Later cART Initiation in Migrant Men from Sub-Saharan Africa without Advanced HIV Disease in France

International audienceObjectiveTo compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care.MethodsAntiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002–2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200–349, 350-499, ≥500/μL), we examined the crude time until cART initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection.ResultsAmong 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1–28) and 20% (95%CI, 2–38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM.ConclusionSSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible

La contraception chez la femme africaine subsaharienne séropositive pour le virus d'immunodéficience humaine dans trois hôpitaux de la Seine Saint-Denis

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocNANTERRE-BDIC (920502101) / SudocSudocFranceF

Déterminants et outils de prévention de la contamination par le VIH sur le sol français des femmes migrantes originaires d'Afrique Subsaharienne et d'Haïti

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Faisabilité de la prise en charge de l'hépatite C chez les patients co-infectés VIH/VHC (étude rétrospective sur 50 patients co-infectés dans le service de maladies infectieuses et tropicales à l'hôpital Delafontaine à Saint Denis)

La prévalence globale de l infection par le VHC chez les patients infectés par le VIH est élevée (environ 25%). En cas de co-infection par le VIH et le VHC, les lésions hépatiques dues au VHC sont plus sévères. Cette étude portant sur 50 patients co-infectés à l hôpital Delafontaine à Saint-Denis a permis de mettre en évidence la faible proportion de sujets pouvant bénéficier d un traitement anti-viral C (10%).Les facteurs limitants sont représentés par les contre-indications médicales et psychiatriques, l alcoolisation chronique et le toxicomanie active. Le refus de la ponction biopsie hépatique, la méconnaissance de l hépatite chronique C et de ses complications représentent autant de facteurs limitant la prise en charge de la co-infection. La prise en charge des patients co-infectés : dépistage systématique, biopsie hépatique, traitement plus précoce et plus actif, est à considérer sérieusement, compte tenu de l amélioration de la survie liée aux progrès des traitements contre le VIH et de la mise à disposition de traitements anti-VHC plus efficaces.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Etude d'une cohorte de 103 patientes enceintes séropositives pour le virus de l'immuno-déficience humaine (VIH) suivies à l'hôpital Delafontaine (Seine-Saint-Denis) de 1994-2000

PARIS13-BU Serge Lebovici (930082101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dépistage de la violence conjugale chez les femmes séropositives

Comme l'Afrique et l'Amérique du Nord avant elle, l'Europe médicale s'interroge de plus en plus sur les liens entre violences conjugales et VIH SIDA chez les femmes. D'abord, parce que la violence conjugale semble être aujourd'hui un facteur de propagation de l'épidémie. Ensuite, parce que cette violence exercée dans l'intimité du couple s'avère un obstacle à la bonne prise en charge de la maladie. Il devient donc essentiel pour les médecins traitants et les médecins généralistes de savoir détecter les situations de violence, afin d'y faire face et, si possible, de les prévenir. L'étude rapportée isi porte sur un échantillon de 95 femmes séropositives pour le VIH, soignées à l'hôpital Delafontaine à Saint-Denis. Il s'agit d'une population majoritairement immigrée et d'origine africaine. Les questions (posées par le médecin traitant à ses patientes) portent à la fois sur les caractéristiques sociétales des interrogées et de leur conjoint (situation de famille, éducation, religion, nombre d'enfants, activité professionnelle...), sur la fréquence et le type de violences qu'elles subissent (psychologique, physique, sexuelle, économique...), et sur les conséquences de celles-ci. En gardant bien à l'esprit les limites de cette étude, notamment en terme d'échantillonnage, les résultats constatés permettent de mettre en valeur des facteurs statistiquement significatifs pour détecter la présence de violence dans le couple. Ces résultats ouvrent ainsi sur une réflexion sur la nécessaire vigilance dont doit faire preuve le médecin traitant face à la violence conjugale chez les femmes séropositives. Ils nous apportent des indications pour savoir comment et quand faire un dépistage actif de la violence conjugale.PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Treatment as prevention (TasP) and perceived sexual changes in behavior among HIV-positive persons: a French survey in infectious diseases departments in Paris

International audienceWe evaluated awareness of treatment as prevention (TasP) among adults people living with HIV (PLHIV) in five infectious disease departments in Paris, then how they perceived its impact on their sexual well-being. This cross-sectional multicenter survey was conducted in 2014 during scheduled clinical appointments using a self-administered questionnaire. We analyzed 520 questionnaires (42% women, 54% men of whom 57% were MSM [men who have sex with men]). 75% of women were born abroad, most commonly in sub-Saharan Africa, whereas 64% of men were French-born. The mean time since HIV diagnosis was 12.8 ± 7.8 years. Eighty-seven percent [84-90%]95 % reported being aware of the impact of ART on HIV transmission, 94% MSM, 86% women, 83% heterosexual men. PLHIV reported that they gained awareness of TasP through medical doctors (86%). The fear of transmission was perceived as alleviated for 73% [69%;78%]95%, more often among MSM; the sexual life was reported to be improved for 28% [24%;33%]95%; and ART adherence to be improved for 45% [40%;50%]95%, more often among women. The awareness of TasP was relatively high, but it seems important to understand the features of male and female populations of PLHIV to adapt counseling during follow-up appointments, as women's answers differed in various regards

Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study

BACKGROUND: Dolutegravir has been shown to be non-inferior to an integrase inhibitor and superior to a non-nucleoside reverse transcriptase inhibitor (NNRTI). In FLAMINGO, we compared dolutegravir with darunavir plus ritonavir in individuals naive for antiretroviral therapy. METHODS: In this multicentre, open-label, phase 3b, non-inferiority study, HIV-1-infected antiretroviral therapy-naive adults with HIV-1 RNA concentration of 1000 copies per mL or more and no resistance at screening were randomly assigned (1:1) to receive either dolutegravir 50 mg once daily or darunavir 800 mg plus ritonavir 100 mg once daily, with investigator-selected tenofovir-emtricitabine or abacavir-lamivudine. Randomisation was stratified by screening HIV-1 RNA (≤100,000 or >100,000 copies per mL) and nucleoside reverse transcriptase inhibitor (NRTI) selection. The primary endpoint was the proportion of patients with HIV-1 RNA concentration lower than 50 copies per mL (Food and Drug Administration [FDA] snapshot algorithm) at week 48 with a 12% non-inferiority margin. This trial is registered with ClinicalTrials.gov, NCT01449929. FINDINGS: Recruitment began on Oct 31, 2011, and was completed on May 24, 2012, in 64 research centres in nine countries worldwide. Of 595 patients screened, 484 patients were included in the analysis (242 in each group). At week 48, 217 (90%) patients receiving dolutegravir and 200 (83%) patients receiving darunavir plus ritonavir had HIV-1 RNA of less than 50 copies per mL (adjusted difference 7·1%, 95% CI 0·9-13·2), non-inferiority and on pre-specified secondary analysis dolutegravir was superior (p=0·025). Confirmed virological failure occurred in two (<1%) patients in each group; we recorded no treatment-emergent resistance in either group. Discontinuation due to adverse events or stopping criteria was less frequent for dolutegravir (four [2%] patients) than for darunavir plus ritonavir (ten [4%] patients) and contributed to the difference in response rates. The most commonly reported (≥10%) adverse events were diarrhoea (dolutegravir 41 [17%] patients vs darunavir plus ritonavir 70 [29%] patients), nausea (39 [16%] vs 43 [18%]), and headache (37 [15%] vs 24 [10%]). Patients receiving dolutegravir had significantly fewer low-density lipoprotein values of grade 2 or higher (11 [2%] vs 36 [7%]; p=0·0001). INTERPRETATION: Once-daily dolutegravir was superior to once-daily darunavir plus ritonavir. Once-daily dolutegravir in combination with fixed-dose NRTIs represents an effective new treatment option for HIV-1-infected, treatment-naive patients. FUNDING: ViiV Healthcare and Shionogi & Co

Visiting One’s Native Country

The aim of this study was to evaluate to what extent travel-related factors may cause adherence failure to antiretroviral therapy (ART) in otherwise adherent migrants when traveling back to Africa. HIV-infected sub-Saharian migrants living in France with a plasma HIV viral load < 200 copies/mL, with no change in ART for ≥3 months and who were about to visit their native country for between 2 weeks and 6 months were enrolled for the study. Patients completed a self-administered adherence questionnaire both at enrollment and during the week following their return to France. Adherence failure occurred in 23 (11.5%) of 200 patients. Negative perception about ART effectiveness (adjusted odds ratio = 4.3; 95% confidence interval = 1.3-13.7), unexpected traumatic events during their stay in their native country (7.8; 2.3-26.1), and a prolongation of their stay (5.2; 1.4-20.4) were independently associated with a higher likelihood of adherence failure. Owning/renting one’s house in France (0.30; 0.10-0.96), singlehood (0.23; 0.05-1.00), and HIV status disclosure (0.19; 0.05-0.76) were correlates of sustained adherence during traveling