Predictive factors of HTLV1-HIV coinfections in French Guiana.

International audienceFrench Guiana, the French territory most affected by human immunodeficiency virus (HIV) (1.3% of pregnant women), is also endemic for human T lymphotropic virus 1 (HTLV1). The objective of this study was to determine if the HTLV1/HIV coinfected patients had particular characteristics. All HIV-infected patients having a computerized medical file containing an HTLV1 serology were included: there were 1,333 HIV monoinfections and 76 HTLV1/VIH coinfections. The prevalence of HTLV1/HIV coinfections was 5.39%. Women (odds ratio [OR] = 1.91[1.13-3.24]), subjects > 40 years of age, and patients of Surinamese origin (OR = 2.65 [1.25-5.61]) were overrepresented among the coinfected. CD4 count at the time of diagnosis and viral loads were higher among coinfected patients. The clinical stage was not significantly different between the two groups. The number of CD4 cells was not higher among the coinfected, unlike most reports from the literature. Prevalence of HTLV1 among HIV-infected patients is high in French Guiana, and physicians seem to omit the prescription of serology for this potentially serious coinfection

Predictive factors of unprotected sex for female sex workers: first study in French Guiana, the French territory with the highest HIV prevalence.

International audience: French Guiana is the French territory that is most affected by HIV. AIDS incidence is much higher than in mainland France and sex work seems to be an important driver of the epidemic. The objective of this study was to describe consistent condom use among female sex workers with their clients and their intimate partners and to identify determinants of non-use of condoms. An HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey was conducted in 2009-2010 among sex workers in French Guiana. A total of 477 sex workers were interviewed. Female sex workers were more likely to use condoms with their clients (97%) than with their intimate partners (45%). The factors associated with non-consistent condom use with the intimate partner were having had an abortion, feeling at risk for HIV, not evaluating one's own risk for HIV, living as a couple, being Dominican, not feeling comfortable asking intimate partners to use condoms. Although a high proportion of female sex workers declared using condoms with commercial partners, there is still room for improvement in the prevention of transmission with both commercial and intimate partners

Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana.

Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 count<50 per mm3, CD4 count between 50 and 200 per mm3, a CD4 nadir <50 per mm3, CD8 count in the lowest quartile, herpes infection, and recent antiretroviral treatment initiation (less than 6 months). The variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era

Knowledge, Attitudes, Beliefs and Practices on HIV/AIDS among Boatmen on the Maroni River: A Neglected Bridging Group?

International audienceIn French Guiana, the prevalence of HIV among pregnant women along the Maroni river, has risen from 0 to over 1% in the 1990's. Despite this sharp increase, no behavioural surveillance study has ever taken place in this border region. The present study showed that an important proportion of boatmen have risky sexual behaviour. These results underline the importance of targeting prevention interventions on this population that is not currently receiving specific HIV prevention messages

Independent predictors of a first episode of disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana: 1996–2008.

*<p>Cox multiple model in HIV positive patients with first episode of disseminated histoplasmosis as failure event. Model with 1404 subjects and 94 single failures.</p

Predictors of death within 6 months in HIV infected patients with disseminated histoplasmosis in French Guiana: 1996–2008.

*<p>Cox model in HIV positive patients with disseminated histoplasmosis with death at 6 months as failure event adjusted for sex, antiretroviral treatment, CD4 count (below 50/mm3 or not) and CD8 count (below first quartile or not). Oral fluconazole or cotrimoxazole were not significantly linked to outcome, and thus removed from the final model with 156 subjects and 28 failures.</p

Azoles and incidence of a first episode of histoplasmosis.

*<p>Cox multiple model in HIV positive patients with first episode of disseminated histoplasmosis as failure event. Model with 1404 subjects and 94 single failures.</p

Incidence of a first episode of histoplasmosis stratified by CD4 count.

<p>The Y axis represents the percentage of persons that have never had histoplasmosis.</p