PLoS One

BACKGROUND: Direct-acting antivirals (DAA) have dramatically increased HCV cure rates with minimal toxicity in HIV-HCV co-infected patients. This study aimed to compare the socio-behavioral characteristics of patients initiating pegylated-interferon (PEG-IFN)-based HCV treatment with those of patients initiating DAA-based treatment. METHODS: ANRS CO13 HEPAVIH is a national multicenter prospective cohort started in 2005, which enrolled 1,859 HIV-HCV co-infected patients followed up in French hospital outpatient units. Both clinical/biological and socio-behavioral data were collected during follow-up. We selected patients with socio-behavioral data available before HCV treatment initiation. RESULTS: A total of 580 patients were included in this analysis. Of these, 347 initiated PEG-IFN-based treatment, and 233 DAA-based treatment. There were significant differences regarding patient mean age (45 years+/-6 for the PEG-IFN group vs. 52 years+/-8 for the DAA group, p<0.001), unstable housing (21.4% vs. 11.2%, p = 0.0016), drug use (44.7% vs. 29.6%, p = 0.0003), regular or daily use of cannabis (24.3% vs. 15.6%, p = 0.0002), a history of drug injection (68.9% vs 39.0%, p<0.0001) and significant liver fibrosis (62.4% vs 72.3%, p = 0.0293). In multivariable analysis, patients initiating DAA-based treatment were older than their PEG-IFN-based treatment counterparts (aOR = 1.17; 95%CI [1.13; 1.22]). Patients receiving DAA treatment were less likely to report unstable housing (0.46 [0.24; 0.88]), cannabis use (regular or daily use:0.50 [0.28; 0.91]; non-regular use: 0.41 [0.22; 0.77]), and a history of drug injection (0.19 [0.12; 0.31]). CONCLUSION: It is possible that a majority of patients who had socio-economic problems and/or a history of drug injection and/or a non-advanced disease stage were already treated for HCV in the PEG-IFN era. Today, patients with unstable housing conditions are prescribed DAA less frequently than other populations. As HCV treatment is prevention, improving access to DAA remains a major clinical and public health strategy, in particular for individuals with high-risk behaviors

Nutrients

BACKGROUND: Coffee intake has been shown to modulate both the effect of ethanol on serum GGT activities in some alcohol consumers and the risk of alcoholic cirrhosis in some patients with chronic diseases. This study aimed to analyze the impact of coffee intake and alcohol consumption on advanced liver fibrosis (ALF) in HIV-HCV co-infected patients. METHODS: ANRS CO13-HEPAVIH is a French, nationwide, multicenter cohort of HIV-HCV-co-infected patients. Sociodemographic, behavioral, and clinical data including alcohol and coffee consumption were prospectively collected using annual self-administered questionnaires during five years of follow-up. Mixed logistic regression models were performed, relating coffee intake and alcohol consumption to ALF. RESULTS: 1019 patients were included. At the last available visit, 5.8% reported high-risk alcohol consumption, 27.4% reported high coffee intake and 14.5% had ALF. Compared with patients with low coffee intake and high-risk alcohol consumption, patients with low coffee intake and low-risk alcohol consumption had a lower risk of ALF (aOR (95% CI) 0.24 (0.12(-)0.50)). In addition, patients with high coffee intake had a lower risk of ALF than the reference group (0.14 (0.03(-)0.64) in high-risk alcohol drinkers and 0.11 (0.05(-)0.25) in low-risk alcohol drinkers). CONCLUSIONS: High coffee intake was associated with a low risk of liver fibrosis even in HIV-HCV co-infected patients with high-risk alcohol consumption

PLoS One

Compared to the general population, HIV-infected patients are at higher risk of developing non-AIDS-defining cancers. Chronic HCV infection has also been associated with a higher risk than that of the general population of developing cancers other than hepatocarcinoma. Evaluation of the impact of HCV-related factors on non-AIDS-defining and non HCV-liver (NANL) related cancers among HIV/HCV co-infected patients are scarce. The aim of this study was to identify the impact of HIV/HCV clinical characteristics on NANL related cancers in a large cohort of HIV/HCV-coinfected patients followed from 2005 to 2017. Cox proportional hazards models with delayed entry were used to estimate factors associated with NANL related cancer. Among 1391 patients followed for a median of 5 years, 60 patients developed NANL related cancers, yielding an incidence rate of 8.9 per 1000 person-years (95% CI, [6.6-11.1]). By final multivariable analysis, after adjustment for sex, tobacco or alcohol consumption, baseline CD4 cell count and HCV sustained viral response (SVR), age and a longer duration since HIV diagnosis were independently associated with a higher risk of NANL related cancer (aHR for each additional year 1.10, 95% CI 1.06-1.14, p<0.0001 and 1.06, 95% CI 1.01-1.11, p = 0.02, respectively). Duration of HCV infection, cirrhosis, HCV viral load, genotype and SVR were not associated with the occurrence of NANL related cancer. Among HIV/HCV-coinfected patients, age and the duration of HIV infection were the only characteristics found to be associated with the occurrence of NANL related cancer. In contrast, no association was observed with any HCV-related variables

PLoS One

BACKGROUND: The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. METHODS: HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with >/=1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. RESULTS: 1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4-49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2-6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM 12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR

Facteurs nutritionnels et génétiques associés à la santé osseuse chez l'enfant et l'adolescent en bonne santé

L'enfance et l'adolescence sont des périodes cruciales pour la minéralisation du squelette. J'ai montré que la minéralisation des vertèbres lombaires pendant l' adolescence était associée à la consommation de lait plus qu'à celle d'autres sources de calcium. Le polymorphisme associé à l'hypolactasie n'est pas corrélé à l'acquisition de la masse osseuse pendant l'adolescence. En revanche, le polymorphisme en -1012 du VDRp influence l'association entre la minéralisation osseuse des vertèbres lombaires et les apports en lait. Les jeunes filles porteuses des variants G/A et G/G en - 1012 VDRp (70 % des Européennes) ont besoin d'apports en laits plus élevés que celles portant le variant (A/A), variant majeur dans les populations Africaines et Asiatiques. Des déformations osseuses et des signes biologiques d'insuffisance en vitamine D ont été observés chez des enfants et adolescents ayant des niveaux de 25-(OH)D<30 nmol/L, particulièrement chez ceux ayant de faibles apports en lait/calcium.Childhood and adolescence are critical periods for bone mineralization. I have shown that lumbar spine mineralization during adolescence was associated with milk intakes more than other sources of dietary calcium. Polymorphism associated with hypolactasia was not correlated to lumbar spine bone mass accrual during adolescence. In contrast, the -1012 polymorphism in VDRp influence of the association between lumbar spine mineralization and milk intakes. Girls carry G / A and G / G -1012 variants in VDRp (70% of European population) need higher milk intakes than those with bearing a A/A genotype, major variant in African and Asians populations. Bone deformities and biological signs of vitamin D deficiency were observed in children and adolescents with levels of 25 - (OH) D <30 nmol / L, especially in those with low milk / calcium intakes.PARIS5-BU Méd.Cochin (751142101) / SudocSudocFranceF

Rôle de la vitamine D et risque de maladies auto-immunes/cancers

Si La vitamine D est connue depuis près d’un siècle pour son action antirachitique, depuis quelques années de nombreux travaux mettent en évidence l’implication de la vitamine D dans le développement des maladies auto-immunes (psoriasis, asthme, diabète de type 1...), sensibilité au virus (tuberculose, grippe, bronchiolite...) ou de cancers. La forme active de la vitamine D, la 1,25-(OH)2D joue un rôle immunomodulateur complexe associant : (1) une activation des systèmes non spécifiques de défense immunitaire, en favorisant la différenciation et les activités cytotoxiques des monocytes-macrophages; et (2) une inhibition des systèmes de défense immunitaire antigènes-spécifiques, en diminuant la fonction de présentation des antigènes des monocytes, en modulant la prolifération et les activités des lymphocytes T et B, et en favorisant le maintien ou la restauration de la fonction immunosuppressive des lymphocytes. Ces actions permettent d’expliquer les effets préventifs de la 1,25-(OH)2D sur le développement des maladies auto-immunes ou le rejet des hétérogreffes chez l’animal. La synthèse d’analogues ayant les mêmes activités immunomodulatrices que la 1,25-(OH)2D, tout en étant moins hypercalcémiants, ouvre des perspectives intéressantes pour cette prévention en clinique humaine. La question qui reste ouverte porte sur les niveaux de vitamine D à recommander car les niveaux de vitamine D (25(OH)D) nécessaire pour observer ce rôle protecteur sont beaucoup plus élevés que les niveaux pour maintenir une santé osseuse optimale. Il faudrait largement augmenter les supplémentations. Toute la difficulté réside dans le fait que ces supplémentations élevées peuvent s’associer à des signes d’hypercalcémie. L’autre question est « qui supplémenter » : à quel âge, à quelle dose

Rôle de la vitamine D et risque de maladies auto-immunes/cancers

Si La vitamine D est connue depuis près d’un siècle pour son action antirachitique, depuis quelques années de nombreux travaux mettent en évidence l’implication de la vitamine D dans le développement des maladies auto-immunes (psoriasis, asthme, diabète de type 1...), sensibilité au virus (tuberculose, grippe, bronchiolite...) ou de cancers. La forme active de la vitamine D, la 1,25-(OH)2D joue un rôle immunomodulateur complexe associant : (1) une activation des systèmes non spécifiques de défense immunitaire, en favorisant la différenciation et les activités cytotoxiques des monocytes-macrophages; et (2) une inhibition des systèmes de défense immunitaire antigènes-spécifiques, en diminuant la fonction de présentation des antigènes des monocytes, en modulant la prolifération et les activités des lymphocytes T et B, et en favorisant le maintien ou la restauration de la fonction immunosuppressive des lymphocytes. Ces actions permettent d’expliquer les effets préventifs de la 1,25-(OH)2D sur le développement des maladies auto-immunes ou le rejet des hétérogreffes chez l’animal. La synthèse d’analogues ayant les mêmes activités immunomodulatrices que la 1,25-(OH)2D, tout en étant moins hypercalcémiants, ouvre des perspectives intéressantes pour cette prévention en clinique humaine. La question qui reste ouverte porte sur les niveaux de vitamine D à recommander car les niveaux de vitamine D (25(OH)D) nécessaire pour observer ce rôle protecteur sont beaucoup plus élevés que les niveaux pour maintenir une santé osseuse optimale. Il faudrait largement augmenter les supplémentations. Toute la difficulté réside dans le fait que ces supplémentations élevées peuvent s’associer à des signes d’hypercalcémie. L’autre question est « qui supplémenter » : à quel âge, à quelle dose

Rôle de la vitamine D et risque de maladies auto-immunes/cancers

Si La vitamine D est connue depuis près d’un siècle pour son action antirachitique, depuis quelques années de nombreux travaux mettent en évidence l’implication de la vitamine D dans le développement des maladies auto-immunes (psoriasis, asthme, diabète de type 1...), sensibilité au virus (tuberculose, grippe, bronchiolite...) ou de cancers. La forme active de la vitamine D, la 1,25-(OH)2D joue un rôle immunomodulateur complexe associant : (1) une activation des systèmes non spécifiques de défense immunitaire, en favorisant la différenciation et les activités cytotoxiques des monocytes-macrophages; et (2) une inhibition des systèmes de défense immunitaire antigènes-spécifiques, en diminuant la fonction de présentation des antigènes des monocytes, en modulant la prolifération et les activités des lymphocytes T et B, et en favorisant le maintien ou la restauration de la fonction immunosuppressive des lymphocytes. Ces actions permettent d’expliquer les effets préventifs de la 1,25-(OH)2D sur le développement des maladies auto-immunes ou le rejet des hétérogreffes chez l’animal. La synthèse d’analogues ayant les mêmes activités immunomodulatrices que la 1,25-(OH)2D, tout en étant moins hypercalcémiants, ouvre des perspectives intéressantes pour cette prévention en clinique humaine. La question qui reste ouverte porte sur les niveaux de vitamine D à recommander car les niveaux de vitamine D (25(OH)D) nécessaire pour observer ce rôle protecteur sont beaucoup plus élevés que les niveaux pour maintenir une santé osseuse optimale. Il faudrait largement augmenter les supplémentations. Toute la difficulté réside dans le fait que ces supplémentations élevées peuvent s’associer à des signes d’hypercalcémie. L’autre question est « qui supplémenter » : à quel âge, à quelle dose

Exploring the risk of hypospadias in children born from mothers living close to a vineyard

International audienceHypospadias (H) is a common birth defect affecting the male urinary tract. It has been suggested that exposure to endocrine disrupting chemicals might increase the risk of H by altering urethral development. However, whether H risk is increased in places heavily exposed to agricultural pesticides, such as vineyards, remains debated and difficult to ascertain. The objective of the work is to test the possible association of H with residential proximity to vineyards. Residential address at birth of 8,766 H cases born 1980-2011 was taken from 17 specialized surgery centers. The geographical distribution of vineyards was obtained from the European Land Parcel Identification System (LPIS) and the distance of address to the nearest vineyard was computed. A first estimate of the variation of H relative risk with distance to vineyards was obtained using as controls 13,105 cryptorchidism (C) cases operated during the same period in the same centers. A separate estimate was obtained from a case-control study using "virtual controls" (VC) defined as points of the map sampled to match the demographic distribution of births within the recruitment territories of the study centers. Non-exposed patients were defined as those with a residence between 5,000 and 10,000 m from the closest vineyard. The residential distance to vineyard was smaller for H than for C cases (p<10 −4). We found 42/8766 H cases (0.48%) and 50/13,105 C cases (0.38%) born to mothers living within 20 m of a vineyard. The odds ratios for H were 2.48 (CI: 1.0 to 5.1) and 2.4 (CI: 1.3 to 4.4), vs C or vs VC, respectively, when pregnant mothers lived 10-20 m from a vineyard. In conclusion, our study supports that children born to mothers living close to a vineyard have a twofold increased risk of H. For environmental research, the use of VC provides an alternative to classical case control technique

J Hepatol

International audienceno abstrac