Infant neurodevelopment and behavior in Guadeloupe after lead exposure and Zika maternal infection during pregnancy

International audienceBACKGROUND: Prenatal lead exposure is known to have neurotoxic effects on the developing fetus, while some viral infections may have a tropism for the central nervous system. Our objective was to study whether the effects of prenatal lead exposure on infant development and behaviors at 18 months of age are modified by the occurrence of a maternal infection to Zika virus (ZIKV) during pregnancy. METHODS: During the ZIKV epidemic in Guadeloupe in 2016 a cohort of pregnant women was set up. Blood samples (pregnancy, childbirth and cord) (n = 297) enabled us to measure blood lead levels aimed to determine prenatal lead exposure and the likelihood of maternal infection during pregnancy (ZIKV status + vs -). The 18 months "Ages and Stages Questionnaire" (ASQ) was used to generate scores for global development, fine and gross motor skills, communication, problem solving, and personal-social skills. The questions from a longitudinal cohort study conducted in Canada (Québec) were used to generate hyperactivity, opposition, inattention and physical aggression scores. Associations were tested by multivariate linear regressions. RESULTS: Prenatal lead exposure was associated with delays in neurodevelopment at 18 months, reflected by lower scores in ASQ totals, and in the fine motor and problem-solving domains. Some of these associations appeared to be sex-specific, observed almost exclusively in boys (ASQ total, fine motor and personal-social scores). Prenatal lead exposure was not associated with behavioral scores. ZIKV infection during pregnancy was associated with a lower fine motor ASQ score, and higher scores for hyperactivity, opposition and physical aggression. Significant interaction between prenatal lead exposure and ZIKV status was observed with a lower personal-social score in ZIKV (-) only, and for hyperactivity and inattention scores, though some of these interactions (ASQ personal-social score, inattention score) were no longer significant when children with microcephaly were excluded from the analyses. DISCUSSION/CONCLUSION: Our study confirms previous findings of associations between prenatal exposure to lead at low levels and adverse neurodevelopmental outcomes during infancy and the particular vulnerability of boys. It suggests associations between ZIKV infection during pregnancy and adverse effects on a number of neurodevelopmental functions (fine motor function) and behaviors (opposition, hyperactivity), that need to be confirmed at later age. There is no strong evidence of interaction between ZIKV infection and lead exposure but both prenatal risk factors may affect fine motor function

148 - Co-exposition prénatale au Zika et au plomb et développement à 18 mois

International audienceContexte : L'exposition prénatale au plomb (EPP) est connue pour ses effets neurotoxiques sur le fœtus. Certaines infections virales pouvant avoir un tropisme pour le système nerveux central, notre objectif est d’étudier si les effets de l'EPP sur le développement de l'enfant à l’âge de 18 mois sont modifiés par la survenue d'une infection maternelle par le virus Zika (ZIKV) pendant la grossesse. Méthodes : Durant l’épidémie de ZIKV en Guadeloupe en 2016, dans une cohorte de femme enceintes, des prélèvements de sang (grossesse, accouchement et cordon) (n=297) ont permis de doser la plombémie chez la mère et de déterminer sa possible infection lors de la grossesse (statut ZIKV + versus -). Le « Âges and Stages Questionnaire» (ASQ) passé à 18 mois a permis de générer des scores de développement global, motricité fine et globale, communication, résolution de problèmes, aptitudes individuelles et sociales. Les scores d'hyperactivité, opposition, inattention et agressivité physique sont issus de l’étude Québécoise ELDEQ. Les associations ont été testées par des régressions linéaires multivariées. Résultats : L'EPP est associée à des scores ASQ inférieurs quel que soit le statut ZIKV (p-interaction >0,20) pour l'ASQ total, motricité fine et résolution de problème. Une interaction significative entre l'EPP et le statut ZIKV a été observée avec un score inférieur d'aptitude sociale chez les ZIKA (-) uniquement. L'EPP n'est pas associée aux scores comportementaux, cependant des interactions sont significatives entre l'EPP et le statut ZIKV pour les scores d'hyperactivité et d'inattention: une augmentation monotone du score d'hyperactivité est observée chez les femmes ZIKA (+), alors qu'une relation non monotone est observée pour le score d'inattention chez les femmes ZIKA (-). Discussion/Conclusion :Notre étude confirme les effets délétères de l'EPP à faible dose, et suggère une interaction entre l'EPP et l'infection par ZIKV sur les scores d'aptitude sociale, d'hyperactivité et d'inattention. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts

Simultaneous exposure to both Zika virus and household insecticides during pregnancy, and fetal growth and infant developmental behavior outcomes at 18 months, in Guadeloupe

International audienceBACKGROUND: Perinatal infection with Zika virus (ZIKV) could result in adverse growth, developmental and behavioral outcomes, while insecticides used to control mosquitoes are neurotoxic. OBJECTIVES: We aim to study the role played by exposure during pregnancy to both ZIKV and household insecticides in newborn health, development and behavior at age of 18 months. METHODS: Maternal and cord blood samples from a cohort of pregnant women (created during Guadeloupe’s Zika epidemic of 2016) were used to identify ZIKV infection during pregnancy. A self-administered questionnaire at birth documented prenatal household use of insecticides. Birth weight and head circumference were collected from maternity records (n = 708). Infant development and behaviors were documented at 18 months of age through the Ages and Stages Questionnaire and the Quebec Longitudinal Study of Child Development (n = 409). Logistic and linear regression models were performed, taking into account confounding factors. RESULTS: Use of household insecticides was associated with smaller head circumference and lower birth weight among newborns from mothers not exposed to ZIKV: 0.3 cm (95% CI: 0.6, 0) and -82 g (95% CI: 165, 0), respectively. Similar decreases were observed with ZIKV exposure among mothers not reporting household insecticides use, and with presence of both exposures. The combined presence of ZIKV exposure and insecticide use was associated with lower ASQ fine motor scores (-3.9; 95% CI: 7.3, -0.4), and higher hyperactivity scores (0.8; 95% CI: 0.0, 1.5), compared to no exposure to either. A higher opposition score was observed in association with ZIKV exposure among non-users of insecticide (0.6; 95% CI: 0.0, 1.2). CONCLUSION: Adverse neurodevelopmental outcomes at 18 months of age were observed with prenatal ZIKV exposure, and with higher magnitude when mothers reported use of household insecticides. At birth, rates of adverse fetal growth were however similar for the combined presence of exposure and either of the exposures

Drépanocytose et priapisme : rôle des paramètres hématologiques et hémorhéologiques

National audienc

Frequency and Risk Factors for Associated Lymphomas in Patients With Lymphomatoid Papulosis

International audienceLymphomatoid papulosis (LyP) is classified as an indolent cutaneous lymphoma, but outcome dramatically worsens if LyP is associated with lymphoma. The frequency of this association remains unclear in the literature. Here, we assess the frequency and risk factors of association between LyP and another lymphoma in an 11-year retrospective study conducted in 8 dermatology departments belonging to the French Study Group on Cutaneous Lymphoma (FSGCL)

No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study

International audienceAbstract Objectives Even in an ‘optimal’ health system, patients’ characteristics may have an impact on their care. We investigated whether age, gender and place of birth have an impact in the HIV care continuum in France, a country with a universal free healthcare system. Methods We estimated differences in the 5 year restricted mean percentage of person-time spent (i) in care, (ii) receiving ART and (iii) on ART and virally suppressed among 2432 (30.2%) women, 3925 MSM (48.7%) and 1709 men who have sex with women (MSW; 21.2%) entering care in the Dat’AIDS French prospective cohort between 1 January 2013 and 31 December 2017. Trial registration: Clinicaltrials.gov reference NCT02898987. Results Men and women spent 85.6% and 82.8% of person-time on ART and 69.9% and 65% suppressed, respectively. MSM, MSW and women spent 86.9%, 82.6% and 82.8% of person-time on ART and 72.5%, 63.7% and 65% suppressed, respectively. Patients born in France (47%) and patients born abroad spent 87.9% and 81.9% of person-time on ART and 74.6% and 62.9% suppressed, respectively. Young men born abroad were found to spend the smallest person-time with non-detectable viral load (53% for MSW and 58.1% for MSM). Conclusions Despite free access to care and universal ART in France, disparities remain in the HIV continuum care across age, country of birth and way of HIV acquisition. Clinical and public health interventions targeting specific patients’ conditions are needed