Post-Epidemic Chikungunya Disease on Reunion Island: Course of Rheumatic Manifestations and Associated Factors over a 15-Month Period

Although the acute manifestations of Chikungunya virus (CHIKV) illness are well-documented, few data exist about the long-term rheumatic outcomes of CHIKV-infected patients. We undertook between June and September 2006 a retrospective cohort study aimed at assessing the course of late rheumatic manifestations and investigating potential risk factors associated with the persistence of these rheumatic manifestations over 15 months. 147 participants (>16 yrs) with laboratory-confirmed CHIKV disease diagnosed between March 1 and June 30, 2005, were identified through a surveillance database and interviewed by telephone. At the 15-month-period evaluation after diagnosis, 84 of 147 participants (57%) self-reported rheumatic symptoms. Of these 84 patients, 53 (63%) reported permanent trouble while 31 (37%) had recurrent symptoms. Age ≥45 years (OR = 3.9, 95% CI 1.7–9.7), severe initial joint pain (OR = 4.8, 95% CI 1.9–12.1), and presence of underlying osteoarthritis comorbidity (OR = 2.9, 95% CI 1.1–7.4) were predictors of nonrecovery. Our findings suggest that long-term CHIKV rheumatic manifestations seem to be a frequent underlying post-epidemic condition. Three independent risk factors that may aid in early recognition of patients with the highest risk of presenting prolonged CHIKV illness were identified. Such findings may be particularly useful in the development of future prevention and care strategies for this emerging virus infection

Severe transaminitis after interferon-ribavirin therapy in HIV/HCV-coinfected patients: influence of a sustained HCV response

EA MERS CT3 Enjeu 3International audienceChronic hepatitis C is an independent risk factor for severe drug hepatotoxicity. Successful treatment of chronic hepatitis C may modulate drug hepatotoxicity, as it is associated with a decline in hepatic enzyme release and halts fibrosis progression in HIV/HCV-coinfected patients. The aim of this study was to determine biological and/or clinical determinants of alanine aminotransferase and/or aspartate aminotransferase elevation (>five-fold above the upper limit of normal in patients with normal baseline levels or >3.5-fold increase from baseline in those with increased baseline levels) in a large prospective cohort of HIV/HCV-coinfected patients on HAART who had previously been treated for HCV infection. Median follow-up exceeded five years. Cox proportional hazards models were used. At baseline, 248 patients had been receiving antiretroviral therapy for a mean of 6.3 (+/- 3.2) years. Seventy-one patients (29%) had a sustained HCV viral response (SVR). During follow-up, 66 patients (26.6%) received a second course of HCV therapy and 29 (44%) of them had an SVR. Severe transaminitis occurred in 64 patients (26%). In multivariate analysis, no SVR (HR 33.33, 95% CI 4.54222, P = 0.001) and stavudine-based therapy (HR 2.11, 95% CI 1.123.99, P = 0.018) remained significantly associated with severe transaminitis. A SVR to anti-HCV therapy is thus associated with a markedly reduced risk of severe transaminitis during antiretroviral therapy. Treatment of HCV infection should therefore be a priority in HIV-coinfected patients. Stavudine is associated with an increased risk of severe transaminitis

Conservative Treatment of Congenital Clinical Anophthalmia

When a child is born with the absence of one or both eyes, the functional and psychological impacts are profound. It is imperative that the ophthalmologist and ocularist begin promptly to expand the socket, stimulate orbital and eyelid growth, and create an orbital volume, socket size, and eyelid length adequate to allow the wear of a normal-sized ocular prosthesis. The tissues in these young children can expand rapidly. It is also important to avoid any unnecessary surgical procedures that can cause scar tissue to form in the socket. Importantly, the lateral canthus should not be cut, as a normal lateral canthal angle is imperative for good expansion. Many techniques have been described, including implanted expanding hydrogel implants, balloon tissue expanders, and a variety of other surgical techniques. The authors feel that the use of a sequence of gradually enlarging acrylic conformers followed by placement of an adult-sized orbital implant at age 4–5 years gives excellent cosmetic and functional outcomes without exposing young children to the risks of multiple surgeries and general anesthesia, as well as the risks related to repeated exposure to radiation through multiple imaging studies. This chapter summarizes the causes and epidemiology of congenital anophthalmia, different expansion techniques described in the past, and the authors’ recommended management of these challenging patients