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Protiere C, Sagaon-Teyssier L, Donadille C, Sow A, Gaubert G, Girard G, Mora M, Assoumou L, Beniguel L, Michels D, Ghosn J, Costagliola D, Rojas Castro D, Molina JM, Spire B. Perception of PrEP-related stigma in PrEP users: Results from the ANRS-PREVENIR cohort. HIV Med 2023; 24:938-945. [PMID: 37046178 DOI: 10.1111/hiv.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Since the advent of HIV pre-exposure prophylaxis (PrEP), stigma has been shown to be a major barrier to its uptake and adherence. It is therefore essential to define the proportion of users who consider that PrEP can negatively impact their image and the factors associated with this perception. METHOD We performed a multivariable logistic regression on data from the 2567 participants in the ANRS-PREVENIR study who answered the outcome question. RESULTS Almost one-third of the sample (comprising mostly cisgender men who have sex with men [94.3%]) considered that taking PrEP could give others a negative image of them. Younger participants (adjusted odds ratio [aOR] 0.98; 95% confidence interval [CI] 0.97-0.99) and more psychologically vulnerable participants (i.e., lower self-esteem score [aOR 0.98; 95% CI 0.96-0.99] and higher depression score [aOR 1.02; 95% CI 1.00-1.03]) were also more likely to have this perception. In contrast, participants encouraged to take PrEP by their main partner (aOR 0.67; 95% CI 0.51-0.88) and friends (aOR 0.79; 95% CI 0.66-0.95), and those who protected themselves more because they had knowledge of their most recent sexual partner's HIV status (aOR 0.83; 95% CI 0.69-0.99) and systematic use of PrEP and/or condoms during intercourse in the previous 3 months (aOR 0.80; 95% CI 0.67-0.96) were less likely to have this perception. DISCUSSION Given the strong interrelation between stigmatization (real or perceived), risky behaviours and adherence, our results emphasize the need for HIV prevention campaigns to promote a positive image of PrEP users. They also show that stigmatization and its effects need to be fully considered to improve HIV prevention offers to current and potential PrEP users who are most likely to be psychologically vulnerable.
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Affiliation(s)
- C Protiere
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | | | - C Donadille
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - A Sow
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - G Gaubert
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - G Girard
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - M Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
| | - L Assoumou
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - L Beniguel
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - D Michels
- AIDES, Paris, France
- Coalition PLUS, Community-based Research Laboratory, Paris, France
| | - J Ghosn
- University Paris Diderot, Sorbonne Paris Cité, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - D Costagliola
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - D Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
- AIDES, Paris, France
- Coalition PLUS, Community-based Research Laboratory, Paris, France
| | - J-M Molina
- Hospital Saint-Louis, Assistance Publique Hôpitaux de Paris, Department of Infectious diseases, Paris, France
| | - B Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, ISSPAM, Marseille, France
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Molina JM, Hernández YI, Ferrer O, Conde-Felipe MM, Rodríguez F, Ruiz A. Immunization with thiol-binding proteins from Haemonchus contortus adult worms partially protects goats against infection during prepatency. Exp Parasitol 2023; 248:108512. [PMID: 36965594 DOI: 10.1016/j.exppara.2023.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/25/2022] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
To contribute of the knowledge of the immune mechanisms underlying the response to the immunization of goats with thiol-binding proteins fractions (PBS-TSBP) from Haemonchus contortus (H. contortus) adult worms, this study analyzed the degree of protection and the immune responses developed against the parasite after vaccination with this antigenic complex during the time-elapsing between challenge with L3 of the parasite and the development of adult worms, evidenced by the appearance of first faecal eggs (prepatent period or prepatency). Goat kids immunized with PBS-TBSP generated an immune response during the prepatency which translates into a reduction in the number of worms, as well as a lower reduction on packed cell volume and plasma protein levels in relation to the non-vaccinated animals. As previously described in other studies carried out after the prepatent period, this protection was associated with a systemic humoral response. At the local level, a specific humoral response was also observed, together with an immune-inflammatory infiltrate in the gastric mucosa of MCH-II + cells and CD4+ lymphocytes, whose number was associated with a reduction in the number of worms and an increase in plasma proteins. A high peripheral eosinophilia was detected, but no corresponding increased infiltration of the gastric mucosa by eosinophils or globular leukocytes was observed. In agreement with previous data on the immunolocalization of the antigens used here, the results obtained contribute to the idea that these may be excretion/secretion (E/S) products necessary for parasite survival, whose inactivation during the larval and/or pre-adult stages may have contributed to immunoprotection.
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Affiliation(s)
- J M Molina
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - Y I Hernández
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - O Ferrer
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - M M Conde-Felipe
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Gran Canaria, Spain.
| | - F Rodríguez
- Department of Anatomy and Compared Anatomy Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Spain.
| | - A Ruiz
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Gran Canaria, Spain.
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3
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Lafaurie M, Burdet C, Hammas K, Goldwirt L, Berçot B, Sauvageon H, Houze P, Fourmont M, Mentré F, Molina JM. Population pharmacokinetics and pharmacodynamics of imipenem in neutropenic adult patients. Infect Dis Now 2023; 53:104625. [PMID: 36174960 DOI: 10.1016/j.idnow.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Imipenem is recommended in patients with chemotherapy-induced febrile neutropenia. Although alterations of antibiotic pharmacokinetic parameters have been reported in such patients, little data is available on imipenem. METHODS Prospective, single-center, non-interventional pharmacokinetic cohort study in adults with chemotherapy-induced febrile neutropenia. Critically ill patients were excluded. Imipenem was administered as a 30-min infusion of 1000 mg/8h. Total imipenem plasma concentrations were assayed by high-performance liquid chromatography during neutropenia and just after neutrophil recovery. We estimated population pharmacokinetic parameters of imipenem by non-linear mixed-effect modelling using the SAEM algorithm. RESULTS Sixteen patients were included in the study, including nine women (56.3%), median age 37 years (range, 18.3; 78.3). Eight patients had an hematological malignancy (50.0%) and seven had a solid tumor (43.8%). Imipenem pharmacokinetics were best described by a one-compartment model with first-order elimination. Mean values for imipenem were: clearance 14.3L/h and 10.9L/h and volume of distribution 20.7L and 14.5 L during neutropenia and after recovery, respectively. Imipenem plasma area under the curve at steady state was reduced by 23% during neutropenia. However, all patients achieved a pharmacodynamic target of %fT>MIC ≥ 40% with a regimen of 1000 mg/8 h or 500 mg/6 h, for MICs up to 2 mg/L. The pharmacodynamics profile for a target of %fT > MIC = 100% was however less favorable with 500 mg/6 h or 1000 mg/8 h either during or after neutropenia. CONCLUSION Pharmacokinetic/pharmacodynamic goals for imipenem were similar in patients during and after neutropenia, despite reduced plasma exposure.
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Affiliation(s)
- M Lafaurie
- AP-HP, Hôpital Saint-Louis, Lariboisière, Département de Maladies Infectieuses et Tropicales, F-75010 Paris, France.
| | - C Burdet
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - K Hammas
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France
| | - L Goldwirt
- AP-HP, Hôpital Saint-Louis, Laboratoire de Pharmacologie Biologique, F-75010 Paris, France
| | - B Berçot
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Saint-Louis, Service de Bactériologie, F-75010 Paris, France
| | - H Sauvageon
- AP-HP, Hôpital Saint-Louis, Laboratoire de Pharmacologie Biologique, F-75010 Paris, France; Université de Paris, UMR S976, INSERM, F-75006 Paris, France
| | - P Houze
- Université de Paris, UTCBS, CNRS UMR8258, INSERM U1022, Paris, France
| | - M Fourmont
- AP-HP, Hôpital Saint-Louis, Service d'hématologie, unité Adolescent et jeunes adultes, F-75010 Paris, France
| | - F Mentré
- AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, F-75018 Paris, France; Université de Paris, IAME, INSERM, F-75018 Paris, France
| | - J M Molina
- AP-HP, Hôpital Saint-Louis, Lariboisière, Département de Maladies Infectieuses et Tropicales, F-75010 Paris, France; Université de Paris, UMR S976, INSERM, F-75006 Paris, France
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De Castro N, Mechaï F, Bachelet D, Canestri A, Joly V, Vandenhende M, Boutoille D, Kerjouan M, Veziris N, Molina JM, Grall N, Tattevin P, Laouénan C, Yazdanpanah Y. Treatment with a three-drug regimen for pulmonary tuberculosis based on rapid molecular detection of isoniazid resistance: a non-inferiority randomized trial (FAST-TB). Open Forum Infect Dis 2022; 9:ofac353. [PMID: 35949399 PMCID: PMC9356674 DOI: 10.1093/ofid/ofac353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The rationale behind the use of ethambutol in the standard tuberculosis treatment is to prevent the emergence of resistance to rifampicin in case of primary resistance to isoniazid. We evaluated whether early detection of isoniazid resistance using molecular testing allows the use an ethambutol-free regimen. Methods FAST-TB, a phase 4, French, multicenter, open-label, non-inferiority trial, compared 2 strategies: (1) polymerase chain reaction (PCR)-based detection of isoniazid and rifampicin resistance at baseline using Genotype MTBDRplus version 2.0 followed by ethambutol discontinuation if no resistance was detected (PCR arm) and (2) a standard 4-drug combination, pending phenotypic drug-susceptibility results (C arm). Adult patients with smear-positive pulmonary tuberculosis were enrolled. The primary endpoint was the proportion of patients with treatment success defined as bacteriological or clinical cure at the end of treatment. A non-inferiority margin of 10% was used. Results Two hundred three patients were randomized, 104 in the PCR arm and 99 in the C arm: 26.6% were female, median age was 37 (interquartile range, 28–51) years, 72.4% were born in Africa, and 5.4% were infected with human immunodeficiency virus. Chest x-ray showed cavities in 64.5% of the cases. Overall, 169 patients met criteria of treatment success: 87 of 104 (83.7%) in the PCR arm and 82 of 99 (82.8%) in the C arm with a difference of +0.8% (90% confidence interval, −7.9 to 9.6), meeting the noninferiority criteria in the intention-to-treat population (P = .02). Conclusions In a setting with low prevalence of primary isoniazid resistance, a 3-drug combination with isoniazid, rifampicin, and pyrazinamide, based on rapid detection of isoniazid resistance using molecular testing, was noninferior to starting the recommended 4-drug regimen.
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Affiliation(s)
| | - F Mechaï
- AP-HP Hôpital Avicenne , Bobigny , France
| | - D Bachelet
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | | | - V Joly
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - M Vandenhende
- Hôpital Saint-André - CHU de Bordeaux , France
- Université Bordeaux , Bordeaux , France
| | - D Boutoille
- CHU Nantes , Nantes , France
- Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM , Nantes , France
| | | | - N Veziris
- Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris) , UMR 1135 , France
- AP-HP Hôpital Saint-Antoine, Centre National de Référence des Mycobactéries , Paris , France
| | - JM Molina
- APHP Hôpital Saint-Louis , Paris , France
- Université de Paris , Paris , France
| | - N Grall
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - P Tattevin
- CHU de Rennes , Rennes , France
- Université de Rennes , France
| | - C Laouénan
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
| | - Y Yazdanpanah
- AP-HP Hôpital Bichat-Claude Bernard , Paris , France
- Université de Paris , Paris , France
- Inserm , IAME UMR 1137 INSERM, Paris , France
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Boussen I, Lisan Q, Raffoux E, Di Blasi R, Boissel N, Oksenhendler E, Adès L, Xhaard A, Bretagne S, Alanio A, Molina JM, Denis B. Hepatosplenic candidiasis in patients with hematological malignancies: a 13-year retrospective cohort study. Open Forum Infect Dis 2022; 9:ofac088. [PMID: 35355897 PMCID: PMC8962726 DOI: 10.1093/ofid/ofac088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/18/2022] [Indexed: 11/14/2022] Open
Abstract
Background Hepatosplenic candidiasis (HSC) used to be reported in patients with acute myeloid leukemia (AML) without antifungal prophylaxis. The aim was to describe the clinical features and outcomes of HSC over the last 13 years in a single French hematology center. Methods All patients diagnosed with HSC between 2008 and 2020 were included in a single-center retrospective cohort study. Data were collected from patient charts, and HSC was classified according to the 2020 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definitions. Results Sixty patients were included, with 18.3% proven, 3.3% probable, and 78.3% possible HSC according to the 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group classification. Among them, 19 patients were treated for acute myeloid leukemia (AML), 21 for lymphomas, and 14 for acute lymphoblastic leukemia. HSC occurred in 13 patients after autologous stem cell transplantation for lymphoma. At HSC diagnosis, 13 patients were receiving antifungal prophylaxis. Candida colonization was present in 84.2%, with prior candidemia in 36.7% of cases. β-D-glucans was positive in 55.8%, and 45.8% of tissue biopsies were contributive. First-line antifungal therapy was azoles in 61.7%, and steroids were associated in 45% of cases. At 3 months of follow-up, partial response to antifungal therapy was 94.2%. At last follow-up (mean, 22.6 months), 41 patients (68.3%) presented a complete hematological remission and 22 patients were deceased, none because of HSC. Conclusions The epidemiology of HSC has changed in the last decade, with fewer cases occurring in the AML setting. A better identification of patients at risk could lead to specific prophylaxis and improved diagnosis.
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Affiliation(s)
- I Boussen
- Department of infectious diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France
- Université de Paris, Paris, France
| | - Q Lisan
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France
| | - E Raffoux
- Department of adult hematology, Saint Louis Hospital, APHP, Paris, France
| | - R Di Blasi
- Department of hemato-oncology, Saint Louis Hospital, APHP, Paris, France
| | - N Boissel
- Department of teenagers and young adult hematology, Saint Louis Hospital, APHP, Paris, France
| | - E Oksenhendler
- Department of clinical immunology, Saint Louis Hospital, APHP, Paris, France
| | - L Adès
- Department of senior adult hematology, Saint Louis Hospital, APHP, Paris, France
| | - A Xhaard
- Department of hematology - transplantation, Saint Louis Hospital, APHP, Paris, France
| | - S Bretagne
- Université de Paris, Paris, France
- Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France
- Department of mycology, Saint Louis Hospital, APHP, Paris, France
| | - A Alanio
- Université de Paris, Paris, France
- Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France
- Department of mycology, Saint Louis Hospital, APHP, Paris, France
| | - J M Molina
- Department of infectious diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France
- Université de Paris, Paris, France
| | - B Denis
- Department of infectious diseases, Saint Louis and Lariboisière Hospitals, APHP, Paris, France
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Lerolle N, Laanani M, Galicier L, Rivière S, Meynard JL, Azoulay E, Jeblaoui A, Lalande V, Mougari F, Fardet L, Coppo P, Goujard C, Molina JM, Lambotte O. Factors associated with tuberculosis-associated haemophagocytic syndrome: a multicentre case-control study. Int J Tuberc Lung Dis 2021; 24:124-130. [PMID: 32005316 DOI: 10.5588/ijtld.19.0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) is a potential trigger of haemophagocytic syndrome (HS) but little is known about the features of TB-associated HS.OBJECTIVE: To assess the risk factors associated with HS in patients with TB.DESIGN: We performed a multicentre case-control study assessing the medical records of adult patients diagnosed with proven TB with (TB/HS+) or without (TB/HS-) associated HS.RESULTS: Twenty-one patients with TB/HS+ (24% women, median age, 37 years [IQR 30-48]) were included in the study. Eleven patients (52%) were infected with human immunodeficiency virus and seven patients (33%) were immunocompromised due to other reasons. TB was disseminated in 17 patients (81%). Compared with 50 control TB patients (TB/HS-), patients with TB/HS+ were more likely to be immunocompromised (86% vs. 18%; P < 0.001) and to present with disseminated TB (80% vs. 12%; P < 0.001). The outcome was poorer in patients with TB/HS+, with a higher admission rate to intensive care (71% vs. 0%; P < 0.001) and a higher risk of death (38% vs. 7%; P = 0.005).CONCLUSION: TB/HS+ occurred more likely in immunocompromised patients and severely impaired the prognosis of TB. Further studies are needed to devise therapeutic strategies for patients with TB/HS+.
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Affiliation(s)
- N Lerolle
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre
| | - M Laanani
- Unité de Biostatistiques et Epidémiologie, Hôtel Dieu, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre
| | - L Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris
| | - S Rivière
- Service de Médecine interne, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - J-L Meynard
- Service de Maladies infectieuses, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - E Azoulay
- Service de réanimation médicale, Hôpital Saint Louis, APHP, Université Paris 6, Paris
| | - A Jeblaoui
- Service de Microbiologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre
| | - V Lalande
- Service de Microbiologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - F Mougari
- Service de Microbiologie, Hôpital Lariboisière, APHP, Université Paris Diderot, Paris
| | - L Fardet
- Service de Dermatologie, Hôpital Henri Mondor, APHP, Université Paris 12, Créteil
| | - P Coppo
- Service d'hématologie, Hôpital Saint Antoine, APHP, Université Paris 6, Paris
| | - C Goujard
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Centre de recherche en Epidémiologie et Santé des Populations, Institut national de la santé et de la recherche médicale (INSERM) Unité 1018, Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre
| | - J-M Molina
- Service de maladies Infectieuses, Hôpital Saint Louis, APHP, Université Paris Diderot, Paris
| | - O Lambotte
- Service de médecine interne et d'immunologie clinique, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, Immunology of Viral Infections and Autoimmune Diseases, INSERM Unité 1184, Kremlin-Bicêtre, Life Sciences Division, Infectious Disease Models and Innovative Therapies, Commissariat à l'énergie atomique et aux énergies alternatives, Institute of Emerging Diseases and Innovative Therapies, Fontenay-aux-Roses, France
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7
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Pérez D, Muñoz-Caro T, Silva LMR, Muñoz MC, Molina JM, Taubert A, Hermosilla C, Ruiz A. Eimeria ninakohlyakimovae casts NOX-independent NETosis and induces enhanced IL-12, TNF-α, IL-6, CCL2 and iNOS gene transcription in caprine PMN. Exp Parasitol 2020; 220:108034. [PMID: 33188795 DOI: 10.1016/j.exppara.2020.108034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/25/2022]
Abstract
Eimeria ninakohlyakimovae represents a highly pathogenic coccidian parasite causing severe haemorrhagic typhlocolitis in goat kids worldwide. NETosis was recently described as an efficient defense mechanism of polymorphonuclear neutrophils (PMN) acting against different parasites in vitro and in vivo. In vitro interactions of caprine PMN with parasitic stages of E. ninakohlyakimovae (i. e. oocysts and sporozoites) as well as soluble oocyst antigens (SOA) were analyzed at different ratios, concentrations and time spans. Extracellular DNA staining was used to illustrate classical molecules induced during caprine NETosis [i. e. histones (H3) and neutrophil elastase (NE)] via antibody-based immunofluorescence analyses. Functional inhibitor treatments with DPI and DNase I were applied to unveil role of NADPH oxidase (NOX) and characterize DNA-backbone composition of E. ninakohlyakimovae-triggered caprine NETosis. Scanning electron microscopy (SEM)- and immunofluorescence-analyses demonstrated that caprine PMN underwent NETosis upon contact with sporozoites and oocysts of E. ninakohlyakimovae, ensnaring filaments which firmly entrapped parasites. Detailed co-localization studies of E. ninakohlyakimovae-induced caprine NETosis revealed presence of PMN-derived DNA being adorned with nuclear H3 and NE corroborating molecular characteristics of NETosis. E. ninakohlyakoimovae-induced caprine NETosis was found to be NOX-independent since DPI inhibition led to a slight decrease of NETosis. Exposure of caprine PMN to vital E. ninakohlyakimovae sporozoites as well as SOA resulted in up-regulation of IL-12, TNF-α, IL-6, CCL2 and iNOS gene transcription in stimulated PMN. Since vital E. ninakohlyakimovae-sporozoites induced caprine NETosis, this effective entrapment mechanism might reduce initial sporozoite epithelial host cell invasion during goat coccidiosis ultimately resulting in less macromeront formation and reduced merozoites I production.
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Affiliation(s)
- D Pérez
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - T Muñoz-Caro
- Escuela de Medicina Veterinaria, Facultad de Recursos Naturales y Medicina Veterinaria, Universidad Santo Tomas, Chile
| | - L M R Silva
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - M C Muñoz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J M Molina
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - A Taubert
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - C Hermosilla
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - A Ruiz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
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Ryom L, Cotter A, De Miguel R, Béguelin C, Podlekareva D, Arribas JR, Marzolini C, Mallon P, Rauch A, Kirk O, Molina JM, Guaraldi G, Winston A, Bhagani S, Cinque P, Kowalska JD, Collins S, Battegay M. 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0. HIV Med 2020; 21:617-624. [PMID: 32885559 PMCID: PMC7754379 DOI: 10.1111/hiv.12878] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years. GUIDELINE HIGHLIGHTS The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included. CONCLUSIONS The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
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Affiliation(s)
- L Ryom
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Cotter
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - R De Miguel
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Podlekareva
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J R Arribas
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Pgm Mallon
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - A Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Kirk
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J M Molina
- Department of Infectious Diseases, St Louis and Lariboisière Hospitals, APHP and University of Paris, Paris, France
| | - G Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Trust, Institute of Global Health, University College London, London, UK
| | - P Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - J D Kowalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - M Battegay
- Division of Infectious Diseases et Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
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Siguier M, Mera R, Pialoux G, Ohayon M, Cotte L, Valin N, Ghosn J, Cua E, Pintado C, Chas J, Barriere G, Durand F, Molina JM. First year of pre-exposure prophylaxis implementation in France with daily or on-demand tenofovir disoproxil fumarate/emtricitabine. J Antimicrob Chemother 2020; 74:2752-2758. [PMID: 31219561 DOI: 10.1093/jac/dkz220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In January 2016, the French Medicine Agency initiated a Temporary Recommendation for Use (TRU) to allow the use of oral intake of tenofovir disoproxil fumarate and emtricitabine for pre-exposure prophylaxis (PrEP) in adults at high risk of HIV. We report the results of the first year of PrEP implementation in France. METHODS Data were collected by physicians using a secured web subject-monitoring interface, with two forms: an initiation form, with patients' baseline characteristics, and an HIV seroconversion form. Univariate and adjusted multivariate analysis using a logistic regression model were performed to identify baseline factors associated with on-demand PrEP regimen prescription. RESULTS From 4 January 2016 to 28 February 2017, 3405 subjects were enrolled, with 2774 initiation forms completed; 98.1% were male and 96.9% were MSM. An on-demand regimen was prescribed to 57% of subjects. Older age (OR for participants older than 50 years = 1.76, 95% CI 1.35-2.3, P < 0.001) and site of prescription (OR of former IPERGAY sites = 2.28, 95% CI 1.84-2.83, P < 0.001) were associated with on-demand prescription. Those reporting sexually transmitted infection (STI) and condomless anal sex with at least two different partners were less likely to receive on-demand PrEP (OR = 0.68, 95% CI 0.57-0.82 and 0.75, 95% CI 0.57-0.98, respectively; P < 0.05 for all). Four breakthrough HIV infections were reported during the study, in the context of PrEP interruption or acute infection at the time of PrEP initiation. CONCLUSIONS In a real-life setting in France, PrEP was used, either daily or on-demand, mostly by MSM, with breakthrough infections being rare.
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Affiliation(s)
- M Siguier
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
| | - R Mera
- Gilead Sciences, Epidemiology, Foster City, CA, USA
| | - G Pialoux
- Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | | | - L Cotte
- Hôpital Croix Rousse, Department of Infectious Diseases, Lyon, France
| | - N Valin
- Hôpital Saint-Antoine, Department of Infectious Diseases, Paris, France
| | - J Ghosn
- Hôtel Dieu, Department of Infectious Diseases, Paris, France
| | - E Cua
- Hôpital L'Archet, Department of Infectious Diseases, Nice, France
| | - C Pintado
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
| | - J Chas
- Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | - G Barriere
- Gilead Sciences S.A.S., Boulogne-Billancourt, France
| | - F Durand
- Gilead Sciences S.A.S., Boulogne-Billancourt, France
| | - J M Molina
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
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10
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Gazaignes S, Bergeron A, Menotti J, Desseaux K, Molina JM, De Castro N. [Pneumocystis jirovecii and quantitative PCR: Pneumonia or colonization?]. Rev Mal Respir 2020; 37:299-307. [PMID: 32273116 DOI: 10.1016/j.rmr.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/31/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Quantitative PCR to detect Pneumocystis jirovecii (Pj) is a new tool for the diagnosis of Pneumocystis jirovecii pneumonia (PJP). The yield of this technique, in cases of low fungal burden, when the standard technique using immunofluorescence (IF) is negative, needs to be evaluated. METHODS We retrospectively reviewed the charts of all patients with a positive PCR but negative IF test (PCR+/IF-) in bronchoalveolar lavage (BAL) fluid performed over one year. We used an algorithm based on underlying immunosuppression, clinical picture, thoracic CT scan appearances, existence of an alternative diagnosis and the patient's outcome on treatment. Using this, each case was classified as probable PJP, possible PJP or colonization. RESULTS Among the 416 BAL performed, 48 (12%) were PCR+/IF- and 43 patients were analyzed. Patients were mostly male (56%) with a median age of 60 years. Thirty-five (84%) were immunocompromised: 4 (9%) HIV-infected patients, 26 (60%) with hematologic or solid organ cancer, 3 (7%) were renal transplant recipients. Seven (16%) were classified as probable PPJ and 9 (21%) as possible PJP. Patients with a probable or possible PJP were more frequently admitted to the ICU (P<0.02) and had higher risk of death (P<0.01) when compared to those with colonization. Median PCR levels were very low and were not different between PJP or colonized patients (P=0.23). CONCLUSIONS Among patients with a positive Pj PCR in BAL but with negative IF, only 37% had probable or possible PJP and PCR could not discriminate PJP from colonization.
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Affiliation(s)
- S Gazaignes
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris 7, Paris, France
| | - A Bergeron
- Service de pneumologie, hôpital Saint-Louis, AP-HP, Paris, France; Université Paris 7, Paris, France
| | - J Menotti
- Service de mycologie - parasitologie, Paris, France; Université Paris 7, Paris, France
| | - K Desseaux
- Service de biostatistiques et information médicale, Paris, France
| | - J-M Molina
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris 7, Paris, France
| | - N De Castro
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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11
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Zeggagh J, Brun A, Siguier M, Molina JM. Knowledge and practices of Parisian family physicians for the management of men who have sex with men in the era of HIV pre-exposure prophylaxis. Med Mal Infect 2020; 50:597-605. [PMID: 32199671 DOI: 10.1016/j.medmal.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/23/2019] [Accepted: 02/21/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The optimal management of men who have sex with men (MSM) requires active involvement of family physicians (FP). We assessed knowledge and practices of Parisian FPs related to the management of MSM for sexually transmitted infections (STIs) and pre-exposure prophylaxis for HIV (PrEP). METHOD We conducted an observational prospective study between June 20 and July 31, 2017, with a sample of FPs practicing in Paris. The questionnaire posted via the Google Form website included 42 questions on sexual health management of MSM patients. A statistical analysis was then performed. RESULTS One hundred and four FPs took part in the study. The median age was 34 and 68% were women. Overall, 86.5% of FPs had already heard about PrEP, but only 36% of them were familiar with the indication for therapy and 77.9% of FPs declared to be willing to renew PrEP prescription. Overall, 89.4% of respondents declared to be willing to attend additional training on sexual health of MSM patients, including 73% on PrEP. CONCLUSION FPs have an important role in the management of MSM patients. They showed strong interest in PrEP despite limited knowledge of indications and methods of administration. They declared to be willing to attend additional training for further involvement.
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Affiliation(s)
- J Zeggagh
- Service des maladies infectieuses et tropicales, hôpital Saint Louis, 1, avenue Claude Vellefaux, France.
| | - A Brun
- COREVIH Ile de France Est, hôpital Saint Louis, France
| | - M Siguier
- Service des maladies infectieuses et tropicales, hôpital Saint Louis, 1, avenue Claude Vellefaux, France
| | - J M Molina
- Service des maladies infectieuses et tropicales, hôpital Saint Louis, 1, avenue Claude Vellefaux, France; COREVIH Ile de France Est, hôpital Saint Louis, France; Université Paris Diderot Sorbonne, Inserm U491, France
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12
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Puppo C, Spire B, Morel S, Génin M, Béniguel L, Costagliola D, Ghosn J, Mabire X, Molina JM, Rojas Castro D, Préau M. How PrEP users constitute a community in the MSM population through their specific experience and management of stigmatization. The example of the French ANRS-PREVENIR study. AIDS Care 2020; 32:32-39. [PMID: 32174136 DOI: 10.1080/09540121.2020.1742863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ANRS-PREVENIR (2017-2020) prospective cohort study aims to reduce the number of new HIV infections in the "Ile-de-France" region in France, by enrolling individuals at high risk of HIV infection and proposing daily and on-demand pre-exposure prophylaxis (PrEP). The qualitative component of the ANRS-PREVENIR study aimed to investigate social and relational evolutions associated with PrEP use in men who have sex with men (MSM). In 2018, 12 focus groups with MSM (n = 68) were conducted by a social sciences researcher in Paris. A thematic analysis was performed. Results showed that stigma concerning PrEP use is a complex issue, with various kinds of stigmatization being practiced, sometimes even by the wider MSM population and PrEP users themselves. All types of stigma identified were expressed in forms of verbal abuse which made PrEP use taboo. Inside the wider MSM population a PrEP-user "community" was identified which shared a certain complicity in terms of values and a positive attitude towards PrEP. The emergence of new intragroup and intergroup social norms should be taken into account by policy makers to promote a more positive image of PrEP users.
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Affiliation(s)
- C Puppo
- GRePS, Lyon 2 University, Lyon, France
| | - B Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - S Morel
- AIDES, Paris, France.,Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - M Génin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - L Béniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - D Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - J Ghosn
- APHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Nord site Bichat-Claude Bernard, Université Paris Diderot, INSERM U 1137 IAME, PRES Sorbonne Paris-Cité, Paris, France
| | - X Mabire
- GRePS, Lyon 2 University, Lyon, France
| | - J M Molina
- Department of infectious Diseases, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - D Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Université, Inserm, IRD, Sesstim (Sciences économiques et sociales de la santé et traitement de l'information médicale), Marseille, France
| | - M Préau
- GRePS, Lyon 2 University, Lyon, France
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13
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Lafaurie M, d'Anglejan E, Donay JL, Glotz D, Sarfati E, Mimoun M, Legrand M, Oksenhendler E, Bagot M, Valade S, Bercot B, Molina JM. Utility of anaerobic bottles for the diagnosis of bloodstream infections. BMC Infect Dis 2020; 20:142. [PMID: 32059701 PMCID: PMC7023744 DOI: 10.1186/s12879-020-4854-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/06/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.
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Affiliation(s)
- M Lafaurie
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France. .,Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, 1 avenue Claude Vellefaux, Paris, 75010, France.
| | - E d'Anglejan
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France
| | - J L Donay
- Laboratory of Microbiology, Saint-Louis Hospital, Paris, France
| | - D Glotz
- Nephrology Unit, Saint-Louis Hospital, Paris, France
| | - E Sarfati
- Department of Digestive and Emergency Surgery, Saint-Louis Hospital, Paris, France
| | - M Mimoun
- Department of Plastic Surgery, Saint-Louis Hospital, Paris, France
| | - M Legrand
- Department of Anesthesiology, Critical Care and Burn Unit, St-Louis hospital, University Paris Diderot, Paris, France
| | - E Oksenhendler
- Department of Clinical Immunopathology, Saint-Louis Hospital, Paris, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, Paris, France
| | - S Valade
- Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | - B Bercot
- Laboratory of Microbiology, Saint-Louis Hospital, Paris, France
| | - J M Molina
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, University of Paris Diderot Paris 7, Sorbonne Paris Cité, INSERM U941, Paris, France
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14
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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15
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Gatey C, Brun A, Hamet G, Diamantis S, Sellier P, Bouchaud O, Garrait V, Rozenbaum W, Molina JM, Abgrall S. Does region of origin influence the timing and outcome of first-line antiretroviral therapy in France? HIV Med 2018; 20:175-181. [PMID: 30506853 DOI: 10.1111/hiv.12697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. METHODS Antiretroviral therapy-naïve HIV-1-infected adults with at least two follow-up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)-containing cART among individuals initiating cART, and with 1-year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub-Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. RESULTS Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36-0.82; and aOR 0.52; 95% CI 0.28-0.98, respectively]. PI-containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. CONCLUSIONS Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.
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Affiliation(s)
- C Gatey
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France
| | - A Brun
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - G Hamet
- Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - S Diamantis
- Department of Infectious Diseases, Marc Jacquet Hospital, Melun, France
| | - P Sellier
- Department of Internal Medicine, Saint Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - O Bouchaud
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France.,Laboratory Health Education and Practice (LEPS EA 3412), Paris 13 University, Bobigny, France
| | - V Garrait
- Department of Internal Medicine, Intercommunal Hospital Centre, Créteil, France
| | - W Rozenbaum
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,Est Paris Area COREVIH (Regional Coordination of the fight against HIV infection), Saint Louis Hospital, Paris, France
| | - J M Molina
- Department of Infectious Diseases, Saint-Louis Hospital, AP-HP, Paris, France.,University of Paris Diderot, Sorbonne Paris University, Paris, France
| | - S Abgrall
- Department of Internal Medicine, Antoine Béclère Hospital, Clamart, France.,University of Paris Saclay, Paris-Sud University, UVSQ, Le Kremlin-Bicêtre, France.,CESP INSERM U1018, Le Kremlin-Bicêtre, France
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16
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Tremblay JF, Molina JM, Pocard M. Recurrent anal squamous cell carcinoma in a patient who refuses end colostomy: What to do? J Visc Surg 2018; 155:79-81. [PMID: 29100741 DOI: 10.1016/j.jviscsurg.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J-F Tremblay
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-M Molina
- Infectious Disease Department, Saint-Louis Hospital, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Pocard
- Digestive and Surgical Oncology Department, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; Paris-Diderot University, USPC, Sorbonne-Paris-Cité, Inserm U965, CART Carcinomatosis angiogenesis and translational research, 74575 Paris, France.
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17
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Siguier M, Molina JM. HIV preexposure prophylaxis: An essential, safe and effective prevention tool for sexual health. Med Mal Infect 2018; 48:318-326. [PMID: 29433965 DOI: 10.1016/j.medmal.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Abstract
Preexposure prophylaxis of HIV with antiretroviral drugs is a prevention tool available in France since 2016, combined with the prevention methods already used (condoms, post-exposure treatment, rapid treatment of diagnosed HIV infections, etc.). It is targeted at populations at high risk of HIV infection, especially men who have sex with men, for whom traditional prevention methods are insufficient. We collected clinical research data, which resulted in the launch of preexposure prophylaxis in the United States and then elsewhere in the world, safety, tolerability and cost data, as well as ongoing research data (new molecules/methods of administration). We also provided an update of its use in France.
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Affiliation(s)
- M Siguier
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - J-M Molina
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France
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18
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Rosenthal E, Fougerou-Leurent C, Renault A, Carrieri MP, Marcellin F, Garraffo R, Teicher E, Aumaitre H, Lacombe K, Bailly F, Billaud E, Chevaliez S, Dominguez S, Valantin MA, Reynes J, Naqvi A, Cotte L, Metivier S, Leroy V, Dupon M, Allegre T, De Truchis P, Jeantils V, Chas J, Salmon-Ceron D, Morlat P, Neau D, Perré P, Piroth L, Pol S, Bourlière M, Pageaux GP, Alric L, Zucman D, Girard PM, Poizot-Martin I, Yazdanpanah Y, Raffi F, Pabic EL, Tual C, Pailhé A, Amri I, Bellissant E, Molina JM. Efficacy, safety and patient-reported outcomes of ledipasvir/sofosbuvir in NS3/4A protease inhibitor-experienced individuals with hepatitis C virus genotype 1 and HIV coinfection with and without cirrhosis (ANRS HC31 SOFTRIH study). HIV Med 2017; 19:227-237. [PMID: 29214737 DOI: 10.1111/hiv.12571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Studies evaluating the efficacy and safety of the fixed-dose combination ledipasvir (LDV)/sofosbuvir (SOF) in patients coinfected with HIV-1 and hepatitis C virus (HCV) have mainly included treatment-naïve patients without cirrhosis. We aimed to evaluate the efficacy and safety of this combination in treatment-experienced patients with and without cirrhosis. METHODS We conducted a multicentre, open-label, double-arm, nonrandomized study in patients coinfected with HIV-1 and HCV genotype 1 with and without cirrhosis, who had good viral suppression on their antiretroviral regimens. All patients were pretreated with a first-generation NS3/4A protease inhibitor (PI) plus pegylated interferon/ribavirin. Patients received a fixed-dose combination of LDV/SOF for 12 weeks, or for 24 weeks if cirrhosis was present. The primary endpoint was a sustained virological response (SVR) 12 weeks after the end of therapy. Secondary endpoints included safety, pharmacokinetics and patient-reported outcomes. RESULTS Of the 68 patients enrolled, 39.7% had cirrhosis. Sixty-five patients [95.6%; 95% confidence interval (CI): 87.6-99.1%; P < 0.0001] achieved an SVR, with similar rates of SVR in those with and without cirrhosis. Tolerance was satisfactory, with mainly grade 1 or 2 adverse events. Among patient-reported outcomes, only fatigue significantly decreased at the end of treatment compared with baseline [odds ratio (OR): 0.36; 95% CI: 0.14-0.96; P = 0.04]. Mean tenofovir area under the plasma concentration-time curve (AUC) at week 4 was high, with mean ± SD AUC variation between baseline and week 4 higher in cirrhotic than in noncirrhotic patients (3261.57 ± 1920.47 ng/mL vs. 1576.15 ± 911.97 ng/mL, respectively; P = 0.03). Mild proteinuria (54.4%), hypophosphataemia (50.0%), blood bicarbonate decrease (29.4%) and hypokalaemia (13.2%) were reported. The serum creatinine level was not modified. CONCLUSIONS LDV/SOF provided a high SVR rate in PI-experienced subjects coinfected with HCV genotype 1 and HIV-1, including patients with cirrhosis.
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Affiliation(s)
- E Rosenthal
- Internal Medicine Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - C Fougerou-Leurent
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Renault
- Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - M P Carrieri
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - F Marcellin
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Inserm, IRD, Aix Marseille Univ, Marseille, France.,Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - R Garraffo
- Clinical Pharmacology and Toxicology Department, CHU de Nice, Nice, France
| | - E Teicher
- Infectious Diseases Department, APHP, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - H Aumaitre
- Infectious and Tropical Diseases Department, Hôpital de Perpignan, Perpignan, France
| | - K Lacombe
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - F Bailly
- Hepatology Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - E Billaud
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - S Chevaliez
- Virology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - S Dominguez
- Clinical Immunology Department, APHP, Hôpital Henri Mondor, Créteil, France
| | - M A Valantin
- Infectious Diseases Department, APHP, Hôpital La Pitié Salpêtrière, Paris, France
| | - J Reynes
- Infectious Diseases Department, CHU Montpellier, Montpellier, France
| | - A Naqvi
- Infectious Diseases Department, CHU de Nice, Hôpital Archet 1, Nice, France
| | - L Cotte
- Infectious Diseases Department, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - S Metivier
- Hepatogastroenterology Department, CHU Toulouse, Toulouse, France
| | - V Leroy
- Hepatogastroenterology Department, CHU Grenoble, Grenoble, France
| | - M Dupon
- Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - T Allegre
- Hemato Oncology Department, CH du Pays d'Aix, Aix-en-Provence, France
| | - P De Truchis
- Infectious Diseases Department, APHP, Hôpital R Poincaré, Garches, France
| | - V Jeantils
- Infectious Diseases Department, APHP, Hôpital J Verdier, Bondy, France
| | - J Chas
- Infectious and Tropical Diseases Department, APHP, Hôpital Tenon, Paris, France
| | - D Salmon-Ceron
- Infectious Diseases Department, APHP, Hôpital Cochin, Paris, France
| | - P Morlat
- Internal Medicine and Infectious Diseases Department, CHU Bordeaux, Bordeaux, France
| | - D Neau
- Infectious and Tropical Diseases Department, CHU Bordeaux, Bordeaux, France
| | - P Perré
- Internal Medicine Department, CHD Vendée, La Roche sur Yon, France
| | - L Piroth
- Infectious Diseases Department, CHU Dijon, Dijon, France
| | - S Pol
- Hepato-Gastroenterology Department, APHP, Hôpital Cochin, Paris, France
| | - M Bourlière
- Hepatogastroenterology Department, Hôpital Saint Joseph, Marseille, France
| | - G P Pageaux
- Hepatogastroenterology Department, CHU Montpellier, Montpellier, France
| | - L Alric
- Internal Medicine Department, CHU Toulouse, Toulouse, France
| | - D Zucman
- Internal Medicine Department, Hôpital Foch, Suresne, France
| | - P M Girard
- Infectious Diseases Department, APHP, Hôpital Saint Antoine, Paris, France
| | - I Poizot-Martin
- Immuno and Clinical Hematology department, APHM Sainte-Marguerite, Aix Marseille Univ, Marseille, France.,Inserm U912 (SESSTIM), Marseille, France
| | - Y Yazdanpanah
- Infectious and Tropical Diseases Department, APHP, Hôpital Bichat, Paris, France
| | - F Raffi
- Infectious Diseases Department, CHU Nantes, Nantes, France
| | - E Le Pabic
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - C Tual
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France
| | - A Pailhé
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - I Amri
- Unité de Recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France Recherche Nord & Sud Sida-hiv Hépatites), Paris, France
| | - E Bellissant
- Pharmacology Department, CHU Rennes, Rennes, France.,Inserm, CIC1414, Rennes, France.,Pharmacology Laboratory, Faculté de Médecine, Univ Rennes 1, Rennes, France
| | - J M Molina
- Hepatogastroenterology Department, APHP, Hôpital Saint Louis, Paris, France
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19
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Munier AL, Biard L, Rousseau C, Legrand M, Lafaurie M, Lomont A, Donay JL, de Beaugrenier E, Flicoteaux R, Mebazaa A, Mimoun M, Molina JM. Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit. J Hosp Infect 2017; 97:226-233. [PMID: 28751010 DOI: 10.1016/j.jhin.2017.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multidrug-resistant Acinetobacter baumannii (MR-AB) can cause outbreaks in a burns unit. AIM To study the incidence, risk factors and outcome of MR-AB colonization during an outbreak. METHODS A prospective study was conducted from April to November 2014 in a burns unit in Paris. Weekly surveillance cultures of patients and their environment were performed. MR-AB acquisition, discharge, or death without MR-AB colonization were considered as competing events. To identify risk factors for colonization, baseline characteristics and time-dependent variables were investigated in univariate and multivariate analyses using Cox models. MR-AB strains were genotypically compared using multi-locus sequence typing. FINDINGS Eighty-six patients were admitted in the burns unit during the study period. Among 77 patients without MR-AB colonization at admission, 25 (32%) acquired MR-AB with a cumulative incidence of 30% at 28 days (95% CI: 20-40). Median time to MR-AB acquisition was 13 days (range: 5-34). In multivariate analysis, risk factors for MR-AB acquisition were ≥2 skin graft procedures performed [hazard ratio (HR): 2.97; 95% confidence interval (CI): 1.10-8.00; P = 0.032] and antibiotic therapy during hospitalization (HR: 4.42; 95% CI: 1.19-16.4; P = 0.026). A major sequence type of MR-AB (ST2) was found in 94% and 92% of patients and environmental strains, respectively, with all strains harbouring the blaOXA-23 gene. MR-AB colonization increased length of hospitalization (HR: 0.32; 95% CI: 0.17-0.58; P = 0.0002) by a median of 12 days. CONCLUSION A high incidence of MR-AB acquisition was seen during this outbreak with most strains from patients and their environment belonging to single sequence type. MR-AB colonization was associated with more skin graft procedures, antibiotic use, and prolonged hospitalization.
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Affiliation(s)
- A-L Munier
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France.
| | - L Biard
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - C Rousseau
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - M Legrand
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France; INSERM U942, France
| | - M Lafaurie
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Lomont
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - J-L Donay
- Microbiology Department, St Louis Hospital, APHP and EA4065, University Paris Descartes, Paris, France
| | - E de Beaugrenier
- Pharmacy Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - R Flicoteaux
- Department of Biostatistics, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - A Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - M Mimoun
- Plastic Surgery Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
| | - J-M Molina
- Infectious Disease Department, St Louis Hospital, APHP and University Paris Diderot, Paris, France
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20
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Gallien S, Journot V, Loriot MA, Sauvageon H, Morlat P, Reynes J, Reliquet V, Chêne G, Molina JM. Cytochrome 2B6 polymorphism and efavirenz-induced central nervous system symptoms : a substudy of the ANRS ALIZE trial. HIV Med 2017; 18:537-545. [PMID: 28145050 DOI: 10.1111/hiv.12488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Single nucleotide polymorphisms in the cytochrome P450 (CYP) 2B6 gene have been associated with high interindividual variation in efavirenz pharmacokinetics. However, clinical data on the relationship of CYP2B6 polymorphisms with the occurrence of efavirenz-induced central nervous system (CNS) symptoms are limited. METHODS We analysed four polymorphisms in the CYP2B6 (516 G>T), CYP3A5 (6986 A>G) and ATP-binding cassette, sub-family B, member 1 (ABCB1) (2677 G>T/A and 3435 C>T) genes in HIV-infected adults virologically suppressed on a protease inhibitor-based regimen who switched to a regimen containing emtricitabine, didanosine and efavirenz in the setting of the ANRS ALIZE trial. Kaplan-Meier methods and Cox regression analysis were used to investigate their association with efavirenz plasma levels and CNS events up to 48 months after switching. RESULTS In total, 191 patients with a median age of 41 years, who were 87% male and 85% Caucasian, were enrolled in the study. Variant allelic frequencies were 0.49, 0.93, 0.59 and 0.63 for CYP2B6 516, CYP3A5 392, ABCB1 2677 and ABCB1 3435, respectively. The median efavirenz plasma concentration (MEPC) was 2.2 mg/L [interquartile range (IQR) 1.7-2.8 mg/L] and was significantly higher in patients with the deficient CYP2B6 516T. Overall, 242 CNS events were reported in 104 individuals (54%). No correlation was found between MEPC and CNS events. The occurrence of a first CNS event was lower in patients with the CYP2B6 516 G/G genotype vs. CYP2B6 516 T genotypes [50% (IQR: 40-60%) vs. 66% (IQR: 56-75%), respectively; P = 0.02]. In an adjusted Cox regression model, there was a tendency towards a higher risk of a first CNS event among carriers of the variant CYP2B6 516 T allele (relative risk 1.4 [95% CI, 0.99-2.1]; P?=?.06), compared with noncarriers. CONCLUSIONS The deficient CYP2B6 516 T allele is associated with higher efavirenz plasma drug levels and more frequent CNS-related symptoms.
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Affiliation(s)
- S Gallien
- Sorbonne Paris Cité, Université Paris Diderot Paris 7, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses, Hôpital Saint-Louis, Paris, France
| | | | - M-A Loriot
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM UMR_S1147, Centre Universitaire des Saints-Pères, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Biochimie, Hôpital Européen Georges Pompidou, Paris, France
| | - H Sauvageon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pharmacie, Hôpital Saint-Louis, Paris, France
| | - P Morlat
- Service de médecine interne, Hôpital Saint-André, Bordeaux, France
| | - J Reynes
- Département des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - V Reliquet
- Service de Maladies Infectieuses, CHU Nantes, Nantes, France
| | - G Chêne
- INSERM U1219, Bordeaux, France
| | - J-M Molina
- Sorbonne Paris Cité, Université Paris Diderot Paris 7, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses, Hôpital Saint-Louis, Paris, France
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21
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Colombier MA, Lafaurie M, de Fontbrune FS, Resche-Rigon M, Donay JL, Pons JL, Molina JM, Socie G. Usefulness of daily surveillance blood cultures in allogeneic hematopoietic stem cell transplant recipients on steroids: a 1-year prospective study. Transpl Infect Dis 2016; 18:504-11. [PMID: 27218243 DOI: 10.1111/tid.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/17/2016] [Accepted: 02/23/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Bloodstream infections (BSI) are frequent and potentially severe complications in allogeneic hematopoietic stem cell transplant (AHSCT) recipients. In patients on steroids, surveillance blood cultures (SBCs) are routinely performed to detect asymptomatic BSI but their usefulness remains controversial. METHODS We performed a 1-year, observational, prospective, single-center study to assess the utility of daily SBCs in AHSCT recipients on steroids and a case-control study to identify risk factors associated with positive SBCs. All blood cultures (BCs) obtained from adults hospitalized in the HSCT unit were prospectively studied throughout 1 year. Characteristics, treatments, and outcome of patients were retrieved from medical charts. RESULTS A total of 3594 BCs were obtained in 177 patients, including 1450 SBCs in 82 AHSCT recipients on steroids. In 33 patients, 103 SBCs (7%) were positive. Low-virulence bacteria were identified in 74% of episodes. When analyzing first episode of positive SBCs (28 patients), 6 (21%) true BSI were identified. CONCLUSIONS Patients with positive SBCs were receiving antibiotic treatment less frequently at the time of SBCs (P < 0.001) and had more frequently BCs obtained through central venous access (P < 0.04) when compared to patients with negative SBCs. Daily SBCs in AHSCT recipients on steroids only rarely identify BSI and clear benefit for patients could not be demonstrated.
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Affiliation(s)
- M-A Colombier
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France
| | - M Lafaurie
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France
| | - F S de Fontbrune
- Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France
| | - M Resche-Rigon
- Biostatistic Unit, Hôpital Saint-Louis, AP-HP, Inserm 1153 ECSTRA Team, Université Paris 7 Diderot, Paris, France
| | - J-L Donay
- Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France
| | - J-L Pons
- Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - J-M Molina
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - G Socie
- Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.,Inserm UMR 1160, Paris, France
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Pérez D, Muñoz MC, Molina JM, Muñoz-Caro T, Silva LMR, Taubert A, Hermosilla C, Ruiz A. Eimeria ninakohlyakimovae induces NADPH oxidase-dependent monocyte extracellular trap formation and upregulates IL-12 and TNF-α, IL-6 and CCL2 gene transcription. Vet Parasitol 2016; 227:143-50. [PMID: 27523951 DOI: 10.1016/j.vetpar.2016.07.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/22/2022]
Abstract
Extracellular trap (ET) formation has been demonstrated as novel effector mechanism against diverse pathogens in polymorphonuclear neutrophils (PMN), eosinophils, mast cells, macrophages and recently also in monocytes. In the current study, we show that E. ninakohlyakimovae triggers the deliverance of monocyte-derived ETs in vitro. Fluorescence illustrations as well as scanning electron microscopy (SEM) analyses showed that monocyte-derived ET formation was rapidly induced upon exposure to viable sporozoites, sporocysts and oocysts of E. ninakohlyakimovae. Classical features of monocyte-released ETs were confirmed by the co-localization of extracellular DNA adorned with myeloperoxidase (MPO) and histones (H3) in parasite-entrapping structures. The treatment of caprine monocyte ET structures with NADPH oxidase inhibitor diphenylene iodondium (DPI) significantly reduced ETosis confirming the essential role of reactive oxygen species (ROS) in monocyte mediated ETs formation. Additionally, co-culture of monocytes with viable sporozoites and soluble oocyst antigen (SOA) induced distinct levels of cytokine and chemokine gene transcription. Thus, the transcription of genes encoding for IL-12 and TNF-α was significantly upregulated after sporozoite encounter. In contrast IL-6 and CCL2 gene transcripts were rather weakly induced by parasites. Conversely, SOA only induced the up-regulation of IL-6 and CCL2 gene transcription, and failed to enhance transcripts of IL-12 and TNF-α in vitro. We here report on monocyte-triggered ETs as novel effector mechanism against E. ninakohlyakimovae. Our results strongly suggest that monocyte-mediated innate immune reactions might play an important role in early host immune reactions against E. ninakohlyakimovae in goats.
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Affiliation(s)
- D Pérez
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - M C Muñoz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J M Molina
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - T Muñoz-Caro
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - L M R Silva
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - A Taubert
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - C Hermosilla
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - A Ruiz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
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Lerolle N, Laanani M, Rivière S, Galicier L, Coppo P, Meynard JL, Molina JM, Azoulay E, Aumont C, Marzac C, Fardet L, Lambotte O. Diversity and combinations of infectious agents in 38 adults with an infection-triggered reactive haemophagocytic syndrome: a multicenter study. Clin Microbiol Infect 2015; 22:268.e1-8. [PMID: 26686809 DOI: 10.1016/j.cmi.2015.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/25/2015] [Accepted: 11/29/2015] [Indexed: 12/21/2022]
Abstract
Reactive haemophagocytic syndrome (HS) is a rare condition that occurs in patients with infections, haematological malignancies or autoimmune diseases. Although various microorganisms are thought to trigger HS, most of the literature data on this topic have been gathered in single-centre case series. Here, we sought to characterize infectious triggers in a large, multicentre cohort of patients with HS. Patients were included in the present study if HS was solely due to one or more infections. Detailed microbiological data were recorded. Of the 162 patients with HS in the cohort, 40 (25%) had at least one infection and 38 of the latter (including 14 women, 36.8%) were included. The median age was 46 years. Seven patients were presumed to be immunocompetent (18.4%), whereas 19 patients (50%) were infected with human immunodeficiency virus and 12 patients (31.6%) were immunocompromised for other reasons. Twenty-seven patients (71.1%) had a single infection, whereas six (15.8%) and five (13.1%) patients had, respectively, two and three concomitant infections. We observed pyogenic bacterial infections (n = 7), tuberculosis (n = 10), non-tuberculous mycobacteriosis (n = 3), viral infections (n = 17: 11 cytomegalovirus, three Epstein-Barr virus, two human herpesvirus 8, one herpes simplex virus 2), parasitic infections (n = 8: four disseminated toxoplasmosis, one leishmaniasis, three malaria), fungal infections (n = 5: four pulmonary pneumocystosis and one candidaemia). Eighteen patients (47.4%) received corticosteroids and/or etoposide. Twelve patients died (31.6%). All multiple infections and all deaths occurred in immunocompromised patients. When compared with patients suffering from malignancy-associated HS, patients with infection-triggered HS were younger and more likely to be immunocompromised, and had a better outcome.
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Affiliation(s)
- N Lerolle
- Service de Médecine Interne-Immunologie clinique, Hôpital Bicêtre, Université Paris Sud, Paris, France.
| | - M Laanani
- INSERM CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Group, Paris, France
| | - S Rivière
- Service de Médecine Interne, Hôpital Saint Antoine, Université Paris 6, Paris, France
| | - L Galicier
- Service d'Immunologie Clinique, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - P Coppo
- Service d'Hématologie, Hôpital Saint Antoine, Université Paris 6, Centre de Référence des Microangiopathies Thrombotiques, Paris, France
| | - J-L Meynard
- Service de Maladies Infectieuses, Hôpital Saint Antoine, Université Paris 6, Paris, France
| | - J-M Molina
- Service de Maladies Infectieuses, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - E Azoulay
- Service de Réanimation Médicale, Hôpital Saint Antoine, Université Paris 6, Paris, France
| | - C Aumont
- Service d'Hématologie Biologique, Hôpital Bicêtre, Université Paris Sud, Paris, France
| | - C Marzac
- Service d'Hématologie Biologique, Hôpital Saint Antoine, Université Paris 6, Paris, France
| | - L Fardet
- Service de Dermatologie, Hôpital Henri Mondor, Université Paris 12, Paris, France
| | - O Lambotte
- Service de Médecine Interne-Immunologie clinique, Hôpital Bicêtre, Université Paris Sud, Paris, France
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Ferri JM, Molina JM, Louis E. Fabrication of Mg foams for biomedical applications by means of a replica method based upon spherical carbon particles. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/4/045002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pulcini C, Alfandari S, Ballereau F, Bonnet E, Bruneel F, Castan B, Chidiac C, Cohen R, Descamps D, Doco-Lecompte T, Gauzit R, Guéry B, Jarlier V, Lesprit P, Marcelin AG, Molina JM, Rabaud C, Riché A, Salmon-Céron D, Senneville E, Stahl JP, Tattevin P, Varon E, Roblot F. [European Antibiotic Awareness Day: What is new in France?]. Med Mal Infect 2015; 45:345-7. [PMID: 26411783 DOI: 10.1016/j.medmal.2015.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Affiliation(s)
- C Pulcini
- Université de Lorraine, université Paris Descartes, EA 4360 APEMAC, France; Service de maladies infectieuses et tropicales, CHU de Nancy, Nancy, France.
| | | | | | - E Bonnet
- Hôpital Ducuing, Toulouse, France
| | - F Bruneel
- Service de réanimation, CH de Versailles, Le Chesnay, France
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, CH d'Ajaccio, Ajaccio, France
| | - C Chidiac
- Service de maladies infectieuses et tropicales, hôpital de la Croix Rousse, CHU de Lyon, Lyon, France
| | - R Cohen
- CH de Créteil, Créteil, France
| | - D Descamps
- Laboratoire de virologie, infections antimicrobials modelling evolution (IAME), Inserm UMR 1137, université Paris Diderot, Sorbonne Paris Cité, GH Bichat-Claude-Bernard, Paris, France
| | | | | | | | - V Jarlier
- CHU Pitié-Salpêtrière, Paris, France
| | - P Lesprit
- Hôpital Foch, infectiologie transversale, Suresnes, France
| | | | | | - C Rabaud
- Service de maladies infectieuses et tropicales, CHU de Nancy, Nancy, France
| | - A Riché
- CH de Angoulême, Angoulême, France
| | | | | | - J P Stahl
- CHU et université de Grenoble, Grenoble, France
| | | | - E Varon
- Hôpital européen Georges-Pompidou, Paris, France
| | - F Roblot
- CHU de Poitiers, Poitiers, France
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Ruiz A, Pérez D, Muñoz MC, Molina JM, Taubert A, Jacobs-Lorena M, Vega-Rodríguez J, López AM, Hermosilla C. Targeting essential Eimeria ninakohlyakimovae sporozoite ligands for caprine host endothelial cell invasion with a phage display peptide library. Parasitol Res 2015; 114:4327-31. [PMID: 26341796 DOI: 10.1007/s00436-015-4666-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/06/2015] [Indexed: 01/14/2023]
Abstract
Eimeria ninakohlyakimovae is an important coccidian parasite of goats which causes severe diarrhoea in young animals. Specific molecules that mediate E. ninakohlyakimovae host interactions and molecular mechanisms involved in the pathogenesis are still unknown. Although strong circumstantial evidence indicates that E. ninakohlyakimovae sporozoite interactions with caprine endothelial host cells (ECs) are specific, hardly any information is available about the interacting molecules that confer host cell specificity. In this study, we describe a novel method to identify surface proteins of caprine umbilical vein endothelial cells (CUVEC) using a phage display library. After several panning rounds, we identified a number of peptides that specifically bind to the surface of CUVEC. Importantly, caprine endothelial cell peptide 2 (PCEC2) and PCEC5 selectively reduced the infection rate by E. ninakohlyakimovae sporozoites. These preliminary data give new insight for the molecular identification of ligands involved in the interaction between E. ninakohlyakimovae sporozoites and host ECs. Further studies using this phage approach might be useful to identify new potential target molecules for the development of anti-coccidial drugs or even new vaccine strategies.
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Affiliation(s)
- A Ruiz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35416, Arucas, Las Palmas, Spain.
| | - D Pérez
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35416, Arucas, Las Palmas, Spain
| | - M C Muñoz
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35416, Arucas, Las Palmas, Spain
| | - J M Molina
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35416, Arucas, Las Palmas, Spain
| | - A Taubert
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - M Jacobs-Lorena
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Vega-Rodríguez
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - A M López
- Parasitology Unit, Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, 35416, Arucas, Las Palmas, Spain
| | - C Hermosilla
- Institute of Parasitology, Faculty of Veterinary Medicine, Justus Liebig University Giessen, Giessen, Germany
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Denis B, Lafaurie M, Donay JL, Fontaine JP, Oksenhendler E, Raffoux E, Hennequin C, Allez M, Socie G, Maziers N, Porcher R, Molina JM. Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study. Int J Infect Dis 2015; 39:1-6. [PMID: 26189774 DOI: 10.1016/j.ijid.2015.07.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/01/2015] [Accepted: 07/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The impact of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) bacteraemia on outcome remains controversial. METHODS A retrospective analysis of the prevalence, risk factors, clinical features, and outcomes of all ESBL-EC bacteraemia in one French hospital over a 5-year period was performed. A case-control study was undertaken: cases had at least one ESBL-EC bacteraemia and controls a positive non-ESBL-EC bacteraemia. RESULTS The prevalence of ESBL-EC bacteraemia increased from 5.2% of all positive E. coli blood cultures in 2005 to 13.5% in 2009 (p<0.003). CTX-M represented 70% of ESBL-EC bacteraemia strains, and strains were not clonally related. On adjusted analysis, the only significant risk factor for ESBL-EC bacteraemia was a previous ESBL-EC colonization (odds ratio 11.3, 95% confidence interval 1.2-107; p=0.003). Initial antimicrobial therapy was less frequently adequate in the ESBL-EC group (48% vs. 85%; p=0.003). The presence of ESBL-EC bacteraemia was not associated with a longer hospital stay (p=0.088). Day 30 mortality was high, but not significantly different in the two groups (30% vs. 27%; p=0. 82). CONCLUSION The prevalence of ESBL-EC bacteraemia has been increasing dramatically. Previous colonization with ESBL-EC was a strong risk factor for ESBL-EC bacteraemia. More inadequate initial antimicrobial therapy was noted in the ESBL-EC group, but mortality and length of hospital stay were not significantly different from those of patients with non-ESBL-EC bacteraemia.
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Affiliation(s)
- B Denis
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France; Inserm UMRS 1136, UPMC Université Paris 06, Paris, France.
| | - M Lafaurie
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J-L Donay
- Department of Microbiology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - J-P Fontaine
- Emergency Department, Hôpital Saint-Louis, AP-HP, Paris, France
| | - E Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - E Raffoux
- Department of Haematology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - C Hennequin
- Department of Oncology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - M Allez
- Department of Gastroenterology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - G Socie
- Department of Haematology-Bone Marrow Transplantation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - N Maziers
- Department of Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France
| | - R Porcher
- Department of Biomedical Statistics and Methodology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - J-M Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
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Gallien S, Charreau I, Nere ML, Mahjoub N, Simon F, de Castro N, Aboulker JP, Molina JM, Delaugerre C. Archived HIV-1 DNA resistance mutations to rilpivirine and etravirine in successfully treated HIV-1-infected individuals pre-exposed to efavirenz or nevirapine. J Antimicrob Chemother 2014; 70:562-5. [PMID: 25344807 DOI: 10.1093/jac/dku395] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Efavirenz and nevirapine failure is associated with a rapid selection of resistance-associated mutations (RAMs), which may impact on etravirine or rilpivirine susceptibility. However, RAMs for rilpivirine and etravirine cannot be reported on previous resistance genotypes because these specific RAMs were not analyzed at that time. Therefore, our objective was to determine, in virologically suppressed HIV-1-infected individuals, the presence of RAMs to rilpivirine, etravirine and the combination of tenofovir/emtricitabine/rilpivirine in HIV-1 DNA from individuals previously exposed to efavirenz and/or nevirapine. METHODS The studied population included 169 treatment-experienced individuals enrolled in the ANRS 138-EASIER trial who previously failed on and/or were intolerant to efavirenz and/or nevirapine and who had plasma HIV-1 RNA<400 copies/mL. Resistance to rilpivirine, etravirine, tenofovir and emtricitabine by bulk sequencing was performed on extracted HIV-1 DNA from whole blood collected at the time of trial inclusion. RESULTS Reverse transcriptase gene amplification was successful in 128/169 (76%) individuals and 95% of HIV-1 were infected with subtype B. Rilpivirine RAMs were detected in 41 (32%) individuals, with highest frequency for the mutations Y181C/I/V (18%), K101E/P (7%) and E138A/G/K/Q/R/S (6%) and the association L100I+K103N/S (5%). Etravirine RAMs were detected in five (4%) individuals. Resistance to emtricitabine, tenofovir and at least one drug included in the combination of tenofovir/emtricitabine/rilpivirine were detected in 72 (56%), 12 (9%) and 88 (69%), respectively. CONCLUSIONS In individuals with suppressed viraemia under antiretroviral therapy (ART), but who had been previously exposed to an efavirenz and/or nevirapine-based regimen, rilpivirine RAMs are frequent and etravirine RAMs are rare. This finding suggests that the switch to a rilpivirine-based regimen should not be recommended.
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Affiliation(s)
- S Gallien
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Louis-APHP, Paris, France INSERM U941, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - M L Nere
- Laboratoire de Virologie, Hôpital Saint Louis-APHP, Paris, France
| | - N Mahjoub
- Laboratoire de Virologie, Hôpital Saint Louis-APHP, Paris, France
| | - F Simon
- INSERM U941, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Laboratoire de Virologie, Hôpital Saint Louis-APHP, Paris, France
| | - N de Castro
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Louis-APHP, Paris, France
| | | | - J M Molina
- Service de Maladies Infectieuses et Tropicales, Hôpital Saint-Louis-APHP, Paris, France INSERM U941, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - C Delaugerre
- INSERM U941, Université Paris Diderot, Sorbonne Paris Cité, Paris, France Laboratoire de Virologie, Hôpital Saint Louis-APHP, Paris, France
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Gallien S, Taieb F, Hamane S, De Castro N, Molina JM. Autochthonous falciparum malaria possibly transmitted by luggage-carried vector in Paris, France, February 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 24128697 DOI: 10.2807/1560-7917.es2013.18.40.20600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of autochthonous falciparum malaria in a patient in Paris, France, in February 2013 who reported no recent travel to malaria-endemic countries. The parasite, Plasmodium falciparum, was possibly transmitted by an infective Anopheles mosquito carried in baggage from a malaria-endemic area.
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Affiliation(s)
- S Gallien
- Department of Infectious and Tropical Diseases, Paris Diderot University, Paris 7, Saint-Louis Hospital, Paris, France
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de Lastours V, LeGoff J, Brière J, Agbalika F, Boulet T, Lévy Y, Simon F, Aboulker JP, Molina JM. Lymphoma and Epstein−Barr virus DNA in blood during interleukin-2 therapy in antiretroviral-naïve HIV-1-infected patients: a substudy of the ANRS 119 trial. HIV Med 2013; 15:23-9. [DOI: 10.1111/hiv.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- V de Lastours
- Department of Infectious Diseases; Saint-Louis Hospital; Paris France
- University Paris Diderot; Sorbonne Paris Cité; Paris France
| | - J LeGoff
- University Paris Diderot; Sorbonne Paris Cité; Paris France
- Department of Microbiology; Saint-Louis Hospital; Paris France
- INSERM U941; Paris France
| | - J Brière
- University Paris Diderot; Sorbonne Paris Cité; Paris France
- Department of Pathology; Saint-Louis Hospital; Paris France
| | - F Agbalika
- University Paris Diderot; Sorbonne Paris Cité; Paris France
- Department of Microbiology; Saint-Louis Hospital; Paris France
| | - T Boulet
- Institut National Recherche Médicale (INSERM) SC10; Villejuif France
| | - Y Lévy
- INSERM U955; Creteil France
| | - F Simon
- University Paris Diderot; Sorbonne Paris Cité; Paris France
- Department of Microbiology; Saint-Louis Hospital; Paris France
- INSERM U941; Paris France
| | - J-P Aboulker
- Institut National Recherche Médicale (INSERM) SC10; Villejuif France
| | - J-M Molina
- Department of Infectious Diseases; Saint-Louis Hospital; Paris France
- University Paris Diderot; Sorbonne Paris Cité; Paris France
- INSERM U941; Paris France
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Molina JM, Clumeck N, Orkin C, Rimsky LT, Vanveggel S, Stevens M. Week 96 analysis of rilpivirine or efavirenz in HIV-1-infected patients with baseline viral load ≤ 100 000 copies/mL in the pooled ECHO and THRIVE phase 3, randomized, double-blind trials. HIV Med 2013; 15:57-62. [PMID: 23980523 DOI: 10.1111/hiv.12071] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES These 96-week, ECHO/THRIVE pooled analyses evaluated data for antiretroviral treatment-naïve, HIV-1-infected adults with viral load (VL) ≤ 100 000 HIV-1 RNA copies/mL receiving rilpivirine or efavirenz. METHODS ECHO and THRIVE were phase 3, randomized, double-blind trials. Patients received rilpivirine 25 mg once daily (qd) or efavirenz 600 mg qd, with a fixed (ECHO) or investigator-chosen (THRIVE) nucleoside/tide reverse transcriptase inhibitor (N[t]RTI) background regimen. Response rate (the percentage of patients with VL < 50 copies/mL, using an intent-to-treat-population, time-to-loss-of-virological-response algorithm), virological failure (VF), resistance development, safety and tolerability were evaluated. RESULTS Baseline characteristics were comparable between the rilpivirine (n = 368) and efavirenz (n = 329) groups. At week 96, response rates [84% for rilpivirine vs. 80% for efavirenz; difference 4.0%; 95% confidence interval (CI) -1.7% to 9.7%] and incidences of VF for the resistance analysis (VFres) (8% for rilpivirine vs. 6% for efavirenz; P = 0.46) were similar in the two groups. Among patients with VFres , a comparable proportion in each group developed nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance-associated mutations (RAMs). Among those with VFres , more patients in the rilpivirine group than in the efavirenz group developed N[t]RTI RAMs, mostly M184I/V. The mean (95% CI) CD4 cell count increased from baseline to week 96 by 224 (208-240) cells/μL in the rilpivirine group and by 206 (188-225) cells/μL in the efavirenz group. Treatment-related grade 2-4 overall adverse events, any rash and dizziness were less frequent for rilpivirine than for efavirenz (P < 0.0001). CONCLUSIONS Rilpivirine demonstrated antiviral efficacy similar to that of efavirenz in antiretroviral treatment-naïve adults with baseline VL ≤ 100 000 copies/mL over 96 weeks. Frequencies of VFres and emergent NNRTI RAMs in each group were similar. More patients with VFres in the rilpivirine group than in the efavirenz group developed N[t]RTI RAMs (mostly M184I/V). Rilpivirine had a more favourable safety/tolerability profile than efavirenz.
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Affiliation(s)
- J-M Molina
- Department of Infectious Diseases, Saint Louis Hospital-APHP, INSERM U941 and University of Paris Diderot, Paris, France
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Boyd MA, Kumarasamy N, Moore CL, Nwizu C, Losso MH, Mohapi L, Martin A, Kerr S, Sohn AH, Teppler H, Van de Steen O, Molina JM, Emery S, Cooper DA. Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of HIV-1 infection in adults with virological failure of a standard first-line ART regimen (SECOND-LINE): a randomised, open-label, non-inferiority study. Lancet 2013; 381:2091-9. [PMID: 23769235 DOI: 10.1016/s0140-6736(13)61164-2] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Uncertainty exists about the best treatment for people with HIV-1 who have virological failure with first-line combination antiretroviral therapy of a non-nucleoside analogue (NNRTI) plus two nucleoside or nucleotide analogue reverse transcriptase inhibitors (NtRTI). We compared a second-line regimen combining two new classes of drug with a WHO-recommended regimen. METHODS We did this 96-week, phase 3b/4, randomised, open-label non-inferiority trial at 37 sites worldwide. Adults with HIV-1 who had confirmed virological failure (plasma viral load >500 copies per mL) after 24 weeks or more of first-line treatment were randomly assigned (1:1) to receive ritonavir-boosted lopinavir plus two or three NtRTIs (control group) or ritonavir-boosted lopinavir plus raltegravir (raltegravir group). The randomisation sequence was computer generated with block randomisation (block size four). Neither participants nor investigators were masked to allocation. The primary endpoint was the proportion of participants with plasma viral load less than 200 copies per mL at 48 weeks in the modified intention-to-treat population, with a non-inferiority margin of 12%. This study is registered with ClinicalTrials.gov, number NCT00931463. FINDINGS We enrolled 558 patients, of whom 541 (271 in the control group, 270 in the raltegravir group) were included in the primary analysis. At 48 weeks, 219 (81%) patients in the control group compared with 223 (83%) in the raltegravir group met the primary endpoint (difference 1·8%, 95% CI -4·7 to 8·3), fulfilling the criterion for non-inferiority. 993 adverse events occurred in 271 participants in the control group versus 895 in 270 participants in the raltegravir group, the most common being gastrointestinal. INTERPRETATION The raltegravir regimen was no less efficacious than the standard of care and was safe and well tolerated. This simple NtRTI-free treatment strategy might extend the successful public health approach to management of HIV by providing simple, easy to administer, effective, safe, and tolerable second-line combination antiretroviral therapy. FUNDING University of New South Wales, Merck, AbbVie, the Foundation for AIDS Research.
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Lafaurie M, Dolivo M, Girard PM, May T, Bouchaud O, Carbonnel E, Madelaine I, Loze B, Porcher R, Molina JM. Polylactic acidvs.polyacrylamide hydrogel for treatment of facial lipoatrophy: a randomized controlled trial [Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS) 132 SMILE]. HIV Med 2013; 14:410-20. [DOI: 10.1111/hiv.12021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - T May
- Department of Infectious Diseases; Brabois Hospital; Vandoeuvre les Nancy; Paris; France
| | - O Bouchaud
- Department of Infectious Diseases; Avicenne Hospital; Bobigny Cedex; France
| | - E Carbonnel
- Department of Dermatology; E. Herriot Hospital; Lyon Cedex; France
| | - I Madelaine
- Pharmacy; Saint-Louis Hospital; Paris; France
| | | | - R Porcher
- Department of Biostatistics; Saint-Louis Hospital; Paris; France
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Munier AL, de Lastours V, Varon E, Donay JL, Porcher R, Molina JM. Invasive pneumococcal disease in HIV-infected adults in France from 2000 to 2011: antimicrobial susceptibility and implication of serotypes for vaccination. Infection 2013; 41:663-8. [PMID: 23404685 DOI: 10.1007/s15010-013-0419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/31/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Invasive pneumococcal diseases (IPD) remain frequent and severe events in human immunodeficiency virus (HIV)-infected subjects despite the use of antiretroviral therapy and the availability of vaccines. Our aim was to assess the antibiotic susceptibilities and serotypes of strains responsible for IPD in HIV-infected patients. METHODS We retrospectively analyzed all Streptococcus pneumoniae strains isolated from normally sterile sites between 2000 and 2011 in HIV-infected patients from a single reference center in Paris. The minimum inhibitory concentrations were determined by the E-test, and serotyping was performed by the antiserum agglutination method. RESULTS Among our study group, 41 HIV-infected adults presented 43 IPD during the study period. Of these 41 patients, 78 % were men, and the median age was 43 (range 23-62) years. the median CD4 cell count was 184/mm(3) (6-1,090/mm(3)), 51 % were receiving antiretroviral therapy, and 24 % had plasma HIV-RNA levels of <400 copies/mL. Only two patients had received the pneumococcal polysaccharide 23-valent vaccine (PPV23). Isolates were susceptible to penicillin G, amoxicillin, and cotrimoxazole in 44, 70, and 59 % of cases, respectively, and were significantly less susceptible to these antibiotics than isolates in the French general population during the same period. Among the 27 strains serotyped, 18 different serotypes were observed, of which 19A, 14, 7F, and 6A were the most frequent. Serotype distribution was similar to that in the French general population. The PPV23 vaccine and the 13-valent conjugate vaccine (PCV13) would have theoretically covered 78 and 70 % of cases, respectively. CONCLUSIONS In our HIV-infected patient cohort, S. pneumoniae isolates demonstrated higher levels of resistance to beta-lactamines and cotrimoxazole than in the French general population. HIV-infected patients should benefit from the herd protection effect expected from the large-scale vaccination of children by PCV13.
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Affiliation(s)
- A-L Munier
- Infectious Diseases Department, St Louis Hospital, Assistance-Publique-Hôpitaux de Paris (APHP), 1, Avenue Claude Vellefaux, 75010, Paris, France.
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Nguyen HL, Charpentier C, Nguyen N, de Truchis P, Molina JM, Ruxrungtham K, Delaugerre C. Longitudinal analysis of integrase N155H variants in heavily treated patients failing raltegravir-based regimens. HIV Med 2012; 14:85-91. [PMID: 22994529 DOI: 10.1111/j.1468-1293.2012.01039.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The mechanism of raltegravir (RAL)-resistant evolutions has not already been elucidated. Because the emergence of RAL resistance is usually initiated by the N155H mutant, we assessed the role of minor N155H-mutated variants in circulating RNA and archived DNA in five heavily treated patients experiencing long-term RAL therapy failure and harbouring three different resistance profiles determined by standard genotyping. METHODS Allele-specific polymerase chain reaction (AS-PCR) was used to detect N155H mutants in longitudinal stored plasma and whole-blood samples before, during and after RAL-based regimens in five patients infected with the HIV-1 B subtype. RESULTS No minor N155H-mutated variant was found by AS-PCR in either plasma or whole-blood samples collected at baseline and after RAL withdrawal in any of the five patients. During RAL failure, the mutation N155H was detected at different levels in three patients displaying the N155H pathway and gradually declined when the double mutant Q148H+G140S was selected in one patient. In two patients with the Q148H resistance pathway, no N155H variant was identified by AS-PCR in either viral RNA or DNA. CONCLUSIONS The N155H mutation present at various levels from minority to majority showed no relationship with the three RAL-associated resistance profiles, suggesting that this mutant may not play a role in determining different resistance profiles. Moreover, pre-existing N155H is very infrequent and, if selected during RAL failure, the N155H mutant disappears quickly after RAL withdrawal.
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Affiliation(s)
- H L Nguyen
- Virology Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, INSERM U941, Paris Diderot University, Sorbonne Paris Cité, Paris, France
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Ruiz A, Matos L, Muñoz MC, Hermosilla C, Molina JM, Andrada M, Rodríguez F, Pérez D, López A, Guedes A, Taubert A. Isolation of an Eimeria ninakohlyakimovae field strain (Canary Islands) and analysis of its infection characteristics in goat kids. Res Vet Sci 2012; 94:277-84. [PMID: 22989759 DOI: 10.1016/j.rvsc.2012.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 08/02/2012] [Accepted: 08/07/2012] [Indexed: 11/28/2022]
Abstract
The current study was conducted to isolate a field strain of Eimeria ninakohlyakimovae, characterize its infectivity and the response to challenge under experimental conditions. The isolated strain (GC) induced a prepatent period of 14-15 days p.i., a patency of 7±2 days and a noticeable pathogenicity in infected goat kids. Challenge trials resulting in a decrease of oocysts per gram counts as well as a milder intensity of clinical signs in re-infected animals indicated the capacity of this strain to induce protective immune response. Altogether, the data reported in the present study suggest that the strain E. ninakohlyakimovae GC is a useful tool for the investigation of mechanisms of pathogenicity as well as host protective immune response in caprine coccidiosis, representing a valuable prerequisite for the development of future strategies in prophylaxis and control of this important parasitic disease in goat.
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Affiliation(s)
- A Ruiz
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Spain.
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Lévy Y, Sereti I, Tambussi G, Routy JP, Lelièvre JD, Delfraissy JF, Molina JM, Fischl M, Goujard C, Rodriguez B, Rouzioux C, Avettand-Fenoël V, Croughs T, Beq S, Morre M, Poulin JF, Sekaly RP, Thiebaut R, Lederman MM. Effects of recombinant human interleukin 7 on T-cell recovery and thymic output in HIV-infected patients receiving antiretroviral therapy: results of a phase I/IIa randomized, placebo-controlled, multicenter study. Clin Infect Dis 2012; 55:291-300. [PMID: 22550117 PMCID: PMC3381639 DOI: 10.1093/cid/cis383] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The immune deficiency of human immunodeficiency virus (HIV) infection is not fully corrected with ARV therapy. Interleukin-7 (IL-7) can boost CD4 T-cell counts, but optimal dosing and mechanisms of cellular increases need to be defined. METHODS We performed a randomized placebo-controlled dose escalation (10, 20 and 30 µg/kg) trial of 3 weekly doses of recombinant human IL-7 (rhIL-7) in ARV-treated HIV-infected persons with CD4 T-cell counts between 101 and 400 cells/µL and plasma HIV levels <50 copies/mL. Toxicity, activity and the impact of rhIL-7 on immune reconstitution were monitored. RESULTS Doses of rhIL-7 up to 20 µg/kg were well tolerated. CD4 increases of predominantly naive and central memory T cells were brisk (averaging 323 cells/µL at 12 weeks) and durable (up to 1 year). Increased cell cycling and transient increased bcl-2 expression were noted. Expanded cells did not have the characteristics of regulatory or activated T cells. Transient low-level HIV viremia was seen in 6 of 26 treated patients; modest increases in total levels of intracellular HIV DNA were proportional to CD4 T-cell expansions. IL-7 seemed to increase thymic output and tended to improve the T-cell receptor (TCR) repertoire in persons with low TCR diversity. CONCLUSIONS Three weekly doses of rhIL-7 at 20 µg/kg are well tolerated and lead to a dose-dependent CD4 T-cell increase and the broadening of TCR diversity in some subjects. These data suggest that this rhIL-7 dose could be advanced in future rhIL-7 clinical studies. CLINICAL TRIALS REGISTRATION NCT0047732.
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Molina JM, Martín S, Hernández YI, González JF, Ferrer O, Ruiz A. Immunoprotective effect of cysteine proteinase fractions from two Haemonchus contortus strains adapted to sheep and goats. Vet Parasitol 2012; 188:53-9. [PMID: 22487211 DOI: 10.1016/j.vetpar.2012.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 03/03/2012] [Accepted: 03/05/2012] [Indexed: 11/24/2022]
Abstract
A preliminary analysis of the significance of genetic diversity in cysteine proteinase genes has been performed simultaneously in sheep and goats, with regard to the immunological control using these enzymes against haemonchosis. For this purpose, we have studied the cross-immunoprotective effect of cysteine protease-enriched protein fractions (CPFs) in adult worms of two Haemonchus contortus strains from North America and Spain that are adapted to sheep and goats, respectively. Previous genetic analysis of cysteine proteinase genes in both strains has shown that some of loci are polymorphic and these differences are translated into changes in the amino acid sequences. However, our results show that CPFs from H. contortus adult worms have a protective effect against the parasite in both sheep and goats. These results are similar regardless of whether they were obtained from sheep or goat-adapted H. contortus strains, which could be very important in case H. contortus CPFs were commercially used in different countries, as vaccines to prevent the negative effects of this parasite. Interestingly, this experimental inoculation of both species with a heterologous strain of H. contortus contributes to the idea shown in previous studies about how difficult is the interpretation and the comparison of vaccination where strains not adapted to a specific host are used. Therefore, the challenger of using heterologous strains could provide similar results to those observed in immunised animals. This study suggests the possibility of exploring the mechanisms involved in natural protection against non-adapted strains, in order to develop strategies to control haemonchosis.
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Affiliation(s)
- J M Molina
- Unit of Parasitology, Faculty of Veterinary Medicine, University of Las Palmas de Gran Canaria, Trasmontaña s/n. 35413-Arucas, Las Palmas, Spain.
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Delaugerre C, Braun J, Charreau I, Delarue S, Nere ML, de Castro N, May T, Marchou B, Simon F, Molina JM, Aboulker JP. Comparison of resistance mutation patterns in historical plasma HIV RNA genotypes with those in current proviral HIV DNA genotypes among extensively treated patients with suppressed replication. HIV Med 2012; 13:517-25. [PMID: 22416781 DOI: 10.1111/j.1468-1293.2012.01002.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Heavily treatment-experienced patients with good virological control could be at risk of virological failure on switching to a new regimen if pre-existing drug resistance is not taken into account. We examined whether genotyping based on cellular HIV-1 DNA during controlled viraemia identifies resistance mutations detected in plasma HIV-1 RNA during treatment with previous antiretroviral regimens. PATIENTS AND METHODS All 169 patients enrolled in the Agence Nationale de Recherche sur le SIDA (ANRS) 138-intEgrase inhibitor MK_0518 to Avoid Subcutaneous Injections of EnfuviRtide (EASIER) trial had already received three antiretroviral drug classes [nucleoside reverse transcriptase inhibitor (NRTI), nonnucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI)] and had plasma HIV-1 RNA<400 copies/ml at baseline. The results of previous resistance genotyping of plasma HIV-1 RNA in individual patients were compared with those of resistance genotyping of whole-blood HIV-1 DNA at randomization. RESULTS A median of 4 plasma RNA genotypes were available for the 169 patients. The median numbers of resistance mutations in HIV-1 RNA and DNA were, respectively, 5 and 4 for NRTIs, 2 and 1 for NNRTIs, and 10 and 8 for PIs. The difference was significant for all three drug classes (P=0.001). Resistance to at least one antiretroviral drug was detected exclusively in HIV-1 RNA or in DNA in 63% and 13% of patients for NRTI, 47% and 1% of patients for NNRTI, and 50% and 7% of patients for PI, respectively. CONCLUSION This study shows that, among highly treatment-experienced patients on effective highly active antiretroviral therapy, resistance genotyping of HIV-1 DNA detects fewer resistance mutations than previous analyses of HIV-1 RNA. These results have implications for patient management and for the design of switch studies.
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Affiliation(s)
- C Delaugerre
- Virology Department, Saint-Louis Hospital-APHP, Inserm U941-Paris 7 Diderot University, Paris, France.
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Lagrange-Xélot M, Porcher R, Gallien S, Wargnier A, Pavie J, de Castro N, Molina JM. Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study. Clin Microbiol Infect 2011; 17:610-4. [PMID: 20459437 DOI: 10.1111/j.1469-0691.2010.03259.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guidelines help to prevent the transmission of Mycobacterium tuberculosis in healthcare settings, but may also result in the unnecessary isolation of many patients. We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a pre-existing clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. In conclusion, the prevalence of PTB among isolated inpatients was high, and the use of a clinical decision rule in addition to clinical impression might improve isolation decisions.
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Affiliation(s)
- M Lagrange-Xélot
- Department of Infectious Diseases, Laboratory of Microbiology, Saint Louis Hospital, AP-HP and University of Paris Diderot Paris, Paris, France.
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De Castro N, Xu F, Porcher R, Pavie J, Molina JM, Peraldi MN. Pneumocystis jirovecii pneumonia in renal transplant recipients occurring after discontinuation of prophylaxis: a case–control study. Clin Microbiol Infect 2011; 16:1375-7. [PMID: 20041898 DOI: 10.1111/j.1469-0691.2009.03143.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case-control study was conducted to identify risk factors for Pneumocystis jirovecii pneumonia (PCP) in renal transplant recipients. Eleven cases of PCP were matched with 22 controls. Cases occurred a median of 18 months after transplantation, and none of the recipients was receiving prophylaxis. Univariate analysis showed that graft rejection, duration of steroid use, use of mammalian target of rapamycin (mTOR) inhibitors and lymphocytopenia at the time of prophylaxis discontinuation were risk factors for PCP. In the multivariate model, only graft rejection (OR 8.66, p 0.017) remained significantly associated with PCP. In patients with a history of graft rejection, PCP prophylaxis should be maintained, especially among those with lymphocytopenia.
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Affiliation(s)
- N De Castro
- Department of Infectious Diseases, Saint-Louis Hospital, Assistance-Publique Hôpitaux de Paris, University of Paris Diderot, Paris, France.
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Clumeck N, Cahn P, Molina JM, Mills A, Nijs S, Vingerhoets J, Witek J. Virological response with fully active etravirine: pooled results from the DUET-1 and DUET-2 trials. Int J STD AIDS 2011; 21:738-40. [PMID: 21187353 DOI: 10.1258/ijsa.2010.010139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this subanalysis of the Phase III DUET trials was to examine virological response to an etravirine-containing regimen in patients harbouring virus fully sensitive to etravirine. Full etravirine sensitivity was defined as fold change in 50% effective concentration (FC) ≤3 or weighted genotypic score ≤2. At Week 48 in the etravirine group, 74% of patients with etravirine FC ≤3 and 77% with etravirine genotypic score ≤2 had viral load <50 HIV-1 RNA copies/mL, versus 48% and 46%, respectively, in the placebo group (P < 0.0001). Response rates increased with baseline phenotypic sensitivity score, but were consistently higher with etravirine (56-82%) than placebo (2-72%). Similar observations were made in patients harbouring virus with full etravirine and darunavir sensitivity. Our findings support current recommendations to include three active agents in treatment-experienced patients' regimens.
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Affiliation(s)
- N Clumeck
- Division of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium.
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Alanio A, Desoubeaux G, Sarfati C, Hamane S, Bergeron A, Azoulay E, Molina JM, Derouin F, Menotti J. Real-time PCR assay-based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients. Clin Microbiol Infect 2011; 17:1531-7. [PMID: 20946413 DOI: 10.1111/j.1469-0691.2010.03400.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diagnosis of pneumocystosis usually relies on microscopic demonstration of Pneumocystis jirovecii in respiratory samples. Conventional PCR can detect low levels of P. jirovecii DNA but cannot differentiate active pneumonia from colonization. In this study, we used a new real-time quantitative PCR (qPCR) assay to identify and discriminate these entities. One hundred and sixty-three bronchoalveolar lavage fluids and 115 induced sputa were prospectively obtained from 238 consecutive immunocompromised patients presenting signs of pneumonia. Each patient was classified as having a high or a low probability of P. jirovecii pneumonia according to clinical and radiological presentation. Samples were processed by microscopy and by a qPCR assay amplifying the P. jirovecii mitochondrial large-subunit rRNA gene; qPCR results were expressed as trophic form equivalents (TFEq)/mL by reference to a standard curve obtained from numbered suspensions of trophic forms. From 21 samples obtained from 16 patients with a high probability of P. jirovecii pneumonia, 21 were positive by qPCR whereas only 16 were positive by microscopy. Fungal load ranged from 134 to 1.73 × 10(6) TFEq/mL. Among 257 specimens sampled from 222 patients with a low probability of P. jirovecii pneumonia, 222 were negative by both techniques but 35 were positive by qPCR (0.1-1840 TFEq/mL), suggesting P. jirovecii colonization. Two cut-off values of 120 and 1900 TFEq/mL were proposed to discriminate active pneumonia from colonization, with a grey zone between them. In conclusion, this qPCR assay discriminates active pneumonia from colonization. This is particularly relevant for patient management, especially in non-human immunodeficiency virus (HIV)-infected immunocompromised patients, who often present low-burden P. jirovecii infections that are not diagnosed microscopically.
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Affiliation(s)
- A Alanio
- Laboratory of Parasitology-Mycology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris-Diderot, Paris, France
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Champion L, Durrbach A, Lang P, Delahousse M, Chauvet C, Sarfati C, Glotz D, Molina JM. Fumagillin for treatment of intestinal microsporidiosis in renal transplant recipients. Am J Transplant 2010; 10:1925-30. [PMID: 20636462 DOI: 10.1111/j.1600-6143.2010.03166.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report 10 cases of intestinal microsporidiosis due to Enterocytozoon bieneusi in renal transplant (RT) recipients who were treated with fumagillin. All patients presented with afebrile subacute diarrhea (median of 2 weeks), associated with abdominal cramps (n = 5), and weight loss (n = 6), a mean of 68 months after RT. The diagnosis was made by the identification of microsporidial spores in stools with the use of appropriate staining and confirmed by a specific polymerase chain reaction assay for E. bieneusi in 7 patients. Median CD4 cell count was 292 cells/mm(3). All patients received a median of 14 days of oral fumagillin (20 mg tid), and four patients also discontinued or tapered their immunosuppressive regimen (mycophenolate mofetil in 3, and azathioprine in 2). Clinical symptoms resolved rapidly with the clearance of microsporidial spores from stools in all patients. A severe but reversible thrombocytopenia was observed in one patient during fumagillin therapy, and another patient presented with abdominal cramps. Trough levels of tacrolimus measured in seven patients dropped below 5 ng/mL in six of them after 7-14 days of fumagillin. Intestinal microsporidiosis can cause subacute diarrhea in RT recipients. Fumagillin is an effective treatment with an acceptable safety profile, but monitoring of tacrolimus levels is warranted.
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Affiliation(s)
- L Champion
- Department of Renal Transplantation, Saint Louis Hospital and Paris-Diderot Paris 7 University, Paris, France.
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Borie C, Euvrard S, Vérola O, Buhard O, Barete S, Molina JM, Kanitakis J, Kérob D, Lebbé C, Duval A. No evidence for microsatellite instability in immunodeficiency-related skin cancers. Am J Transplant 2010; 10:192-3. [PMID: 19889122 DOI: 10.1111/j.1600-6143.2009.02862.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Cohen C, Molina JM, Cahn P, Clotet B, Fourie J, Grinsztejn B, Hao W, Johnson M, Supparatpinyo K, Crauwels HM, Rimsky L, Vanveggel S, Williams P, Boven K. Pooled week 48 safety and efficacy results from the ECHO and THRIVE phase III trials comparing TMC278 vs EFV in treatment-naïve, HIV-1-infected patients. J Int AIDS Soc 2010. [PMCID: PMC3112863 DOI: 10.1186/1758-2652-13-s4-o48] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Boyd A, Lacombe K, Miailhes P, Gozlan J, Bonnard P, Molina JM, Lascoux-Combe C, Serfaty L, Gault E, Desvarieux M, Girard PM. Longitudinal evaluation of viral interactions in treated HIV-hepatitis B co-infected patients with additional hepatitis C and D virus. J Viral Hepat 2010; 17:65-76. [PMID: 19682317 DOI: 10.1111/j.1365-2893.2009.01153.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Virological interactions of hepatitis B (HBV), hepatitis C (HCV) and hepatitis D (HDV) viruses in HIV-infected patients have been poorly characterized especially under treatment influences. Undetection rates of hepatitis viruses were longitudinally analyzed in a 3-year cohort of 308 HIV-HBV co-infected patients and compared using Generalized Estimating Equation models adjusted for age, HIV-RNA, CD4 cell-count and antiviral treatment. Chronic hepatitis co-infection in HIV-infected patients (age years, SD) was: 265 HBV (40.7, 8.2); 19 HBV-HCV (39.7, 4.1); 12 HBV-HDV (35.2, 9.9); 12 HBV-HCV-HDV (39.2, 5.2). At inclusion, treatment with lamivudine/tenofovir was not significantly different between co-infection groups. HBV suppression was significantly associated with HDV (aOR = 3.85, 95%CI 1.13-13.10, P = 0.03) and HCV tri-infection (aOR = 2.65, 95%CI 1.03-6.81, P = 0.04), but marginally associated with HIV-HBV-HCV-HDV (aOR = 2.32, 95%CI 0.94-5.74, P = 0.07). In quad-infection, lower HDV-undetectability (vs HIV-HBV-HDV, P = 0.2) and higher HCV-undetectability (vs HIV-HBV-HCV, P = 0.1) were demonstrated. The degree of HBV suppression varied between visits and co-infection groups [range of aOR during follow-up (vs HIV-HBV co-infection): HIV-HBV-HCV = 2.23-5.67, HIV-HBV-HDV = 1.53-15.17]. In treated co-infected patients, HDV expressed continuous suppression over HCV- and HBV-replications. Peaks and rebounds from undetectable hepatitis B, C and/or D viremia warrant closer follow-up in this patient population. HDV-replication was uncontrolled even with antiviral treatment.
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Affiliation(s)
- A Boyd
- INSERM, Paris and UMR-S707, Université Pierre et Marie Curie-Paris6, Paris, France
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Vragovic I, Molina JM, Prieto R, Duarte M, Narciso J, Louis E. Debris and 1/f noise in sliding friction dynamics under wear conditions. Phys Rev E Stat Nonlin Soft Matter Phys 2009; 80:066123. [PMID: 20365247 DOI: 10.1103/physreve.80.066123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 10/13/2009] [Indexed: 05/29/2023]
Abstract
Friction force time series showing irregular fluctuations have been since long considered one of the possible stick-slip regimes in sliding friction. However, it has not been until recently that a 1/f power spectrum in friction force time series derived from sliding friction experiments under wear conditions has been identified. A variety of models, mostly inspired in the field of earthquakes, has been explored, without reaching a fully satisfactory explanation of that behavior. Recently, the present authors have reported results of sliding friction experiments on steel with alumina pins, carried out with and without debris blowing, that proved the role of loose debris in determining the 1/f character of the friction force. A damped-forced harmonic oscillator with two friction terms was proposed to describe the dynamics of friction under wear conditions: one purely random, which accounts for surface roughness, and another inversely proportional to the amount of loose debris that was calculated by means of a modified sand-pile model. This paper presents a full discussion of the experiments that allowed to reach that conclusion and of the model proposed to rationalize the results. In addition, the results of experiments devised to understand the transition from friction with debris to friction without debris (experiment initiated without blowing and after some time switching on blowing) and vice versa are reported. The results of further studies of the wear track are presented, namely, the variation in the track width with sliding distance and results of chemical analyses and surface roughness measurements of the track, for both with or without debris blowing experiments. These additional data give further support to the crucial role of debris in the 1/f character of the friction force.
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Affiliation(s)
- I Vragovic
- Departamento de Física Aplicada and Instituto Universitario de Materiales, Universidad de Alicante, San Vicente del Raspeig, Alicante, Spain
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Yazdanpanah Y, Fagard C, Descamps D, Taburet AM, Colin C, Roquebert B, Katlama C, Pialoux G, Jacomet C, Piketty C, Bollens D, Molina JM, Chêne G. High Rate of Virologic Suppression with Raltegravir plus Etravirine and Darunavir/Ritonavir among Treatment‐Experienced Patients Infected with Multidrug‐Resistant HIV: Results of the ANRS 139 TRIO Trial. Clin Infect Dis 2009; 49:1441-9. [PMID: 19814627 DOI: 10.1086/630210] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Y Yazdanpanah
- Hôpital Tourcoing, Lille School of Medicine, Lille, France.
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Priego P, Ramiro C, Molina JM, Rodríguez Velasco G, Lobo E, Galindo J, Fresneda V. Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience. Rev Esp Enferm Dig 2009; 101:20-30. [PMID: 19335030 DOI: 10.4321/s1130-01082009000100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. MATERIAL AND METHODS Between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of women and 30.2% of men, with a mean age of 56.95 years (range 9-94 years). In all, 54.68% of patients had a concomitant disease before surgery (hypertension, diabetes, ischemic heart disease, respiratory disease). Surgery was performed by a staff surgeon for 58.04% of cases, and by a resident in the remaining 41.96%. Surgical indications were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis in 6.3%, choledocholithiasis in 3.05%, and others in 1.2% of cases. RESULTS Mean hospital stay was 3.06 days. Conversion to open surgery was required for 8.3% of cases (331 patients). The major surgical complication rate was 2.34%, with the most frequent being hemoperitoneum (1%). Common bile duct injury occurred in thirteen cases (0.3%), 51 patients (1.3%) were soon re-operated, and 5 patients died (0.13%). When the results of both decades (1991-2000 vs. 2001-2007) were compared, we observed differences in the number of procedures performed by residents (31.7 vs. 51.1%, p = 0.00001), number of laparoscopic cholecystectomies for cholecystitis (4.9 vs. 7.53%, p = 0.001), conversion rate (5.46 vs. 11%, p = 0.000001), and mean hospital stay (2.43 vs. 3.7 days, p = 0.001). CONCLUSION These results should be interpreted with caution as this is a retrospective study with multiple uncontrolled variables (high number of surgeons and continuous learning curve). The lower conversion rate and mean hospital stay in the first decade of the learning curve are amazing, although this could be related to better patient selection and a lower number of cholecystites operated using a laparoscopic approach in the initial series. In general, these results are acceptable and concur with the rest of the literature.
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Affiliation(s)
- P Priego
- Department of General Surgery, Hospital General de Castellón, Spain.
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