Chagas Disease, France

Chagas Disease, Franc

La vaccination par le Gardasil® dans la région Nord-Pas-de-Calais (point en mai 2009 sur les délivrances du vaccin)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Délivrances des vaccins contre la grippe et contre le pneumocoque durant les saisons 2008-2009 et 2009-2010 dans la régions Nord Pas-de-Calais (impact de la grippe H1N1)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Médecine des voyages et patients infectés par le VIH (étude auprès de 104 patients suivis au COREVIH de Tourcoing)

Contexte / Introduction : Parmi le milliard de voyageurs de 2012, on compte des patients infectés par le VIH (PIVIH). Le progrès des traitements pour les PIVIH contribue à une santé sûre avec gain de confiance et désir de voyager (présence toutefois de restrictions dans certains pays), notamment auprès de leurs familles et amis (VFR : Visiting Friends and Relatives) pour ceux non originaires de France. Depuis l apparition des thérapies antirétrovirales de haute activité, en dehors de 4 études (européennes et canadiennes), aucune étude française n a analysée le profil et les risques des PIVIH voyageurs. Objectif : Analyse épidémiologique descriptive des caractéristiques et risques des PIVIH voyageurs hors Europe. Méthode : A travers un auto-questionnaire sur le pré-voyage, le séjour et le retour, nous avons colligé le vécu des événements et le comportement des PIVIH suivis au COREVIH de Tourcoing du 04 mars au 30 juillet 2013. Résultats : 341 PIVIH ont consulté en hôpital de jour et 104 questionnaires ont été recueillis. 70% des PIVIH de l étude étaient des hommes. 90 % étaient traités et en bonne santé (ARN VIH médian à 62 copies/ml et CD4 à 545/ mm3). La durée médiane du séjour était de 21 jours (15 pour les touristes, 30 pour les VFR). L Afrique Sub-Saharienne est la destination préférentielle avec 44%, suivie de l Afrique du Nord (22%) puis de l Asie (15%). On note 51 % de VFR et 42% de touristes. 70% des PIVIH ont consulté avant leur départ. 29 voyageurs ont eu un événement médical au cours du voyage dont 9 ont consulté sur place et 1 fut hospitalisé. 4 voyageurs se sont fait voler les antirétroviraux. Au retour, 21 patients ont consulté, dans les 15 jours en moyenne, et 2 ont été hospitalisés (accès palustre à P. ovale et déshydratation sur turista). Enfin 10 patients n ont pas bien pris leur traitement antirétroviral Conclusion : Nos données sont similaires à la littérature spécifique et générale. Nos PIVIH sont plus âgés mais les études sont plus anciennes. L exposition à un évènement médical serait moins fréquente que les autres voyageurs (mais petit effectif). Une attention particulière doit toutefois être dirigée vers les VFR qui partent pour une longue durée et risquent de s exposer entre autre à l arrêt des antiviraux.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Hyperlactataemia During Antiretroviral Therapy: Incidences, Clinical Data and Treatment

Lactic acidosis is a serious complication of antiretroviral therapy. Symptomatic hyperlactataemia is a milder form of this syndrome, but its incidence is unclear. In this prospective ongoing observational study of a large cohort of HIV-infected adults, hyperlactataemia was diagnosed in 64 patients. Incidences were 18.3/1000 person-years with antiretroviral therapy, and 35.8/1000 person-years for stavudine (d4T) regimens. Ten of the 64 patients developed lactic acidosis during the first 13 months of treatment (incidence 2.9/1000 treated person-years). In four of ten patients, symptoms were absent or mild. More patients on d4T first-line therapy developed lactic acidosis than patients previously treated with other drugs ($\rm p = 0.008$). Despite the occurrence of one death, the subsequent outcome for the remaining patients was favourable after antiretroviral therapy was stopped and supportive treatment with vitamins and antioxidants initiated. The early diagnosis of cases was the result of great vigilance and, combined with routine measurements of the anion gap, might be the most crucial factor explaining the low mortality rate observed here

Once-Daily Dolutegravir versus Darunavir plus Cobicistat in Adults at the Time of Primary HIV-1 Infection: The OPTIPRIM2-ANRS 169 Randomized, Open-Label, Phase 3 Trial

International audienceAbstract Background Whether integrase strand transfer inhibitors (INSTIs) can decrease HIV-1 DNA levels more rapidly than boosted PIs during primary HIV-1 infection (PHI) is unknown. We hypothesized that once-daily dolutegravir/tenofovir/emtricitabine could reduce the viral reservoir through rapid viral replication control further than once-daily darunavir/cobicistat/tenofovir/emtricitabine. Methods The OPTIPRIM2-ANRS 169 study was a randomized (1:1), open-label, multicentre trial in adults with ≤q5 or ≤q3 HIV antibodies detected, respectively, by western blot or immunoblot in the last 10\hspace0.25emdays. The primary endpoint was total HIV-1 DNA levels in PBMCs at Week 48 (W48) adjusted for baseline levels. The main secondary endpoint was HIV-1 RNA level decrease. Results Between April 2017 and August 2018, 101 patients were included from 31 hospitals. Most patients were men (93%), the median age was 36\hspace0.25emyears and 17% were Fiebig stage ≤q3. The median (IQR) plasma HIV-1 RNA and DNA levels were, respectively, 5.8 (5.0\textendash 6.6) and 3.87 (3.52\textendash 4.15)\hspace0.25emlog10 copies/million PBMCs. The median (IQR) decreases in HIV-1 DNA levels at W48 were -1.48 (-1.74 to -1.06) and -1.39 (-1.55 to -0.98)\hspace0.25emlog10 copies/million PBMCs in the dolutegravir and darunavir/cobicistat groups, respectively (P\mkern1mu=\mkern1mu0.52). Plasma HIV-1 RNA levels were <50\hspace0.25emcopies/mL in 24% versus 0% of patients in the dolutegravir and darunavir/cobicistat groups at W4, 55% versus 2% at W8, 67% versus 17% at W12, and 94% versus 90% at W48, respectively. Conclusions Dolutegravir-based and darunavir-based regimens initiated during PHI strongly and similarly decreased the blood reservoir size. Considering the rapid viral suppression during a period of high HIV-1 transmission risk, dolutegravir-based regimens are a major first-line option

Hypogonadism: A neglected comorbidity in young and middle-aged HIV-positive men on effective combination antiretroviral therapy

International audienceObjective: Male hypogonadism is poorly characterized in young-to-middle-aged people with HIV (PWH). We used a reliable free testosterone assay to assess the prevalence and predictive factors for male hypogonadism in PWH on effective combined antiretroviral therapy (cART).Design:A French cross-sectional study from January 2013 to June 2016.Methods:We included HIV-1-infected men aged between 18 and 50years with HIV loads of 50 RNA copies/ml or less, on effective cART for at least 6 months. Hypogonadism was defined, according to guidelines, as a mean calculated serum free testosterone concentration less than 70pg/ml (Vermeulen equation). Sociodemographic, anthropo-metric, bone-densitometry, hormonal, immunovirological, metabolic, and therapeutic parameters were collected. The IIEF-5, HAM-D, and AMS scales, respectively, assessed erectile function, depression, and quality of life.Results:Overall, 240 patients were enrolled, 231 were analyzed. Low free testosterone concentrations (<70pg/ml) were recorded in 20 patients (8.7%), and were exclusively of secondary origin. In multivariable analysis, the risk factors predictive of male hypogonadism were age more than 43 years [adjusted odds ratio (aOR) 3.17, 95% confidence interval (95% CI) 1.02-9.86;P = 0.04], total fat percentage more than 19% (aOR3.5, 95% CI 1.18-10.37; P = 0.02), and treatment including efavirenz (aOR3.77, 95% CI 1.29-10.98;P=0.02). A nadir CD4+ T-cell count more than 200 cells/μl (aOR 0.22, 95% CI 0.07-0.65;P < 0.01) were protective.Conclusion:Male hypogonadism remains common in young-to-middle-aged PWH with stably suppressed viral replication. Treatment including efavirenz, being over 43 years old, and having a total body fat percentage greater than 19% could be used as criteria for identifying PWH at risk. Early screening for male hypogonadism might improve care by identifying patients requiring testosterone replacement. Copyrigh