High efficacy of lopinavir/r-based second-line antiretroviral treatment after 24 months of follow up at ESTHER/Calmette Hospital in Phnom Penh, Cambodia

<p>Abstract</p> <p>Background</p> <p>The number of patients on second-line highly active antiretroviral therapy (HAART) regimens is increasing in resource-limited settings. We describe the outcomes after 24 months for patients on LPV/r-based second-line regimens followed up by the ESTHER programme in Phnom Penh, Cambodia.</p> <p>Methods</p> <p>Seventy patients who initiated second-line HAART regimens more than 24 months earlier were included, and immuno-virological data analyzed. HIV RNA viral load was determined by real-time RT-PCR. HIV-1 drug resistance was interpreted according to the ANRS algorithm.</p> <p>Results</p> <p>Of the 70 patients, two were lost to follow up, three died and 65 (92.8%) remained on second-line treatment after 24 months of follow up (median duration of treatment: 27.4 months). At switch to second-line, the median CD4 T cell count was 106 cells/mm³and the median viral load was 4.7 Log₁₀. Second-line regimens prescribed were ddI/3TC/LPV_/r(65.7%), ddI/TDF/LPV_/r(10.0%), ddI/AZT/LPV_/r(8.6%) and TDF/3TC/LPV_/r(7.1%). The median CD4 T cell gain was +258 cells/mm³at 24 months (n = 63). After 24 months of follow up, 92.3% (60/65) of the patients presented undetectable viral loads, giving an overall treatment success rate of 85.7% (CI: 75.6- 92.0) in intent-to-treat analysis.</p> <p>Conclusions</p> <p>These data suggest that a LPV_/r-based second-line regimen is associated with a high rate of virological suppression and immune reconstitution after 24 months of follow up in Cambodia.</p

Description de la population infectée par le VIH, suivie dans la file active de Bicêtre, âgée de 60 ans et plus, fonctions cognitives et qualité de vie (l étude Sigma)

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

Mucor irregularis-associated cutaneous mucormycosis: Case report and review

Solid organ transplant recipients are at risk for invasive fungal diseases, and are also exposed to healthcare-associated mucormycosis. Mainly causing localized cutaneous mucormycosis, Mucor irregularis infection is reported for the first time in a kidney-transplant recipient. A healthcare-associated origin was highly suspected in this case. We performed a literature review and highlight the characteristics of this very rare fungus

Psychiatric Symptoms and Cognitive Disorders in Behçet’s Disease: A Single-Center, Cross-Sectional Study

International audienceBackground: Behçet’s disease (BD) is a rare form of vasculitis involving both veins and arteries of all calibers. Psychological symptoms and cognitive impairment appear to be frequent, but few data are available. Methods: All consecutive patients in our center fulfilling the 2013 BD criteria underwent a psychometric evaluation with auto- (SCL-90-R and Modified Fatigue Index) and hetero-questionnaires (MINI). A standardized test battery assessed cognitive dysfunction. Data were correlated with BD activity as well as quality of life (SF-36). Results: We included 20 consecutive patients (16 men, four women) with a median [IQR] age of 38 (30.0–45.5) and a median disease duration of 7 years (1.8–11.0). Five patients had an abnormal brain MRI. The SCL-90-R questionnaire highlighted eight psychopathological profiles (42.1%) that correlated with altered quality of life and more severe fatigue. The most frequent symptoms were anxiety (9/19, 47.4%), somatization (8/19, 42.1%) and phobia (5/19, 26.3%). Psychopathological symptoms appeared to be more severe, but not more frequent, in neuro-Behçet’s patients. Based on standardized cognitive evaluation, nine patients had cognitive impairment defined by three or more altered tests. Notably, 6/9 patients did not have any complaint of memory loss and were thus considered ansognostic. Conclusion: Cognitive involvement was significantly associated with BD activity score (BSAS) but not with brain MRI abnormalities

Characteristics of the study population at enrollment into the cohort.

<p>Results are quoted as the median [IQR] or as a percentage. All comparisons were performed relative to the group of non-progressor HICs.</p><p>*: p<0.05</p><p>**: p<0.01</p><p>***: p<0.001</p><p>Characteristics of the study population at enrollment into the cohort.</p

Study flow diagram.

<p>ANRS: <i>Agence Nationale de Recherche sur le SIDA et les Hépatites Virales</i>, cART: antiretroviral therapy, CODEX: <i>Cohorte des Extrêmes</i> study, HICs: HIV controllers.</p

Comparison of immune activation parameters in immunologic or virologic progressor HICs, non-progressor HICs, ART-treated patients, chronic viremic patients and healthy donors.

<p>(A) Proportion of activated circulating HLA-DR+CR38+ CD4+ T cells. (B) Proportion of activated circulating HLA-DR+CD38+ CD8+ T cells. (C) Plasma IP10 levels (pg/mL, logarithmic scale).</p

Intra-venous bevacizumab in hereditary hemorrhagic telangiectasia (HHT): A retrospective study of 46 patients

<div><p>Background</p><p>Bevacizumab, an anti-VEGF monoclonal antibody, has recently emerged as a new option for severe forms of hereditary hemorrhagic telangiectasia (HHT). Its utilization in this orphan disease has rapidly spread despite the lack of randomized trials and international guidelines. The objective of this study is to report the main clinical data (baseline characteristics, dose schedule, efficacy, adverse events and deaths) of HHT patients treated by intravenous bevacizumab in France.</p><p>Methods</p><p>Retrospective observational study of HHT patients treated with bevacizumab for a severe form of the disease in the 14 centers of the French HHT network.</p><p>Results</p><p>Forty-six patients (median age: 68 years) were treated between March 2009 and May 2015. Ten patients were treated for high output cardiac failure, 20 patients for severe hemorrhages and 16 for both indications. The standard protocol (6 infusions of 5mg/kg every 2 weeks) was initially used in 89% of the cases but diverse strategies were subsequently applied. A clinical improvement was noted by the referent physician for 74% of the patients with a median effect’s duration of 6 months. Wound healing complications led to 2 amputations. Arthralgia/arthritis and arterial hypertension occurred in 5 patients each. One third of the patients were dead at the time of the final update, coherently with age and the poor prognosis of these highly symptomatic patients.</p><p>Conclusion</p><p>Intravenous bevacizumab seems to provide a clinical benefice in severe HHT patients. Precautions concerning wound healing and vascular pathologies must be respected. Prospective double blinded versus placebo trials are needed.</p></div

Recommendations for the use of intra-venous bevacizumab in HHT patients.

<p>Recommendations for the use of intra-venous bevacizumab in HHT patients.</p

Patient’s characteristics before treatment (n = 46).

<p>Patient’s characteristics before treatment (n = 46).</p