11 research outputs found

    Efficacy of Oseltamivir-Zanamivir Combination Compared to Each Monotherapy for Seasonal Influenza: A Randomized Placebo-Controlled Trial

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    Analysis of virological and clinical outcomes from a randomized trial that was terminated early suggest that combined treatment of seasonal influenza in adult outpatients with oseltamivir plus zanamivir is no more effective than either oseltamivir or zanamivir monotherapy

    Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness

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    BACKGROUND. In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS. We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE. One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.Haute Autorite de Sante; the Institut de Veille Sanitaire; Sidaction; the Agence Nationale de Recherches sur le SIDA et les hepatites virales; the National Institute of Allergy and Infectious Diseases (R01 AI042006, K24 AI062476, P30 AI42851); the National Institute of Mental Health (R01 MH65869); the National Institute on Drug Abuse (R01 DA015612

    Neither genotyping nor contact tracing allow correct understanding of MDR TB transmission

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    International audienceObjectives: Active case tracing and strain genotyping are the main strategies used for identifying multidrug resistant tuberculosis (MDR TB) transmission. The objective of this study was to evaluate the performances of these strategies.Materials and Methods: We conducted a prospective study of active case finding of contacts of MDR TB cases in Paris between 2010 and 2013. Contact cases underwent clinical evaluation, chest X-ray and QuantiFERON® testing. MIRU VNTR genotyping was done for all MDR strains.Results: Investigations identified 84 contacts of 68 index MDR TB cases. Five had tuberculosis (6%). Of these, three (60%) had a strain sharing same genotype as the index case while 2 had drug susceptible TB. Genotyping allowed identification of 3 other possible transmissions not detected by contact investigation. However, retrospective investigation did not allow understanding how transmission occurred.Conclusion: Contact case tracing identified only 50% of secondary MDR cases identified by genotyping and misidentified 38% of cases as secondary to index case. However, by definition, genotyping identified secondary cases at the time tuberculosis had declared. As a consequence additional investigation conducted many months after transmission did not allow understanding how it occurred and didnot allow implementation of additional preventive measures

    Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial

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    International audienceOBJECTIVES:We aimed to evaluate and compare non-adherence to oral and inhaled antiviral therapies prescribed of a randomised clinical trial in outpatients with influenza A infection.DESIGN:A parallel, three-arm, double-blinded trial randomly allocated antiviral therapies twice daily for 5 days: (1) oral oseltamivir plus inhaled zanamivir (arm OZ); (2) oseltamivir plus inhaled placebo (arm Opz); or (3) oral placebo plus inhaled zanamivir (arm poZ). Analysis of non-adherence was a secondary objective of the trial.SETTINGS:Outpatients were enrolled by 145 general practitioners throughout France during the 2008-2009 seasonal influenza epidemics.PARTICIPANTS:A total of 541 adults presenting with influenza-like illness for less than 36 hours.PRIMARY OUTCOMES:Non-persistence, the time between inclusion and the last dose treated as a failure time, was used as the primary endpoint.RESULTS:The proportions of patients who persisted on treatment until the end of prescription were estimated at 85.73% (±3.28%) for the oral route and 82.73% (±3.44%) for the inhaled route. Based on multivariable models, non-persistence was associated with a PCR confirmation of influenza for both the oral (HR=0.54, p=0.010) and inhaled (HR=0.59, p=0.018) drugs and antibiotic coprescriptions (HR=2.07, p=0.007; and HR=1.88, p=0.017, respectively) and active combination treatment (HR=1.71, p=0.035; and HR=1.58, p=0.035, respectively). The hazard of non-persistence of the inhaled therapy was increased compared with that of the oral therapy (HR=1.23, p=0.043).CONCLUSION:In addition to the clinical and virological profiles of influenza infection, non-persistence may have been influenced by an active combination and the route of administration

    Effectiveness of hepatitis B rapid tests toward linkage-to-care: results of a randomized, multicenter study

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    International audienceObjectives: Worldwide, many infected individuals are unaware of their hepatitis B virus (HBV) status. We evaluated the effectiveness of HBV rapid testing in promoting linkage-to-care.Methods: In 2012, volunteers were recruited from five Parisian centers. Participants were randomized 1 : 1 to receive standard serology (S) or rapid testing (VIKIA-HBsAg/Quick Profile anti-HBsAb) with confirmatory serology (R+S). The primary endpoint was percentage of individuals with appropriate linkage-to-care (nonimmunized individuals starting vaccination or HBsAg-positive individuals receiving medical evaluation). The secondary outcomes were percentage receiving HBV-test results and performance of HBV rapid tests.Results: In total, 995 individuals were screened. Among the HBV-infection groups included in the primary endpoint (n=409), 20 (4.9%) received appropriate linkage-to-care, with no difference between S and R+S groups (5.7 vs. 4.1%, P=0.5). Two of eight HBsAg-positive participants had a medical visit (1/6 and 1/2 in the S and R+S groups, respectively) and 18/401 (4.5%) nonimmunized participants initiated HBV-vaccination (11/205 and 7/196). Factors that tended to be associated with linkage-to-care were female sex, birth country of high HBV prevalence, and extended medical stay. Test results were not obtained in 4.7% of participants, which was significantly higher in the S arm (P=0.02). Both sensitivity and specificity were 100% for the VIKIA-HBsAg rapid test and 94.4 and 80.8%, respectively, for the anti-HBsAb Quick Profile rapid test.Conclusion: Despite a higher proportion of participants obtaining their results in the R+S arm and better performance of anti-HBsAb rapid tests than described previously, we found no evidence that HBV screening based initially on rapid tests leads to increased HBV-vaccination rates or medical evaluation. This strategy should be evaluated in more hard-to-reach population

    Genotyping results of BRC TgH41001 strain and 12 reference strains with 15 microsatellite markers.

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    1<p>PTG is a clone of the ME49 strain; CTG is also known as CEP or C strain; COUGAR is also known as TgCgCa1 or COUG strain; BRC TgH18001 is also known as GUY-DOS or GUY-2001-DOS strain; BRC TgH18002 is also known as GUY-KOE or GUY-2002-KOE strain; BRC TgH18003 is also known as GUY-MAT or GUY-2002-MAT.</p
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