Prise en charge des comorbidités chez les sujets porteurs du VIH (étude de l'observance aux antihypertenseurs en fonction de la perception de l'hypertension artérielle chez 115 sujets VIH-positifs d'un hôpital New Yorkais)

Introduction. Les affections cardio-vasculaires sont une cause majeure de décès chez les sujets infectés par le VIH, et l'hypertension artérielle (HTA) une comorbidité fréquente chez ces patients. Or, l'observance médicamenteuse aux antihypertenseurs n'a encore jamais été étudiée chez les sujets porteurs du VIH. L'objectif de cette étude est d'évaluer la perception qu'ont les patients VIH-positifs et hypertendus de leurs deux maladies (poids et compréhension de la maladie, croyances relatives à la nécessité d'un traitement) et le degré d'observance aux antirétroviraux (ARV) et aux antihypertenseurs. Patients et Méthodes. 149 patients VIH-positifs sous ARV et antihypertenseurs suivis dans trois hôpitaux New Yorkais ont été inclus et 115 ont rempli les questionnaires "perception des maladies" et "croyances à propos des médicaments" pour les deux maladies. Les taux d'observance ont été évalués par monitoring électronique d'un ARV et d'un antihypertenseur pendant 10 semaines. Résultats. 102 patients ont rendu les capsules de monitoring électronique et ces patients étaient plus susceptibles d'avoir une charge virale indétectable à l'inclusion en comparaison aux patients ne les ayant pas rendues, biaisant l'échantillon final en une population plus observante. Les taux d'observance aux ARV et aux antihypertenseurs étaient globalement élevés. L'observance de dose et l'observance d'horaire étaient meilleures pour les ARV que pour les antihypertenseurs, alors que l'observance de prise était identique pour les deux médicaments. Le VIH était considéré comme plus incontrôlable, mieux compris, plus chronique, suscitait plus d'émotion, était associé à plus de conséquences et plus de symptômes physiques que l'HTA. Les patients rapportaient une nécessité de prise des ARV plus importante que celle des antihypertenseurs. L'observance aux deux traitements était moins bonne chez les sujets noirs et hispaniques par rapport aux sujets blancs, concordant avec la reconnaissance d'une moins bonne compréhension de la maladie dans ces groupes ethniques. Conclusion. Les interventions visant à améliorer l'observance aux antihypertenseurs chez les sujets VIH-positifs doivent tenir compte des perceptions spécifiques de l'HTA en contexte d'infection à VIH tout en s'adaptant au contexte culturel de chaque malade.BORDEAUX1-Bib.electronique (335229901) / SudocSudocFranceF

Infectious disease consultation is effective in boosting vaccine coverage in patients awaiting kidney transplantation: A French prospective study

International audienceRecommended preventive strategies before kidney transplantation include screening and treatment of latent tuberculosis infection (LTBI), and updating of the recommended vaccines. We prospectively evaluated in dedicated infectious diseases consultations, from 2014 to 2018, the clinical and vaccination data of new adult kidney allograft candidates. Patients were offered an updated vaccination schedule, if appropriate, and were screened for LTBI using chest imaging and interferon gamma release assay (IGRA). Overall, 467 patients with median age of 58 [46-66] years were evaluated, of whom 302 patients (65%) were men (sex ratio 1.83), and 333 (71%) were on dialysis. Main causes of renal insufficiency were diabetes (25%) and autoimmune nephropathies (18%). The vaccination coverage was low and varied according to the different types of vaccines and patients. Vaccination or immunization rates were 24%, 6%, 54%, and 51% for tetanus-diphtheria-polio-acellular pertussis, Pneumococcus, hepatitis B, and seasonal influenza, respectively. ID consultation successfully rose patients' vaccinations coverage, in fulfillment with recommendations, in 465 (99%) patients. LTBI treatment was administered in 78 (16.7%) patients and caused drug-related adverse events in 9 (11%). A dedicated infectious disease consultation should become a critical tool for coordinating infection prevention strategies

Impact of a Dedicated Pretransplant Infectious Disease Consultation on Respiratory Tract Infections in Kidney Allograft Recipients: A Retrospective Study of 516 Recipients

Background: Respiratory tract infections (RTIs) are a leading cause of death after kidney transplant. Preventive strategies may be implemented during a dedicated infectious disease consultation (IDC) before transplantation. Impact of IDC on RTIs after transplant has not been determined. Methods: We conducted a monocentric retrospective cohort analysis including all kidney transplant recipients from January 2015 to December 2019. We evaluated the impact of IDC on RTIs and identified risk and protective factors associated with RTIs. Results: We included 516 kidney transplant recipients. Among these, 145 had an IDC before transplant. Ninety-five patients presented 123 RTIs, including 75 (61%) with pneumonia. Patient that benefited from IDC presented significantly less RTIs (p = 0.049). RTIs were an independent risk factor of mortality (HR = 3.64 (1.97–6.73)). Independent risk factors for RTIs included HIV (OR = 3.33 (1.43–7.74)) and HCV (OR = 3.76 (1.58–8.96)). IDC was identified as an independent protective factor (OR = 0.48 (0.26–0.88)). IDC prior to transplantation is associated with diminished RTIs and is an independent protective factor. RTIs after kidney transplant are an independent risk factor of death. Implementing systematic IDC may have an important impact on reducing RTIs and related morbidity and mortality

De Novo Focal and Segmental Glomerulosclerosis After COVID-19 in a Patient With a Transplanted Kidney From a Donor With a High-risk APOL1 Variant

International audienc

Vancomycin-Associated Cast Nephropathy

International audienceVancomycin is a widely prescribed antibiotic, but the exact nature of vancomycin-associated nephrotoxicity is unclear, in particular when considering the frequent coadministration of aminoglycosides. We describe here the initial case of a 56-year-old woman with normal renal function developing unexplained ARF without hypovolemia after administration of vancomycin without coadministration of aminoglycosides. Studying the patient’s renal biopsy specimen, we ascertained that obstructive tubular casts composed of noncrystal nanospheric vancomycin aggregates entangled with uromodulin explained the vancomycin-associated ARF. We developed in parallel a new immunohistologic staining technique to detect vancomycin in renal tissue and confirmed retrospectively that deleterious vancomycin-associated casts existed in eight additional patients with acute tubular necrosis in the absence of hypovolemia. Concomitant high vancomycin trough plasma levels had been observed in each patient. We also reproduced experimentally the toxic and obstructive nature of vancomycin-associated cast nephropathy in mice, which we detected using different in vivo imaging techniques. In conclusion, the interaction of uromodulin with nanospheric vancomycin aggregates represents a new mode of tubular cast formation, revealing the hitherto unsuspected mechanism of vancomycin-associated renal injury