Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018

Background

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.

Methods

This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.

Results

From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.

Conclusions

A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

Clinical Trials Registration. NCT02898987.

Caractéristiques de la COVID-19 chez les patients âgés de 75 ans et plus, hospitalisés

Introduction

Les personnes âgées comptent parmi le groupe de population le plus touché et le plus à risque de développer une forme grave de la COVID-19. La symptomatologie est parfois frustrée et aspécifique dans cette population.

L’objectif est de comparer les caractéristiques d’une population ≥ 75 ans hospitalisée pour une COVID-19 à celles d’une population < 75 ans, en incluant la mortalité toute cause à 28 jours du début des signes cliniques.

Matériels et méthodes

Il s’agit d’une étude prospective observationnelle descriptive monocentrique incluant tous les patients hospitalisés, initialement hors réanimation, avec une COVID-19 confirmée par RT-PCR et/ou par imagerie scanographique entre le 3 mars et le 24 avril 2020. Pour tous les patients, étaient recueillies de façon standardisée des variables démographiques, cliniques et paracliniques. Tous les patients ont eu un suivi clinique et/ou téléphonique jusqu’à j28 du début des signes cliniques. Les caractéristiques des patients de ≥ 75 ans sont comparées à celles des patients < 75 ans (tests du Chi² et exact de Fisher ; la valeur p < 0,05 est considérée comme statistiquement significative).

Résultats

Ont été hospitalisés 436 patients (femmes : 196 [45 %] ; âge moyen : 69 ± 18 ans ; patients ≥ 75 ans : 186 [43 %]). Le délai moyen entre le début des symptômes et l’hospitalisation était de 5,8 ± 5 jours. Le score moyen de Charlson était de 5,7 (± 3). Cinquante-quatre patients (12 %) ont été transférés en réanimation (âge moyen : 67 ± 18 ans). Soixante-dix-neuf patients sont décédés (18 %) dont 7 après leur transfert en réanimation.

À l’admission, les patients ≥ 75 ans présentaient moins souvent des symptômes ORL (8 % vs 16 %, p < 0,01), une toux (70 % vs 81 %, p < 0,012) et une dyspnée (44 % vs 56 %, p = 0,013). À noter qu’ils présentaient aucun signe respiratoire dans 11 % des cas vs dans 5,6 % chez les plus jeunes (p = 0,047). Une chute les jours précédant l’hospitalisation, un syndrome confusionnel et une atteinte digestive fébrile étaient plus souvent retrouvés chez les patients ≥ 75 ans (respectivement, 22 % vs 4 %, p < 0,001 ; 19 % vs 5 %, p < 0,001 et 6 % vs 2 %, p = 0,015).

Les transferts en réanimation étaient moins fréquents chez les patients ≥ 75 ans (6 % vs 18 %, p < 0,001), la mortalité toute cause à 28 jours y est en revanche plus élevée (30 % vs 8 %, p < 0,001).

Conclusion

Comparés aux < 75 ans, les patients ≥ 75 ans ont moins souvent des symptômes respiratoires et plus souvent des symptômes classiquement retrouvés dans la population gériatrique, quelle que soit l’étiologie : chute, confusion et troubles digestifs. En période d’épidémie, il est important de prendre en compte ces spécificités gériatriques afin de mettre en place les précautions complémentaires adaptées et de réaliser un test diagnostique du virus SARS-CoV-2.

Functional signs in patients consulting for presumed Lyme borreliosis

INTRODUCTION

Little is known about the functional symptoms associated with Lyme borreliosis (LB) in Europe. We aimed to assess functional symptoms associated with presumed LB and to compare patients with and without confirmed LB.

MATERIALS AND METHODS

We performed a retrospective monocenter study. Patients consulting for presumed LB were included.

RESULTS

Between November 2015 and June 2018, 355patients were included (mean age: 51years, 52% of women) of which 48had LB: erythema migrans (42%), early disseminated LB (50%; 35% of neuroborreliosis cases), and late disseminated LB (8%). The most frequently reported functional symptoms were neuropathic pain (23%), arthralgia (23%), and asthenia (17%). Other functional symptoms were rare (≤10%). Three hundred and seven (86%) patients did not have LB. Patients with confirmed LB reported fewer functional symptoms than patients without LB (1.8 (±1.7) vs. 3.6 (±2.5), P<0.001) with a shorter duration of symptoms (< 3 months in 48% vs. 16% of cases, P<0.001). They less often reported asthenia (17% vs. 59%, P<0.001), widespread pain (10% vs. 31%, P=0.003), myalgia (10% vs. 32%, P=0.002), memory disorders (4% vs. 16%, P=0.03), irritability (2% vs. 23%, P±0.001), and sadness (0% vs. 16%, P=0.003).

CONCLUSION

In patients consulting for presumed LB, patients diagnosed with LB had fewer and shorter functional symptoms than patients without LB.

Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"?

OBJECTIVES

Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients.

METHODS

All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection.

RESULTS

Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR.

CONCLUSIONS

HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.