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Baza MB, Jerónimo A, Río I, Rodriguez C, Vera M, Hernando V, Castilla J, Del Romero J. Natural Conception is Safe for HIV-Serodiscordant Couples with Persistent Suppressive Antiretroviral Therapy for the Infected Partner. J Womens Health (Larchmt) 2019; 28:1555-1562. [PMID: 31329519 DOI: 10.1089/jwh.2018.7485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Sustained use of antiretroviral treatment to achieve a suppressed viral load in persons living with HIV is associated with zero or near-zero risk of sexual and vertical HIV transmission. This has led to an increasing number of HIV-serodiscordant couples (SDCs) who wish to have children. The aim of this study was to describe the most recent results of a protocol for reproductive counseling directed at HIV-SDCs who desire natural conception and to identify some of the factors influencing reproductive success. Methods: Two hundred fourteen couples were enrolled. Sociodemographic/behavioral and clinical data were collected. CD4+ lymphocyte count, HIV viral load, serology/viral load of hepatitis B/C viruses, syphilis serology, and other sexually transmitted infection diagnosis in both members of couple; spermiogram in men, HIV proviral and viral load in semen of male HIV-infected partners, and urine luteinizing hormone qualitative test in women were performed. Unprotected vaginal intercourses, pregnancies achieved, and their outcomes were recorded. Results: After almost 10,000 sexual relations, a total of 188 pregnancies was achieved, 62% of couples became pregnant once or several times with no HIV transmission to either the partner or the offspring. Younger age of woman, no fertility disorders in both members of couple, and no treatment with efavirenz in men were factors related with reproductive success. Conclusions: Natural conception, under controlled conditions, can be offered to SDCs who wish to have children as a safe method of conception and its effectiveness seems to be related to factors not different from those of the general population.
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Affiliation(s)
- María Begoña Baza
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Adrian Jerónimo
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Isabel Río
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Carmen Rodriguez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Mar Vera
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Victoria Hernando
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Jesus Castilla
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - Jorge Del Romero
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Louis M, Cottenet J, Salmon-Rousseau A, Blot M, Bonnot PH, Rebibou JM, Chavanet P, Mousson C, Quantin C, Piroth L. Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study. BMJ Open 2019; 9:e029211. [PMID: 31061062 PMCID: PMC6501953 DOI: 10.1136/bmjopen-2019-029211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To describe hospitalisations for kidney disease (KD) among people living with HIV (PLHIV) in France and to identify the factors associated with such hospitalisations since data on the epidemiology of KD leading to hospitalisation are globally scarce. DESIGN Observational nationwide study using the French Programme de Médicalisation des Systèmes d'Information database. SETTING France 2008-2013. PARTICIPANTS Around 10 862 PLHIV out of a mean of 5 210 856 patients hospitalised each year. All hospital admissions with a main diagnosis code indicating KD (International Classification of Diseases, 10th revision codes, N00 to -N39) were collected. MAIN OUTCOME MEASURES The prevalence and incidence of KD leading to hospital admission in PLHIV and the associated risk factors. RESULTS The prevalence of patients hospitalised for KD was 1.5 higher in PLHIV than in the general population, and increased significantly from 3.0% in 2008 to 3.7% in 2013 (p<0.01). The main cause of hospitalisation for KD was acute renal failure (ARF, 25.4%). Glomerular diseases remained stable (6.4%) throughout the study period, focal segmental glomerulosclerosis being the main diagnosis (37.6%). Only 41.3% of patients hospitalised for glomerular disease were biopsied. The other common motives for admission were nephrolithiasis (22.1%) and pyelonephritis (22.6%).The 5-year cumulative incidence of KD requiring hospitalisation was 5.9% in HIV patients newly diagnosed for HIV in 2009. Factors associated with a higher risk of incident KD requiring hospitalisation were cardiovascular disease (HR 3.30, 95% CI 1.46 to 7.49), and, for female patients, AIDS (HR 2.45, 95% CI 1.07 to 5.58). Two-thirds of hospitalisations for incident ARF occurred in the first 2 years of follow-up. CONCLUSIONS Hospital admission for KD is more frequent in PLHIV than in the general population and increases over time. ARF remains the leading cause. Glomerular diseases are infrequently documented by renal biopsies. Older patients and those with cardiovascular disease are particularly concerned.
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Affiliation(s)
- Magali Louis
- Infectious Diseases Department, University Hospital, Dijon, France
- Nephrology, University Hospital, Dijon, France
| | - Jonathan Cottenet
- CHRU Dijon, Service de Biostatistique et d’Informatique Médicale (DIM), Université de Bourgogne, Dijon, France
| | | | - Mathieu Blot
- Infectious Diseases Department, University Hospital, Dijon, France
| | | | | | - Pascal Chavanet
- Infectious Diseases Department, University Hospital, Dijon, France
- CIC 1432, INSERM, Dijon, France
| | | | - Catherine Quantin
- CHRU Dijon, Service de Biostatistique et d’Informatique Médicale (DIM), Université de Bourgogne, Dijon, France
| | - Lionel Piroth
- Infectious Diseases Department, University Hospital, Dijon, France
- CIC 1432, INSERM, Dijon, France
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Gantner P, Sylla B, Morand-Joubert L, Frange P, Lacombe K, Khuong MA, Duvivier C, Launay O, Karmochkine M, Arvieux C, Ménard A, Piroth L, Canestri A, Trias D, Peytavin G, Landman R, Ghosn J. "Real life" use of raltegravir during pregnancy in France: The Coferal-IMEA048 cohort study. PLoS One 2019; 14:e0216010. [PMID: 31017957 PMCID: PMC6481866 DOI: 10.1371/journal.pone.0216010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Limited "real life" data on raltegravir (RAL) use during pregnancy are available. Thus, we aimed at describing effectiveness and safety of RAL-based combined antiretroviral therapy (cART) in this setting. METHODS HIV-1-infected women receiving RAL during pregnancy between 2008 and 2014 in ten French centers were retrospectively analysed for: (1) proportion of women receiving RAL anytime during pregnancy who achieved a plasma HIV-RNA (pVL) < 50 copies/mL at delivery, and (2) description of demographics, immuno-virological parameters and safety in women and new-borns. RESULTS We included 94 women (median age, 33 years) of which 85% originated from Sub-Saharan Africa and 16% did not have regular health insurance coverage. Sixteen women were cART-naïve (median HIV diagnosis at 30 weeks of gestation), whereas 78 were already on cART before pregnancy (40% with pVL < 50 copies/mL). RAL was initiated before pregnancy (n = 33), during the second trimester (n = 11) and the third trimester of pregnancy (n = 50). No RAL discontinuations due to adverse events were observed. Overall, at the time of delivery, pVL was < 50 copies/mL in 70% and < 400 copies/mL in 84% of women. Specifically, pVL at delivery was < 50 copies/mL in 82%, 55% and 56% of cases when RAL was started before pregnancy, during the second or third trimester of pregnancy, respectively. Median term was 38 weeks of gestation, no defect was reported and all new-borns were HIV non-infected at Month 6. CONCLUSIONS RAL appears safe and effective in this "real-life" study. No defect and no HIV transmission was reported in new-borns.
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Affiliation(s)
- Pierre Gantner
- Hôpitaux Universitaires de Strasbourg, Laboratoire de Virologie, Strasbourg, France
| | - Babacar Sylla
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Laboratoire de Virologie, Hôpital Saint-Antoine, Paris, France
| | - Pierre Frange
- APHP, Hopital Necker Enfants malades, Laboratoire de Microbiologie clinique, Paris, France
- EHU 7328, Institut Imagine, Université Paris Descartes, Paris, France
| | - Karine Lacombe
- Inserm UMR-S1136, IPLESP, AP-HP, Hôpital Saint Antoine, Department of Infectious Diseases, Paris, France
| | - Marie-Aude Khuong
- Hôpital Delafontaine, Department of Infectious Diseases, Saint Denis, France
| | - Claudine Duvivier
- APHP, Hopital Necker Enfants Malades, Department of Infectious Diseases, Centre d’Infectiologie Necker – Pasteur, IHU Imagine, Paris, France
| | - Odile Launay
- Université Paris Descartes, APHP, CIC Cochin Pasteur, Paris, France
| | - Marina Karmochkine
- APHP, Hopital Européen Georges Pompidou, Department of Clinical Immunology, Paris, France
| | | | - Amélie Ménard
- Institut hospitalo-universitaire (IHU) Méditerranée infection, Marseille, France
| | - Lionel Piroth
- Département d’Infectiologie, CHU Dijon, Dijon, France
| | - Ana Canestri
- APHP, Hôpital Tenon, Maladies Infectieuses, Paris, France
| | | | - Gilles Peytavin
- APHP, Hopital Bichat Claude Bernard, Department of Pharmacology-Toxicology, Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
| | - Roland Landman
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
| | - Jade Ghosn
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
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4
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HBV or HCV Coinfection in HIV-1-Infected Pregnant Women in France: Prevalence and Pregnancy Outcomes. J Acquir Immune Defic Syndr 2019; 77:439-450. [PMID: 29287028 DOI: 10.1097/qai.0000000000001618] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is frequent in HIV-infected persons but their impact on pregnant HIV-infected women is understudied. We explored whether these coinfections are associated with adverse pregnancy outcomes and lower response to antiretroviral therapy (ART). METHODS Pregnancies in HIV-1-infected women included in the ANRS French Perinatal Cohort between 2005 and 2013 were analyzed if HBV and HCV infection statuses were available. RESULTS Among 4236 women, the prevalence of HBV (HBs Ag+) and HCV (RNA+) were 6.2% (95% confidence interval: 5.4 to 6.8) and 1.7% (1.3 to 2.1), respectively. HCV coinfection was strongly associated with a history of drug use; HBV coinfection was 6 times more frequent in women born in Sub-Saharan Africa than in European France. Baseline HIV viral load, CD4 count, and HIV care during pregnancy were similar in coinfected and monoinfected HIV mothers, except that 90% of HBV/HIV women were receiving tenofovir and/or lamivudine or emtricitabine. HCV coinfection was significantly associated with cholestasis [adjusted odds ratio: 4.1 (1.5-10.8), P = 0.005], preterm delivery [3.0 (1.6-5.7), P < 0.001], lower CD4 [2.6 (1.0-6.4), P < 0.001], and detectable viral load [2.3 (1.0-5.5), P = 0.06] at the end of pregnancy. HBV coinfection was not associated with any of these outcomes. CONCLUSIONS In HIV-infected women, chronic HBV infection, mostly treated using targeted ART, had no major impact on the course of pregnancy. By contrast, chronic HCV infection was associated with a higher risk of obstetrical complications and a poorer immune-virological response to ART. It is yet unknown whether cure of HCV infection before conception can limit these adverse outcomes.
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Ninive C, Ferraretto X, Gricourt S, Llabador MA, Lepage J, Gauché-Cazalis C, Epelboin S, Peigné M. [Assisted reproductive technologies in HIV patients: Which results and which strategy in France in 2019?]. ACTA ACUST UNITED AC 2019; 47:362-369. [PMID: 30753900 DOI: 10.1016/j.gofs.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Indexed: 01/22/2023]
Abstract
With the use of antiretroviral therapy, HIV transmission from mother to fetus and between sexual partners has been significantly reduced, successively allowing pregnancy, then assisted reproductive technologies, and targeted unprotected sex among couples living with HIV. Since first French Morlat report in 2013, natural procreation is now possible under certain conditions for these couples living with HIV and the use of assisted reproductive technologies is increasingly limited to the treatment of infertility. While the results of intrauterine insemination seem satisfactory for serodiscordant couples living with HIV, in vitro fertilization results appear to be unfavorable when the woman is infected with HIV. In vitro fertilization results appear to be comparable to those in general population when only the man is infected with HIV. It can be assumed that ovaries are impacted by the treatment and/or the HIV in infected women.
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Affiliation(s)
- C Ninive
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - X Ferraretto
- Service de biologie de la reproduction, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - S Gricourt
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - M A Llabador
- Service de biologie de la reproduction, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - J Lepage
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - C Gauché-Cazalis
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - S Epelboin
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France
| | - M Peigné
- Unité de médecine de la reproduction, service de gynécologie-obstétrique, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri Huchard, 75018 Paris, France.
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6
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Tournu G, Abramowitz L, Couffignal C, Juguet F, Sénéjoux A, Berger S, Wiart AL, Bernard M, Provost F, Pillant-Le Moult H, Bouchard D, Aubert JP. Prevalence of anal symptoms in general practice: a prospective study. BMC FAMILY PRACTICE 2017; 18:78. [PMID: 28774265 PMCID: PMC5543599 DOI: 10.1186/s12875-017-0649-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/24/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice. METHODS In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected. RESULTS From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases. CONCLUSIONS Patients' concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.
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Affiliation(s)
- Géraldine Tournu
- General practice department, University Paris Diderot, F-75018 Paris, France
| | - Laurent Abramowitz
- AP-HP and GREP; Gastroenterology and proctology unit, Bichat University hospital, Paris, France
| | - Camille Couffignal
- INSERM, IAME, UMR 1137, F-75018 Paris, France
- University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
- AP-HP, Bichat hospital, Biostatistics unit, F-75018 Paris, France
| | | | - Agnès Sénéjoux
- Proctology unit, Private hospital, Saint Grégoire, France
| | | | | | | | | | | | | | - Jean-Pierre Aubert
- Sorbonne Paris Cité, General practice department, University Paris Diderot, F-75018 Paris, France ; REMES, F-75018 Paris, France
| | - for the GREP study group
- General practice department, University Paris Diderot, F-75018 Paris, France
- AP-HP and GREP; Gastroenterology and proctology unit, Bichat University hospital, Paris, France
- INSERM, IAME, UMR 1137, F-75018 Paris, France
- University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
- AP-HP, Bichat hospital, Biostatistics unit, F-75018 Paris, France
- Tivoli Ducos Clinic, Bordeaux, France
- Proctology unit, Private hospital, Saint Grégoire, France
- Montigny les Cormeilles, France
- Bordeaux, France
- Cadaujac, France
- Rennes, France
- Blomet Clinic, Paris, France
- Proctology unit, Bagatelle hospital, Talence, France
- Sorbonne Paris Cité, General practice department, University Paris Diderot, F-75018 Paris, France ; REMES, F-75018 Paris, France
| | - for the MG-PREVAPROCT study group
- General practice department, University Paris Diderot, F-75018 Paris, France
- AP-HP and GREP; Gastroenterology and proctology unit, Bichat University hospital, Paris, France
- INSERM, IAME, UMR 1137, F-75018 Paris, France
- University Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France
- AP-HP, Bichat hospital, Biostatistics unit, F-75018 Paris, France
- Tivoli Ducos Clinic, Bordeaux, France
- Proctology unit, Private hospital, Saint Grégoire, France
- Montigny les Cormeilles, France
- Bordeaux, France
- Cadaujac, France
- Rennes, France
- Blomet Clinic, Paris, France
- Proctology unit, Bagatelle hospital, Talence, France
- Sorbonne Paris Cité, General practice department, University Paris Diderot, F-75018 Paris, France ; REMES, F-75018 Paris, France
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7
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Risso K, Guillouet-de-Salvador F, Valerio L, Puglièse P, Naqvi A, Durant J, Demonchy E, Perbost I, Cua E, Marquette CH, Roger PM. COPD in HIV-Infected Patients: CD4 Cell Count Highly Correlated. PLoS One 2017; 12:e0169359. [PMID: 28056048 PMCID: PMC5215875 DOI: 10.1371/journal.pone.0169359] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND COPD is a frequent and significant cause of respiratory morbidity in HIV-infected patients despite the control of HIV. We aimed to analyze the factors correlated with COPD in this population to evaluate the existence of specific indicators of vulnerability in this population. METHODS AND FINDINGS 623 HIV-infected outpatients were enrolled during one year. This population was characterised by a dedicated questionnaire and electronic patient records. COPD screening was performed according to recommended spirometric criteria. The prevalence of COPD was 9.0%. Age and smoking were independently correlated with COPD (OR, 1.61 per 10 years increase, P = 0.007; OR, 1.28 per 10 pack-year increase, P = 0.003, respectively). Body mass index (BMI) and CD4 cell-count were independently and negatively correlated with COPD (OR, 0.78, P < 0.001; 0R, 0.77 per 100 cell/mm3 increase, P < 0.001, respectively). Among COPD patients, 77% did not know their diagnosis. Five COPD-patients never smoked and 44.2% did not have any respiratory symptoms and so were not eligible to perform a spirometry according to the guidelines. CONCLUSIONS In addition to known risk factors, immune defect through CD4 cell count was independently and strongly correlated with COPD. COPD is largely underdiagnosed and thus unmanaged. However, early management and urgent smoking cessation are essential to improve prognosis. Clinicians' awareness on the particular vulnerability for COPD in HIV-infected patients is crucial. Moreover, indications to perform conventional spirometry to diagnose COPD may include more parameters than tobacco-smoking and respiratory complaints with a particular concern toward patients with a profound CD4 cell count defect.
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Affiliation(s)
- Karine Risso
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
- Université de Nice-Sophia-Antipolis, Nice, France
| | | | - Laure Valerio
- Département d’Informations Médicales, Centre Hospitalier de la Dracénie, Draguignan, France
| | - Pascal Puglièse
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Alissa Naqvi
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jacques Durant
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Elisa Demonchy
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
- Université de Nice-Sophia-Antipolis, Nice, France
| | - Isabelle Perbost
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Eric Cua
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Charles-Hugo Marquette
- Université de Nice-Sophia-Antipolis, Nice, France
- Service de Pneumologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pierre-Marie Roger
- Service d’Infectiologie, Centre Hospitalier Universitaire de Nice, Nice, France
- Université de Nice-Sophia-Antipolis, Nice, France
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8
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Peyre M, Gauchet A, Roustit M, Leclercq P, Epaulard O. Influence of the First Consultation on Adherence to Antiretroviral Therapy for HIV-infected Patients. Open AIDS J 2016; 10:182-189. [PMID: 27708747 PMCID: PMC5037933 DOI: 10.2174/1874613601610010182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/29/2016] [Accepted: 08/05/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Physician attitude influences the way patients cope with diagnosis and therapy in chronic severe diseases such as cancer. Previous studies showed that such an effect exists in HIV care; it is likely that it begins with the first contact with a physician. OBJECTIVE We aimed to explore in HIV-infected persons their perception of the first consultation they had with an HIV specialist (PFC-H), and whether this perception correlates with adherence to antiretroviral therapy. METHOD The study was conducted in Grenoble University Hospital, France, a tertiary care center. Every antiretroviral-experienced patient was asked to freely complete a self-reported, anonymous questionnaire concerning retrospective PFC-H, present adherence (Morisky scale), and present perceptions and beliefs about medicine (BMQ scale). RESULTS One hundred and fifty-one questionnaires were available for evaluation. PFC-H score and adherence were correlated, independently from age, gender, and numbers of pill(s) and of pill intake(s) per day. BMQ score also correlated with adherence; structural equation analysis suggested that the effect of PFC-H on adherence is mediated by positive beliefs. CONCLUSION These results suggest that for HIV-infected persons, the perceptions remaining from the first consultation with an HIV specialist physician influence important issues such as adherence and perception about medicine. Physicians must be aware of this potentially long-lasting effect.
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Affiliation(s)
- Marion Peyre
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- Université Grenoble Alpes, Grenoble,France
| | - Aurélie Gauchet
- Université Grenoble Alpes, Grenoble,France
- Laboratoire Inter-Universitaire de Psychologie - Personnalité, Cognition, Changement Social (LIP/PC2S) EA 4145, Université Grenoble Alpes, Grenoble, France
| | - Matthieu Roustit
- Université Grenoble Alpes, Grenoble,France
- Pharmacologie Clinique - CIC1406, Pôle Recherche, Centre Hospitalier Universitaire de Grenoble,
Grenoble, France
- Inserm, HP2, 38000 Grenoble, France
| | - Pascale Leclercq
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Olivier Epaulard
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- Université Grenoble Alpes, Grenoble,France
- Team “HIV and other human persistent viruses”, Institut de Biologie Structurale, UMR 5075 UGA-CEA-CNRS, Grenoble, France
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9
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Del Romero J, Baza MB, Río I, Jerónimo A, Vera M, Hernando V, Rodríguez C, Castilla J. Natural conception in HIV-serodiscordant couples with the infected partner in suppressive antiretroviral therapy: A prospective cohort study. Medicine (Baltimore) 2016; 95:e4398. [PMID: 27472733 PMCID: PMC5265870 DOI: 10.1097/md.0000000000004398] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 12/17/2022] Open
Abstract
The potential of antiretroviral treatment (ART) to prevent the sexual transmission of HIV has increased the number of serodiscordant couples who are considering natural conception. We aim to describe the results of a protocol for reproductive counseling aimed at HIV serodiscordant couples who desire natural conception, in which the infected partner, the index case, is receiving suppressive antiretroviral treatment.A prospective cohort included all HIV serodiscordant couples attended a counseling program in the period 2002 to 2013 who opted for natural conception and met the following criteria: index case on ART with persistent plasma viral suppression for at least the previous 6 months, ART compliance over 95%, preserved immune status, undetectable HIV viral and proviral load in semen in male index cases, and absence of genitourinary infections and fertility problems in both members of the couple.Of the 161 HIV serodiscordant couples included, 133 with male index cases, 66% achieved at least 1 pregnancy, 18% a second one, and 5% a third pregnancy. A total of 144 natural pregnancies occurred and 107 babies were born. The pregnancy rate was 1.9 for each 100 acts of vaginal intercourse, and the mean time to conception was 6.1 months, both independently of the sex of the index case. No case of sexual or vertical HIV transmission occurred.In the absence of fertility problems and under controlled conditions, natural conception might be a safe and effective reproductive method for those HIV serodiscordant couples who choose this reproductive option.
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Affiliation(s)
- Jorge Del Romero
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC
| | - María Begoña Baza
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC
| | - Isabel Río
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid
| | - Adrián Jerónimo
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC
| | - Mar Vera
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC
| | - Victoria Hernando
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid
- CIBER Epidemiología y Salud Pública
| | - Carmen Rodríguez
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos -IdISSC
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública
- Instituto de Salud Pública de Navarra, IdiSNA—Navarra Institute for Health Research, Pamplona, Spain
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Abstract
OBJECTIVE To evaluate HIV directly or indirectly related altered ovarian function, using serum anti-Müllerian hormone (AMH) levels in HIV-infected women as compared with seronegative women. DESIGN We conducted a matched cohort study from January 2008 to December 2013 in a tertiary university centre. Two hundred and one HIV-infected women requesting assisted reproductive technology and 603 age and cause of infertility-matched HIV seronegative women were enrolled in this study. METHODS All data were prospectively collected using a semistructured questionnaire. Serum AMH levels in HIV-infected women and matched controls were compared. To find out the contributing factors to increased serum AMH levels in HIV-infected women, a backward multiple linear regression was performed. RESULTS Serum AMH levels were significantly lower in HIV-infected group as compared with seronegative controls (3.0 ± 2.8 vs 3.7 ± 3.5 ng/ml; respectively, P = 0.001). Looking for factors associated with altered AMH among HIV-infected women, an association has been shown between tubal disease and a further decrease in serum AMH levels (2.4 ± 2.4 vs 3.4 ± 3.0 ng/ml; respectively, P = 0.011). Among HIV-infected women, after multivariate linear regression analysis, we showed that increased age, BMI and viral load were associated with decreased serum AMH levels whereas in striking contrast an increase in CD4⁺ cell count was associated with an increase of serum AMH levels. CONCLUSION Serum AMH levels were lower in the HIV-infected group than in the control group. Age, BMI, CD4⁺ cell count and viral load were the independent contributors affecting serum AMH levels among HIV-infected women.
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Immunologic and Virologic Progression in HIV Controllers: The Role of Viral "Blips" and Immune Activation in the ANRS CO21 CODEX Study. PLoS One 2015; 10:e0131922. [PMID: 26146823 PMCID: PMC4493076 DOI: 10.1371/journal.pone.0131922] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/08/2015] [Indexed: 12/23/2022] Open
Abstract
Some HIV controllers (HICs) experience CD4+T cell count loss and/or lose their ability to control HIV. In this study, we investigated the rate of immunologic and/or virologic progression (ImmP/VirP) and its determinants in the ANRS CO21/CODEX cohort. Immunologic progression was defined as a lasting fall in CD4+T cell count below 350/mm(3) or more than 200/mm(3) with a baseline count below 600/mm(3). Virologic progression was defined as a HIV viral load (VL) above 2000 copies/mL on two consecutive determinations. Clinical characteristics, immune activation, ultrasensitive HIV VL and total HIV DNA were analyzed. Disease progression was observed in 15 of the 217 patients followed up between 2009 and 2013 (ImmP, n = 10; VirP, n = 5). Progressors had higher ultrasensitive HIV RNA levels at inclusion (i.e. 1-2 years before progression) than non-progressors. ImmP had also lower CD4+T cell nadir and CD4+T cell count at inclusion, and VirP had higher HIV DNA levels in blood. T cell activation and IP10 levels at inclusion were significantly higher in ImmP than in non-progressors. In summary, the lasting loss of CD4+T cells, residual HIV replication and basal levels of immune activation appear to be major determinants of progression in HICs. These factors should be considered for adjusting their follow-up.
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Cazanave C, Reigadas S, Mazubert C, Bellecave P, Hessamfar M, Le Marec F, Lazaro E, Peytavin G, Bruyand M, Fleury H, Dabis F, Neau D. Switch to Rilpivirine/Emtricitabine/Tenofovir Single-Tablet Regimen of Human Immunodeficiency Virus-1 RNA-Suppressed Patients, Agence Nationale de Recherches sur le SIDA et les Hépatites Virales CO3 Aquitaine Cohort, 2012-2014. Open Forum Infect Dis 2015; 2:ofv018. [PMID: 26034768 PMCID: PMC4438898 DOI: 10.1093/ofid/ofv018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/27/2015] [Indexed: 12/18/2022] Open
Abstract
We evaluated the efficacy and tolerability of a single-tablet regimen strategy in 304 HIV-1 virologically suppressed patients switching to RPV/FTC/TDF for adverse events or treatment simplification. This strategy maintained virologic suppression and was associated with improved tolerability after 12 months follow-up. Background. The purpose of this study was to assess the efficacy and tolerability of combined antiretroviral therapy (cART) in human immunodeficiency virus (HIV)-1 virologically suppressed patients who switched to rilpivirine (RPV)/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) as a single-tablet regimen (STR). Methods. A retrospective multicenter cohort study was performed between September 2012 and February 2014 in Bordeaux University Hospital-affiliated clinics. Patients with a plasma HIV viral load (VL) lower than 50 copies/mL and switching to STR were evaluated at baseline, 3, 6, 9, and 12 months from switch time (M3, M6, M9, M12) for VL and other biological parameters. Change from baseline in CD4 cell counts was evaluated at M6 and M12. Virological failure (VF) was defined as 2 consecutive VL >50 copies/mL. Results. Three hundred four patients were included in the analysis. Single-tablet regimen switch was proposed to 116 patients with adverse events, mostly efavirenz (EFV)-based (n = 59), and to 224 patients for cART simplification. Thirty of 196 patients with available genotype resistance test results displayed virus with ≥1 drug resistance mutation on reverse-transcriptase gene. After 12 months of follow-up, 93.4% (95.5% confidence interval, 89.9–96.2) of patients remained virologically suppressed. There was no significant change in CD4 cell count. During the study period, 5 patients experienced VF, one of them harboring RPV resistance mutation. Clinical cART tolerability improved in 79 patients overall (29.9%) at M6, especially neurological symptoms related to EFV. Fasting serum lipid profiles improved, but a significant estimated glomerular function rate decrease (−11 mL/min/1.73 m2; P < 10−4) was observed. Conclusions. Overall, virologic suppression was maintained in patients after switching to RPV/TDF/ FTC. This STR strategy was associated with improved tolerability.
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Affiliation(s)
- Charles Cazanave
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales ; Université Bordeaux, Unité Sous Contrat Équipe d'Accueil 3671, Infections Humaines à mycoplasmes et à chlamydiae ; Institut National de la Recherche Agronomique, Unité Sous Contrat Équipe d'Accueil 3671, Infections Humaines à mycoplasmes et à chlamydiae
| | - Sandrine Reigadas
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Virologie ; Université Bordeaux, Centre National de la Recherche Scientifique Unite Mixte de Recherche 5234
| | - Cyril Mazubert
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales
| | - Pantxika Bellecave
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Virologie ; Université Bordeaux, Centre National de la Recherche Scientifique Unite Mixte de Recherche 5234
| | - Mojgan Hessamfar
- Centre Hospitalier Universitaire de Bordeaux, Département de Médecine Interne ; Université Bordeaux, L'Institut de santé Publique, d'Épidémiologie et de Développement, Centre Institut National de la santé et de la Recherche Médicale U897 ; Institut National de la santé et de la Recherche Médicale, Centre Institut National de la santé et de la Recherche Médicale U897
| | - Fabien Le Marec
- Université Bordeaux, L'Institut de santé Publique, d'Épidémiologie et de Développement, Centre Institut National de la santé et de la Recherche Médicale U897 ; Institut National de la santé et de la Recherche Médicale, Centre Institut National de la santé et de la Recherche Médicale U897
| | - Estibaliz Lazaro
- Centre Hospitalier Universitaire de Bordeaux, Département de Médecine Interne , Pessac
| | - Gilles Peytavin
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie ; Infection, Antimicrobiens, Modélisation, Evolution, Unite Mixte de Recherche 1137, Université Paris Diderot, Sorbonne Paris Cité and Institut National de la santé et de la Recherche Médicale , Paris , France
| | - Mathias Bruyand
- Université Bordeaux, L'Institut de santé Publique, d'Épidémiologie et de Développement, Centre Institut National de la santé et de la Recherche Médicale U897 ; Institut National de la santé et de la Recherche Médicale, Centre Institut National de la santé et de la Recherche Médicale U897
| | - Hervé Fleury
- Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Virologie ; Université Bordeaux, Centre National de la Recherche Scientifique Unite Mixte de Recherche 5234
| | - François Dabis
- Université Bordeaux, L'Institut de santé Publique, d'Épidémiologie et de Développement, Centre Institut National de la santé et de la Recherche Médicale U897 ; Institut National de la santé et de la Recherche Médicale, Centre Institut National de la santé et de la Recherche Médicale U897
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Tropicales
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