Action - Traitement. Traitement antirétroviral chez les patients naïfs

International audienc

Traitement antirétroviral prophylactique après exposition sexuelle au VIH (étude épidémiologique de l'observance dans 138 cas)

Depuis la parution en France de la circulaire DSG/DH/DRT/DSS nʿ98/228 du 9 avril 1998 les personnes ayant eu un rapport sexuel potentiellement contaminant pour le VIH peuvent recevoir un traitement antirétroviral pendant 28 jours. Notre étude a évalué l'observance de 138 patients mis sous traitement antirétroviral à l'hôpital de Saint Antoine d'octobre 2001 à septembre 2002. Cette observance est assez satisfaisante (80.3%). Une étude épidémiologique a été menée afin de rechercher si parmi ces patients des facteurs pouvant expliquer une mauvaise observance. En analyse univariée, les patients d'origine européenne, la connaissance d'une sérologie antérieure, un type de pénétration à risque important (anal> vaginal> oral) sont des facteurs de bonne observance alors que des rapports sexuels avec des prostituées est un facteur de mauvaise observance. En analyse multivariée, 3 variables restent significatives : pays de naissance, habiter le Val de Marne et avoir un rapport sexuel moins risqué entraînent une moins bonne observance. La prescription d'antirétroviraux à visée prophylactique a très vraisemblablement diminué le risque d'infection par le VIH chez les patients ayant eu un risque sexuel, mais ce traitement est très coûteux et non dénué d'effets secondaires. La connaissance des facteurs de risque de mauvaise observance permet au médecin d'adapter le suivi individuel de chacun des patients.Since the ministerial recommandation of april 1998, people who had a sexual intercourse that could induce a contamination for the HIV can receive a post exposure treatment . That treatment conciste in taking a tritherapy of antiretrovirals drugs during 28 days. Our study has evaluated the compliance of 138 patients taking antiretoviral treatment initialized in the Saint Antoine hospital from october 2001 to september 2002. the compliance was quite good: 80.3% of the patients took completely the treatment. An epidemiologic study was made to assess if some patients has specificities that could modify the compliance to the treatment. In univarious analysis, being an europeen patients, knowing that a previous serology has been made, having a high risky penetration (anal>vaginal>oral) are related to a better compliance to the treatment than the other patients. In opposition, the fact that some patients had an sexual intercourse with female sex workers is related to a less effective compliance to the treatment. After mutlivarious analysis, only 3 caracteristics remains significatively linked to a bad compliance : being an europeen patient, living in a particular sub-urb (Val de Marne), having a sexual intercourse knowed to be less at risk than the others. The prescription of post exposure treatment has probably reduced the number of contamination to HIV after sexual risky behavour, but those treatment are very expensive and know ed to induced frequents sides effects. Knowing that the patient belongs to a group of person less compliant (by his personnal story or sexual intercourse) can be a precious help to improve the follow up of the treatment and of the performance of the serology.PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les infections aigües communautaires chez les sujets ägés de plus de 80 ans (diagnostic et devenir au cours de 101 hospitalisations dans le service des maladies infectieuses et tropicales de l'hôpital Saint-Antoine, en 1999)

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Evaluation of tolerability with the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate for post-HIV exposure prophylaxis

International audienceBackground: The preferred regimen for HIV post-exposure prophylaxis (PEP) is based mainly on safety and tolerability because it is given to immunocompetent people without HIV infection for a limited time (28 days). The frequency of adverse events (AEs) may be > 60%. Although AEs are generally not severe, they can lead to lack of adherence and failure to complete the regimen. We evaluated the co-formulation elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild ®) prescribed as one pill taken once daily for HIV PEP in terms of tolerability and adherence.MethodsThis was a prospective cohort study conducted in one hospital in Paris (April to December 2015. Each participant receiving the PEP treatment (FTC-150 mg/TDF-245 mg/elvitegravir-200 mg/cobicistat 150 mg once daily) at the pharmacy of the hospital were recruited consecutively. A clinical visit was planned at 8 weeks after sexual exposure. Reminders were sent to participants who missed the appointment. A standardized questionnaire was administered to evaluate completeness and tolerability at week 8.ResultsOverall, 284 participants (86% men; 80% MSM; median age 30 years) were prescribed Stribild®; 50 stopped after reassessment of risk. Among 234 participants who effectively received PEP, 215 (92%) completed 28 days of PEP with only three who switched from Stribild® to another PEP because of side effects. More than 60% of participants reported at least one AE, which were mild to moderate. Fatigue, central neurological and abdominal side effects were the most frequently reported.ConclusionsStribild® seems to be a good option for HIV PEP due to the easiness of use, the side effects profile and the high completion rate

Prophylaxis by doravirine-lamivudine-tenofovir disoproxil fumarate or elvitegravir-cobicistat-emtricitabine-tenofovir alafenamide after sexual exposure to HIV

Abstract HIV post- exposure prophylaxis (PEP) is a prevention tool for individuals with a recent potential exposure to HIV. Doravirine has been available since 2019 in combination with tenofovir disoproxil fumarate and lamivudine and has not been evaluated as a PEP. DOR/3TC/TDF is our department’s most commonly prescribed PEP treatment since 2021. This study evaluates the completion rate of the DOR/3TC/TDF as compared to EVG/c/FTC/TAF for PEP, which was the regimen prescribed until 2020 in our hospital. This retrospective observational study was conducted between January 2020 and September 2021. The subjects included consecutively were adults who consulted for an HIV sexual exposure accident and for whom DOR/3TC/TDF in 2021 or EVG/c/FTC/TAF in 2020 was prescribed. The outcomes were the completion rate to the end of treatment (28 days), the seroconversion rate, and the description of side effects. During the study period, 311 people were included: 140 treated with DOR/3TC/TDF and 171 treated with EVGc/FTC/TAF. Considering subjects with a follow-up visit, the completion rate was 96.8% (90/93) in the DOR/3TC/TDF group, and 94.6% (123/130) in the EVG/c/FTC/TAF group (p-value: 0.53). The number of people lost to follow-up was nearly equivalent in both groups: 27.1% (38/140) in the DOR/3TC/TDF group and 23.4% (40/171) in the EVG/c/FTC/TAF group (p-value: 0.45). A side effect was described for 38% (36/94) in the DOR/3TC/TDF group, and 29.7% (38/128) in the EVG/c/FTC/TAF group. No cases of seroconversion were observed. DOR/3TC/TDF appears to have a similar safety profile to EVG/c/FTC/TAF. Due to its lower cost, it seems to be a treatment option for consideration in the context of HIV-exposure accidents

First Report of CD4 Lymphopenia and Defective Neutrophil Functions in a Patient with Amebiasis Associated with CMV Reactivation and Severe Bacterial and Fungal Infections

International audienceWe report the case of a patient with acute necrotizing colitis due to invasive amebiasis associated with CD4 lymphopenia and impaired neutrophil responses. The course of the disease was characterized by CMV reactivation and severe and recurrent bacterial and fungal infections, which might be related to the decreased CD4 T cell count and the impaired functional capacities of neutrophils, respectively. The clinical outcome was positive with normalization of both CD4 cell count and neutrophil functions

Clostridium difficile-associated diarrhea in HIV-infected patients: Epidemiology and risk factors

A retrospective analysis of all the cases of Clostridium difficile-associated diarrhea (CDAD) in hospitalized patients infected with HIV was performed over a 52-month period to assess the incidence, epidemiology, and risk factors of CDAD. A case of CDAD was defined as a patient with diarrhea and a positive stool cytotoxin B assay. Sixty-seven cases of CDAD were recorded in HIV-infected patients between January 1991 and April 1995. The annual incidence of CDAD ranged from 1.7 to 6.4 per 100 HIV-infected patients discharged from hospital. The 67 CDAD cases included 48 (72%) first episodes and 19 (28%) relapses. Serogroup C accounted for 69% of strains from initial episodes of CDAD. To identify risk factors for CDAD, 34 HIV-infected patients with a first episode were compared with 66 HIV-infected controls matched for the length of hospital stay. Three independent factors remained significantly associated with CDAD among HIV-infected patients: CD4(+) cell counts <50/ mm(3) (OR = 5.2; 95% CI = 1.4-19.3, p = 0.01), clindamycin use (OR = 5.0; 95% CI = 1.3-18.3: p = 0.02) and penicillin use (OR = 4.6; 95% CI = 1.1-18.8; p = 0.03). C. difficile is a common enteric pathogen responsible for nosocomial diarrhea in HIV-infected patients. Clinicians should keep this pathogen in mind when searching for the cause of diarrhea in these patients, especially those who are severely immunocompromised or have received clindamycin or penicillin

Clarithromycin and other antimicrobial agents in the treatment of disseminated Mycobacterium avium infections in patients with acquired immunodeficiency syndrome

Background: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. Methods: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin - a new macrolide antibiotic - against disseminated Mavium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. Results: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. Conclusions: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs.SCOPUS: ar.jinfo:eu-repo/semantics/publishe