Is Impact of Statin Therapy on All-Cause Mortality Different in HIV-Infected Individuals Compared to General Population? Results from the FHDH-ANRS CO4 Cohort

French Hospital Database on HIVInternational audienceBackgroundThe effect of statins on all-cause mortality in the general population has been estimated as 0.86 (95%CI 0.79-0.94) for primary prevention. Reported values in HIV-infected individuals have been discordant. We assessed the impact of statin-based primary prevention on all-cause mortality among HIV-infected individuals.MethodsPatients were selected among controls from a multicentre nested case-control study on the risk of myocardial infarction. Patients with prior cardiovascular or cerebrovascular disorders were not eligible. Potential confounders, including variables that were associated either with statin use and/or death occurrence and statin use were evaluated within the last 3 months prior to inclusion in the case-control study. Using an intention to continue approach, multiple imputation of missing data, Cox’s proportional hazard models or propensity based weighting, the impact of statins on the 7-year all-cause mortality was evaluated.ResultsAmong 1,776 HIV-infected individuals, 138 (8%) were statins users. During a median follow-up of 53 months, 76 deaths occurred, including 6 in statin users. Statin users had more cardiovascular risk factors and a lower CD4 T cell nadir than statin non-users. In univariable analysis, the death rate was higher in statins users (11% vs 7%, HR 1.22, 95%CI 0.53-2.82). The confounders accounted for were age, HIV transmission group, current CD4 T cell count, haemoglobin level, body mass index, smoking status, anti-HCV antibodies positivity, HBs antigen positivity, diabetes and hypertension. In the Cox multivariable model the estimated hazard ratio of statin on all-cause mortality was estimated as 0.86 (95%CI 0.34-2.19) and it was 0.83 (95%CI 0.51-1.35) using inverse probability treatment weights.ConclusionThe impact of statin for primary prevention appears similar in HIV-infected individuals and in the general population

Evaluation de l'efficacité d'une trithérapie initiale sans inhibiteurs de la protéase sur une population VIH-1 positive avec une charge virale de plus de 100 000 copies/ML et des lymphocytes T CD4 inférieurs à 200/MM cube (observation rétrospective de 32 cas.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Traitement antirétroviral et risque d'accouchement prématuré chez les femmes enceintes vivant avec le VIH (Etude rétrospective de 121 grossesses suivies au "Trait d'Union, centre de soins de l'infection par le VIH", à Strasbourg de 2001 à 2010)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Toxicité des antirétroviraux (lipodystrophie et syndrome métabolique)

STRASBOURG ILLKIRCH-Pharmacie (672182101) / SudocSudocFranceF

Prévention de la transmission materno-foetale du virus de l'immunodéficience humaine (expérience du C.I.S.I.H. de Strasbourg de 1994 à 2004)

STRASBOURG ILLKIRCH-Pharmacie (672182101) / SudocSudocFranceF

Assisted reproduction techniques for HIV serodiscordant couples: 18 months of experience. Hum Reprod 18,1244–1249

BACKGROUND: Assisted reproduction techniques can minimize the risk of infection and treat possible sterility associated with serodiscordant couples. METHODS: We assessed the ef®cacy of these techniques in 57 couples in which at least one partner had human immunode®ciency virus (HIV-1) infection that was currently under control (47 men and 10 women). The semen of seropositive men was prepared and tested for viruses. Assisted reproduction techniques included intrauterine insemination (IUI), IVF and especially ICSI, with ovarian stimulation that used a long agonist protocol and recombinant FSH. Embryos were transferred on day 3 after oocyte retrieval. RESULTS: For couples with seropositive men, ®ve IUI and 49 IVF or ICSI attempts were perfomed, whilst for seropositive women these numbers were three IUI and 12 IVF or ICSI. No pregnancy occurred following the eight IUI trials. Seroconversion was not observed in any partners of seropositive men. Ef®cacy of treatment for these couples with ICSI was good, the clinical pregnancy rate per embryo transfer was 48.8%. The results for seropositive women were disappointing, with a clinical pregnancy rate per embryo transfer of 9.1%. Fourteen babies from 47 treated couples have so far been born and no pregnancies from IUI. CONCLUSIONS: Assisted reproduction techniques and particularly ICSI provide HIV-1-seropositive men with a safe and highly effective means of fathering children. These techniques may be less effective for seropositive women. Key words: assisted reproduction techniques/HIV/pregnanc

Predictors of Standard Follow-Up Completion after Sexual Exposure to HIV: Five-Year Retrospective Analysis in a French HIV-Infection Care Center.

OBJECTIVES:The care of exposed individuals to HIV remains a challenge regarding follow-up completion and HIV-testing of the partner. Identifying patients with risk of not fulfilling HIV-testing follow-up completion (FC), among patients demanding non-occupational post-exposure prophylaxis (nPEP), may improve clinical practice. METHODS:A retrospective chart review was conducted in a single French HIV-infection care center. FC predictors were assessed in a multivariate logistic regression model (Likelihood ratios test). RESULTS:Between 2009 and 2013, 646 sexual exposures to HIV were evaluated for nPEP, of which 507 effectively received nPEP (78%). FC rate was 30% (194/646). In the multivariate analysis, FC rates rose with age of exposed individuals (OR, 1.04 [0.25-4.28]; p<0.001) and decreased with the year of sexual exposure (OR, 0.74 [0.65-0.85]; p<0.001). FC was associated with sexual encounter with a sex worker (OR, 4.07 [0.98-16.82]; p<0.001) and nPEP use (OR, 2.69 [2.37-3.06]; p<0.001). nPEP early discontinuation was associated with decreased FC rates (OR, 0.18 [0.08-0.39]; p<0.001). No documented nPEP failure was identified. However, five Men who have Sex with Men (MSM) nPEP recipients for unprotected anal receptive intercourse subsequently seroconverted to HIV more than 6 months after nPEP. Seroconversion to HIV was associated with the lack of FC (p = 0.04) and multiple presentations for nPEP over the study period (p = 0.002). CONCLUSIONS:We identified significant predictors of not fulfilling sequential HIV-testing. They appear to be linked with a self-perceived HIV risk, especially in young adults recently exposed. Enhanced counseling in targeted individuals with high risk behaviors and using smartphone and internet-based strategies may be interesting retention in care options

Treatment as prevention enrolling at least 75% of individuals on ART will be needed to significantly reduce HIV prevalence in a HIV cohort

International audienc

Reasons for stopping treatment according with nPEP regimen.

<p>AZT, zidovudine; 3TC, lamivudine; NVP, nevirapine.</p

Significant predictors associated with follow-up completion (FC) and condom use.

<p>CI, Confidence Interval; FC, Follow-up Completion; IQR, Interquartile Range; nPEP, Non-Occupational Post-Exposure Prophylaxis; NS, Not Significant; OR, Odd-Ratio. a, per year; b, per hour.</p