Chagas Disease, France

Chagas Disease, Franc

Infections sévères chez les personnes vivant avec le VIH sous l’ère des cART

Severe infections remain the main cause of hospitalization of PWH in both low- and high-income countries. The objectives were to estimate the incidence and determinants of these severe infections among PWH, using the French Hospital Database on HIV infection (ANRS CO4-FHDH). In the ANRS CO4-FHDH database, the incidence of progressive multifocal leukoencephalopathy (PML), which is associated with the highest mortality risk among opportunistic infections, decreased from 1.15 per 1,000 person-years (PY) (95% CI 0.98-1.31) to 0.49 per 1,000 PY (95% CI 0.37- 0.61) between 1997 and 2011. Sub-Saharan African origin had no protective effect, and injection drug users were at an increased risk of PML. cART initiation was associated with an excess of PML, which may be due to pre-existing lesions revealed by immune restoration. The incidence of severe bacterial infections decreased from 13.2 per 1,000 PY (95% CI 12.3-14.1) to 7.1 per 1,000 PY (95% CI 6.3-7.8) between 2005 and 2015. Regardless of cirrhosis, daily alcohol consumption of 40-80 g was associated with a 30% increased risk (95% CI 10-70%), and daily alcohol consumption above 80 g being associated with a 60% (95% CI 20-110%) increased risk of severe bacterial infection, compared to moderate consumption of less than 40 g per day. This excess risk could be explained by the immunosuppressive effect of alcohol. The risk of severe bacterial infection increased with the presence of co-morbidities affecting neutrophil function among diabetes, chronic kidney disease, cirrhosis and cancers. The increasing burden of multimorbidity could impact the life expectancy of PWH in the future.Les infections sévères restent la principale cause d'hospitalisation des PVVIH, aussi bien dans les pays à faibles ressources que dans les pays à ressources élevées. Les objectifs ont été d’estimer leurs incidences et leurs déterminants, en utilisant la base de données hospitalière française sur l’infection à VIH (ANRS CO4-FHDH). L’incidence de la leuco-encéphalopathie multifocale progressive (LEMP), associée au risque de mortalité le plus élevé parmi les infections opportunistes, a diminué de 1,15 (IC 95%, 0,98-1,31) à 0,49 (IC 95%, 0,37- 0,61) pour 1 000 Personne-Années (PA) entre 1997 et 2011. L'origine africaine n'avait pas d'effet protecteur alors que les individus usagers de drogues par voie intraveineuse étaient exposés à un risque accru. L'initiation de la cART était associée à un sur-risque de LEMP, probablement en révélant des lésions préexistantes par la restauration immune. L’incidence des infections bactériennes sévères a diminué de 13,2 pour 1 000 PA (IC 95%, 12,3-14,1) à 7,1 pour 1 000 PA (IC 95%, 6,3-7,8) entre 2005 et 2015. Indépendamment d’une cirrhose, une consommation quotidienne d’alcool de 40 à 80 g était associée à un risque accru de 30% (IC 95%, 10-70%), et une consommation supérieure à 80 g de 60% (IC 95%, 20-110%), en comparaison avec une consommation modérée inférieure à 40 g par jour. Ce sur-risque pourrait s’expliquer par l’effet immunosuppresseur de l’alcool. Le risque d’infection bactérienne sévère était augmenté en présence de comorbidités altérant la fonction neutrophile parmi diabète, maladie rénale chronique, cirrhose et cancer. Le poids croissant de cette multimorbidité pourrait impacter l’espérance de vie des PVVIH dans le futur

Severe infections among people living with HIV in the cART era

Les infections sévères restent la principale cause d'hospitalisation des PVVIH, aussi bien dans les pays à faibles ressources que dans les pays à ressources élevées. Les objectifs ont été d’estimer leurs incidences et leurs déterminants, en utilisant la base de données hospitalière française sur l’infection à VIH (ANRS CO4-FHDH). L’incidence de la leuco-encéphalopathie multifocale progressive (LEMP), associée au risque de mortalité le plus élevé parmi les infections opportunistes, a diminué de 1,15 (IC 95%, 0,98-1,31) à 0,49 (IC 95%, 0,37- 0,61) pour 1 000 Personne-Années (PA) entre 1997 et 2011. L'origine africaine n'avait pas d'effet protecteur alors que les individus usagers de drogues par voie intraveineuse étaient exposés à un risque accru. L'initiation de la cART était associée à un sur-risque de LEMP, probablement en révélant des lésions préexistantes par la restauration immune. L’incidence des infections bactériennes sévères a diminué de 13,2 pour 1 000 PA (IC 95%, 12,3-14,1) à 7,1 pour 1 000 PA (IC 95%, 6,3-7,8) entre 2005 et 2015. Indépendamment d’une cirrhose, une consommation quotidienne d’alcool de 40 à 80 g était associée à un risque accru de 30% (IC 95%, 10-70%), et une consommation supérieure à 80 g de 60% (IC 95%, 20-110%), en comparaison avec une consommation modérée inférieure à 40 g par jour. Ce sur-risque pourrait s’expliquer par l’effet immunosuppresseur de l’alcool. Le risque d’infection bactérienne sévère était augmenté en présence de comorbidités altérant la fonction neutrophile parmi diabète, maladie rénale chronique, cirrhose et cancer. Le poids croissant de cette multimorbidité pourrait impacter l’espérance de vie des PVVIH dans le futur.Severe infections remain the main cause of hospitalization of PWH in both low- and high-income countries. The objectives were to estimate the incidence and determinants of these severe infections among PWH, using the French Hospital Database on HIV infection (ANRS CO4-FHDH). In the ANRS CO4-FHDH database, the incidence of progressive multifocal leukoencephalopathy (PML), which is associated with the highest mortality risk among opportunistic infections, decreased from 1.15 per 1,000 person-years (PY) (95% CI 0.98-1.31) to 0.49 per 1,000 PY (95% CI 0.37- 0.61) between 1997 and 2011. Sub-Saharan African origin had no protective effect, and injection drug users were at an increased risk of PML. cART initiation was associated with an excess of PML, which may be due to pre-existing lesions revealed by immune restoration. The incidence of severe bacterial infections decreased from 13.2 per 1,000 PY (95% CI 12.3-14.1) to 7.1 per 1,000 PY (95% CI 6.3-7.8) between 2005 and 2015. Regardless of cirrhosis, daily alcohol consumption of 40-80 g was associated with a 30% increased risk (95% CI 10-70%), and daily alcohol consumption above 80 g being associated with a 60% (95% CI 20-110%) increased risk of severe bacterial infection, compared to moderate consumption of less than 40 g per day. This excess risk could be explained by the immunosuppressive effect of alcohol. The risk of severe bacterial infection increased with the presence of co-morbidities affecting neutrophil function among diabetes, chronic kidney disease, cirrhosis and cancers. The increasing burden of multimorbidity could impact the life expectancy of PWH in the future

Efficacité et coût-efficacité de la vaccination contre le rotavirus dans les pays en développement et les pays développés

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

ValuesTable2017-5-19.xls

Characteristics of the study population at baseline<br

Syndrome inflammatoire de restauration immune (IRIS) lié aux mycobactéries chez les patients infectés par le virus de l'immunodéficience humaine (VIH)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Impact of <it>Herpes simplex virus</it> load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome

Abstract Background Herpes simplex encephalitis (HSE) often leads to severe disability or death. Factors usually associated with outcome include Simplified Acute Physiology Score, age and delay of initiation of acyclovir treatment. Our aim was to determine the impact of Herpes simplex virus (HSV) load in cerebrospinal fluid (CSF) upon HSE outcome. Methods We retrospectively determined HSV load in the CSF of 43 patients with confirmed HSE, hospitalized in northern France from 1998 to 2005, using CSF samples collected the day of hospital admission and stored at −20°C. We analyzed the association between HSV load and mortality/morbidity by the Glasgow Outcome Scale. Fisher’s exact test and Wilcoxon’s test were used for statistical analysis. Results The M/F sex ratio was 1.7 and median patient age was 61 years. Median HSV load in CSF was 2.0 log copies/μL (IQR 25-75=1.2-2.6). The mortality rate was 32.6% six months after HSE diagnosis. Higher age was associated with mortality (p=0.03). Longer delay in acyclovir initiation tended to be associated with higher mortality but did not reach statistical significance (p=0.08). Severe disability and death due to HSV were associated with a higher Knaus score (p=0.004), later acyclovir initiation (p=0.006), older age (p=0.04) and presence of red blood cells in CSF (p=0.05). HSV load in CSF was neither associated with mortality (p=1.00) nor with morbidity (p=0.90). Conclusion In this study, HSV load in CSF was not found to be associated with poor outcome in patients with HSE. These data do not support measurement of HSV load at admission in patients with HSE.</p

Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome.

International audienceABSTRACT: BACKGROUND: Herpes simplex encephalitis (HSE) often leads to severe disability or death. Factors usually associated with outcome include Simplified Acute Physiology Score, age and delay of initiation of acyclovir treatment.Our aim was to determine the impact of Herpes simplex virus (HSV) load in cerebrospinal fluid (CSF) upon HSE outcome. METHODS: We retrospectively determined HSV load in the CSF of 43 patients with confirmed HSE, hospitalized in northern France from 1998 to 2005, using CSF samples collected the day of hospital admission and stored at -20[degree sign]C. We analyzed the association between HSV load and mortality/morbidity by the Glasgow Outcome Scale. Fisher's exact test and Wilcoxon's test were used for statistical analysis. RESULTS: The M/F sex ratio was 1.7 and median patient age was 61 years. Median HSV load in CSF was 2.0 log copies/muL (IQR 25-75=1.2-2.6). The mortality rate was 32.6% six months after HSE diagnosis. Higher age was associated with mortality (p=0.03). Longer delay in acyclovir initiation tended to be associated with higher mortality but did not reach statistical significance (p=0.08). Severe disability and death due to HSV were associated with a higher Knaus score (p=0.004), later acyclovir initiation (p=0.006), older age (p=0.04) and presence of red blood cells in CSF (p=0.005). HSV load in CSF was neither associated with mortality (p=1.00) nor with morbidity (p=0.90). CONCLUSION: In this study, HSV load in CSF was not found to be associated with poor outcome in patients with HSE. These data do not support measurement of HSV load at admission in patients with HSE