Caractéristiques sociodémographiques et médicales de patients infectés par le VIH âgés de 65 ans et plus dans 4 centres hospitaliers d'Ile-de-France

Depuis l arrivée de la trithérapie en 1996, les personnes atteintes par le VIH vieillissent. Il s agit d une étude transversale descriptive sur des patients âgés de 65 ans et plus dans quatre hôpitaux d Ile De France. Les critères étudiés sont sociodémographiques et immunovirologiques. Les patients ont en moyenne 70 ans, avec une majorité d hommes, hétérosexuels et étrangers. Un quart des patients vivent dans des logements précaires. Le principal mode de contamination est sexuel. Le mode de révélation est non spécifique avec des risques de retard diagnostic. Quatre vingt onze pour cent sont traités avec une bonne réponse immunovirologique. L âge constitue un critère d immunodépression qui s ajoute à l infection par le VIH. Ainsi les principales infections opportunistes sont la tuberculose et le sarcome de kaposi contrairement à l épidémiologie des plus jeunes. Les interactions médicamenteuses sont plus compliquées en raison de plus de traitements non VIH chez les patients plus âgés. Cette étude montre aussi que sous traitement antirétroviral, les patients âgés développent plus de complications cardiovasculaires avec 12 % de diabète, 36 % de dyslipidémie et 12 % d infarctus du myocarde. Cela suggère la réalisation d études longitudinales dans le futur pour mieux définir les personnes âgées atteintes par l infection VIH.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

LAV Revisited: Origins of the Early HIV-1 Isolates from Institut Pasteur

International audienceTwo of the first human immunodeficiency virus type-1 (HIV-1) strains isolated were authenticated by reanalyzing original cultured samples stored at the Collection Nationale de Culture des Microorganismes as well as uncultured primary material. Cloned polymerase chain reaction products were used to analyze coding sequences of the V3 loop in the gp120 glycoprotein. The original isolate HIV-1 Bru, formerly called LAV, was derived from patient BRU. HIV-1 Lai was derived from patient LAI and contaminated a HIV-1 Bru culture between 20 July and 3 August 1983. The culture became, in effect, HIV-1 Lai, identifiable by a unique motif in the V3 loop. Because of this contamination two, rather than one, HIV-1 isolates were sent to the Laboratory of Tumor Cell Biology at the National Cancer Institute on 23 September 1983. Original HIV-1 Bru was indeed present in the sample marked JBB/LAV. However the M2T-/B sample harbored HIV-1 Lai, a strain capable of growing on established cell lines. The striking similarity between HIV-1 Lai (formerly LAV-Bru) and HTLV-3B sequences remains

Rilpivirine in HIV-1-positive women initiating pregnancy: to switch or not to switch?

International audienceBackgroundSafety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.ObjectivesTo describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.MethodsIn the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.ResultsAmong 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.ConclusionsIn virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes