Unsupervised PrEP in routine practice: a new challenge?

International audiencePre-exposure prophylaxis (PrEP) for the prevention of HIV infection with 300 mg daily tenofovir co-formulated with 200 mg emtricitabine is recommended as one prevention option for people who are at substantial risk of acquiring an HIV infection. We report the case of a 28-year-old man who has sex with men and who was referred to our unit for a primary HIV infection with positive p18, p24 and gp160 bands on Western blot analysis but with a low HIV plasma viral load. Although HIV misdiagnosis should always be considered in cases of atypical seroconversion pattern with a low viral burden, unsupervised PrEP should be systematically investigated

Is the use of the QPC cognitive complaints questionnaire relevant for the screening strategy of HIV-Associated neurocognitive disorders?

International audienceBackground: The screening strategy for HIV-Associated Neurocognitive Disorders (HAND) is challenging. The French Expert Report recommend the use of the Cognitive Complaints Questionnaire (QPC) and the Montreal Cognitive assessment. However, the QPC has never been studied in People Living with HIV (PLWH). This study aims to determine the degree of agreement between QPC and the presence of HAND according to Frascati criteria, established by a battery of neuropsychological tests.Methods: Data from patients who performed both a QPC and a battery of neuropsychological tests over a six-month follow-up period were evaluated retrospectively.Results: A total of 121 patients were selected, with a median age of 53.1 years old. Among participants, 92.6% had an undetectable plasma viral load, 49.6% had a nadir CD4 less than 200/mm3 and 23.1% had a CDC stage C. Median CD4 cell count was 686/mm3. Prevalence of HAND was 57%, including 28.9% of Asymptomatic Neurocognitive Impairment, 24.8% of Mild Neurocognitive Disorder and 3.3% of HIV-associated Dementia. This analyze shows no agreement between QPC and HIV-associated neurocognitive disorders (kappa = -0.007).Conclusions: The QPC is not relevant in the screening for HAND. Thus, it urges to develop a specific tool to assess cognitive complaints among PLWH

Cancer risk in HIV-infected patients

International audienc

Frailty in HIV infected people: a new risk factor for bone mineral density loss

International audienceObjective: The study aims to assess the association between bone mineral density (BMD) and frailty in a cohort of HIV-infected patients. Design: A cross-sectional study in an HIV outpatient unit where nearly 1000 patients are monitored. Methods: Study participants undergoing bone densitometry were proposed an evaluation of frailty using criteria of the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fractures (SOF). Frailty markers were weight-loss, self-reported exhaustion , physical activity, grip strength, chair stands, and slow gait. Patients' characteristics were collected from an electronic medical record. Associations of frailty with BMD and osteoporosis were tested using multivariate linear and logit regression models, respectively. Results: In total, 175 HIV-infected patients, 121 (69.14%) men, were analyzed. Prevalence of frailty markers, osteopenia, and osteoporosis were comparable among sexes. Despite a younger age, spinal and femoral neck BMD were lower in women (P < 0.05). Linear regression model adjusting by age, duration of HIV follow-up, BMI, smoking status, osteoarthritis, osteoporosis treatment, and the age at menopause showed a negative association of spinal and femoral BMD with frailty according to SOF criteria in women (P < 0.05). In men, SOF-defined frailty was associated with osteoporosis (odds ratio 28.79; 95% confidence interval 2.15-386.4) in a model adjusting for age, duration of HIV follow-up, CD4 þ nadir, CD4 þ T-cell count, tobacco consumption, exposure to tenofovir (TDF) and protease inhibitors. No significant associations were found between BMD and CHS-defined frailty. Conclusion: Our study shows that frailty according to SOF criteria is associated with low spinal BMD values in female and osteoporosis in male HIV-infected patients

Infection par le VIH et parcours de soin : des recommandations à la pratique clinique

International audienceOBJECTIVES:To quantify within a cohort of HIV-infected individuals the number of medical visits and procedures to be carried out according to comorbidities and risk factors to implement a personalized care pathway.PATIENTS AND METHODS:Retrospective study of 915 patients consulting from January 1 to December 31, 2016 at an outpatient unit of multidisciplinary consultations, using an electronic patient record. We built an algorithm using parameters required for the application of the national guidelines for the management of HIV-infected individuals. The frequency of comorbidities was measured according to gender, transmission risk group, and nadir CD4 (200/mm3).RESULTS:Patients were mostly men (median age: 52 years), of whom 16% were aged≥60 years. Viral load was<40 copies/mL in 93.5% of treated patients and CD4 cell count≥500/mm3 for 73%. Overall, 74.5% of patients had at least one comorbidity. The number of comorbidities was similar in men and women but was significantly higher in patients with a nadir CD4 <200/mm3 and increased with age (irrespective of gender). The minimum number of consultations to be scheduled per year was 8123: 70% for the management of comorbidities with an average of six consultations/year/patient. Overall, 53% of patients should attend a proctology consultation. The minimum number of paramedical procedures to be performed was 5115.CONCLUSION:The implementation of a personalized multidisciplinary management within a single facility seems to be a suitable care model to address the needs of HIV-infected individuals.Objectifs. – Quantifier le nombre de consultations et d’actes à réaliser selon les comorbidités et facteurs de risque pour organiser un parcours de soins coordonné et personnalisé d’une file active de personnes vivant avec le VIH (PVVIH).Patients et méthodes. – Étude rétrospective sur 915 PVVIH, suivis du 1erjanvier au 31 décembre 2016 dans une unité ambulatoire pluridisciplinaire avec dossiers patient informatisés. Un algorithme a été construit à partir des caractéristiques sur lesquelles s’appuie le calendrier de suivi des recommandations nationales. La fréquence des comorbidités a été étudiée selon le sexe et le nadir CD4.Résultats. – La file active était composée majoritairement d’hommes (âge médian 52 ans), dont 16 % étaient âgés de ≥ 60 ans, avec un taux deCD4 ≥ 500/mm3chez 73 % et une charge virale < 40 copies/mL chez 93,5 % des patients traités. Au moins, une comorbidité était observée chez74,5 % des patients.Le nombre de comorbidités ne différait pas entre les hommes et les femmes, mais était significativement plus élevé en cas de nadirCD4 < 200/mm3et augmentait avec l’âge, indifféremment du sexe. Le nombre minimal de consultations annuelles à programmer est de 8123 consul-tations, dont 70 % pour la prise en charge des comorbidités avec en moyenne 6 consultations/an/patient. Le nombre minimal de prestationsparacliniques à réaliser était de 5115 actes.Conclusions. – L’organisation d’une gestion en pluridisciplinarité centrée autour du patient au sein d’une même structure apparaît comme unmodèle de prise en charge nécessaire aux besoins des PVVIH

Impact of hepatitis C virus coinfection on T-cell dynamics in long-term HIV-suppressors under combined antiretroviral therapy

International audienceObjective: The objective of this study is to evaluate the impact of hepatitis C virus (HCV) serostatus on the evolution of CD8 þ cells and CD4 þ : CD8 þ ratio in HIV-infected patients on combined antiretroviral therapy (cART) who achieve sustained undetectable viral load (HIV-pVL). Design and methods: A longitudinal study performed in an outpatient HIV-unit following 1495 HIV-infected patients. Data of patients on cART achieving undetectable HIV-pVL for at least 3 years were collected retrospectively from our medical e-database NADIS from January 1997 to April 2005, a period defined in order to select patients who were naive of hepatitis treatment. T-cell counts were assessed every 6 months from HIVsuppression over the study period. Results: Two hundred and twenty-six HIV mono-infected (group 1) and 130 HCVcoinfected patients (group 2; genotype prevalence: 42% HCV-G1, 26% HCV-G3, 11% HCV-G4 and 21% HCV-G2) fulfilled the selection criteria. cART regimens were comparable between the groups, as were CD4 þ and CD8 þ cell counts at the first undetectable HIV-pVL. After 3 years, both groups displayed similar CD4 þ cell reconstitution, although CD4 þ percentage was higher in group 1 (30.3 AE 1.1 vs. 27 AE 1.1%; P < 0.001). HIV suppression led to a significant drop of median CD8 þ cell counts in group 1 (P ¼ 0.027), but not in group 2, which displayed higher CD8 þ cell counts all through the follow-up (mean diff. ¼ 135.71 AE 26.89 cells/ml, P < 0.001). Moreover, the fraction of patients reaching CD4 þ : CD8 þ ratio ! 1 was lower in group 2 (14 vs. 27.7%; P < 0.05). Conclusion: Despite sustained HIV suppression under cART, HCV coinfection was found to hamper CD8 þ downregulation. Further studies will determine the impact of treatment with direct-acting antiviral agents on the CD8 þ pool, and the advantage of systematic HCV-targeted therapy for HIV/HCV-coinfected patients

Cannabis Use as a Protective Factor Against Overweight in HIV-Hepatitis C Virus Co-Infected People (ANRS CO13 HEPAVIH Cohort)

International audienceOverweight is increasingly prevalent in people living with HIV (PLWH), and is a high risk factor for metabolic disorders in this population. PLWH co-infected with hepatitis C virus (HCV) have a higher risk of metabolic disorders than their mono-infected counterparts. The putative relationship between cannabis use and body weight found in the general population has never been documented in HIV-HCV co-infected people. We tested whether cannabis use is associated with body mass index (BMI), overweight, and underweight in HCV co-infected PLWH (N = 992). Mixed-effects linear and logistic regression models were used to study the association between cannabis use and the three outcomes over time. After multivariable adjustment, cannabis use was inversely associated with BMI. Cannabis use was associated with a lower and higher risk of overweight and underweight, respectively. Cannabis use should be assessed and taken into account in the clinical management of the HIV-HCV co-infected population

Consultation « santé sexuelle et affective » : quelles attentes pour les personnes vivant avec le VIH ?

International audienceObjectivesPeople living with HIV (PLWH) are particularly affected in their sexual life. Medical support of PLWH's sexuality is increasingly proposed however no data are available. We assessed the interest of PLWH for sexual and emotional health support within a French HIV outpatient care facility.Population and methodsAnonymous questionnaire proposed to PVWH attending our facility. Five types of consultations were investigated: overall sexual and emotional health; HIV transmission and prevention; sexually transmitted diseases; sexual practices; recreational drugs. Cluster analysis in order to identify groups of PLWH with similar expectations.ResultsA total of 138 questionnaires completed: 64.5% were interested by at least one type of consultation. No significant differences between clusters by gender, age, or sexual orientation.ConclusionThese results confirm patients’ demand for sexual and emotional health support in the frame of PLWH's health care. Patients declaring no interest for this type of consultation were no different from those interested.ObjectifsLes personnes vivant avec le VIH (PVVIH) sont particulièrement affectées dans leur vie sexuelle. La prise en charge médicale de leur sexualité se développe, mais aucune donnée n’est disponible. Évaluation de l’intérêt pour des consultations de santé sexuelle et affective au sein d’une unité ambulatoire de prise en charge des PVVIH.Patients et méthodesQuestionnaire anonyme proposé aux patients fréquentant le service. Cinq types de consultations évaluées : santé sexuelle et affective, modes de transmission et de prévention, infections sexuellement transmissibles, pratiques sexuelles, drogues récréatives. Analyse de cluster pour identifier des patients ayant des besoins similaires.RésultatsAu total, 138 questionnaires complétés. Le pourcentage des intéressés par au moins un type de consultation est de 64,5. Pas de différence en termes d’âge, de sexe ou d’orientation sexuelle entre les clusters.ConclusionCette étude met en évidence le besoin des patients concernant la prise en charge de leur santé sexuelle et affective

Boceprevir (BOC) and Telaprevir (TPV) therapeutic drug monitoring in HCV and HIV-HCV infected patients treated with triple therapy Ribavirine/Peg-interferon/Boceprevir or Telaprevir: impact of the antiretroviral (ARV) treatment

International audienc

Brief Report: frailty in aging people living with HIV: a matched controlled study

International audienceBackground: We compared the prevalence of frailty among aging people living with HIV (PLHIV) with people without HIV from the ANS EP58 HAND 55–70 Study.Methods: Cross-sectional multicentric study which consecutively included 200 PLHIV and 1000 people without HIV from the French national CONSTANCES cohort, matched on age, sex, and education level. PLHIV were aged 55–70 years, with a HIV viral load 200 cells/µL for the last 24 and 12 months, respectively. We measured frailty (>2 items) and prefrailty (one or 2 items) using a proxy of the 5-item Fried score. Multivariate logistic regression was performed to assess the association between HIV and frailty/prefrailty, adjusting for demographic, social, behavioral, and comorbidity confounders.Results: Outcome measures were available for 192 PLHIV and 822 people without HIV. The median age was 62 years, and 84.9% were men. Among PLHIV, the median CD4 cell count was 645.5 cells/µL. Prevalence of frailty/prefrailty was 5.73%/57.3% in PLHIV vs. 1.73%/52.2% in people without HIV, respectively. HIV was associated with prefrailty/frailty [odds ratio = 1.89; 95% confidence interval = 1.37 to 2.61), but after adjusting for social and behavioral factors and comorbidities, HIV was not significantly associated with prefrailty/frailty (odds ratio = 1.24; 95% confidence interval: = 0.84 to 1.81). In PLHIV only, frailty/prefrailty was associated with depressive symptomatology, kidney disease, and time since HIV infection.Conclusions: Prevalence of frailty is increased in aging PLHIV with well-controlled HIV disease, but other factors than HIV are predominant, particularly depression and comorbidities