Rôle des anticorps neutralisants autologues dans la guérison spontanée lors d'une infection par le virus de l'hépatite C

Environ 30% des patients infectés par le virus de l hépatite C guérissent spontanément. Le but de ce travailétait (i) d examiner l évolution des protéines d enveloppe en cas de guérison spontanée (ii) de comparerl infectivité des variants présents aux stades précoces (iii) d explorer la capacité neutralisante des anticorps(Ac) vis-à-vis des variants majoritaires et minoritaires. Nous avons sélectionné 2 patients avec une hépatiteaigue C suivie d une guérison très rapide. Pour explorer la capacité d entrée de ces variants et leur aptitude àêtre neutralisés, nous avons produit des pseudo-particules rétrovirales portant les enveloppes de différentsvariants. Pour le 1er patient, une réponse neutralisante autologue était détectable précocement, avec unmaximum entre le 2ème et le 3èmemois suivant la cytolyse. Elle était encore détectable au 30ème mois. Pourle 2ème patient, des Ac vis-à-vis du variant majoritaire étaient détectés dans le sérum prélevé 4 jours après lacytolyse et dans les sérums plus tardifs. Le titre des Ac était maximum au 5ème mois. La réponse neutralisanteest d apparition précoce et persiste même après l élimination virale. Ces observations nous questionnent parrapport au rôle éventuel joué par ces Ac dans les cas de recontamination.Only 30% of Hepatitis C virus infected individuals recover spontaneously. We investigated the mechanismsleading to early HCV clearance. The purpose of this work was: (i) to explore the diversity and the early geneticevolution of the HCV envelope glycoproteins, and the infectivity spectrum of isolated variants and (ii) toanalyze the ability of the autologous neutralizing response to control these variants. We selected two patientswho developed an acute HCV infection. To explore the impact of mutations on infectivity and neutralization,retroviral pseudoparticules were produced with representative E1 and E2 sequences. For the first case, themaximum neutralizing activity was observed in the serum collected between 2 and 3 months post ALT peak,the activity was still detectable after 30 months. For the second case, autologous neutralizing activity wasdetected in every serum collected between 4 days and 13 months after. A gradual increase of neutralizationactivity was observed over time with a maximum 5 to 6 months. We have shown that the neutralizing responsewas detectable at early stages of primoinfection and was sustained beyond the time at which the virus wascleared. These observations raise interesting questions about the role of such antibodies in case of re-exposure.TOURS-Bibl.électronique (372610011) / SudocSudocFranceF

Long-Term Hepatitis B Virus (HBV) Response to Lamivudine-Containing Highly Active Antiretroviral Therapy in HIV-HBV Co-Infected Patients in Thailand

Background: Approximately 4 million of people are co-infected with HIV and Hepatitis B virus (HBV). In resource-limited settings, the majority of HIV-infected patients initiate first-line highly active antiretroviral therapy containing lamivudine (3TC-containing-HAART) and long-term virological response of HBV to lamivudine-containing HAART in co-infected patients is not well known. Methodology/Principal Finding: HIV-HBV co-infected patients enrolled in the PHPT cohort (ClinicalTrials.gov NCT00433030) and initiating a 3TC-containing-HAART regimen were included. HBV-DNA, HIV-RNA, CD4+ T-cell counts and alanine transaminase were measured at baseline, 3 months, 12 months and then every 6 months up to 5 years. Kaplan-Meier analysis was used to estimate the cumulative rates of patients who achieved and maintained HBV-DNA suppression. Of 30 co-infected patients, 19 were positive for HBe antigen (HBeAg). At initiation of 3TC-containing-HAART, median HBV DNA and HIV RNA levels were 7.35 $log_{10}$ IU/mL and 4.47 $log_{10}$ copies/mL, respectively. At 12 months, 67% of patients achieved HBV DNA suppression: 100% of HBeAg-negative patients and 47% of HBeAg-positive. Seventy-three percent of patients had HIV RNA below 50 copies/mL. The cumulative rates of maintained HBV-DNA suppression among the 23 patients who achieved HBV-DNA suppression were 91%, 87%, and 80% at 1, 2, and 4 years respectively. Of 17 patients who maintained HBV-DNA suppression while still on 3TC, 4 (24%) lost HBsAg and 7 of 8 (88%) HBeAg-positive patients lost HBeAg at their last visit (median duration, 59 months). HBV breakthrough was observed only in HBeAg-positive patients and 6 of 7 patients presenting HBV breakthrough had the rtM204I/V mutations associated with 3TC resistance along with rtL180M and/or rtV173L. Conclusions: All HBeAg-negative patients and 63% of HBeAg-positive HIV-HBV co-infected patients achieved long-term HBV DNA suppression while on 3TC-containing-HAART. This study provides information useful for the management of co-infected patients in resource-limited countries where the vast majority of co-infected patients are currently receiving 3TC

Viral sequence variation in chronic carriers of hepatitis C virus has a low impact on liver steatosis.: HCV variability and steatosis

International audienceMost clinical studies suggest that the prevalence and severity of liver steatosis are higher in patients infected with hepatitis C virus (HCV) genotype 3 than in patients infected with other genotypes. This may reflect the diversity and specific intrinsic properties of genotype 3 virus proteins. We analyzed the possible association of particular residues of the HCV core and NS5A proteins known to dysregulate lipid metabolism with steatosis severity in the livers of patients chronically infected with HCV. We used transmission electron microscopy to quantify liver steatosis precisely in a group of 27 patients, 12 of whom were infected with a genotype 3 virus, the other 15 being infected with viruses of other genotypes. We determined the area covered by lipid droplets in liver tissues and analyzed the diversity of the core and NS5A regions encoded by the viral variants circulating in these patients. The area covered by lipid droplets did not differ significantly between patients infected with genotype 3 viruses and those infected with other genotypes. The core and NS5A protein sequences of the viral variants circulating in patients with mild or severe steatosis were evenly distributed throughout the phylogenic trees established from all the collected sequences. Thus, individual host factors seem to play a much greater role than viral factors in the development of severe steatosis in patients chronically infected with HCV, including those infected with genotype 3 viruses

Variabilité génétique de l'enveloppe du virus de l'hépatite C de génotype 1b en relation avec la réponse au traitement antiviral (étude du polymorphisme des régions HVR1 et PePHD)

L'implication de la variabilité génétique du virus de l'hépatite C dans la résistance au traitement est encore mal connue. Deux régions du gène de l'enveloppe ont été explorées : la région hypervariable (HVR1) et le domaine PePHD. Nous avons exploré la diversité de HVR1 chez 15 patients infectés par un VHC de génotype 1b. Après analyse de 150 domaines pré-thérapeutiques de HVR1, aucune mutation de HVR1 ne paraît associée à la résistance ou à la sensibilité au traitement. Les domaines HVR1 issus des patients répondeurs ne présentent pas de trou antigénique régulièrement marqué aux positions 16 et 17, comme le montrent ceux issus des patients non répondeurs. L'implication de PePHD dans la résistance au traitement a été testée. Les résultats du séquençage, réalisé chez 25 patients, montrent une conservation du motif quel que soit le type de réponse, indiquant que le séquençage de PePHD n'est pas informatif pour prédire le type de réponse chez les patients infectés un VHC de génotype 1b.TOURS-BU Médecine (372612103) / SudocSudocFranceF

L' infection par le virus de l'hépatite C chez les sujets infectés par le virus de l'immunodéficience humaine (données épidémiologiques, stratégie de dépistage, aspects thérapeutiques)

TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Bilan du dépistage et du suivi des infections liées aux papillomavirus dans une cohore de 509 femmes présentant un frottis de type ASCUS ou AGC (2007-2008)

TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Diagnostic biologique de l'infection par le virus de l'hépatite E (analyse de 9 cas recensés au CHRU [centre hospitalier régional universitaire] de Tours (2005-2007))

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Recherche des mutations du virus de l'hépatite B aux analogues nucléo(t)idiques chez 88 patients (bilan des indications, principaux profils mutationnels et impact sur les options thérapeutique)

TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Caractérisation des mutants du promoteur basal du core, et de la région précore du virus de l'hépatite B (étude de 36 souches isolées chez des patients suivis dans le service de gastroentérologie du CHRU de Tours)

TOURS-BU Sciences Pharmacie (372612104) / SudocSudocFranceF

Usefulness of the Hepatitis C Virus Core Antigen Assay for Screening of a Population Undergoing Routine Medical Checkup

We studied the usefulness of the recently designed Trak-C assay for the detection and quantification of the hepatitis C virus (HCV) core antigen (Ag) for the screening of HCV infection in 4,201 subjects selected from 74,150 consecutive volunteers undergoing routine medical checkups. Subjects were selected for screening because they had risk factors (group II, n = 321) and/or elevated alanine transaminase activity (group I, n = 3847). Initially, the anti-HCV antibody assay and the Trak-C assay were performed on each patient. Subsequently, the Trak-C assay was performed only when the anti-HCV enzyme immune assay (EIA) was positive. Positive samples were further evaluated for anti-HCV antibodies by a third-generation strip immunoblot assay and for HCV RNA. Four samples (1.2%) from group II and 113 (2.9%) from group I were anti-HCV EIA positive. We also tested 33 subjects who previously tested positive for anti-HCV in our medical center. Among the 150 anti-HCV EIA-positive samples, the HCV core Ag result was in accord with the HCV RNA result in 146 cases (97.3%). When the EIA result was positive, the HCV core Ag concentration and the HCV RNA load were correlated (r(2) = 0.78; P < 0.001). Four samples with low viral loads were Trak-C negative but HCV RNA positive. Among the 2,395 anti-HCV EIA-negative serum samples collected during the first part of the study, 17 (0.7%) were found to contain very low levels of HCV core Ag (<8.5 pg/ml, the cutoff value being 1.5 pg/ml). All these samples were HCV RNA negative and considered to be false positives. This was confirmed by HCV core Ag neutralization analysis. The HCV core Ag assay is a useful method in the screening strategy of HCV infection and provides a reliable means of distinguishing between current and cleared HCV infections that is well correlated with HCV RNA testing