The HIV RNA setpoint theory revisited

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Simplified Assessment of Antiretroviral Adherence and Prediction of Virological Efficacy in HIV-Infected Patients in Cambodia

Background. Adherence to antiviral therapy is important for HIV-infected people living in low- and middle-income countries, because of poor access to alternative regimens. Methods. We conducted a cross-sectional survey of adherence in Cambodian patients enrolled in the ESTHER program and treated with WHO first-line regimen for at least 6 months. The survey was based on a self-report questionnaire, drug assay, MCV measurement, visual analog scale, and viral load HIV RNA. Results. Two hundred fifty-nine patients treated for a median of 16 months participated in the survey. At inclusion in the program, 158 patients (61%) were ARV-naïve. The virological success rate was 71% overall and 81% in previously ARV-naive patients. Considered individually, the measures suggested perfect adherence in 71% to 93% of patients. In multivariate analysis adjusted for sex and therapeutic status before HAART initiation, only the biological markers were associated with virological efficacy. Self-funded treatment before entry to the program was highly predictive of virological failure. Conclusion. Adherence was excellent in these Cambodian patients. Biological markers were predictive of virological efficacy. MCV might thus serve as a simple alternative for assessing adherence and predicting virological efficacy among patients receiving AZT- or d4T-based regimens

Phenotypic characterization of virological failure following lopinavir/ritonavir monotherapy using full-length Gag-protease genes.

OBJECTIVES: Major protease mutations are rarely observed following first-line failure with PIs and interpretation of genotyping results in this context may be difficult. We performed extensive phenotyping of viruses from five patients failing lopinavir/ritonavir monotherapy in the MONARK study without major PI mutations by standard genotyping. METHODS: Phenotypic susceptibility testing and viral infectivity assessments were performed using a single-cycle assay and fold changes (FC) relative to a lopinavir-susceptible reference strain were calculated. RESULTS: >10-fold reduced baseline susceptibility to lopinavir occurred in two of five patients and >5-fold in another two. Four of five patients exhibited phylogenetic evidence of a limited viral evolution between baseline and failure, with amino acid changes at drug resistance-associated positions in one: T81A emerged in Gag with M36I in the protease gene, correlating with a reduction in lopinavir susceptibility from FC 7 (95% CI 6-8.35) to FC 13 (95% CI 8.11-17.8). Reductions in darunavir susceptibility (>5 FC) occurred in three individuals. DISCUSSION: This study suggests both baseline reduced susceptibility and evolution of resistance could be contributing factors to PI failure, despite the absence of classical PI resistance mutations by standard testing methods. Use of phenotyping also reveals lower darunavir susceptibility, warranting further study as this agent is commonly used following lopinavir failure

ETUDE DE LA PRODUCTION D'INTERLEUKINE 12 PAR LE MONOCYTE ET LE MACROPHAGE ET DE SES MODIFICATIONS LORS DE L'INFECTION PAR LE VIRUS DE L'IMMUNODEFICIENCE HUMAINE

PARIS-BIUSJ-Physique recherche (751052113) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

La nouvelle loi de bioéthique en question(s)

International audienceLa loi relative à la bioéthique est sans conteste particulière. Par son objet, car le développement des biotechnologies appliquées à l’humain engage les sciences « dures », mais convoque également les sciences humaines et sociales dans une approche tant individuelle que populationnelle. La bioéthique invite chacun à réfléchir à l’équilibre entre les possibilités d’applications de la science, en constante évolution, et le respect de nos valeurs intangibles, au premier rang desquelles la sauvegarde de la dignité humaine. Particulière aussi par sa procédure préparatoire : les États généraux de la bioéthique en 2018 ont permis une vaste consultation des Français destinée à recueillir l’opinion de la cité sur les différents thèmes abordés par la loi. Cet ouvrage, au travers de 10 questions, analyse les principales dispositions de la loi du 2 août 2021, en s’attardant sur la raison d’être des changements attendus par certains, redoutés par d’autres. Il offre ainsi une vue synthétique et analytique du nouveau cadre légal relatif à la bioéthique qui concerne les professionnels de santé, juristes, associations de patients et, au-delà, impacte la vie des citoyens

La nouvelle loi de bioéthique en question(s)

International audienceLa loi relative à la bioéthique est sans conteste particulière. Par son objet, car le développement des biotechnologies appliquées à l’humain engage les sciences « dures », mais convoque également les sciences humaines et sociales dans une approche tant individuelle que populationnelle. La bioéthique invite chacun à réfléchir à l’équilibre entre les possibilités d’applications de la science, en constante évolution, et le respect de nos valeurs intangibles, au premier rang desquelles la sauvegarde de la dignité humaine. Particulière aussi par sa procédure préparatoire : les États généraux de la bioéthique en 2018 ont permis une vaste consultation des Français destinée à recueillir l’opinion de la cité sur les différents thèmes abordés par la loi. Cet ouvrage, au travers de 10 questions, analyse les principales dispositions de la loi du 2 août 2021, en s’attardant sur la raison d’être des changements attendus par certains, redoutés par d’autres. Il offre ainsi une vue synthétique et analytique du nouveau cadre légal relatif à la bioéthique qui concerne les professionnels de santé, juristes, associations de patients et, au-delà, impacte la vie des citoyens

Lancet Public Health

International audienc

After 2 years of the COVID-19 pandemic, translating One Health into action is urgent

International audienc

Targeted vs. systematic early antiviral treatment against A(H1N1)v influenza with neuraminidase inhibitors in patients with influenza-like symptoms: Clinical and economic impact

Capitalizing on available data, we used a decision model to estimate the clinical and economic outcomes associated with early initiation of treatment with neuraminidase inhibitors in all patients with influenza-like illnesses ( ILI ) (systematic strategy) vs. only those at high risk of complications (targeted strategy). Systematic treatment of ILI during an A(H1N1)v influenza epidemic wave is both effective and cost-effective. Patients who present to care with ILI during an A(H1N1)v influenza epidemic wave should initiate treatment with neuraminidase inhibitors, regardless of risk status. Administering neuraminidase inhibitors between epidemic waves, when the probability of influenza is low, is less effective and cost-effective