Factors associated with the continuum of care of HIV infected patients in Belgium

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Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

M. Ristola on SPREAD Program -työryhmän jäsen.Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%-9.5%) in 2008-2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.Peer reviewe

Péritonite à Raoultella planticola chez un patient en dialyse péritonéale automatisée 48 heures après ensablement d’une piste équestre

We here report a case of Raoultella planticola peritonitis in an immunocompromised patient on automated peritoneal dialysis. The patient had worked in sanding a horse trail during hours two days earlier. Clinical and biological outcomes were rapidly favourable on ciprofloxacin antibiotherapy. Ciprofloxacin was substituted for by amoxicillin/acid clavulanic for a total duration of 3 weeks because of Achilee’s heel tendinopathy. Up to now no other case was reported in the French language home dialysis registry (RDPLF)Nous rapportons ici un cas de péritonite à Raoultella planticola multisensible chez un patient immunodéprimé en dialyse péritonéale automatisée. Le patient avait travaillé à l’ensablement d’une piste équestre 48 heures auparavant. L’évolution clinique et biologique a été rapidement favorable sous antibiothérapie par ciprofloxacine. La ciprofloxacine est remplacée dans un second temps par de l’amoxyclavulanate en raison d’une tendinopathie achiléenne. L’antibiothérapie est poursuivie pour une durée totale de 3 semaines avec une bonne réponse clinique.Aucun autre cas de péritonite à raoultella n’a été rapporté à ce jour auprès du registre de Dialyse Péritonéale de Langue Française. &nbsp