. Le diagnostic de tuberculose a été confirmé par l'isolation en culture de Mycobacterium Tuberculosis. Huit ans après, le patient est encore vivant, sans intervention chirurgicale et se plaint de douleurs thoraciques intermittentes. Sa pression artérielle est stable et a une insuffisance rénale modérée. Nous rapportons un cas rare de dissection aortique anévrismale chez un adulte infecté par le VIH-1 dans le cadre d'un syndrome de reconstitution immune avec tuberculose pulmonaire

Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries.: Tobacco use in HIV-infected patients in West Africa

International audienceBACKGROUND: Tobacco smoking is common in human immunodeficiency virus (HIV) infected patients from industrialised countries. In West Africa, few data concerning tobacco consumption exist. METHODS: A cross-sectional survey of the International Epidemiological Database to Evaluate AIDS (IeDEA) network in West Africa was conducted. Health workers administered a questionnaire assessing tobacco and cannabis consumption among patients receiving antiretroviral treatment. Regular smokers were defined as current smokers who smoked >1 cigarette per day for >or=1 year. RESULTS: Overall, 2920 patients were enrolled in three countries. The prevalence of ever smokers and regular smokers were respectively 46.2% (95%CI 42.8-49.5) and 15.6% (95%CI 13.2-18.0) in men and 3.7% (95%CI 2.9-4.5) and 0.6% (95%CI 0.3-0.9) in women. Regular smoking was associated with being from Côte d'Ivoire or Mali compared to Benin (OR 4.6, 95%CI 2.9-7.3 and 7.7, 95%CI 4.4-13.6), severely impaired immunological status at highly active antiretroviral treatment initiation (OR 1.5, 95%CI 1.1-2.2) and history of tuberculosis (TB; OR 1.8, 95%CI 1.1-3.0). CONCLUSION: There are marked differences in smoking prevalence among these West African countries. This survey approach also provides proof of the association between cigarette smoking and TB in HIV-infected patients, a major public health issue in this part of the world

Gender and the use of antiretroviral treatment in resource-constrained settings: Findings from a multicenter collaboration

Aims: To compare the gender distribution of HIV-infected adults receiving highly active antiretroviral treatment (HAART) in resource-constrained settings with estimates of the gender distribution of HIV infection; to describe the clinical characteristics of women and men receiving HAART. Methods: The Antiretroviral Therapy in Lower-Income Countries, ART-LINC Collaboration is a network of clinics providing HAART in Africa, Latin America, and Asia. We compared UNAIDS data on the gender distribution of HIV infection with the proportions of women and men receiving HAART in the ART-LINC Collaboration. Results: Twenty-nine centers in 13 countries participated. Among 33,164 individuals, 19,989 (60.3%) were women. Proportions of women receiving HAART in ART-LINC centers were similar to, or higher than, UNAIDS estimates of the proportions of HIV-infected women in all but two centers. There were fewer women receiving HAART than expected from UNAIDS data in one center in Uganda and one center in India. Taking into account heterogeneity across cohorts, women were younger than men, less likely to have advanced HIV infection, and more likely to be anemic at HAART initiation. Conclusions: Women in resource-constrained settings are not necessarily disadvantaged in their access to HAART. More attention needs to be paid to ensuring that HIV-infected men are seeking care and starting HAART

Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial

International audienc

Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial

Background: Temprano ANRS 12136 was a factorial 2 × 2 trial that assessed the benefits of early antiretroviral therapy (ART; ie, in patients who had not reached the CD4 cell count threshold used to recommend starting ART, as per the WHO guidelines that were the standard during the study period) and 6-month isoniazid preventive therapy (IPT) in HIV-infected adults in Côte d'Ivoire. Early ART and IPT were shown to independently reduce the risk of severe morbidity at 30 months. Here, we present the efficacy of IPT in reducing mortality from the long-term follow-up of Temprano. Methods: For Temprano, participants were randomly assigned to four groups (deferred ART, deferred ART plus IPT, early ART, or early ART plus IPT). Participants who completed the trial follow-up were invited to participate in a post-trial phase. The primary post-trial phase endpoint was death, as analysed by the intention-to-treat principle. We used Cox proportional models to compare all-cause mortality between the IPT and no IPT strategies from inclusion in Temprano to the end of the follow-up period. Findings: Between March 18, 2008, and Jan 5, 2015, 2056 patients (mean baseline CD4 count 477 cells per μL) were followed up for 9404 patient-years (Temprano 4757; post-trial phase 4647). The median follow-up time was 4·9 years (IQR 3·3–5·8). 86 deaths were recorded (Temprano 47 deaths; post-trial phase 39 deaths), of which 34 were in patients randomly assigned IPT (6-year probability 4·1%, 95% CI 2·9–5·7) and 52 were in those randomly assigned no IPT (6·9%, 5·1–9·2). The hazard ratio of death in patients who had IPT compared with those who did not have IPT was 0·63 (95% CI, 0·41 to 0·97) after adjusting for the ART strategy (early vs deferred), and 0·61 (0·39–0·94) after adjustment for the ART strategy, baseline CD4 cell count, and other key characteristics. There was no evidence for statistical interaction between IPT and ART (pinteraction=0·77) or between IPT and time (pinteraction=0·94) on mortality. Interpretation: In Côte d'Ivoire, where the incidence of tuberculosis was last reported as 159 per 100 000 people, 6 months of IPT has a durable protective effect in reducing mortality in HIV-infected people, even in people with high CD4 cell counts and who have started ART. Funding: National Research Agency on AIDS and Viral Hepatitis (ANRS)