Cerebrospinal fluid HIV-1 escape in patients with neurocognitive symptoms: pooled data from a neuro-HIV platform and the NAMACO study.

BACKGROUND Despite modern antiretroviral therapy, HIV-1 RNA escape into the cerebrospinal fluid (CSF) may occur. We examined the prevalence of and factors associated with CSF HIV-1 escape among people living with HIV (PLWH) in Switzerland. SETTING The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is an ongoing, prospective, longitudinal, multicenter study within the Swiss HIV Cohort Study. The neuro-HIV platform is a multi-disciplinary, single-day outpatient consultation at Lausanne University Hospital. METHODS We pooled data from the NAMACO study and the neuro-HIV platform participants who underwent lumbar puncture (LP) between 2011 and 2019. Both patient groups had neurocognitive symptoms. CSF HIV-1 escape was defined as the presence of quantifiable CSF HIV-1 RNA when plasma HIV-1 RNA was suppressed or CSF HIV-1 RNA greater than plasma HIV-1 RNA when the latter was detectable. RESULTS Of 1166 PLWH assessed, 288 underwent LP. CSF HIV-1 escape was observed in 25 PLWH (8.7%) of whom 19 (76%) had supressed plasma HIV-1 RNA. Characteristics of PLWH were comparable whether they had CSF HIV-1 escape or not, including comorbidities, time since HIV diagnosis (15 vs 16 years, p=0.9), median CD4 nadir (158.5/mm3 vs 171/mm3, p=0.6), antiretroviral CSF-Penetration-Effectiveness score (7 vs 7 points, p=0.8), neurocognitive diagnosis based on Frascati criteria and radiological findings. CONCLUSIONS In this large pooled sample of PLWH with neurocognitive symptoms, CSF HIV-1 escape occurred in 8.7% of PLWH. PLWH with CSF HIV-1 escape presented no distinctive clinical or paraclinical characteristics. We conclude that LP is unavoidable in confirming CSF HIV-1 escape

Traitements antirétroviraux : vers un allègement ?

The chronicity of HIV infection and the use of antiretroviral therapy among all individuals living with HIV necessitate new treatment strategies. Alternatives to lifelong tri-therapy treatment are under investigation with the aim to improve the quality of life of patients. New therapies with longer half-lives or « biological » treatments are also under study in clinical trials in order to develop streamlined maintenance strategies. These simplified therapies represent the near future of HIV management both with regards to less toxic molecules and a change in the traditional dogma of tri-therapy, including the daily dose thanks to the possibility of dosage only on certain weekdays or via molecules under development with a long duration of action.La chronicisation de l’infection VIH et l’utilisation des antirétroviraux chez l’ensemble des personnes vivant avec le VIH rendent nécessaires de nouvelles stratégies de traitement médicamenteux. Des alternatives au traitement à vie par une trithérapie sont étudiées pour améliorer la qualité de vie des patients. De nouveaux médicaments, avec des demi-vies prolongées, ou des traitements dit « biologiques » sont également en phase d’étude clinique afin d’élaborer des stratégies de maintenance.L’avenir proche de la prise en charge du VIH s’inscrit dans ces allègements thérapeutiques par exemple en utilisant des molécules moins toxiques, moins dosées, des bithérapies à longue durée d’action ou encore des molécules

VIH et Covid-19 : deux pandémies virales en interaction

First AIDS cases have been described 40 years ago in June 1981. Today we see the major impact of COVID-19 pandemic on that of HIV/AIDS. Data tends to show frequency of severe forms of COVID-19 increased in people living with HIV. We review the current knowledge about COVID-19 and its impact on people living with HIV.Les tout premiers cas de sida ont été décrits il y a 40 ans, en juin 1981. Aujourd’hui, on constate l’impact majeur de la pandémie de Covid-19 sur celle du VIH/sida. Les données tendent à montrer que la fréquence des formes graves de Covid-19 est augmentée chez les personnes vivant avec le VIH. Nous faisons le point sur les connaissances actuelles concernant le Covid-19 et son impact sur la prise en charge des personnes vivant avec le VIH

VIH/sida - VIH au temps du Covid-19 : rencontre de deux pandémies

The current COVID-19 pandemic is the main topic of news worldwide by its magnitude and consequences across the entire planet. From a medical point of view, several risk factors for developing severe illness have been reported in the literature, notably an immunosuppressed status. For people living with HIV, several questions have been raised concerning not only their vulnerability, but also in relation to an eventual protection conferred by antiretroviral therapy. This article will address these two pandemics by looking at the potential impact of SARS-CoV-2 on people living with HIV and, in parallel, exploring similarities and differences in terms of treatment, potential for recovery, prevention and their impact on clinical research. We review also future novel therapies for the treatment of HIV.La pandémie de Covid-19 est le sujet d’actualité mondial tant par son ampleur que par ses immenses conséquences. Du point de vue médical, plusieurs facteurs de risque de développer une maladie sévère ont été établis dans la littérature, et l’immunosuppression en fait partie. Concernant les personnes vivant avec le VIH, plusieurs questions se sont posées : sont-elles plus vulnérables à l’acquisition de SARS-CoV-2, ou à une maladie Covid-19 sévère ? Ou au contraire sont-elles protégées par les antirétroviraux ? Cet article aborde ces deux pandémies et recherche des similitudes et des différences en termes de traitement, de guérison, de prévention et de recherche clinique. Nous décrivons brièvement quelques-uns des traitements antirétroviraux les plus innovants

Chemsex, a contemporary challenge for public health

Chemsex, a specific form of sexualized drug use (SDU), has rapidly increased in the last decade. This phenomenon could result in a complex public health issue because of the heterogeneity amongst socio-psychological profiles of the practitioners, leading to the difficulty to target specific populations. Healthcare professionals need to be aware of this practice and its related risks to provide care adapted to the individual who consults. Here, we suggest that better knowledge of this field can help to improve prevention measures and provide information with a non-judgmental and respectful approach to those who practice chemsex