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Palich R, Saliba S, Landowski S, Abdi B, Valantin MA, Mahrez R, Katlama C, de Truchis P. Intermittent doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintains a high level of viral suppression in virologically suppressed people living with HIV. Infect Dis Now 2023; 53:104736. [PMID: 37321402 DOI: 10.1016/j.idnow.2023.104736] [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: 01/17/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION We aimed to determine whether doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) given 5 or 4 days a week was able to maintain viral suppression in people living with HIV (PLHIV). METHODS In this observational, retrospective study, we included all PLHIVs who had received intermittent DOR/3TC/TDF between 10/01/2019 and 01/31/2021, in two French hospitals. RESULTS Forty-three PLHIVs were included, median (IQR) age: 52 years (48-58), ART duration: 15 years (8-23), duration of virological suppression: 6 years (2-10). Median follow-up was 78 weeks (IQR 62-97). One virological failure (VF) occurred at W38 (HIV-RNA = 61 and 76 copies/mL), in a patient with no viral resistance at baseline or at time of VF, and during the study period five individuals discontinued DOR/3TC/TDF due to adverse events. There were no significant changes during follow-up in the CD4 count, CD4/CD8 ratio, body weight or residual viremia rate. CONCLUSION These findings suggest the potential for intermittent DOR/3TC/TDF to maintain virological control.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France.
| | - Sanaa Saliba
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Stéphanie Landowski
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health institute (iPLESP), INSERM U1136, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Rezak Mahrez
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Paris, France
| | - Pierre de Truchis
- Paris-Saclay University, Infectious Diseases Department, Raymond Poincare Hospital, AP-HP, Garches, France
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Bérot V, Eremin A, Fauchois A, Dechamp J, Schneider L, Chermak A, Faycal A, Sellem B, Orriere T, Favier M, Tubiana R, Valantin MA, Pourcher V, Todesco E, Monsel G, Agher R, Palich R, Katlama C. Hepatitis A, hepatitis B and HPV vaccine needs and coverage in MSM initiating HIV PrEP in a sexual health clinic in Paris. Sex Transm Infect 2023:sextrans-2023-055802. [PMID: 37173130 DOI: 10.1136/sextrans-2023-055802] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Vincent Bérot
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Anton Eremin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Antoine Fauchois
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Jeanne Dechamp
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Luminita Schneider
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Aziza Chermak
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Antoine Faycal
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Baptiste Sellem
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Thibault Orriere
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Marion Favier
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Roland Tubiana
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | - Valerie Pourcher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | - Eve Todesco
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Gentiane Monsel
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Rachid Agher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
| | - Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, Île-de-France, France
- INSERM U1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, Île-de-France, France
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Sellem B, Abdi B, Lê M, Tubiana R, Valantin MA, Seang S, Schneider L, Fayçal A, Peytavin G, Soulié C, Marcelin AG, Katlama C, Pourcher V, Palich R. Intermittent Bictegravir/Emtricitabine/Tenofovir Alafenamide Treatment Maintains High Level of Viral Suppression in Virally Suppressed People Living with HIV. J Pers Med 2023; 13:jpm13040583. [PMID: 37108969 PMCID: PMC10145141 DOI: 10.3390/jpm13040583] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
In this observational study, we aimed to evaluate whether bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) administered 5 or 4 days a week is able to maintain viral suppression in people living with HIV (PLHIV). We enrolled 85 patients who initiated intermittent B/F/TAF between 28 November 2018 and 30 July 2020: median (IQR) age 52 years (46–59), duration of virological suppression 9 years (3–13), CD4 633/mm3 (461–781). Median follow-up was 101 weeks (82–111). The virological success rate (no virological failure [VF]: confirmed plasma viral load [pVL] ≥ 50 copies/mL, or single pVL ≥ 200 copies/mL, or ≥50 copies/mL with ART change) was 100% (95%CI 95.8–100) and the strategy success rate (pVL < 50 copies/mL with no ART regimen change) was 92.9% (95%CI 85.3–97.4) at W48. Two VF occurred at W49 and W70, in 2 patients self-reporting poor compliance. No resistance mutation emerged at time of VF. Eight patients presented strategy discontinuation for adverse events. There was no significant change in the CD4 count, residual viraemia rate, neither body weight during follow-up, but a slight increase in CD4/CD8 ratio (p = 0.02). In conclusion, our findings suggest that B/F/TAF administered 5 or 4 days a week could maintain the control of HIV replication in virologically suppressed PLHIV while reducing cumulative exposition of ART.
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Nouchi A, Brin C, Martin A, Favier M, Palich R, Wakim Y, Gavaud A, Seang S, Valantin MA, Bleibtreu A, Burrel S, Bérot V, Pourcher V, Monsel G. Prospective cohort of 70 consecutive cases of human monkeypox: Clinical description with focus on dermatological presentation. J Eur Acad Dermatol Venereol 2023; 37:e403-e405. [PMID: 36377334 DOI: 10.1111/jdv.18742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Agathe Nouchi
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,MonkeyPeauX Group, GrIDIST (Infectious and Sexually Transmitted Infections Group) of the French Society of Dermatology, Paris, France
| | - Cécile Brin
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,MonkeyPeauX Group, GrIDIST (Infectious and Sexually Transmitted Infections Group) of the French Society of Dermatology, Paris, France
| | - Abigail Martin
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marion Favier
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Romain Palich
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Yara Wakim
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Ariane Gavaud
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Sophie Seang
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marc-Antoine Valantin
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Alexandre Bleibtreu
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Sonia Burrel
- Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Vincent Bérot
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,MonkeyPeauX Group, GrIDIST (Infectious and Sexually Transmitted Infections Group) of the French Society of Dermatology, Paris, France
| | - Valérie Pourcher
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Gentiane Monsel
- Department of Infectious and Tropical Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,MonkeyPeauX Group, GrIDIST (Infectious and Sexually Transmitted Infections Group) of the French Society of Dermatology, Paris, France
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Pourcher V, Capeau J, Dudoit Y, Boccara F, Soulié C, Ndoadoumgue AL, Charlotte F, Fellahi S, Bastard JP, Béréziat V, Lagathu C, Marcelin AG, Peytavin G, Boutron-Ruault MC, Tubbax C, D'Avout D'Auerstaedt A, Valantin MA, Schneider L, Costagliola D, Katlama C, Assoumou L, Pourcher G. Comparison of HIV-Infected and Noninfected Patients Undergoing Bariatric Surgery: The ObeVIH Study. J Acquir Immune Defic Syndr 2022; 90:240-248. [PMID: 35185138 DOI: 10.1097/qai.0000000000002939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare clinical characteristics and adipose/liver tissue histology analysis in HIV-infected and HIV-uninfected subjects undergoing bariatric surgery. DESIGN This was a cross-sectional study of HIV-infected subjects undergoing single-port sleeve gastrectomy with prospective enrolment and frequency age (±5 years), sex, and body mass index (BMI, ± 5 kg/m2) matched on HIV-uninfected subjects. METHODS This study was conducted at a single clinical site at Pitié-Salpêtrière hospital-Paris-France comprising 19 HIV-uninfected and 21 HIV-infected subjects with plasma VL < 20 copies/mL, all with a BMI > 40 kg/m2 or >35 kg/m2 with comorbidities. Histology of subcutaneous and visceral abdominal adipose tissue (SCAT/VAT) and liver biopsies was collected during single-port sleeve gastrectomy. Outcomes included anthropometric characteristics, comorbidities, cardiovascular parameters, adipose tissue, and liver histology. RESULTS The age of HIV-infected participants was (median, interquartile range IQR) 48 y (42-51), with 76.2% females, a BMI of 41.4 kg/m2 (37.3-44.4), an antiretroviral duration of 16 y (8-21), current integrase strand transfer inhibitor (INSTI)-based regimen in 15 participants and non-INSTI regimen in 6 participants, and a CD4 count of 864/mm3 (560-1066). The age of controls was 43 y (37-51), with 78.9% females and a BMI of 39.2 kg/m2 (36.3-42.6). Anthropometric characteristics, comorbidities, and cardiovascular parameters did not differ according to HIV status and INSTI treatment. The number of macrophage crown-like structures in SCAT was lower in INSTI-treated participants than in HIV-uninfected participants (P = 0.02) and non-INSTI-treated HIV-infected subjects (P = 0.07). Hepatic steatosis and liver disease severity global score were lower in INSTI-treated participants than in non-INSTI-treated HIV-infected participants (P = 0.05 and P = 0.04, respectively). CONCLUSIONS HIV-infected and HIV-uninfected subjects undergoing bariatric surgery presented a similar profile regarding anthropometric measures, cardiovascular parameters, and comorbidities. However, INSTI-treated participants presented milder SCAT and liver alterations than non-INSTI-treated participants.
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Affiliation(s)
- V Pourcher
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - J Capeau
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Y Dudoit
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - F Boccara
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Sorbonne Université, GRC n°22, C MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Saint-Antoine Service de Cardiologie, Paris, France
| | - C Soulié
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
- Laboratoire de Virologie, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - A L Ndoadoumgue
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - F Charlotte
- Service d'anatomie pathologique, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - S Fellahi
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Biochemistry-Pharmacology-Molecular Biology, APHP, Hôpital Henri-Mondor, Université Paris Est Créteil, France
| | - J P Bastard
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Biochemistry-Pharmacology-Molecular Biology, APHP, Hôpital Henri-Mondor, Université Paris Est Créteil, France
| | - V Béréziat
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - C Lagathu
- Sorbonne Université, INSERM UMR_S 938, Centre de Recherche Saint-Antoine (CRSA), RHU CARMMA, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - A G Marcelin
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
- Laboratoire de Virologie, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - G Peytavin
- APHP, Service de Pharmacologie and Toxicologie, Hôpital Bichat, IAME, Inserm UMR 1137, UF301, Université de Paris, Paris, France
| | - M C Boutron-Ruault
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France; and
| | - C Tubbax
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France; and
| | - A D'Avout D'Auerstaedt
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France; and
| | - M A Valantin
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - L Schneider
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - D Costagliola
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - C Katlama
- Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - L Assoumou
- Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - G Pourcher
- Obesity Center, Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France; and
- Centre de Recherche en Epidémiologie et Santé des Population (CESP), Inserm, Paris-Saclay University, France
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Rojas Rojas T, Poizot-Martin I, Rey D, Duvivier C, Bani-Sadr F, Cabie A, Delobel P, Jacomet C, Allavena C, Ferry T, Pugliese P, Valantin MA, Lamaury I, Hustache-Matthieu L, Fresard A, Houyou T, Huleux T, Cheret A, Makinson A, Obry-Roguet V, Lions C, Carrieri MP, Protopopescu C. Incidence of cervical, breast and colorectal cancers between 2010 and 2015 in people living with HIV in France. PLoS One 2022; 17:e0261069. [PMID: 35333883 PMCID: PMC8956191 DOI: 10.1371/journal.pone.0261069] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to evaluate the incidence rates between 2010 and 2015 for invasive cervical cancer (ICC), breast cancer (BC), and colorectal cancer (CRC) in people living with HIV (PLWH) in France, and to compare them with those in the French general population. These cancers are targeted by the national cancer-screening program. SETTING This is a retrospective study based on the longitudinal data of the French Dat'AIDS cohort. METHODS Standardized incidence ratios (SIR) for ICC and BC, and incidence rates for all three cancers were calculated overall and for specific sub-populations according to nadir CD4 cell count, HIV transmission category, HIV diagnosis period, and HCV coinfection. RESULTS The 2010-2015 CRC incidence rate was 25.0 [95% confidence interval (CI): 18.6-33.4] per 100,000 person-years, in 44,642 PLWH (both men and women). Compared with the general population, the ICC incidence rate was significantly higher in HIV-infected women both overall (SIR = 1.93, 95% CI: 1.18-3.14) and in the following sub-populations: nadir CD4 ≤ 200 cells/mm3 (SIR = 2.62, 95% CI: 1.45-4.74), HIV transmission through intravenous drug use (SIR = 5.14, 95% CI: 1.93-13.70), HCV coinfection (SIR = 3.52, 95% CI: 1.47-8.47) and HIV diagnosis before 2000 (SIR = 2.06, 95% CI: 1.07-3.97). Conversely, the BC incidence rate was significantly lower in the study sample than in the general population (SIR = 0.56, 95% CI: 0.42-0.73). CONCLUSION The present study showed no significant linear trend between 2010 and 2015 in the incidence rates of the three cancers explored in the PLWH study sample. Specific recommendations for ICC screening are still required for HIV-infected women and should focus on sub-populations at greatest risk.
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Affiliation(s)
- Teresa Rojas Rojas
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Isabelle Poizot-Martin
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - David Rey
- Le Trait d’Union, HIV-Infection Care Center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
- Institut Cochin—CNRS 8104—INSERM U1016—RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France
- Centre Médical de l’Institut Pasteur, Institut Pasteur, Paris, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - André Cabie
- Université des Antilles, CHU de Martinique, Fort-de-France, Martinique, France
| | - Pierre Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR 1043- Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christine Jacomet
- Clermont-Ferrand University Hospital Infectious and Tropical disease Department, Clermont Ferrand, France
| | - Clotilde Allavena
- Infectious Diseases Department, CHU Hôtel-Dieu, INSERM UIC 1413, CHU Nantes, Nantes, France
| | - Tristan Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | | | - Marc-Antoine Valantin
- GHPS Pitié Salpêtrière APHP, Infectious Diseases, Paris, France
- Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - Anne Fresard
- Department of Infectious and Tropical Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Tamazighth Houyou
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Thomas Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur—Centre Hospitalier G. DRON Tourcoing, Tourcoing, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department of Internal Medicine, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Alain Makinson
- Department of Infectious Diseases, Montpellier University Hospital, INSERM U1175/IRD UMI 233, Montpellier, France
| | - Véronique Obry-Roguet
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Caroline Lions
- Aix-Marseille Univ, APHM Sainte-Marguerite, Clinical Immuno-Hematological Unit Marseille, Marseille, France
| | - Maria Patrizia Carrieri
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Camelia Protopopescu
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional De La Santé Provence-Alpes-Côte d’Azur, Marseille, France
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7
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Dalla-Pozza P, Hentzien M, Allavena C, Doe de Maindreville A, Bouiller K, Valantin MA, Lafont E, Zaegel-Faucher O, Cheret A, Martin-Blondel G, Cotte L, Bani-Sadr F. Progressive multifocal leukoencephalopathy in patients with immunovirological control and at least 6 months of combination antiretroviral therapy. AIDS 2022; 36:539-549. [PMID: 34873087 DOI: 10.1097/qad.0000000000003145] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES AND METHODS : Progressive multifocal leukoencephalopathy (PML) has rarely been reported in people with HIV (PWH) with long-term HIV immune-virological control. We describe the clinical and biological characteristics of patients with confirmed PML among PWH with a CD4+ cell count more than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of combined antiretroviral therapy (cART) at the time of PML diagnosis, in the large French multicenter Dat'AIDS cohort. RESULTS : Among 571 diagnoses of PML reported in the Dat'AIDS cohort between 2000 and 2019, 10 cases (1.75%) occurred in PWH with a CD4+ cell count greater than 200 cells/μl and an undetectable HIV RNA viral load after at least 6 months of cART. Median CD4+ cell count at PML diagnosis was 395 cells/μl (IQR 310-477). The median duration between the last detectable HIV viral load and the PML diagnosis was 41.1 months (IQR 8.2-67.4). Only one patient treated with rituximab-based chemotherapy for a large B-cell lymphoma had an established risk factor for PML. Among the nine other patients with no apparent severe immunodeficiency, multiple factors of impaired immunity could have led to the development of PML: hepatitis C virus (HCV) co-infection (n = 6), cirrhosis (n = 4), HHV-8 co-infection (n = 3) with Kaposi's sarcoma (n = 2) in association with Castleman's disease (n = 1) and indolent IgA multiple myeloma (n = 1). CONCLUSION : This study highlights that factors other than low CD4+ cell count and high HIV viral load may be associated with the occurrence of PML. Further studies are warranted to investigate in greater detail the immunologic characteristics of PWH with immune-virological control who develop PML.
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Affiliation(s)
- Paul Dalla-Pozza
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
| | - Maxime Hentzien
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
| | - Clotilde Allavena
- Department of Infectious Diseases, University Hospital of Nantes, Nantes
| | | | - Kévin Bouiller
- Department of Infectious Diseases, University Hospital of Besancon
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris
| | - Emmanuel Lafont
- Department of Infectious Diseases, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris
| | - Olivia Zaegel-Faucher
- Department of Immunology and Hematology, Sainte-Marguerite Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille
| | - Antoine Cheret
- Department of Internal Medicine, Kremlin Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Bicêtre
| | - Guillaume Martin-Blondel
- Department of Infectious Diseases, University Hospital of Toulouse, Toulouse, France and Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse
| | - Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, and INSERM U1052, Lyon
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital of Reims
- University of Reims Champagne-Ardenne, EA-4684/SFR CAP-SANTE, Reims, F-51095, France
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8
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Katlama C, Dudoit Y, Huyard J, Blanc C, Soulié C, Schneider L, Faycal A, Lenclume L, Hamani N, Qatib N, Tubiana R, Seang S, Sellem B, Costagliola D, Palich R, Valantin MA, Assoumou L. Household transmission of SARS-CoV-2 infection in the Paris/Ile-de-France area. Eur J Clin Microbiol Infect Dis 2022; 41:445-454. [PMID: 34997388 PMCID: PMC8741543 DOI: 10.1007/s10096-021-04345-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023]
Abstract
This st udy aims to evaluate the prevalence of SARS-CoV-2 antibodies in locked-down family households to determine viral dynamics and immunity acquisition. COVID-19 individuals and their households in lockdown under the same roof during early spring 2020 were interviewed and tested using rapid immunochromatographic lateral flow antibodies assays (LFA) between July and September 2020. Outcomes were secondary infection rate (SIR) among contacts, household infection rate, and predictors of transmission. We enrolled 87 households including 87 COVID-19 index cases (female 78.2%; median age: 47.0 years, IQR: 42.0-51.5) and 255 contacts (males: 52.9%; median age: 19.0 years, IQR: 11.0-43.5) consisting of their children (42%) or spouses/partners (28.2%). A total of 95/255 contacts were SARS-CoV-2 antibody positive leading to a SIR of 37.3% (95% confidence interval (CI): 31.3-43.5%). Viral transmission was observed in 54 households (62%). SARS-CoV-2 infection was asymptomatic in 33/95 (34.7%) of SARS-CoV-2-positive contacts. Independent predictors of virus transmission from index to contacts were housing surface area < 60 m2 (OR: 5.6 [1.1; 28.2] and a four-member family compared to five (OR: 3.6 [1.2; 10.3]). Households represent a high-risk setting for SARS-CoV-2 transmission through close contact within the family amplified by the number of family members and the housing surface area.
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Affiliation(s)
- Christine Katlama
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France.
- Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP 47-83 Boulevard de l'hôpital, 75013, Paris, France.
| | - Yasmine Dudoit
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Julien Huyard
- INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), Sorbonne Université, 75013, Paris, France
| | - Christine Blanc
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Cathia Soulié
- Department of Virology, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013, Paris, France
| | - Luminita Schneider
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Antoine Faycal
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Ludovic Lenclume
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Naima Hamani
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Naoual Qatib
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Roland Tubiana
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Sophie Seang
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Baptiste Sellem
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Dominique Costagliola
- INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), Sorbonne Université, 75013, Paris, France
| | - Romain Palich
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Sorbonne Université, 16 75013, Paris, France
| | - Lambert Assoumou
- INSERM, Pierre Louis Epidemiology and Public Health Institute (iPLESP), Sorbonne Université, 75013, Paris, France
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9
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Poizot-Martin I, Brégigeon S, Palich R, Marcelin AG, Valantin MA, Solas C, Veyri M, Spano JP, Makinson A. Immune Reconstitution Inflammatory Syndrome Associated Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14040986. [PMID: 35205734 PMCID: PMC8869819 DOI: 10.3390/cancers14040986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
People living with HIV (PLWH) with advanced immunosuppression who initiate antiretroviral therapy (ART) are susceptible to the occurrence of an immune reconstitution inflammatory syndrome (IRIS). Although ART is responsible for AIDS- associated Kaposi sarcoma (KS) improvement and resolution, new onset (unmasking KS-IRIS) or sudden progression of preexisting KS (paradoxical KS-IRIS) can occur after a time delay of between a few days and 6 months after the initiation or resumption of ART, even in patients with a low degree of immunocompromise. KS-IRIS incidence varies from 2.4% to 39%, depending on study design, populations, and geographic regions. Risk factors for developing KS-IRIS include advanced KS tumor stage (T1), pre-treatment HIV viral load >5 log10 copies/mL, detectable pre-treatment plasma-KSHV, and initiation of ART alone without concurrent chemotherapy. Both paradoxical and unmasking KS-IRIS have been associated with significant morbidity and mortality, and thrombocytopenia (<100,000 platelets/mm3 at 12 weeks) has been associated with death. KS-IRIS is not to be considered as ART failure, and an ART regimen must be pursued. Systemic chemotherapy for KS in conjunction with ART is recommended and, in contrast with management of IRIS for other opportunistic infections, glucocorticoids are contra-indicated. Despite our preliminary results, the place of targeted therapies in the prevention or treatment of KS-IRIS needs further assessment.
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Affiliation(s)
- Isabelle Poizot-Martin
- Assistance Publique-Hôpitaux de Marseille (APHM), Inserm, Institut de Recherche pour le Développement (IRD), SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, APHM Sainte-Marguerite, Service D’immuno-Hématologie Clinique, Aix-Marseille Université, 13009 Marseille, France
- Correspondence: ; Tel.: +33-4-9174-4966 or +33-4-9174-6163; Fax: +33-4-9174-4962
| | - Sylvie Brégigeon
- Assistance Publique-Hôpitaux de Marseille (APHM) Sainte-Marguerite, Service D’immuno-Hématologie Clinique, Aix-Marseille Université, 13009 Marseille, France;
| | - Romain Palich
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France; (R.P.); (M.-A.V.)
| | - Anne-Geneviève Marcelin
- INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Sorbonne Université, 75013 Paris, France;
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France; (R.P.); (M.-A.V.)
| | - Caroline Solas
- Assistance Publique-Hôpitaux de Marseille (APHM), Hôpital La Timone, Laboratoire de Pharmacocinétique et Toxicologie, INSERM 1207, IRD 190, Unité des Virus Emergents, Aix-Marseille Université, 13005 Marseille, France;
| | - Marianne Veyri
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Institut Universitaire de Cancérologie (IUC), CLIP2 Galilée, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne Université, 75013 Paris, France; (M.V.); (J.-P.S.)
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Institut Universitaire de Cancérologie (IUC), CLIP2 Galilée, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne Université, 75013 Paris, France; (M.V.); (J.-P.S.)
| | - Alain Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, 34000 Montpellier, France;
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10
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Valantin MA, Royston L, Hentzien M, Jary A, Makinson A, Veyri M, Ronot-Bregigeon S, Isnard S, Palich R, Routy JP. Therapeutic Perspectives in the Systemic Treatment of Kaposi’s Sarcoma. Cancers (Basel) 2022; 14:cancers14030484. [PMID: 35158752 PMCID: PMC8833559 DOI: 10.3390/cancers14030484] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Alternative systemic treatments are needed for patients who develop chemotherapy-refractory KS. Anti-angiogenic therapies constitute interesting therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis, and could represent attractive alternatives. Immune checkpoints blockade could also be an interesting therapeutic approach in order to restore anti-HHV-8 immunity and tumor control. Abstract In patients with Kaposi’s sarcoma (KS), the therapeutic goal is to achieve a durable remission in the size and number of skin and visceral lesions. Although most patients show tumor regression in response to standard systemic chemotherapy regimens, alternative systemic treatments are needed for patients who develop refractory KS. Anti-angiogenic therapies represent attractive therapeutic targets in this context, due to the central role of angiogenesis in KS pathogenesis. Pomalidomide, which exhibits such anti-angiogenic activity through inhibition of VEGF, currently constitutes the most promising agent of this class and has been recently approved by the FDA. In addition, immune checkpoint blockade also represents an interesting alternative therapeutic approach through the restoration of immunity against HHV-8, the causative agent of KS, and improvement of tumor control. Although small series of cases treated successfully with these drugs have been reported, there is no marketing approval for anti-immune checkpoint antibodies for KS to date. In the present review, we will discuss potential therapeutic options for patients with recurrent or refractory KS, including systemic chemotherapies, immune checkpoint inhibitors, anti-herpesvirus agents, and anti-angiogenic drugs. Well-conducted clinical trials in this population are urgently needed to correctly address the efficacy of targeted agents and immunomodulators, while monitoring for adverse effects.
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Affiliation(s)
- Marc-Antoine Valantin
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Léna Royston
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Infectious Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: (M.-A.V.); (L.R.); Tel.: +33-142-160-144 (M.-A.V.); +15-14-934-1934 (ext. 76487) (L.R.); Fax: +33-142-1601 (M.-A.V.)
| | - Maxime Hentzien
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU Robert Debré, 51090 Reims, France;
| | - Aude Jary
- Service de Virologie, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Alain Makinson
- Infectious Diseases Department, INSERM U1175, University Hospital of Montpellier, 34000 Montpellier, France;
| | - Marianne Veyri
- Service d’Oncologie Médicale, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Sorbonne University, 75013 Paris, France;
| | - Sylvie Ronot-Bregigeon
- Service d’Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Aix Marseille Université, 13009 Marseille, France;
| | - Stéphane Isnard
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM U1136, Sorbonne University, 75013 Paris, France;
| | - Jean-Pierre Routy
- Infectious Diseases and Immunity in Global Health Program & Chronic Viral Illness Service, McGill University Health Centre, Montréal, QC H4A3J1, Canada; (S.I.); (J.-P.R.)
- Division of Hematology, McGill University Health Centre, Montréal, QC H4A3J1, Canada
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11
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Palich R, Teyssou E, Sayon S, Abdi B, Soulie C, Cuzin L, Tubiana R, Valantin MA, Schneider L, Seang S, Wirden M, Pourcher V, Katlama C, Calvez V, Marcelin AG. Kinetics of archived M184V mutation in treatment-experienced virally suppressed HIV-infected patients. J Infect Dis 2021; 225:502-509. [PMID: 34415048 DOI: 10.1093/infdis/jiab413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/19/2021] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We aimed to assess the kinetics of drug-resistant viral variants (DRVs) harboring the M184V mutation in the proviral DNA of long-term virally suppressed patients, and factors associated with DRV persistence. METHODS HIV-DNA from blood cells stored in 2019 and 2016 was sequenced using both Sanger and ultradeep sequencing (SS and UDS, with a detection threshold of 1%) in ART-treated patients with HIV-RNA <50 copies/mL for at least 5 years, with past M184V mutation documented in HIV-RNA. RESULTS Among the 79 tested patients, by combining SS and UDS, the M184V was found to be absent in 26/79 (33%) patients (M184V- patients), and persisted in 53/79 (67%) (M184V+ patients). The M184V+ patients had a longer history of ART, a lower CD4 nadir and higher pretherapeutic HIV-RNA. Among the 37 patients with viral sequences assessed by UDS, the proportion of M184V+ DRVs significantly decreased between 2016 and 2019 (40% versus 14%, p=0.005). The persistence of M184V was associated with the duration and level of HIV-RNA replication under 3TC/FTC (p=0.0009 and p=0.009, respectively). CONCLUSION While it decreased over time in HIV-DNA, the M184V mutation was more frequently persistent in the HIV-DNA of more experienced patients with longer past replication under 3TC/FTC.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France.,Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Elisa Teyssou
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Sophie Sayon
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Cathia Soulie
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Lise Cuzin
- CERPOP, Toulouse University, Inserm UMR, UPS, Toulouse, France.,Martinique University Hospital, Infectious Diseases Department, Fort-de-France, France
| | - Roland Tubiana
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Luminita Schneider
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Sophie Seang
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Marc Wirden
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Valérie Pourcher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Vincent Calvez
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM, Paris, France
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12
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Abdi B, Lambert-Niclot S, Wirden M, Jary A, Teyssou E, Sayon S, Palich R, Tubiana R, Simon A, Valantin MA, Katlama C, Morand-Joubert L, Calvez V, Marcelin AG, Soulie C. Presence of HIV-1 G-to-A mutations linked to APOBEC editing is more prevalent in non-B HIV-1 subtypes and is associated with lower HIV-1 reservoir. J Antimicrob Chemother 2021; 76:2148-2152. [PMID: 33930161 DOI: 10.1093/jac/dkab123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/14/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES APOBEC3 editing activity contributes to sequences variation and viral diversification. We aimed to characterize virological and clinical factors associated with G-to-A mutations and stop codons in the HIV-1 reservoir, markers of APOBEC3 footprints, in order to better understand HIV-1 diversity among virologically suppressed HIV-1-infected patients. METHODS Immuno-virological and clinical factors were compared between 92 patients harbouring G-to-A mutations and stop codons (APOBEC+) in the reverse transcriptase gene and 92 patients without G-to-A mutations (APOBEC-) and stop codons in their DNA genotypes. RESULTS Patients were predominantly men (74.5%) and were mostly infected by B-subtype (69.0%), with 44.1% and 55.9% in APOBEC+ and APOBEC- groups, respectively. At time of HIV DNA genotypes, the total cell-associated HIV-1 DNA load was 2.34 log10 copies/106 cells (IQR 1.85-2.67) and 33.2% of them had a detectable ultrasensitive plasma viral load. Hypermutated sequences were identified in 28.2% of the APOBEC+ group. The median total cell-associated HIV-1 DNA level was significantly lower in APOBEC+ than APOBEC- group: 2.13 log10 copies/106 cells (IQR 1.60-2.60) versus 2.52 log10 copies/106 cells (IQR 2.19-2.71) (P < 0.001), respectively. Presence of G-to-A mutations and stop codon was independently associated with HIV-1 subtype non-B (P = 0.017). CONCLUSIONS These results show an independent association between the presence of G-to-A mutations and stop codons with HIV-1 subtype non-B and low proviral DNA that could be explained by the APOBEC3 footprints and restriction of DNA synthesis and integration. However, further investigations are needed to study the contribution of Vif amino acid variability among HIV-1 subtypes.
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Affiliation(s)
- Basma Abdi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Sidonie Lambert-Niclot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Saint Antoine, Laboratoire de virologie, Paris, France
| | - Marc Wirden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Aude Jary
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Elisa Teyssou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Sophie Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Romain Palich
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Roland Tubiana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Anne Simon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service de Médecine Interne, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Service des Maladies Infectieuses, Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Saint Antoine, Laboratoire de virologie, Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Cathia Soulie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
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Abdi B, Chebbi M, Wirden M, Teyssou E, Sayon S, Palich R, Seang S, Valantin MA, Simon A, Tubiana R, Katlama C, Calvez V, Marcelin AG, Soulie C. No difference in HIV-1 integrase inhibitor resistance between CSF and blood compartments. J Antimicrob Chemother 2021; 76:1553-1557. [PMID: 33693680 DOI: 10.1093/jac/dkab064] [Citation(s) in RCA: 1] [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] [Received: 12/18/2020] [Accepted: 02/10/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Little is known about HIV-1 integrase inhibitor resistance in the CNS. OBJECTIVES This study aimed to evaluate integrase inhibitor resistance in CSF, as a marker of the CNS, and compare it with the resistance in plasma. METHODS HIV integrase was sequenced both in plasma and CSF for 59 HIV-1 patients. The clinical and biological data were collected from clinical routine care. RESULTS Among the 59 HIV-1 patients, 32 (54.2%) were under antiretroviral (ARV) treatment. The median (IQR) HIV-1 RNA in the plasma of viraemic patients was 5.32 (3.85-5.80) and 3.59 (2.16-4.50) log10 copies/mL versus 4.79 (3.56-5.25) and 3.80 (2.68-4.33) log10 copies/mL in the CSF of ARV-naive and ARV-treated patients, respectively. The patients were mainly infected with non-B subtypes (72.2%) with the most prevalent recombinant form being CRF02_AG (42.4%). The HIV-1 integrase sequences from CSF presented resistance mutations for 9/27 (33.3%) and 8/32 (25.0%) for ARV-naive (L74I, n = 3; L74I/M, n = 1; T97A, n = 1; E157Q, n = 4) and ARV-treated (L74I, n = 6; L74M, n = 1; T97A, n = 1; N155H, n = 1) patients, respectively. Integrase inhibitor resistance mutations in CSF were similar to those in plasma, except for 1/59 patients. CONCLUSIONS This work shows similar integrase inhibitor resistance profiles in the CNS and plasma in a population of HIV-1 viraemic patients.
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Affiliation(s)
- Basma Abdi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Mouna Chebbi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Marc Wirden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Elisa Teyssou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Sophie Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Romain Palich
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Maladies Infectieuses, F75013, Paris, France
| | - Sophie Seang
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Maladies Infectieuses, F75013, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Maladies Infectieuses, F75013, Paris, France
| | - Anne Simon
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Service de Médecine Interne, F75013 Paris, France
| | - Roland Tubiana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Maladies Infectieuses, F75013, Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Service de Maladies Infectieuses, F75013, Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
| | - Cathia Soulie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Laboratoire de Virologie, F75013, Paris, France
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14
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Palich R, Abdi B, Wirden M, Lourida G, Tubiana R, Faycal A, Valantin MA, Schneider L, Seang S, Agher R, Simon A, Soulie C, Le MP, Peytavin G, Calvez V, Marcelin AG, Katlama C. Intermittent two-drug antiretroviral therapies maintain long-term viral suppression in real life in highly experienced HIV-infected patients. J Antimicrob Chemother 2021; 76:1893-1897. [PMID: 33855355 DOI: 10.1093/jac/dkab108] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess in real life whether two-drug regimens (2-DRs) given 4-5 days a week in virally suppressed patients can maintain viral suppression over 48 and 96 weeks. METHODS This observational single-centre study enrolled all patients who initiated an intermittent 2-DR between 01/01/2016 and 30/06/2019. The primary outcome was the rate of virological failure (VF), defined as confirmed plasma viral load (pVL) ≥50 copies/mL or single pVL ≥50 copies/mL followed by ART change at week 48 (W48) and W96. Secondary outcomes were the 2-DR intermittent strategy success rate (pVL <50 copies/mL with no ART change), change in CD4 count, CD4/CD8 ratio and rate of residual viraemia. RESULTS Eighty-five patients were included; 67/85 (79%) were men, median age = 57 years (IQR = 50-63), CD4 nadir = 233 cells/mm3 (110-327), ART duration = 21 years (13-24), duration of virological suppression = 6.5 years (3.7-10.8) and CD4 count = 658 cells/mm3 (519-867). Intermittent 2-DRs consisted of integrase strand transfer inhibitor (INSTI)/NNRTI (58%), INSTI/NRTI (13%), two NRTIs (11%), PI/NRTI (7%) and other combinations (11%). The median follow-up was 90 weeks (IQR = 64-111). Overall, four VFs occurred, leading to a virological success rate of 98.8% (95% CI = 93.6-100) at W48 and 95.3% (95% CI = 88.4-98.7) at W96. Resuming the same 2-DR 7 days a week led to viral resuppression in three patients, whereas the M184V mutation emerged in one patient, leading to ART modification. There was no significant change in the CD4 count or residual viraemia rate, but a small increase in the CD4/CD8 ratio (P = 0.009) occurred over the study period. CONCLUSIONS This observational study shows the potential for intermittent 2-DRs to maintain a high virological success rate, which should be assessed in larger prospective randomized studies.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Basma Abdi
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Marc Wirden
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Giota Lourida
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Roland Tubiana
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Antoine Faycal
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Luminita Schneider
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Seang
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Rachid Agher
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Anne Simon
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Cathia Soulie
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Minh-Patrick Le
- Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, AP-HP, INSERM, UMRS 1144, Université de Paris, Paris, France
| | - Gilles Peytavin
- Bichat Claude Bernard Hospital, Pharmacology-Toxicology Department, AP-HP, IAME, INSERM, UMRS 1137, Université de Paris, Paris, France
| | - Vincent Calvez
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne University, Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Christine Katlama
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
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15
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Soulie C, Assoumou L, Abdi B, Sayon S, Nguyen T, Valantin MA, Beniguel L, Ferre V, Alloui C, Montes B, Avettand-Fenoel V, Delaugerre C, Descamps D, Martinez E, Reynes J, Peytavin G, Costagliola D, Katlama C, Calvez V, Marcelin AG. Characterization of viral rebounds on dual etravirine/raltegravir maintenance therapy (ANRS-163 ETRAL trial). J Antimicrob Chemother 2021; 75:1943-1949. [PMID: 32259255 DOI: 10.1093/jac/dkaa090] [Citation(s) in RCA: 1] [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] [Received: 01/08/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The ANRS-163 ETRAL trial, a switch study to an etravirine 200 mg/raltegravir 400 mg twice-daily regimen in 165 patients with HIV-1 infection, showed durable efficacy until Week 96. The aim of this work was to investigate in detail the virological rebounds (VRs), defined as at least one plasma HIV viral load (VL) >50 copies/mL. METHODS Quantification of HIV-DNA level was assessed at baseline, Week 48 and Week 96 (n = 157). VLs were measured in seminal plasma at Week 48 (n = 26). Genotypic resistance testing by ultra-deep sequencing (UDS) for reverse transcriptase (RT) and integrase regions was performed at baseline and at the time of VR. RESULTS In this study, 19 patients experienced VR, with 2 patients having virological failure (VF; two consecutive VLs >50 copies/mL). For the first patient with VF, UDS detected minority resistant variants only in RT (K103N, 9.6%; Y181C, 4.9%) at baseline. Some RT variants became dominant at VF (K101E, 86.3%; Y181C, 100.0%; G190A, 100.0%) and others emerged in integrase (Y143C, 2.4%; Q148R, 6.2%; N155H, 18.8%). For the second patient with VF, neither RT nor integrase mutations were detected at baseline and VF. Median HIV-DNA level was similar at baseline, Week 48 and Week 96 (2.17, 2.06 and 2.11 log10 copies/106 cells, respectively). Only one patient had a detectable seminal HIV VL (505 copies/mL). CONCLUSIONS The dual etravirine/raltegravir regimen as maintenance therapy was effective and the emergence of mutations in cases of VF was similar to that seen in other dual-regimen studies. No HIV-DNA level modification was evidenced by Week 96.
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Affiliation(s)
- Cathia Soulie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013 Paris, France
| | - Basma Abdi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
| | - Sophie Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
| | - Thuy Nguyen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Service de maladies infectieuses, F75013 Paris, France
| | - Lydie Beniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013 Paris, France
| | | | - Chakib Alloui
- AP-HP, Hôpital Avicennes, Service de Virologie, Bobigny, France
| | | | - Véronique Avettand-Fenoel
- AP-HP, Hôpital Necker, Service de Virologie, Institut Cochin - CNRS 8104/INSERM U1016/Université Paris Descartes, Paris, France
| | | | - Diane Descamps
- Sorbonne Paris Cité, INSERM, IAME, UMR 1137, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Jacques Reynes
- CHU Montpellier, Département de maladies infectieuses, Montpellier, France
| | - Gilles Peytavin
- AP-HP, Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat-Claude Bernard and IAME, UMR 1137, Sorbonne Paris Cité and INSERM, Université Paris Diderot, Paris, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013 Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Service de maladies infectieuses, F75013 Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, laboratoire de virologie, F75013 Paris, France
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16
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Calin R, Landowski S, Valantin MA, Tubiana R, Palich R, Agher R, Marcou M, Blanc C, Katlama C, de Truchis P. Efficacy of intermittent short cycles of integrase inhibitor-based maintenance ART in virologically suppressed HIV patients. J Antimicrob Chemother 2021; 75:1321-1323. [PMID: 31977046 DOI: 10.1093/jac/dkz555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/01/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several studies have shown that NNRTI/PI-based triple therapy could be safely administered as a 4 days (4D) or 5 days (5D) a week maintenance strategy. We report here our experience of using an integrase inhibitor (INSTI)-based 4D/5D regimen in virologically suppressed HIV patients. METHODS This cohort study enrolled adult patients on ART with viral load (VL) <50 copies/mL for >1 year, who switched to an INSTI-based triple regimen given 4D/5D a week. The primary endpoint was the virological efficacy rate at Week (W) 48, with virological failure defined as confirmed VL ≥50 copies/mL. RESULTS A total of 73 patients were included (n = 28 for 4D, n = 45 for 5D): 54 men (74%), median (IQR) age 51 (45-57) years, ART duration 10 (6-18) years and duration of viral suppression 5 (2-9) years at baseline. As of 25 March 2019, the median follow-up was 21 (14-35) months, with a total of 161 patient-years of follow-up; all patients had reached the W24 visit, 66 (90%) W48 and 34 (47%) W96. Four patients discontinued the strategy: virological failure (n = 2) at W60 and W67, respectively, switch for renal toxicity (n = 1) at W28 and switch to rilpivirine/dolutegravir (n = 1) at W65. Overall the rate of virological success (95% CI) was 100% (94%-100%) at W24 and W48 and 93.7% (79.8%-98.2%) at W96. CONCLUSIONS While waiting for the final results of the large randomized QUATUOR ANRS-170 study, our real-life results suggest that the use of an intermittent maintenance triple-drug regimen given as a weekend (2 or 3 days) off is as effective with an INSTI-based regimen as with a PI or an NNRTI.
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Affiliation(s)
- Ruxandra Calin
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
- AP-HP, GHUEP, Tenon Hospital, Sorbonne Université, Paris, France
| | - Stephanie Landowski
- AP-HP, Raymond-Poincaré Hospital, Infectious Diseases Department, Garches France, Saint-Quentin-en-Yvelines University, Paris-Versailles, France
| | - Marc-Antoine Valantin
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Roland Tubiana
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Romain Palich
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Rachid Agher
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Morgane Marcou
- AP-HP, Raymond-Poincaré Hospital, Infectious Diseases Department, Garches France, Saint-Quentin-en-Yvelines University, Paris-Versailles, France
| | - Christine Blanc
- AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, Paris, Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Christine Katlama
- Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Pitié-Salpêtrière Hospital, Infectious Diseases Department, F-75013 Paris, France
| | - Pierre de Truchis
- AP-HP, Raymond-Poincaré Hospital, Infectious Diseases Department, Garches France, Saint-Quentin-en-Yvelines University, Paris-Versailles, France
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17
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Boyd A, Miailhes P, Chas J, Valantin MA, Yazdanpanah Y, Rosenthal E, Chevaliez S, Piroth L, Rougier H, Peytavin G, Pialoux G, Girard PM, Lacombe K. Grazoprevir/elbasvir for the immediate treatment of recently acquired HCV genotype 1 or 4 infection in MSM. J Antimicrob Chemother 2021; 75:1961-1968. [PMID: 32306039 DOI: 10.1093/jac/dkaa091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Europe, increases in HCV infection have been observed over the last two decades in MSM, making them a key population for recently acquired HCV. Alternative combinations of direct-acting antiviral agents against early HCV infection need to be assessed. PATIENTS AND METHODS In this pilot trial, MSM with recently acquired genotype 1 or 4 HCV infection were prospectively included and received 8 weeks of oral grazoprevir 100 mg and elbasvir 50 mg in a fixed-dose combination administered once daily. The primary endpoint was sustained virological response evaluated 12 weeks after the end of treatment (EOT) (SVR12). Secondary endpoints were the virological characterization of failures, the quality of life before, during and after treatment and the rate of reinfection. RESULTS In a 15 month period, 30 patients were enrolled, all of whom were MSM. Of the 29 patients completing follow-up, 28 (96%, 95% CI = 82%-99%) achieved SVR12. One patient interrupted follow-up (suicide) but had undetectable plasma HCV RNA at EOT. One patient with suboptimal adherence confirmed by plasma drug monitoring relapsed and developed NS3, NS5A and NS5B resistance-associated substitutions (V36M, M28V and S556G). The most common adverse events related to study drug were diarrhoea (n = 4, 13%), insomnia (n = 2, 7%) and fatigue (n = 2, 7%), although no patient discontinued treatment. No HIV RNA breakthrough was reported in the 28 patients with HIV coinfection. At Week 48, reinfection was diagnosed in three patients. CONCLUSIONS Our data support the use of grazoprevir/elbasvir for immediate treatment against HCV in order to reduce HCV transmission in MSM.
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Affiliation(s)
- Anders Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75012 Paris, France
| | - Patrick Miailhes
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Service de Maladies Infectieuses et Tropicales, Lyon, France
| | - Julie Chas
- AP-HP, Hôpital Tenon, Service de Maladies Infectieuses et tropicales, Paris, France
| | - Marc-Antoine Valantin
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses et tropicales, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et tropicales, Paris, France
| | - Eric Rosenthal
- Hôpital de l'Archet, Service de médecine interne, Nice, France
| | - Stephane Chevaliez
- AP-HP, département de Virologie, Hôpital Henri Mondor, National Reference Center for Viral Hepatitis B, C and delta, INSERM U955, Créteil, France
| | - Lionel Piroth
- Département d'infectiologie, CHU de Dijon, 21079 Dijon, France; INSERM CIC 1432, Université de Bourgogne, 21079 Dijon, France
| | | | - Gilles Peytavin
- AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmacologie-Toxicologie and IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France
| | - Gilles Pialoux
- AP-HP, Hôpital Tenon, Service de Maladies Infectieuses et tropicales, Paris, France.,Sorbonne Université, Paris, France
| | - Pierre-Marie Girard
- Service de maladies infectieuses et tropicales, Hôpital St Antoine, AP-HP, Paris, France.,Sorbonne Université, INSERM UMR-S1136, Institut Pierre Louis de Santé Publique, Paris, France
| | - Karine Lacombe
- Service de maladies infectieuses et tropicales, Hôpital St Antoine, AP-HP, Paris, France.,Sorbonne Université, INSERM UMR-S1136, Institut Pierre Louis de Santé Publique, Paris, France
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18
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Tebano G, Soulié C, Schneider L, Blanc C, Agher R, Seang S, Valantin MA, Palich R, Tubiana R, Peytavin G, Marcelin AG, Assoumou L, Katlama C. Long-term follow-up of HIV-infected patients on dolutegravir monotherapy. J Antimicrob Chemother 2021; 75:675-680. [PMID: 31800056 DOI: 10.1093/jac/dkz478] [Citation(s) in RCA: 4] [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: 07/05/2019] [Revised: 10/06/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, dolutegravir monotherapy has been explored as a drug-reduced regimen for HIV patients. METHODS This was a retrospective observational study, including patients virologically suppressed for ≥6 months, without previous virological failure (VF) under integrase inhibitors (INIs), who had been switched to dolutegravir monotherapy (50 mg/day). The primary aim was to report the proportion of VF at week 48 (W48) and week 96 (W96) of dolutegravir monotherapy. The evolution from baseline to W48 of residual viraemia on ultra-deep sequencing and HIV DNA was also evaluated. RESULTS Sixty-one patients were included. Prior to switching to dolutegravir monotherapy, they had a median (IQR) of 15.4 (6.5-19.9) years of antiretroviral exposure, 5.8 (3.2-10.3) years of viral suppression and 687 (461-848) CD4+ cells/mm3. They remained on dolutegravir monotherapy for a median (IQR) of 100 (29-148) weeks. Forty-two out of 61 patients (68.9%) reached W48 and 32 out of 61 patients (52.5%) reached W96. VF occurred in three patients, with the emergence of INI resistance. VF occurred before W24 and in patients pre-exposed to INIs. At W48, the probability of VF (Kaplan-Meier analysis) was 5.6% (95% CI = 1.8%-16.4%). The same result was obtained at W96. Detectable residual viraemia did not increase and median HIV DNA did not change significantly (2.4 log/106 cells at baseline and 2.3 log/106 cells at W48). Dolutegravir plasma concentration was above the IC90 in 41/41 samples, from 22 patients. CONCLUSIONS Long-term follow-up showed a low risk of VF under dolutegravir monotherapy, in a selected population of patients with previous long-term virological suppression and low HIV reservoir.
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Affiliation(s)
- G Tebano
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - C Soulié
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Laboratoire de Virologie, F75013 Paris, France
| | - L Schneider
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - C Blanc
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - R Agher
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - S Seang
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - M A Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - R Palich
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - R Tubiana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
| | - G Peytavin
- AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmacologie-Toxicologie; IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France
| | - A G Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Laboratoire de Virologie, F75013 Paris, France
| | - L Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), F-75013 Paris, France
| | - C Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP); AP-HP, Pitié Salpêtrière Hospital, Department of Infectious Diseases, F-75013 Paris, France
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19
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Nguyen T, Valantin MA, Delaugerre C, Amiel C, Netzer E, L'Yavanc T, Ohayon M, Valin N, Day N, Kreplak G, Pialoux G, Calvez V, Molina JM, Marcelin AG, Todesco E. Low level of baseline resistance in recently HCV-infected men who have sex with men with high-risk behaviours. J Glob Antimicrob Resist 2021; 24:311-315. [PMID: 33540082 DOI: 10.1016/j.jgar.2021.01.012] [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: 04/30/2020] [Revised: 12/11/2020] [Accepted: 01/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Presence of baseline hepatitis C virus (HCV) resistance-associated substitutions (RASs) can impair treatment outcome of direct-acting antivirals. We investigated the prevalence of pre-treatment HCV resistance among recently HCV-infected men who have sex with men (MSM) with high risk behaviours, either human immunodeficiency virus (HIV) co-infected or at high risk of HIV acquisition and under pre-exposure prophylaxis (PrEP). METHODS NS5A and NS3 fragments were deep sequenced on pre-treatment samples of 72 subjects using Illumina MiSeq paired-end sequencing technology. Ultra-deep sequencing data were analysed by SmartGene® platform. RASs mentioned in the literature were analysed and interpreted depending on genotype (GT) at 10% cut-off. RESULTS HCV genotyping showed 36 (50.0%) GT1a, 31 (43.1%) GT4d and 5 (6.9%) GT3a infections. Fifty-five patients (76.4%) were co-infected with HIV and 15 (20.8%) received PrEP. In GT1a viruses, NS3 RASs were found in 4/30 viruses (13.3%; S122 G/N, R155 K and I170 V) and Q80 K polymorphism was present in 14/30 viruses (46.7%). No NS3 RASs were detected in GT4d and GT3a viruses. NS5A RASs were detected in 3/36 GT1a viruses (8.3%; Q30E/R, L31 M and H58 L). NS5A subtype-specific polymorphisms L30R and T58 P were found at high frequencies in 31/31 (100%) and 16/31 (51.6%) GT4d viruses, respectively. One RAS M31 L was also observed along with the polymorphisms L30R and T58 P. No NS5A RASs were detected in GT3a viruses. CONCLUSION A low level of RASs to NS3 and NS5A inhibitors in pre-treatment samples was detected in the study population. Our findings reassure the clinical management of HCV infection in this high-risk population.
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Affiliation(s)
- Thuy Nguyen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Services de maladies infectieuses et tropicales, F-75013 Paris, France
| | - Constance Delaugerre
- AP-HP, Hôpital Saint-Louis, Laboratoire de virologie, Paris, France; INSERM UMR 941, Université de Paris Diderot, Paris, France
| | - Corinne Amiel
- Sorbonne Université, Centre d'Immunologie et de Maladies Infectieuses (CIMI) UMRS CR7, Persistent Viral Infection (PVI) Team, Inserm U1135, AP-HP, Groupe Hospitalier Paris Est, Hôpital Tenon, Laboratoire de virologie, F-75020 Paris, France
| | | | - Thomas L'Yavanc
- Centre de santé sexuelle Le 190, Paris, France; Sorbonne Université, AP-HP, Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | - Michel Ohayon
- Centre de santé sexuelle Le 190, Paris, France; Sorbonne Université, AP-HP, Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | - Nadia Valin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint Antoine, Department of Infectious Diseases, F-75012 Paris, France
| | | | | | - Gilles Pialoux
- Sorbonne Université, AP-HP, Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Jean-Michel Molina
- INSERM UMR 941, Université de Paris Diderot, Paris, France; AP-HP, Hôpital Saint-Louis, Department of Infectious Diseases, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Eve Todesco
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France.
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20
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Palich R, Veyri M, Valantin MA, Marcelin AG, Guihot A, Pourcher V, Jary A, Solas C, Makinson A, Poizot-Martin I, Costagliola D, Spano JP, Katlama C. Recurrence and Occurrence of Kaposi's Sarcoma in Patients Living With Human Immunodeficiency Virus (HIV) and on Antiretroviral Therapy, Despite Suppressed HIV Viremia. Clin Infect Dis 2021; 70:2435-2438. [PMID: 31626689 DOI: 10.1093/cid/ciz762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/24/2019] [Accepted: 08/18/2019] [Indexed: 11/14/2022] Open
Abstract
In 21 cutaneous and/or visceral Kaposi's sarcoma cases, occurring in patients living with human immunodeficiency virus (HIV) who were on antiretroviral therapy with suppressed HIV viremia and high CD4 T cell counts, the efficacy of conventional chemotherapies was limited due to cumulative toxicities, comedications, and a lack of immune improvement.
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Affiliation(s)
- Romain Palich
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Marianne Veyri
- Medical Oncology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Marc-Antoine Valantin
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anne-Geneviève Marcelin
- Virology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Amélie Guihot
- Immunology, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris
| | - Valérie Pourcher
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Aude Jary
- Virology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Caroline Solas
- Pharmacology Toxicology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Institut National de la Santé et de la Recherche Médicale (INSERM) Centre de Recherche en Cancérologie de Marseille, Hôpital de la Timone, Aix-Marseille Univ, Marseille
| | - Alain Makinson
- Infectious Diseases, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, Institut de Recherche et de Développement (IRD) Unit 233, INSERM U1175, Université de Montpellier, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Assistance Publique - Hôpitaux de Marseille, INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Hôpital Sainte-Marguerite, Aix Marseille Univ, Marseille
| | - Isabelle Poizot-Martin
- Service d'Immuno-hématologie clinique, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Assistance Publique - Hôpitaux de Marseille, INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Hôpital Sainte-Marguerite, Aix Marseille Univ, Marseille
| | | | - Jean-Philippe Spano
- Medical Oncology, INSERM Unit_S 1136, Inserm U1135, Centre d'Immunologie et des Maladies Infectieuses, AP-HP.6, Hôpital Pitié-Salpêtrière, Sorbonne Université
| | - Christine Katlama
- Infectious Diseases, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Assistance Publique-Hôpitaux de Paris (AP-HP).6, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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21
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Cotte L, Hocqueloux L, Lefebvre M, Pradat P, Bani-Sadr F, Huleux T, Poizot-Martin I, Pugliese P, Rey D, Cabié A, Chirouze C, Drobacheff-Thiébaut C, Foltzer A, Bouiller K, Hustache-Mathieu L, Lepiller Q, Bozon F, Babre O, Brunel AS, Muret P, Chevalier E, Jacomet C, Laurichesse H, Lesens O, Vidal M, Mrozek N, Aumeran C, Baud O, Corbin V, Goncalvez E, Mirand A, brebion A, Henquell C, Lamaury I, Fabre I, Curlier E, Ouissa R, Herrmann-Storck C, Tressieres B, Receveur MC, Boulard F, Daniel C, Clavel C, Roger PM, Markowicz S, Chellum Rungen N, Merrien D, Perré P, Guimard T, Bollangier O, Leautez S, Morrier M, Laine L, Boucher D, Point P, Cotte L, Ader F, Becker A, Boibieux A, Brochier C, Brunel-Dalmas F, Cannesson O, Chiarello P, Chidiac C, Degroodt S, Ferry T, Godinot M, Livrozet JM, Makhloufi D, Miailhes P, Perpoint T, Perry M, Pouderoux C, Roux S, Triffault-Fillit C, Valour F, Charre C, Icard V, Tardy JC, Trabaud MA, Ravaux I, Ménard A, Belkhir AY, Colson P, Dhiver C, Madrid A, Martin-Degioanni M, Meddeb L, Mokhtari M, Motte A, Raoux A, Toméi C, Tissot-Dupont H, Poizot-Martin I, Brégigeon S, Zaegel-Faucher O, Obry-Roguet V, Laroche H, Orticoni M, Soavi MJ, Ressiot E, Ducassou MJ, Jaquet I, Galie S, Colson H, Ritleng AS, Ivanova A, Debreux C, Lions C, Rojas-Rojas T, Cabié A, Abel S, Bavay J, Bigeard B, Cabras O, Cuzin L, Dupin de Majoubert R, Fagour L, Guitteaud K, Marquise A, Najioullah F, Pierre-François S, Pasquier J, Richard P, Rome K, Turmel JM, Varache C, Atoui N, Bistoquet M, Delaporte E, Le Moing V, Makinson A, Meftah N, Merle de Boever C, Montes B, Montoya Ferrer A, Tuaillon E, Reynes J, Lefèvre B, Jeanmaire E, Hénard S, Frentiu E, Charmillon A, Legoff A, Tissot N, André M, Boyer L, Bouillon MP, Delestan M, Goehringer F, Bevilacqua S, Rabaud C, May T, Raffi F, Allavena C, Aubry O, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet-Cartier C, Deschanvres C, Gaborit BJ, Grégoire A, Grégoire M, Grossi O, Guéry R, Jovelin T, Lefebvre M, Le Turnier P, Lecomte R, Morineau P, Reliquet V, Sécher S, Cavellec M, Paredes E, Soria A, Ferré V, André-Garnier E, Rodallec A, Pugliese P, Breaud S, Ceppi C, Chirio D, Cua E, Dellamonica P, Demonchy E, De Monte A, Durant J, Etienne C, Ferrando S, Garraffo R, Michelangeli C, Mondain V, Naqvi A, Oran N, Perbost I, Carles M, Klotz C, Maka A, Pradier C, Prouvost-Keller B, Risso K, Rio V, Rosenthal E, Touitou I, Wehrlen-Pugliese S, Zouzou G, Hocqueloux L, Prazuck T, Gubavu C, Sève A, Giaché S, Rzepecki V, Colin M, Boulard C, Thomas G, Cheret A, Goujard C, Quertainmont Y, Teicher E, Lerolle N, Jaureguiberry S, Colarino R, Deradji O, Castro A, Barrail-Tran A, Yazdanpanah Y, Landman R, Joly V, Ghosn J, Rioux C, Lariven S, Gervais A, Lescure FX, Matheron S, Louni F, Julia Z, Le GAC S, Charpentier C, Descamps D, Peytavin G, Duvivier C, Aguilar C, Alby-Laurent F, Amazzough K, Benabdelmoumen G, Bossi P, Cessot G, Charlier C, Consigny PH, Jidar K, Lafont E, Lanternier F, Leporrier J, Lortholary O, Louisin C, Lourenco J, Parize P, Pilmis B, Rouzaud C, Touam F, Valantin MA, Tubiana R, Agher R, Seang S, Schneider L, PaLich R, Blanc C, Katlama C, Bani-Sadr F, Berger JL, N’Guyen Y, Lambert D, Kmiec I, Hentzien M, Brunet A, Romaru J, Marty H, Brodard V, Arvieux C, Tattevin P, Revest M, Souala F, Baldeyrou M, Patrat-Delon S, Chapplain JM, Benezit F, Dupont M, Poinot M, Maillard A, Pronier C, Lemaitre F, Morlat C, Poisson-Vannier M, Jovelin T, Sinteff JP, Gagneux-Brunon A, Botelho-Nevers E, Frésard A, Ronat V, Lucht F, Rey D, Fischer P, Partisani M, Cheneau C, Priester M, Mélounou C, Bernard-Henry C, de Mautort E, Fafi-Kremer S, Delobel P, Alvarez M, Biezunski N, Debard A, Delpierre C, Gaube G, Lansalot P, Lelièvre L, Marcel M, Martin-Blondel G, Piffaut M, Porte L, Saune K, Robineau O, Ajana F, Aïssi E, Alcaraz I, Alidjinou E, Baclet V, Bocket L, Boucher A, Digumber M, Huleux T, Lafon-Desmurs B, Meybeck A, Pradier M, Tetart M, Thill P, Viget N, Valette M. Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018. Clin Infect Dis 2021; 73:e3266-e3274. [DOI: 10.1093/cid/ciaa1940] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.
Methods
This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.
Results
From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.
Conclusions
A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.
Clinical Trials Registration. NCT02898987.
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Affiliation(s)
- Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1052, Lyon, France
| | - Laurent Hocqueloux
- Department of Infectious Diseases, Centre Hospitalier Régional d’Orléans – La Source, Orléans, France
| | - Maeva Lefebvre
- Department of Infectious Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes; Centre d’Investigation Clinique (CIC) 1413, INSERM, Nantes, France
| | - Pierre Pradat
- Center for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Isabelle Poizot-Martin
- Immuno-Hematology Clinic, Assistance Publique–Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, Aix-MarseilleUniversity–Inserm–Institut de Recherche pour le Développement (IRD), Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet, Nice, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg
| | - André Cabié
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Martinique, Fort de France, Université des Antilles EA4537, Fort de France, INSERM CIC1424, Fort-de-France, France
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Katlama C, Assoumou L, Valantin MA, Soulié C, Martinez E, Béniguel L, Bouchaud O, Raffi F, Molina JM, Fellahi S, Peytavin G, Marcelin AG, Kolta S, Capeau J, Gibowski S, Cardon F, Reynes J, Costagliola D. Dual therapy combining raltegravir with etravirine maintains a high level of viral suppression over 96 weeks in long-term experienced HIV-infected individuals over 45 years on a PI-based regimen: results from the Phase II ANRS 163 ETRAL study—authors’ response. J Antimicrob Chemother 2020; 75:3699-3700. [DOI: 10.1093/jac/dkaa341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Christine Katlama
- Assistance Publique – Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Marc-Antoine Valantin
- Assistance Publique – Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Cathia Soulié
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
- APHP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, Barcelona, Spain
| | - Lydie Béniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Olivier Bouchaud
- Assistance Publique-Hôpitaux de Paris (APHP), Centre Hospitalier Universitaire Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France
- Université Paris 13, IMEA-Fondation Internationale Léon Mba, Paris, France
| | - François Raffi
- INSERM CIC 1413, Université de Nantes, Département des Maladies Infectieuses, Hôpital Hôtel-Dieu, Nantes, France
| | - Jean-Michel Molina
- Université Paris Diderot, Paris, France, Sorbonne Paris Cité, APHP, Hôpital Saint-Louis, Paris, France
| | - Soraya Fellahi
- Sorbonne Université, INSERM UMRS_938, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Paris, France
| | - Gilles Peytavin
- INSERM UMR 1137, Université Paris 7, Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | | | - Sami Kolta
- Département de rhumatologie, Hôpital Cochin, Paris, France - INSERM UMR-1153, Paris, France
| | - Jacqueline Capeau
- Sorbonne Université, INSERM UMRS_938, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Paris, France
| | - Severine Gibowski
- ANRS, France Recherche Nord & Sud Sida-Hiv Hépatites, Agence autonome de l’INSERM, Paris, France
| | - Fanny Cardon
- ANRS, France Recherche Nord & Sud Sida-Hiv Hépatites, Agence autonome de l’INSERM, Paris, France
| | - Jacques Reynes
- Département de maladies infectieuses, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
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23
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Valantin MA, Durand L, Wirden M, Assoumou L, Caby F, Soulié C, Nguyen TTT, Tubiana R, Kirstetter M, Junot H, Marcelin AG, Peytavin G, Tilleul P, Katlama C. Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study. J Antimicrob Chemother 2020; 74:2716-2722. [PMID: 31273376 DOI: 10.1093/jac/dkz255] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression. METHODS ECOVIR was a prospective study aiming to assess whether in patients on combination ART with ≥4 antiretrovirals for ≥24 weeks and virally suppressed for ≥48 weeks, a drug-reduced (DR) regimen could be proposed. The intervention consisted of discontinuing genotypically less susceptible drugs to reach a DR regimen with ≤3 antiretrovirals. The primary endpoint was the proportion of patients maintaining viral suppression at week (W) 24. RESULTS From 89 eligible individuals for the study, a DR regimen was proposed in 86 (97%) patients, of whom 71 were switched to a DR regimen. Baseline characteristics [median (IQR)] were: age 58 (53-65) years, duration of treatment 24 (21-26) years and viral suppression 8 (6-11) years. The cumulative resistance profile showed full resistance to lamivudine/emtricitabine (91%), abacavir (74%), efavirenz/nevirapine (70%), rilpivirine (56%), darunavir (q24h/q12h) (42%/29%), lopinavir (69%), atazanavir (71%) and raltegravir (24%). The final DR regimen consisted of a two-drug or three-drug regimen in 54 patients (76%) and in 17 patients (24%), respectively. The success rate of a DR regimen at W24 was 93.9% (95% CI 84.4-97.6, Kaplan-Meier estimate). Four patients experienced virological failure (at W4, W8 and W12), all with plasma viral load (pVL) <600 copies/mL and no emergence of resistance mutations. The DR strategy allowed a monthly cost saving of 36%. CONCLUSIONS In experienced patients with high-level resistance, individualized strategies based on expert advice can offer DR regimen options with fewer drug-drug interactions and a significant economic impact while ensuring virological success.
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Affiliation(s)
- Marc-Antoine Valantin
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Lise Durand
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France
| | - Marc Wirden
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Lambert Assoumou
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Fabienne Caby
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Cathia Soulié
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Thi Thu-Thuy Nguyen
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Roland Tubiana
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Myriam Kirstetter
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Paris, France
| | - Helga Junot
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France
| | - Anne-Geneviève Marcelin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Gilles Peytavin
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat Claude-Bernard, Paris, France
| | - Patrick Tilleul
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France.,Paris Descartes Université, Pharmacie Clinique, Faculté de Pharmacie, Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, F-75013, Paris, France
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Katlama C, Assoumou L, Valantin MA, Soulié C, Martinez E, Béniguel L, Bouchaud O, Raffi F, Molina JM, Fellahi S, Peytavin G, Marcelin AG, Kolta S, Capeau J, Gibowski S, Cardon F, Reynes J, Costagliola D. Dual therapy combining raltegravir with etravirine maintains a high level of viral suppression over 96 weeks in long-term experienced HIV-infected individuals over 45 years on a PI-based regimen: results from the Phase II ANRS 163 ETRAL study. J Antimicrob Chemother 2020; 74:2742-2751. [PMID: 31269208 DOI: 10.1093/jac/dkz224] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dual therapy combining integrase inhibitors and NNRTIs represents a promising regimen in ageing HIV-infected individuals with long exposure to nucleoside analogues and PIs. METHODS The ANRS 163 ETRAL trial (NCT02212379) was a 96 week, multicentre, single-arm study evaluating the efficacy and safety of raltegravir (400 mg twice daily)/etravirine (200 mg twice daily) in individuals >45 years, on a PI-containing regimen who were integrase inhibitor and etravirine naive. The primary endpoint was the proportion of participants with virological success, defined by the absence of virological failure up to week 48. Main secondary outcomes included evolution of metabolic parameters, CD4/CD8 count, bone mineral density and inflammatory markers. The study was designed to show an efficacy >90%, assuming a success rate ≥95%, with a power of 80% and a 5% type-1 error. RESULTS One hundred and sixty-five participants (median age 52 years, duration of ART 16.9 years, viral suppression 6.9 years and CD4 count 700 cells/mm3) were enrolled. By ITT analysis, viral suppression was maintained in 99.4% of participants (95% CI = 95.6%-99.9%) at week 48 and 98.7% (95% CI = 95.0%-99.7%) at week 96. Two virological failures occurred (week 24 and week 64) without emergence of integrase inhibitor resistance. Eight participants discontinued raltegravir/etravirine for adverse events, leading to a strategy success rate of 95.1% (95% CI = 90.5%-97.5%) at week 48 and 92.7% (95% CI = 87.5%-95.8%) at week 96. Over 96 weeks, lipid fractions improved (P < 0.001), CD4/CD8 ratio increased, IFNγ-induced protein 10 (IP-10) decreased (-8.1%), soluble CD14 decreased (-27%, P < 0.001) bone mineral density improved and BMI increased. CONCLUSIONS Raltegravir plus etravirine dual therapy demonstrated durable efficacy in virologically suppressed ageing patients.
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Affiliation(s)
- Christine Katlama
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Marc-Antoine Valantin
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Cathia Soulié
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.,APHP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clinic and University of Barcelona, Spain
| | - Lydie Béniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Olivier Bouchaud
- Assistance Publique-Hôpitaux de Paris (APHP), Centre Hospitalier Universitaire Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France.,Université Paris 13, IMEA-Fondation Internationale Léon Mba, Paris, France
| | - François Raffi
- INSERM CIC 1413, Université de Nantes, Département des Maladies Infectieuses, Hôpital Hôtel-Dieu, Nantes, France
| | - Jean-Michel Molina
- Université Paris Diderot, Paris, France, Sorbonne Paris Cité, APHP, Hôpital Saint-Louis, Paris, France
| | - Soraya Fellahi
- Sorbonne Université, INSERM UMRS_938, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Paris, France
| | - Gilles Peytavin
- INSERM UMR 1137, Université Paris 7, Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat-Claude Bernard, APHP, Paris, France
| | | | - Sami Kolta
- Département de rhumatologie, Hôpital Cochin, Paris, France - INSERM UMR-1153, Paris, France
| | - Jacqueline Capeau
- Sorbonne Université, INSERM UMRS_938, Institut Hospitalo-Universitaire de Cardio-métabolisme et Nutrition (ICAN), Paris, France
| | - Severine Gibowski
- ANRS, France Recherche Nord & Sud Sida-HIV Hépatites, Agence autonome de l'INSERM, Paris, France
| | - Fanny Cardon
- ANRS, France Recherche Nord & Sud Sida-HIV Hépatites, Agence autonome de l'INSERM, Paris, France
| | - Jacques Reynes
- Département de maladies infectieuses, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
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25
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Castain L, Perrier M, Charpentier C, Palich R, Desire N, Wirden M, Descamps D, Sayon S, Landman R, Valantin MA, Joly V, Peytavin G, Yazdanpanah Y, Katlama C, Calvez V, Marcelin AG, Todesco E. New mechanisms of resistance in virological failure to protease inhibitors: selection of non-described protease, Gag and Gp41 mutations. J Antimicrob Chemother 2020; 74:2019-2023. [PMID: 31050739 DOI: 10.1093/jac/dkz151] [Citation(s) in RCA: 7] [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: 12/23/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To further characterize HIV-1 viruses of patients experiencing unexplained virological failure (VF) on PI-containing regimens, ultradeep sequencing was performed on protease, gag and gp41 genes in patients failing a first-line treatment. METHODS All naive patients initiating an antiretroviral treatment based on boosted darunavir, atazanavir or lopinavir and experiencing VF without any transmitted drug resistance mutation detected by Sanger sequencing on protease and reverse transcriptase genes were selected. Ultradeep sequencing (IlluminaTM Nextera®) was performed on protease, gag and gp41 genes in plasma before initiation of treatment and at VF to identify emergent mutations. RESULTS Among the 32 patients included in the study, emergent and previously undescribed mutations in the viral protease gene were identified in five patients at VF: 64M (1 CRF02_AG), 64M/70R with mutation 15V (2 CRF02_AG), 79A (1 CRF06_cpx) and 79A with mutation 15V (1 CRF02_AG). Two patients showed the emergence of R286K in the gag region, outside of cleavage sites (2 CRF02_AG). In the gp41 region, the V321I mutation emerged inside the cytoplasmic tail (1 subtype A and 1 subtype B). All these patients were treated with a darunavir/ritonavir-based regimen. CONCLUSIONS In some cases of VF to PIs, we observed the emergence of protease, Gag or Gp41 mutations that had not previously been associated with VF or PI resistance. These mutations should be further studied, in particular the 15V/64M/70R pattern in the protease gene identified among CRF02_AG viruses.
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Affiliation(s)
- Louise Castain
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Marine Perrier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Romain Palich
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Nathalie Desire
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Marc Wirden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Sophie Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Roland Landman
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Véronique Joly
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Gilles Peytavin
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Département de Pharmaco-Toxicologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service des maladies infectieuses et tropicales, Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
| | - Eve Todesco
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, Paris, France
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26
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Paccoud O, Tubach F, Baptiste A, Bleibtreu A, Hajage D, Monsel G, Tebano G, Boutolleau D, Klement E, Godefroy N, Palich R, Itani O, Fayssal A, Valantin MA, Tubiana R, Burrel S, Calvez V, Caumes E, Marcelin AG, Pourcher V. Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital. Clin Infect Dis 2020; 73:e4064-e4072. [PMID: 32556143 PMCID: PMC7337663 DOI: 10.1093/cid/ciaa791] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/27/2022] Open
Abstract
Background Data from non-randomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against Covid-19. Methods We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe Covid-19 in a French university hospital. Patients who received hydroxychloroquine (200mg tid dosage for 10 days) on a compassionate basis in addition to SOCwere compared to patients without contraindications to hydroxychloroquine who received SOCalone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, and obesity, NEWS2 score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first. Results Data from 89 patients with laboratory-confirmed Covid-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOCalone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxycholoroquine was not associated with a significantly reduced risk of unfavorable outcome (HR 0.90 [0.38; 2.1], p = 0.81). Overall survival was not significantly different between the two groups (HR 0.89 [0.23; 3.47], p = 1) Conclusion In hospitalized adults with Covid-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to standard of care. Unmeasured confounders may however have persisted despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of Covid-19.
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Affiliation(s)
- Olivier Paccoud
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Florence Tubach
- Sorbonne Université, INSERM UMR 1136, Département de Santé Publique, Unité de Recherche Clinique Pitié Salpêtrière - Charles Foix, Centre de Pharmaco-épidémiologie de l'AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Amandine Baptiste
- Sorbonne Université, INSERM UMR 1136, Département de Santé Publique, Unité de Recherche Clinique Pitié Salpêtrière - Charles Foix, Centre de Pharmaco-épidémiologie de l'AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Alexandre Bleibtreu
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - David Hajage
- Sorbonne Université, INSERM UMR 1136, Département de Santé Publique, Unité de Recherche Clinique Pitié Salpêtrière - Charles Foix, Centre de Pharmaco-épidémiologie de l'AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Gentiane Monsel
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Gianpiero Tebano
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - David Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Elise Klement
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Nagisa Godefroy
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Romain Palich
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Oula Itani
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Antoine Fayssal
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Marc-Antoine Valantin
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Roland Tubiana
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France
| | - Sonia Burrel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Eric Caumes
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Valérie Pourcher
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France.,Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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Lambert-Niclot S, Grude M, Meynard JL, Marcelin AG, Valantin MA, Flandre P, Izopet J, Moinot L, Bouteloup V, Calvez V, Katlama C, Girard PM, Morand-Joubert L. Ultrasensitive Human Immunodeficiency Virus Type 1 Viral Load as a Marker of Treatment Choice for Simplification Strategies. Clin Infect Dis 2019; 67:1883-1889. [PMID: 29767684 DOI: 10.1093/cid/ciy382] [Citation(s) in RCA: 3] [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] [Received: 01/31/2018] [Accepted: 05/14/2018] [Indexed: 12/23/2022] Open
Abstract
Background Using 3 randomized Protease inhibitor (PI) monotherapy studies: Kalesolo, Dream and Monoi, we performed a pooled-analysis. Our objective was to determine in PI monotherapy and standard tritherapy: 1) distribution of ultrasensitive viral load (USVL) at week 96 (W96); 2) factors associated with virological failure (VF) at W96 and 3) factors associated with USVL<1 copy at W96. Methods VF was defined as 2 consecutive measurements of Human Immunodeficiency Virus Type 1 RNA viral load>50 copies/mL and analysed in Intention-To-Treat. A logistic model was used to investigate which variables were predictive of a VF and Fisher test to investigate differences in USVL at W96. Results Among 609 patients, 73% were male with median age of 44.4 years (IQR 39.8-52.1), baseline CD4/CD8 ratio was 0.8 (IQR 0.6-1.10), baseline CD4 was 564.5/mm3 (IQR 422-707) and 59% presented a baseline USVL<1 copy/mL. At W96, the proportion of USVL<1 copy/mL was significantly different between PI monotherapy and standard tritherapy in pooled-analysis (65% versus 74%; p=0.04). Overall, baseline USVL<1copy/mL, tritherapy and to be a female were associated with USVL<1 copy/mL at W96 (p<0.0001, p=0.049 and p=0.006). In PI monotherapy receiving DRV/r was associated with USVL<1 copy/mL at W96 (p=0.003). Factors associated to virological succes at W96 were higher baseline CD4 (p=0.034) and baseline USVL<1 copy/mL (p=0.0005). Conclusion Pooled-analysis of 3 PI monotherapy trials showed better efficacy of tritherapy in terms of USVL at W96. Furthermore regarding USVL at W96, to receive LPV/r seems to be more deleterious than DRV/r. Baseline USVL impacts VF at W96 more specifically in tritherapy arm. Clinical Trials Registration NCT00421551, NCT00946595, and NCT00140751.
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Affiliation(s)
- Sidonie Lambert-Niclot
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,AP-HP, Laboratoire de Virologie, Hôpital Saint-Antoine, Paris, France
| | - Maxime Grude
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Jean-Luc Meynard
- Département de Maladies Infectieuses, Hôpital Saint-Antoine, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,AP-HP, Laboratoire de Virologie, Hôpital Pitié Salpêtrière, Paris, France
| | | | - Philippe Flandre
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Jacques Izopet
- INSERM, U1043, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France.,CHU de Toulouse, Laboratoire de Virologie, Toulouse, France
| | - Laetitia Moinot
- Inserm, Bordeaux Population Health Research Center, Université Bordeaux, ISPED, Bordeaux, France.,CHU de Bordeaux, Pole de Sante Publique, Bordeaux, France
| | - Vincent Bouteloup
- Inserm, Bordeaux Population Health Research Center, Université Bordeaux, ISPED, Bordeaux, France.,CHU de Bordeaux, Pole de Sante Publique, Bordeaux, France
| | - Vincent Calvez
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,AP-HP, Laboratoire de Virologie, Hôpital Pitié Salpêtrière, Paris, France
| | - Christine Katlama
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,Département de Maladies Infectieuses, Hôpital Pitié Salpêtrière, Paris
| | - Pierre-Marie Girard
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,Département de Maladies Infectieuses, Hôpital Saint-Antoine, Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France.,AP-HP, Laboratoire de Virologie, Hôpital Saint-Antoine, Paris, France
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Landon-Cardinal O, Gallay L, Dubourg O, Maisonobe T, Léonard-Louis S, Beniken D, Simon A, Behin A, Stojkovic T, Duyckaerts C, Breton G, Rigolet A, Fain O, Meyohas MC, Leport C, Valantin MA, Vittecoq D, Bergmann JF, Hanslik T, Chauveheid MP, Amoura Z, de Broucker T, Eymard B, Beaudequin N, Benveniste O, Allenbach Y. Expanding the spectrum of HIV-associated myopathy. J Neurol Neurosurg Psychiatry 2019; 90:1296-1298. [PMID: 30975823 DOI: 10.1136/jnnp-2018-319419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/03/2019] [Accepted: 03/24/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Océane Landon-Cardinal
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laure Gallay
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
| | - Odile Dubourg
- Département de Neuropathologie, Sorbonne Université Pierre, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Thierry Maisonobe
- Département de Neuropathologie, Sorbonne Université Pierre, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sarah Léonard-Louis
- Département de Neuropathologie, Sorbonne Université Pierre, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Dalila Beniken
- Service de Maladie Infectieuse, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne Simon
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anthony Behin
- Paris-Est Neuromuscular Center, APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tanya Stojkovic
- Paris-Est Neuromuscular Center, Neuromuscular Disease Centre, Hôpital de la Pitié-Salpétrière, APHP, Paris, France
| | - Charles Duyckaerts
- Département de Neuropathologie Raymond Escourolle, GH Pitié-Salpêtrière, Faculté de médecine Sorbonne Université, Paris, France
| | - Guillaume Breton
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Fain
- Médecine Interne, APHP, DHUi2B, Centre de Référence associé sur les angiœdèmes à kinines, Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - Marie-Caroline Meyohas
- AP-HP, Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Catherine Leport
- IAME, UMR 1137, Inserm, université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Mission COREB nationale, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Marc-Antoine Valantin
- Service de Maladie Infectieuse et Tropicales, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Daniel Vittecoq
- Department of Infectious and Tropical Diseases, AP-HP Bicetre hospital, Le-Kremlin-Bicêtre, France
| | - Jean-François Bergmann
- Médecine Interne, APHP, Hôpital Lariboisière, Service de Médecine Interne, Paris, France
| | - Thomas Hanslik
- Médecine Interne, Hôpital Ambroise Paré, service de médecine interne, Paris, France
| | - Marie-Paule Chauveheid
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine 2, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Bruno Eymard
- Paris-Est Neuromuscular Center, APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nausicaa Beaudequin
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, University Pierre et Marie et Curie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
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Nouchi A, Nguyen T, Valantin MA, Simon A, Sayon S, Agher R, Calvez V, Katlama C, Marcelin AG, Soulie C. Dynamics of drug resistance-associated mutations in HIV-1 DNA reverse transcriptase sequence during effective ART. J Antimicrob Chemother 2019; 73:2141-2146. [PMID: 29846589 DOI: 10.1093/jac/dky130] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/18/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the dynamics of HIV-1 variants archived in cells harbouring drug resistance-associated mutations (DRAMs) to lamivudine/emtricitabine, etravirine and rilpivirine in patients under effective ART free from selective pressure on these DRAMs, in order to assess the possibility of recycling molecules with resistance history. Patients and methods We studied 25 patients with at least one DRAM to lamivudine/emtricitabine, etravirine and/or rilpivirine identified on an RNA sequence in their history and with virological control for at least 5 years under a regimen excluding all drugs from the resistant class. Longitudinal ultra-deep sequencing (UDS) and Sanger sequencing of the reverse transcriptase region were performed on cell-associated HIV-1 DNA samples taken over the 5 years of follow-up. Results Viral variants harbouring the analysed DRAMs were no longer detected by UDS over the 5 years in 72% of patients, with viruses susceptible to the molecules of interest found after 5 years in 80% of patients with UDS and in 88% of patients with Sanger. Residual viraemia with <50 copies/mL was detected in 52% of patients. The median HIV DNA level remained stable (2.4 at baseline versus 2.1 log10 copies/106 cells 5 years later). Conclusions These results show a clear trend towards clearance of archived DRAMs to reverse transcriptase inhibitors in cell-associated HIV-1 DNA after a long period of virological control, free from therapeutic selective pressure on these DRAMs, reflecting probable residual replication in some reservoirs of the fittest viruses and leading to persistent evolution of the archived HIV-1 DNA resistance profile.
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Affiliation(s)
- A Nouchi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - T Nguyen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - M A Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de maladies infectieuses, Paris, France
| | - A Simon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de médecine interne, Paris, France
| | - S Sayon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - R Agher
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de maladies infectieuses, Paris, France
| | - V Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - C Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de maladies infectieuses, Paris, France
| | - A G Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - C Soulie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
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30
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Boccara F, Lang S, Ederhy S, Soulat-Dufour L, Adavane-Scheuble S, Ancedy Y, Chauvet M, Nhan P, Meynard JL, Valantin MA, Slama L, Pialoux G, Katlama C, Girard PM, Cohen A. P5338Atherosclerotic cardiovascular events in people living with Human Immunodeficiency Virus. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0306] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People living with Human Immunodeficiency Virus (PLWHIV) under antiretrovirals have an increased risk of atherosclerotic cardiovascular disease (ASCVD) events. The risk factors associated with ASCVD events in this high risk population are various including traditional vascular risk factors and specific HIV-related factors. However their respective influence is questionable.
Purpose
Our aim was to determine the incidence of ASCVD events in a large cohort of PLWHIV and to identify the risk factors associated.
Methods
We conducted a longitudinal observational cohort study of asymptomatic PLWHIV at high risk of ASCVD addressed to our preventive cardiovascular unit for non-invasive cardiovascular evaluation. The first ASCVD event was censored and included CV death, acute coronary syndromes, coronary and peripheral revascularizations (PCI or CABG or endarterectomy or limb procedures) and ischemic strokes.
Results
From January 2003 to December 2014, 763 consecutive asymptomatic PLWHIV were enrolled (mean age of 51.3±8.3 years, 87% men, 90% were free of known coronary artery disease, mean Left ventricular ejection fraction 60%). At baseline, traditional CV risk factors were as follow: 54% had dyslipidemia, 43% hypertension, 35% were active smokers, 22% had family history of CAD and 11% were diabetics. Statins were prescribed in 38% of the cohort, aspirin in 14%, clopidogrel in 14% betablockers in 14%, RAS blockers in 32%, Calcium channel blockers in 8%. At baseline, median duration of HIV seropositivity was 19.8 years (14.0–23.6), 94% were under ARV predominantly protease inhibitors (68%). Median CD4 cell count was 545/mm3 (404–745) and 92% had undetectable HIV viral load. During a median follow up of 5.8 years (3.7–8.7), 58 (7.3%) subjects had a first ASCVD event (incidence of 12.70 [9.78–16.51] per 1000 persons-years) including 5 cardiovascular deaths, 14 ACS, 20 coronary revascularizations, 13 peripheral vascular procedures and 6 strokes) with a median time of occurrence of 3.1 years (1.5–5.1). CV death (first and second ASCVD events) occurred in 8 patients (22%) after CV death related to malignancies (33%) but before deaths related to unexplained causes (21%), infectious disease (13%), liver disease (8%) and suicides (3%). Coronary events including coronary death, MI, and coronary revascularization occurred in 39 patients (5.2%); Incidence of 8.28 [6.00–11.43] per 1000 persons-years. Conventional multivariate Cox model shows that age and tobacco were the independent risk factors associated with ACSVD events [Hazard ratio (HR) 1.04, 95% CI 0.99–1.09, p=0.05 and HR 2.17, 95% CI 1.07–4.38, p=0.03].
Conclusion
Traditional vascular risk factors (age and active smoking) are associated with the occurrence of ASCVD events predominantly coronary artery disease in our observational cohort of asymptomatic PLWIHV at high risk for ASCVD. Cardiovascular prevention including tobacco cease action is mandatory in the aging HIV population.
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Affiliation(s)
- F Boccara
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Lang
- AP-HP - Hospital Saint Antoine, Paris, France
| | - S Ederhy
- AP-HP - Hospital Saint Antoine, Paris, France
| | | | | | - Y Ancedy
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M Chauvet
- AP-HP - Hospital Saint Antoine, Paris, France
| | - P Nhan
- AP-HP - Hospital Saint Antoine, Paris, France
| | - J L Meynard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - M A Valantin
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - L Slama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - G Pialoux
- Hospital Tenon, Infectious Diseases Department, Paris, France
| | - C Katlama
- Hospital Pitie-Salpetriere, Infectious Diseases Department, Paris, France
| | - P M Girard
- AP-HP - Hospital Saint Antoine, Paris, France
| | - A Cohen
- AP-HP - Hospital Saint Antoine, Paris, France
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Lambert-Niclot S, Boyd A, Fofana D, Valin N, Wirden M, Meynard JL, Palich R, Agher R, Valantin MA, Calvez V, Katlama C, Girard PM, Marcelin AG, Morand-Joubert L. INSTI-Based Triple Regimens in Treatment-Naïve HIV-Infected Patients Are Associated With HIV-RNA Viral Load Suppression at Ultralow Levels. Open Forum Infect Dis 2019; 6:ofz177. [PMID: 31123690 PMCID: PMC6524833 DOI: 10.1093/ofid/ofz177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/29/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
Background During antiretroviral therapy (ART), HIV-1-infected patients may present with ultralow (UL) HIV-RNA viral loads (VLs) below quantification levels of current assays. Reasons for UL-VL detection and its relation to virological rebound (VR) are unclear. Methods HIV-1-infected, ART-naïve patients followed at 2 university hospitals were included. All participants had an HIV-RNA >200 copies/mL at ART initiation and achieved a VL <50 copies/mL during ART. UL-VL was determined by the presence/absence of polymerase chain reaction signal detected using a commercially available assay (COBAS, TaqMan, Roche). Random-effects Poisson regression was used for assessing determinants of UL-VL not detected overtime and conditional risk set analysis for VR (1 VL > 200 copies/mL or 2 VL > 50 copies/mL) while accounting for frequency of VL measurements. Results Between 2009 and 2013, 717 patients initiated ART containing 2 nucleos(-t)ide reverse transcriptase inhibitors (NRTIs) plus a non-NRTI (29.4%), a protease inhibitor (58.4%), or an integrase-strand transfer inhibitor (INSTI; 12.1%). During a median (interquartile range) 3.4 (2.3–4.6) years, 676 (94.3%) patients achieved UL-VL not detected. In multivariable analysis, UL-VL not detected overtime was associated with younger age (P < .001), female gender (P = .04), lower baseline VL (P < .001), baseline CD4+ >500 vs <350/mm3 (P < .001), and INSTI-containing ART (P = .009). One hundred thirty-one (18.3%) patients had VR during follow-up, which was independently associated with a CD4/CD8 ratio <0.8 during follow-up (P = .01) and time spent with UL-VL not detected (P < .001). When UL-VL not detected occurred for ≥50% of the follow-up duration (n = 290), faster time to reach UL-VL not detected (P < .001), faster CD4+ T-cell count increase (P = .03), and faster CD4/CD8 ratio increase (P = .001) were observed. Conclusions VL suppression at an ultralow level is associated with INSTI-class ART initiation. Extensive VL suppression below ultralow detection could improve immune reconstitution.
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Affiliation(s)
- Sidonie Lambert-Niclot
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Anders Boyd
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France
| | - Djeneba Fofana
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Nadia Valin
- AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Marc Wirden
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Jean-Luc Meynard
- AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Romain Palich
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Rachid Agher
- AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Vincent Calvez
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Christine Katlama
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Département de Maladies Infectieuses, Paris, France
| | - Pierre-Marie Girard
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Département de Maladies Infectieuses, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de Virologie, Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Université, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Paris, France.,AP-HP, Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
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Lê MP, Valantin MA, Assoumou L, Soulie C, Le Mestre S, Weiss L, Yazdanpanah Y, Molina JM, Bouchaud O, Raffi F, Reynes J, Calvez V, Marcelin AG, Costagliola D, Katlama C, Peytavin G. Lack of a Clinically Significant Pharmacokinetic Interaction between Etravirine and Raltegravir Using an Original Approach Based on Drug Metabolism, Protein Binding, and Penetration in Seminal Fluid: A Pharmacokinetic Substudy of the ANRS-163 ETRAL Study. Pharmacotherapy 2019; 39:514-520. [PMID: 30815916 DOI: 10.1002/phar.2242] [Citation(s) in RCA: 3] [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] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE The ANRS163-ETRAL study showed that etravirine 200 mg/raltegravir 400 mg twice-daily dual therapy was highly effective in the treatment of human immunodeficiency virus (HIV)-infected patients older than 45 years, with virologic and therapeutic success rates at week 48 of 99.4% and 94.5%, respectively. The objective of this study was to determine whether a clinically significant pharmacokinetic interaction between etravirine and raltegravir exists by assessing steady-state total and unbound etravirine, raltegravir, and inactive raltegravir-glucuronide concentrations 12 hours after last intake (C12h ) in blood plasma (BP) and seminal plasma (SP). DESIGN Pharmacokinetic analysis of data from the ANRS163-ETRAL study. PATIENTS One hundred forty-six HIV-1-infected patients (of the 165 patients included in the ANRS-163 ETRAL study) who were receiving etravirine 200 mg and raltegravir 400 mg twice daily. MEASUREMENTS AND MAIN RESULTS Blood was collected from all 146 patients at weeks 2-4, 12, 24, and 48, and semen was collected from 21 patients at week 48. The extent of BP and SP protein binding was determined by using ultrafiltration assay. Total and unbound etravirine, raltegravir, and raltegravir-glucuronide C12h were determined by ultra high performance liquid chromatography coupled with tandem mass spectrometry and interpreted by using the in vitro calculated protein-bound 95% inhibitory concentration (PBIC95 ) for wild-type (WT) HIV: etravirine (116 ng/ml) and raltegravir (15 ng/ml). Median (interquartile range [IQR]) total BP etravirine C12h (536 ng/ml [376-719]) and raltegravir (278 ng/ml [97-690]) were adequate in 99% and 96% of patients, respectively. Median (IQR) SP:BP C12h ratio and BP unbound fraction were etravirine 0.3 (0.2-0.5) and < 1%, respectively, raltegravir 1.8 (1.3-3.3) and 12%, respectively, and raltegravir-glucuronide 12.0 (6.5-17.7) and > 99%, respectively. The BP raltegravir metabolic ratio (raltegravir glucuronide:raltegravir ratio) was 1.7, suggesting only weak induction of raltegravir glucuronidation by etravirine. Only three patients had etravirine and raltegravir C12h < PBIC95 simultaneously. CONCLUSION No clinically significant pharmacokinetic interaction between etravirine and raltegravir was detected. Total etravirine and raltegravir BP concentrations were adequate in most patients, favoring virologic efficacy and confirming good treatment adherence (> 95%), despite twice-daily administration. The long half-life of etravirine and higher unbound fraction SP of raltegravir (57%) ensured adequate concentrations of dual therapy in genital compartments. Our results indicate that etravirine and raltegravir have good, complementary pharmacokinetic profiles, suggesting that they could be used in a dual-treatment strategy.
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Affiliation(s)
- Minh Patrick Lê
- IAME, UMR 1137, Sorbonne Paris Cité and INSERM, Université Paris Diderot, Paris, France.,Laboratoire de Pharmacologie-Toxicologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marc-Antoine Valantin
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP UMRS 1136), Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Lambert Assoumou
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP UMRS 1136), Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Cathia Soulie
- Laboratoire de Virologie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Soizic Le Mestre
- France Recherche Nord & Sud SIDA-HIV Hépatites (ANRS), Paris, France
| | - Laurence Weiss
- Service d'Immunologie Clinique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, Sorbonne Paris Cité and INSERM, Université Paris Diderot, Paris, France.,Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean-Michel Molina
- Service de Maladies Infectieuses et Tropicales, INSERM U941, AP-HP, Hôpital Saint Louis, Université Denis Diderot Paris VII, Paris, France
| | - Olivier Bouchaud
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Avicenne, Bobigny, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital - INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Jacques Reynes
- Service de Maladies Infectieuses et Tropicales, CHU Montpellier, Montpellier, France.,INSERM U1175, IRD UMI 233, University of Montpellier, Montpellier, France
| | - Vincent Calvez
- Laboratoire de Virologie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Anne-Geneviève Marcelin
- Laboratoire de Virologie, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dominique Costagliola
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP UMRS 1136), Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Christine Katlama
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP UMRS 1136), Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Gilles Peytavin
- IAME, UMR 1137, Sorbonne Paris Cité and INSERM, Université Paris Diderot, Paris, France.,Laboratoire de Pharmacologie-Toxicologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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Shili-Masmoudi S, Sogni P, de Ledinghen V, Esterle L, Valantin MA, Poizot-Martin I, Simon A, Rosenthal E, Lacombe K, Pialoux G, Bouchaud O, Gervais-Hasenknoff A, Goujard C, Piroth L, Zucman D, Dominguez S, Raffi F, Alric L, Bani-Sadr F, Lascoux-Combe C, Garipuy D, Miailhes P, Vittecoq D, Duvivier C, Aumaître H, Neau D, Morlat P, Dabis F, Salmon D, Wittkop L. Increased liver stiffness is associated with mortality in HIV/HCV coinfected subjects: The French nationwide ANRS CO13 HEPAVIH cohort study. PLoS One 2019; 14:e0211286. [PMID: 30682180 PMCID: PMC6347250 DOI: 10.1371/journal.pone.0211286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. Methods HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. Results 1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4–49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2–6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ≤12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders. Conclusion Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.
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Affiliation(s)
- Sarah Shili-Masmoudi
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Service d’Hépatologie, Bordeaux, France
| | - Philippe Sogni
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d’Hépatologie, Paris, France
- INSERM U-1223 –Institut Pasteur, Paris, France
- Université Paris Descartes, Paris, France
| | - Victor de Ledinghen
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Haut-Lévèque, Service d’Hépatologie, Bordeaux, France
- Univ Bordeaux, Inserm, UMR 1053, Bordeaux, France
| | - Laure Esterle
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Marc-Antoine Valantin
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service Maladies infectieuses et tropicales, Paris, France
| | - Isabelle Poizot-Martin
- Aix Marseille Univ, APHM Sainte-Marguerite, Service d’Immuno-hématologie clinique, Marseille, France
- Inserm U912 (SESSTIM) Marseille, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne et Cancérologie, Hôpital l’Archet, Nice, France
- Université de Nice-Sophia Antipolis, Nice, France
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service Maladies infectieuses et tropicales, Paris, France
- UMPC (Université Pierre et Marie Curie), UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Gilles Pialoux
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service Maladies infectieuses et tropicales, Paris, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service Maladies infectieuses et tropicales, Bobigny, France
- Université Paris 13 Nord, Bobigny, France
| | - Anne Gervais-Hasenknoff
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des maladies infectieuses et tropicales, Paris, France
| | - Cécile Goujard
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Médecine interne et Immunologie clinique, Le Kremlin-Bicêtre, France
- Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d’Infectiologie, Dijon, France
- Université de Bourgogne, Dijon, France
| | | | - Stéphanie Dominguez
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service Immunologie clinique et maladies infectieuses, Immunologie clinique, Créteil, France
| | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Service Maladies infectieuses et tropicales, Nantes, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Médecine interne, Toulouse, France
- Université Toulouse III, Paul Sabatier, Toulouse, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Service de médecine interne, maladies infectieuses et immunologie clinique, Reims, France
- Université de Reims, Champagne-Ardenne, Reims, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service Maladies infectieuses et tropicales, Paris, France
| | - Daniel Garipuy
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Maladies infectieuses et tropicales, Toulouse, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, CHU Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Daniel Vittecoq
- Université Paris Sud, Le Kremlin-Bicêtre, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants malades, Service de Maladies Infectieuses et Tropicales, Paris, France
- Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Hugues Aumaître
- Centre Hospitalier de Perpignan, Service Maladies infectieuses et tropicales, Perpignan, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service Maladies infectieuses et tropicales Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Philippe Morlat
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Service de médecine interne, hôpital Saint-André, Bordeaux, France
| | - François Dabis
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Dominique Salmon
- Université Paris Descartes, Paris, France
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service Maladies infectieuses et tropicales, Paris, France
| | - Linda Wittkop
- Univ Bordeaux, ISPED, Inserm Bordeaux Population Health, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
- Centre Hospitalier Universitaire de Bordeaux, Pôle de Santé Publique, Bordeaux, France
- * E-mail:
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Nguyen T, Akhavan S, Caby F, Bonyhay L, Larrouy L, Gervais A, Lebray P, Poynard T, Calmus Y, Simon A, Valantin MA, Calvez V, Marcelin AG, Todesco E. Net emergence of substitutions at position 28 in NS5A of hepatitis C virus genotype 4 in patients failing direct-acting antivirals detected by next-generation sequencing. Int J Antimicrob Agents 2018; 53:80-83. [PMID: 30236959 DOI: 10.1016/j.ijantimicag.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/21/2018] [Revised: 08/16/2018] [Accepted: 09/09/2018] [Indexed: 12/12/2022]
Abstract
More data on resistance of HCV genotype (GT) 3 and 4 to direct-acting antivirals (DAAs) are still needed. Here we investigated the presence of resistance-associated substitutions (RASs) pre- and post-treatment and their emergence under DAAs in HCV GT3- and GT4-infected patients failing DAA regimens by next-generation sequencing (NGS). Sanger sequencing and NGS were performed on NS5B and NS5A in plasma samples prior to and post treatment of 13 patients. Positions implicated in resistance to anti-NS5A and anti-NS5B in the literature were analysed. No baseline RASs was detected in NS5B but one GT4r virus developed the mutation S282T at failure. In NS5A, pre-existing RASs or polymorphisms were detected in viruses of 6/10 patients (L28M for a GT4a, M28V for a GT4r, L30R for a GT4a, 2 GT4d and 1 GT4r, and T58P for a GT4d) by Sanger sequencing and in viruses of 7/10 patients by NGS. Additional baseline minority substitutions detected by NGS were Y93H in a GT3a, L28M in a GT4a and GT4d, and L28F in a GT4d virus. At failure, these substitutions were found at a frequency of 100%. Y93H was detected alone at baseline, whilst L28M and L28F were accompanied by polymorphisms L30R or L30R + T58P. Use of NGS in patients failing DAAs and infected by HCV GT3 and GT4 revealed the emergence of specific patterns of substitutions in NS5A and NS5B, in particular substitutions at position 28 in NS5A in GT4 virus, highlighting the need to list these substitutions in guidelines for resistance interpretation.
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Affiliation(s)
- Thuy Nguyen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France.
| | - Sepideh Akhavan
- Sorbonne Université, INSERM, CIMI-Paris, AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Fabienne Caby
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Services de maladies infectieuses et tropicales, F-75013 Paris, France
| | - Luminita Bonyhay
- AP-HP, Hôpital Pitié-Salpêtrière, Service d'Hépato-Gastroentérologie, F-75013 Paris, France
| | - Lucile Larrouy
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Bichat Claude Bernard, Laboratoire de virologie, F-75018 Paris, France
| | - Anne Gervais
- AP-HP, Hôpital Bichat Claude Bernard, Service des maladies infectieuses et tropicales, F-75018 Paris, France
| | - Pascal Lebray
- AP-HP, Hôpital Pitié-Salpêtrière, Service d'Hépato-Gastroentérologie, F-75013 Paris, France
| | - Thierry Poynard
- Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition (ICAN), AP-HP, Groupe Hospitalier Pitié-Salpêtrière, F-75013 Paris, France
| | - Yvon Calmus
- AP-HP, Hôpital Pitié-Salpêtrière, Unité Médicale de Transplantation Hépatique, Hépato-Gastro-Entérologie, F-75013 Paris, France
| | - Anne Simon
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Médecine Interne, F-75013 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Services de maladies infectieuses et tropicales, F-75013 Paris, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - Eve Todesco
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
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Jaffré J, Armenia D, Bellocchi MC, Wirden M, Carioti L, Lambert S, Valantin MA, Nguyen T, Simon A, Katlama C, Andreoni M, Perno CF, Calvez V, Ceccherini-Silberstein F, Marcelin AG, Todesco E. Ultradeep sequencing detection of the R263K integrase inhibitor drug resistance mutation. J Antimicrob Chemother 2018; 72:1537-1539. [PMID: 28088769 DOI: 10.1093/jac/dkw571] [Citation(s) in RCA: 1] [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] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jérémy Jaffré
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Daniele Armenia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Marc Wirden
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Luca Carioti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Sidonie Lambert
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Marc-Antoine Valantin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Infectious Diseases, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Thuy Nguyen
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Anne Simon
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Christine Katlama
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Infectious Diseases, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Massimo Andreoni
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Vincent Calvez
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | | | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
| | - Eve Todesco
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, F75013, France.,Department of Virology, Hôpital Pitié-Salpêtrière, AP-HP, Paris, F75013, France
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Virlogeux V, Zoulim F, Pugliese P, Poizot-Martin I, Valantin MA, Cuzin L, Reynes J, Billaud E, Huleux T, Bani-Sadr F, Rey D, Frésard A, Jacomet C, Duvivier C, Cheret A, Hustache-Mathieu L, Hoen B, Cabié A, Cotte L. Modeling HIV-HCV coinfection epidemiology in the direct-acting antiviral era: the road to elimination. BMC Med 2017; 15:217. [PMID: 29249202 PMCID: PMC5733872 DOI: 10.1186/s12916-017-0979-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 11/22/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model. METHODS The model was based on epidemiological data from the French Dat'AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015. RESULTS On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026. CONCLUSIONS Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC.
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Affiliation(s)
- Victor Virlogeux
- Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, F-69008, Lyon, France.,Centre for Clinical Research, Department of Hepatology, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.,Lyon University, Lyon, France
| | - Fabien Zoulim
- Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, F-69008, Lyon, France.,Centre for Clinical Research, Department of Hepatology, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France.,Lyon University, Lyon, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet, Nice, France
| | - Isabelle Poizot-Martin
- Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Service d'Immuno-hématologie clinique, INSERM U912 (SESSTIM), 13009, Marseille, France
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne Université, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Lise Cuzin
- CHU Toulouse, COREVIH Toulouse, Toulouse, France.,Université de Toulouse III, Toulouse, France.,INSERM, UMR 1027, Toulouse, France
| | - Jacques Reynes
- Department of Infectious Diseases, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France
| | - Eric Billaud
- Department of Infectious Diseases, Hotel-Dieu Hospital, Nantes, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, CHU Reims, Reims, France.,Université de Reims Champagne-Ardenne, Faculté de Médecine, EA-4684/SFR CAP-SANTE, Reims, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg, France
| | - Anne Frésard
- Department of Infectious Diseases, CHU Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Christine Jacomet
- Department of Infectious Diseases, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claudine Duvivier
- Department of Infectious Diseases, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France
| | - Antoine Cheret
- Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France.,Department of Internal Medicine, CHU Bicètre, Paris, France
| | | | - Bruno Hoen
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, and Service de Maladies Infectieuses et Tropicales, Dermatologie et Médecine Interne, and INSERM CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - André Cabié
- Department of Infectious Diseases, CHU de Martinique, Fort-de-France, France.,Université des Antilles EA4537 and INSERM CIC1424, Fort-de-France, France
| | - Laurent Cotte
- Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, F-69008, Lyon, France. .,Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, 69317, Lyon, CEDEX 04, France. .,Lyon University, Lyon, France.
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37
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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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Isnard Bagnis C, Pieroni L, Inaoui R, Maksud P, Lallauret S, Valantin MA, Tubiana R, Katlama C, Deray G, Courbebaisse M, Tourret J, Tezenas du Montcel S. Impact of lean mass and bone density on glomerular filtration rate estimation in people living with HIV/AIDS. PLoS One 2017; 12:e0186410. [PMID: 29096403 PMCID: PMC5668131 DOI: 10.1371/journal.pone.0186410] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Context Chronic kidney disease is a frequent complication in persons living with HIV/AIDS. Although previous studies have suggested that the CKD-EPI formula is appropriate to estimate glomerular filtration rate (GFR) in HIV-positive adults with normal kidney function, the optimal way to estimate GFR in those with Stage 3 chronic kidney disease is not known. Moreover, the impact of muscle mass on creatinine level and GFR estimation is unknown. Aim and methods Our study aimed to evaluate the accuracy of different diagnostic tests available compared to the gold standard measurement of GFR. A group of 44 HIV-1 patients with an estimated GFR between 60 and 30 ml/min/1.73 m2 were included in a single-center cross-sectional study. Serum creatinine and cystatin C were measured. GFR was estimated using Cockcroft-Gault, MDRD, sMDRD, CKD-EPI, CKD-EPIcyst, and CKD-EPIcyst/creat formulae and was measured using isotopic Chrome51 EDTA clearance. Bone density and muscle mass were measured by DXA scan. Results Mean age was 62±10 years. Mean BMI was 23±4 kg/m2. Prevalence of diabetes was 30% and of hypertension was 47%. Viral load was <40 copies/ml for 90% of the patients, and mean CD4 count was 446±191 cells/mm3. Mean measured GFR was 63.4±16.5 ml/min/1.73 m2. All formulae under-estimated GFR. The best relative precision and accuracy were provided by the CKP-EPI formula. sMDRD, CKD-EPIcyst, and CKD-EPIcyst/creat performed worse than the CKD-EPI formula. Body composition did not significantly influence accuracy or precision of GFR estimation. Conclusion In HIV-infected patients in stable immunovirologic conditions with CKD stage 3 and high prevalence of metabolic associated conditions, the CKD-EPI formula performed best, although all formulae under estimate GFR.
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Affiliation(s)
- Corinne Isnard Bagnis
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
- * E-mail:
| | - Laurence Pieroni
- Biochemistry Department, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Rachida Inaoui
- Rhumatology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Philippe Maksud
- Nuclear Medicine, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Stéphanie Lallauret
- Biostatistics Unit and Clinical Research Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marc-Antoine Valantin
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Roland Tubiana
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Christine Katlama
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Gilbert Deray
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Marie Courbebaisse
- Physiology Department, Hôpital Européen Georges Pompidou, Paris, France et INSERM, Paris, France
| | - Jérôme Tourret
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Sophie Tezenas du Montcel
- Biostatistics Unit and Clinical Research Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Université, UPMC Univ Paris 06 UMR_S1136, Paris, France
- Institut Pierre Louis d’EPIdémiologie et de Santé Publique, Paris, France
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Ailioaie O, Arzouk N, Valantin MA, Tourret J, Calin RO, Turinici M, Mircescu G, Barrou B. Infectious complications in HIV-infected kidney transplant recipients. Int J STD AIDS 2017; 29:341-349. [PMID: 28862528 DOI: 10.1177/0956462417726213] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Renal transplantation is now a viable alternative for dialysis in HIV-infected patients who achieve good immunovirological control with current antiretroviral therapy regimens available. However, there are few studies that analyze the incidence of post-transplant infections in this population. In this study, a retrospective analysis of data files of 24 HIV-infected kidney transplant (KT) recipients was undertaken, matched to 21 non-infected controls. All patients received induction with anti-interleukin-2 antibodies and were followed in the Pitié-Salpêtrière Hospital in Paris, France. The rate of incidence of post-transplant infections was 23.58 and 26.98/100 patient-years, in HIV-infected and HIV-negative groups (relative risk [RR]: 0.90; 95% confidence interval [CI]: 0.58-1.39; p = 0.63). In HIV-infected KT recipients, bacterial infections were the most frequent (67.7%), followed by viral (14.7%) and fungal and parasitic infections (8.8%). Similar trends were seen in the control group. Incidence of opportunistic infections was similar in HIV-infected KT recipients and controls (38.2 vs. 26.5%; p = 0.44). There were three post-transplant HIV reactivations in two patients, secondary to poor adherence to medication. HIV status did not influence survival, but infections increased the risk of unfavorable outcome. Incidence of post-transplant infections was similar in HIV-infected KT recipients and controls. Infections, but not HIV status, had adverse effects on patient and graft survival.
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Affiliation(s)
- O Ailioaie
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - N Arzouk
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - M A Valantin
- 2 Infectious Diseases Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - J Tourret
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - R O Calin
- 2 Infectious Diseases Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
| | - M Turinici
- 3 Biostatistics Department, 26930 Public Assistance of Paris Hospitals , Paris, France
| | - G Mircescu
- 4 "Dr. C. Davila" Teaching Hospital of Nephrology, Bucharest, Romania
| | - B Barrou
- 1 Renal Transplant Department, 26933 Pitié-Salpêtriere Hospital , Paris, France
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40
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Piroth L, Wittkop L, Lacombe K, Rosenthal E, Gilbert C, Miailhes P, Carrieri P, Chas J, Poizot-Martin I, Gervais A, Dominguez S, Neau D, Zucman D, Billaud E, Morlat P, Aumaitre H, Lascoux-Combe C, Simon A, Bouchaud O, Teicher E, Bani-Sadr F, Alric L, Vittecoq D, Boué F, Duvivier C, Valantin MA, Esterle L, Dabis F, Sogni P, Salmon D. Efficacy and safety of direct-acting antiviral regimens in HIV/HCV-co-infected patients - French ANRS CO13 HEPAVIH cohort. J Hepatol 2017; 67:23-31. [PMID: 28235612 DOI: 10.1016/j.jhep.2017.02.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is little data available on the use of new oral direct-acting antiviral (DAA) regimens to treat human immunodeficiency virus and hepatitis C virus (HIV/HCV) co-infected patients in real-life settings. Here, the efficacy and safety of all-oral DAA-based regimens in HIV/HCV-co-infected patients enrolled in the French nationwide ANRS CO13 HEPAVIH observational cohort are reported. METHODS HIV/HCV-co-infected patients enrolled in the ANRS CO13 HEPAVIH observational cohort were included if they began an all-oral DAA-based regimen before 1st May 2015 (12-week regimens) or 1st February 2015 (24-week regimens). Treatment success (SVR12) was defined by undetectable HCV-RNA 12weeks after treatment cessation. Exact logistic regression analysis was used to identify factors associated with SVR12. RESULTS A total of 323 patients (74% men) with a median age of 53years were included, 99% of whom were on combination antiretroviral therapy (cART). HIV RNA load was <50 copies/ml in 88% of patients; median CD4 cell count was 540/mm3; 60% of patients were cirrhotic; 68% had previously received unsuccessful anti-HCV treatment. cART was protease inhibitor (PI)-based in 23%, non-nucleoside reverse transcriptase inhibitor (NNRTI)-based in 15%, and integrase inhibitor (II)-based in 38%, while 24% of patients received other regimens. The SVR12 rate was 93.5% overall (95% confidence interval [CI]: 90.2-95.9), 93.3% (88.8-96.4) in patients with cirrhosis and 93.8% (88.1-97.3) in patients without cirrhosis. The SVR12 rates were 93.1% (84.5-97.7), 91.8% (80.4-97.7) and 95.8% (90.5-98.6) respectively, in patients receiving PI-based, NNRTI-based and II-based cART. In adjusted analysis, SVR12 was not associated with HIV RNA load, the cART regimen, cirrhosis, prior anti-HCV treatment, the duration of anti-HCV therapy, or ribavirin use. The most common adverse effects were fatigue and digestive disorders. CONCLUSIONS New all-oral DAA regimens were well-tolerated and yielded high SVR12 rates in HIV/HCV-co-infected patients. LAY SUMMARY We evaluated efficacy and safety of all-oral DAA regimens in a large French nationwide observational cohort study of HIV/HCV co-infected patients. Sustained virological response 12weeks after treatment cessation was 93.5% overall. The all-oral DAA regimens were well-tolerated and most common adverse effects were fatigue and digestive disorders.
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Affiliation(s)
- Lionel Piroth
- Centre Hospitalier Universitaire de Dijon, Département d'Infectiologie, Dijon, France; Université de Bourgogne, Dijon, France
| | - Linda Wittkop
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France.
| | - Karine Lacombe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Antoine, Service Maladies infectieuses et tropicales, Paris, France; UMPC (Université Pierre et Marie Curie), UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Eric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne, Hôpital l'Archet, Nice, France; Université de Nice-Sophia Antipolis, Nice, France
| | - Camille Gilbert
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France
| | - Patrick Miailhes
- Service des Maladies Infectieuses et Tropicales, CHU Lyon, Hôpital de la Croix Rousse, Lyon, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Julie Chas
- Assistance Publique des Hôpitaux de Paris, Hôpital Tenon, Service Maladies infectieuses et tropicales, Paris, France
| | - Isabelle Poizot-Martin
- Aix Marseille Univ, APHM Sainte-Marguerite, Service d'Immuno-hématologie clinique, Marseille, France
| | - Anne Gervais
- Assistance Publique des Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Service des Maladies Infectieuses et tropicales, Paris, France
| | - Stéphanie Dominguez
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service Immunologie clinique et Maladies Infectieuses, Immunologie clinique, Créteil, France
| | - Didier Neau
- Centre Hospitalier Universitaire de Bordeaux, Service Maladies infectieuses et tropicales Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | | | - Eric Billaud
- Centre Hospitalier Universitaire de Nantes, Service Maladies infectieuses et tropicales, Nantes, France
| | - Philippe Morlat
- Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne, hôpital Saint-André, Bordeaux, France
| | - Hugues Aumaitre
- Centre Hospitalier de Perpignan, Service Maladies infectieuses et tropicales, Perpignan, France
| | - Caroline Lascoux-Combe
- Assistance Publique des Hôpitaux de Paris, Hôpital Saint-Louis, Service Maladies infectieuses et tropicales, Paris, France
| | - Anne Simon
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Olivier Bouchaud
- Assistance Publique des Hôpitaux de Paris, Hôpital Avicenne, Service Maladies infectieuses et tropicales, Bobigny, France; Université Paris 13 Nord, Bobigny, France
| | - Elina Teicher
- Assistance Publique des Hôpitaux de Paris, GH Paris Sud : Service Médecine Interne et Immunologie clinique, Hôpital Bicêtre, Le Kremlin-Bicêtre; Centre Hépato-Biliaire, Hôpital Paul-Brousse,Villejuif, France
| | - Firouzé Bani-Sadr
- Centre Hospitalier Universitaire de Reims, Service de Médecine Interne, Maladies Infectieuses et immunologie clinique, Reims, France; Université de Reims, Champagne-Ardenne, Reims, France
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Service Médecine Interne-Pôle Digestif, Toulouse, France; UMR 152 IRD Université Toulouse III, Paul Sabatier, Toulouse, France
| | - Daniel Vittecoq
- Université Paris Sud, Le Kremlin-Bicêtre, France; Assistance Publique des Hôpitaux de Paris, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Service Maladies infectieuses et tropicales, Le Kremlin-Bicêtre, France
| | - François Boué
- Université Paris Sud, Le Kremlin-Bicêtre, France; Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Paris Sud, Hôpital Antoine-Béclère, Service Médecine Interne et immunologie, Clamart, France
| | - Claudine Duvivier
- Assistance Publique des Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Marc-Antoine Valantin
- Assistance Publique des Hôpitaux de Paris, Hôpital Pitié-Salpétrière, Service Maladies infectieuses et tropicales, Paris, France
| | - Laure Esterle
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France
| | - François Dabis
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France; CHU de Bordeaux, Pole de sante publique, Service d'information medicale, F-33000 Bordeaux, France
| | - Philippe Sogni
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service d'Hépatologie, Paris, France; INSERM U-1223 - Institut Pasteur, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique Salmon
- Assistance Publique des Hôpitaux de Paris, Hôpital Cochin, Service Maladies infectieuses et tropicales, Paris, France
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Pradat P, Pugliese P, Poizot-Martin I, Valantin MA, Cuzin L, Reynes J, Billaud E, Huleux T, Bani-Sadr F, Rey D, Frésard A, Jacomet C, Duvivier C, Cheret A, Hustache-Mathieu L, Hoen B, Cabié A, Cotte L, Chidiac C, Ferry T, Ader F, Biron F, Boibieux A, Miailhes P, Perpoint T, Schlienger I, Lippmann J, Braun E, Koffi J, Longuet C, Guéripel V, Augustin-Normand C, Brochier C, Degroodt S, Pugliese P, Ceppi C, Cua E, Cottalorda J, Courjon J, Dellamonica P, Demonchy E, De Monte A, Durant J, Etienne C, Ferrando S, Fuzibet J, Garraffo R, Joulie A, Risso K, Mondain V, Naqvi A, Oran N, Perbost I, Pillet S, Prouvost-Keller B, Wehrlen-Pugliese S, Rosenthal E, Sausse S, Rio V, Roger P, Brégigeon S, Faucher O, Obry-Roguet V, Orticoni M, Soavi M, Geneau de Lamarlière P, Laroche H, Ressiot E, Carta M, Ducassou M, Jacquet I, Gallie S, Galinier A, Ritleng A, Ivanova A, Blanco-Betancourt C, Lions C, Debreux C, Obry-Roguet V, Poizot-Martin I, Agher R, Katlama C, Valantin M, Duvivier C, Lortholary O, Lanternier F, Charlier C, Rouzaud C, Aguilar C, Henry B, Lebeaux D, Cessot G, Gergely A, Consigny P, Touam F, Louisin C, Alvarez M, Biezunski N, Cuzin L, Debard A, Delobel P, Delpierre C, Fourcade C, Marchou B, Martin-Blondel G, Porte M, Mularczyk M, Garipuy D, Saune K, Lepain I, Marcel M, Puntis E, Atoui N, Casanova M, Faucherre V, Jacquet J, Le Moing V, Makinson A, Merle De Boever C, Montoya-Ferrer A, Psomas C, Reynes J, Raffi F, Allavena C, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet C, Jovelin T, Hall N, Bernaud C, Morineau P, Reliquet V, Aubry O, Point P, Besnier M, Larmet L, Hüe H, Pineau S, André-Garnier E, Rodallec A, Choisy P, Vandame S, Huleux T, Ajana F, Alcaraz I, Baclet V, Huleux T, Melliez H, Viget N, Valette M, Aissi E, Allienne C, Meybeck A, Riff B, Bani-Sadr F, Rouger C, Berger J, N'Guyen Y, Lambert D, Kmiec I, Hentzien M, Lebrun D, Migault C, Rey D, Batard M, Bernard-Henry C, Cheneau C, de Mautort E, Fischer P, Partisani M, Priester M, Lucht F, Frésard A, Botelho-Nevers E, Gagneux-Brunon A, Cazorla C, Guglielminotti C, Daoud F, Lutz M, Jacomet C, Laurichesse H, Lesens O, Vidal M, Mrozek N, Corbin V, Aumeran C, Baud O, Casanova S, Coban D, Hustache-Mathieu L, Thiebaut-Drobacheff M, Foltzer A, Gendrin V, Bozon F, Chirouze C, Abel S, Cabié A, Césaire R, Santos GD, Fagour L, Najioullah F, Ouka M, Pierre-François S, Pircher M, Rozé B, Hoen B, Ouissa R, Lamaury I. Direct-acting antiviral treatment against hepatitis C virus infection in HIV-Infected patients - "En route for eradication"? J Infect 2017; 75:234-241. [PMID: 28579302 DOI: 10.1016/j.jinf.2017.05.008] [Citation(s) in RCA: 17] [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: 11/10/2016] [Revised: 03/17/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients. METHODS All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection. RESULTS Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR. CONCLUSIONS HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.
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Affiliation(s)
- Pierre Pradat
- Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet, Nice, France
| | - Isabelle Poizot-Martin
- Immuno-hematology Clinic, Assistance Publique - Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, France; Aix-Marseille University, Inserm U912 (SESSTIM), Marseille, France
| | - Marc-Antoine Valantin
- Department of Infectious Diseases, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Lise Cuzin
- CHU Toulouse, COREVIH, Toulouse, France; Université de Toulouse III, Toulouse, France; INSERM, UMR, 1027, Toulouse, France
| | - Jacques Reynes
- Department of Infectious Diseases, UMI 233 INSERM U1175, CHU de Montpellier, Montpellier, France
| | - Eric Billaud
- Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, Hôpital Robert Debré, CHU, Reims, France; Université de Reims Champagne-Ardenne, Faculté de médecine, EA-4684/SFR CAP-SANTE, Reims, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg, France
| | - Anne Frésard
- Department of Infectious Diseases, CHU, Saint-Etienne, France
| | - Christine Jacomet
- Department of Infectious Diseases, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claudine Duvivier
- Department of Infectious Diseases, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France
| | - Antoine Cheret
- Department of Internal Medicine, CHU, Bicètre, France; Université Paris Descartes, Sorbonne Paris Cité, EA7327, Paris, France
| | | | - Bruno Hoen
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, and Service de Maladies Infectieuses et Tropicales, Dermatologie et Médecine Interne, and Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - André Cabié
- Department of Infectious Diseases, CHU de Martinique, Fort-de-France, France; Université des Antilles EA4537 and INSERM CIC1424, Fort-de-France, France
| | - Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Lyon, France.
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Bittar R, Aslangul É, Giral P, Assoumou L, Valantin MA, Kalmykova O, Federspiel MC, Cherfils C, Costagliola D, Bonnefont-Rousselot D. Lack of effects of statins on high-density lipoprotein subfractions in HIV-1-infected patients receiving protease inhibitors. C R Biol 2016; 340:109-113. [PMID: 28011249 DOI: 10.1016/j.crvi.2016.11.004] [Citation(s) in RCA: 2] [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: 02/08/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the effect of 45 days of rosuvastatin or pravastatin treatment on the distribution of HDL subfractions in HIV-1-infected individuals receiving boosted protease inhibitors (PIs) with cardiovascular risk. METHODS The distribution of HDL subclasses by gradient gel electrophoresis was blindly assessed in 74 HIV-1-infected individuals receiving boosted PIs at baseline and at day 45 of statin treatment, and compared with the distribution obtained in 63 healthy normolipidemic individuals taken as controls. RESULTS No significant modification appeared in HDL distribution between the two arms of statins for the HIV-1-infected individuals. Nevertheless, when compared to controls, HDL subfractions showed a significantly lower HDL2b proportion and significantly higher proportions of HDL2a and HDL3b (P<0.001). CONCLUSION No difference was observed in HDL distribution between pravastatin and rosuvastatin after 45 days treatment, in HIV-1-infected individuals under PIs. Nevertheless, when compared to healthy normolipidemic subjects, HDL distribution is clearly different, with a distribution in HIV-infected individuals under PIs associated with an increased cardiovascular risk.
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Affiliation(s)
- Randa Bittar
- Unité fonctionnelle de biochimie des maladies métaboliques, service de biochimie métabolique, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; UPMC université Paris 06, UMR_S1166 ICAN, 75013 Paris, France.
| | - Élisabeth Aslangul
- Service de médecine interne, Hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92701 Colombes, France; Université Paris-Descartes, rue de l'École-de-Médecine, 75006 Paris, France
| | - Philippe Giral
- UPMC université Paris 06, UMR_S1166 ICAN, 75013 Paris, France; Unité de prévention cardiovasculaire, service d'endocrinologie métabolisme, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 75651 Paris cedex 13, France
| | - Lambert Assoumou
- Sorbonne universités, UPMC université Paris-6, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Inserm, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne universités, UPMC université Paris-6, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Inserm, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Service des maladies infectieuses et tropicales, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, 75651 Paris cedex 13, France
| | - Olga Kalmykova
- Sorbonne universités, UPMC université Paris-6, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Inserm, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France
| | - Marie-Christine Federspiel
- Unité fonctionnelle de biochimie des maladies métaboliques, service de biochimie métabolique, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Corinne Cherfils
- Unité fonctionnelle de biochimie des maladies métaboliques, service de biochimie métabolique, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - Dominique Costagliola
- Sorbonne universités, UPMC université Paris-6, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Inserm, UMR_S 1136, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; Service des maladies infectieuses et tropicales, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Assistance publique-Hôpitaux de Paris, 75651 Paris cedex 13, France
| | - Dominique Bonnefont-Rousselot
- Unité fonctionnelle de biochimie des maladies métaboliques, service de biochimie métabolique, hôpitaux universitaires Pitié-Salpêtrière - Charles-Foix, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Inserm U 1022 CNRS UMR 8258, Chimie ParisTech, PSL Research University, unité de technologies chimiques et biologiques pour la santé, faculté de pharmacie, Sorbonne Paris Cité, université Paris-Descartes, 75006 Paris, France
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Boesecke C, Ingiliz P, Reiberger T, Stellbrink HJ, Bhagani S, Page E, Mauss S, Lutz T, Voigt E, Guiguet M, Valantin MA, Baumgarten A, Nelson M, Vogel M, Rockstroh JK. Dual treatment of acute HCV infection in HIV co-infection: influence of HCV genotype upon treatment outcome. Infection 2016; 44:93-101. [PMID: 26481253 DOI: 10.1007/s15010-015-0856-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/07/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE With DAAs still only being licensed for chronic HCV infection, the ongoing epidemic of acute hepatitis C (AHC) infection among MSM highlights the need to identify factors allowing for optimal HCV treatment outcome. METHODS 303 HIV-infected patients from 4 European countries with diagnosed acute HCV infection were treated early with pegylated interferon (pegIFN) and ribavirin (RBV) (n = 273) or pegylated interferon alone (n = 30). RESULTS All patients were male, median age was 39 years. Main routes of transmission were MSM (95%) and IVDU (3%). 69% of patients were infected with HCV GT 1, 4.3% with GT 2, 10.6% with GT 3, 16.1% with GT 4. Overall SVR rate was 69.3% (210/303). RVR (p ≤ 0.001), 48-w treatment duration (p ≤ 0.001) and GT 2/3 (p = 0.024) were significantly associated with SVR. SVR rates were significantly higher in HCV GT 2/3 receiving pegIFN and RBV (33/35) when compared with pegIFN mono-therapy (6/10) (94% vs. 60 % respectively; p = 0.016). In multivariate analysis, pegIFN/RBV combination therapy (p = 0.017) and rapid virological response (RVR) (p = 0.022) were significantly associated with SVR in HCV GT 2/3. In HCV GT 1/4, RVR (p ≤ 0.001) and 48-w treatment duration (p ≤ 0.001) were significantly associated with SVR. CONCLUSIONS Treatment of AHC GT 2 and 3 infections with pegIFN/RBV is associated with higher SVR rates suggesting different cure rates depending on HCV genotype similar to the genotype effects seen previously in chronic HCV under pegIFN/RBV. With pegIFN/RBV still being the gold standard of AHC treatment and in light of cost issues around DAAs and very limited licensed interferon-free DAA treatment options for chronic HCV GT 3 infection AHC GT 3 patients might benefit most from early interferon-containing treatment.
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Cotte L, Pugliese P, Valantin MA, Cuzin L, Billaud E, Duvivier C, Naqvi A, Cheret A, Rey D, Pradat P, Poizot-Martin I. Hepatitis C treatment initiation in HIV-HCV coinfected patients. BMC Infect Dis 2016; 16:345. [PMID: 27450098 PMCID: PMC4957284 DOI: 10.1186/s12879-016-1681-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 06/14/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There are few data regarding HCV treatment initiation among HIV/HCV coinfected patients. The objective of this study was to analyze the changing patterns of HCV coinfection and HCV treatment initiation over time in a large French cohort of HIV/HCV coinfected patients at the beginning of DAA's era and to analyze factors associated with treatment initiation. METHODS All HIV/HCV coinfected patients enrolled during 2000-2012 were analyzed. HCV status was defined per calendar year as naïve, spontaneous cure, sustained virological response (SVR), failure or reinfection. HCV treatment initiation rate was determined per year. Trends over time were analyzed using Chi-2 test for trend and linear regression analysis. The effect of covariates on treatment initiation over time was analyzed using generalized estimating equations. RESULTS Among 34,308 HIV-infected patients enrolled between 2000 and 2012, 5,562 were HCV coinfected. HCV prevalence declined from 38.4 to 15.1 %. HCV treatment initiation rate fluctuated from 5.6 to 7.4 %/year from 2000 to 2007, dropped to 5.6 % in 2011 and increased to 8.5 % in 2012 due to the use of first-generation DAAs (29.1 % of initiations in 2012). Cumulative HCV treatment initiation rate increased from 14.8 % in 2000 to 54.7 % in 2012. HCV cure rate increased from 12.4 to 45.2 %. Older age, male gender, male homosexuality, high CD4, undetectable HIV-RNA, CDC stage A-B, and severe fibrosis/cirrhosis were associated with a higher treatment initiation rate. The role of HCV genotype 1, CDC stage, fibrosis and recent HCV infection on treatment initiation rate changed over time. CONCLUSION A high rate of HCV treatment initiation was observed at the beginning of DAAs era in HIV/HCV coinfected patients. Given the very high efficacy of new DAA-based regimens and if treatment initiation keeps increasing, HCV prevalence among HIV patients will drastically decrease during the forthcoming years.
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Affiliation(s)
- Laurent Cotte
- />Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, INSERM U1052, Lyon, France
- />Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, 103 grande rue de la Croix-Rousse, 69317 Lyon, CEDEX 04 France
| | - Pascal Pugliese
- />Department of Infectious Diseases, Centre Hospitalier Universitaire de l’Archet, Nice, France
| | - Marc-Antoine Valantin
- />Department of infectious diseases, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- />UMR-S 943, INSERM, Paris, France
| | - Lise Cuzin
- />INSERM, UMR 1027, Toulouse, F-31000 France
- />Université de Toulouse III, Toulouse, F-31000 France
- />CHU Toulouse, COREVIH Toulouse, F-31000 France
| | - Eric Billaud
- />Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France
| | - Claudine Duvivier
- />Université Paris Descartes, Sorbonne Paris Cité, EA7327 Paris, France
- />Assistance Publique - Hôpitaux de Paris - Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Alissa Naqvi
- />Department of Infectious Diseases, Centre Hospitalier Universitaire de l’Archet, Nice, France
| | - Antoine Cheret
- />Department of infectious diseases, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - David Rey
- />Department of Infectious Diseases, Hôpitaux Universitaires, Strasbourg, France
| | - Pierre Pradat
- />Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Poizot-Martin
- />Aix-Marseille University, Assistance Publique – Hôpitaux de Marseille - Hôpital Sainte-Marguerite, Immuno-hematology clinic, 13009 Marseille France, Inserm U912 (SESSTIM), 13009 Marseille, France
| | - the Dat’AIDS study Group
- />Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, INSERM U1052, Lyon, France
- />Department of Infectious Diseases, Centre Hospitalier Universitaire de l’Archet, Nice, France
- />Department of infectious diseases, Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- />UMR-S 943, INSERM, Paris, France
- />INSERM, UMR 1027, Toulouse, F-31000 France
- />Université de Toulouse III, Toulouse, F-31000 France
- />CHU Toulouse, COREVIH Toulouse, F-31000 France
- />Department of Infectious Diseases, Hotel Dieu Hospital, Nantes, France
- />Université Paris Descartes, Sorbonne Paris Cité, EA7327 Paris, France
- />Assistance Publique - Hôpitaux de Paris - Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
- />Department of infectious diseases, Centre Hospitalier de Tourcoing, Tourcoing, France
- />Department of Infectious Diseases, Hôpitaux Universitaires, Strasbourg, France
- />Center for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- />Aix-Marseille University, Assistance Publique – Hôpitaux de Marseille - Hôpital Sainte-Marguerite, Immuno-hematology clinic, 13009 Marseille France, Inserm U912 (SESSTIM), 13009 Marseille, France
- />Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, 103 grande rue de la Croix-Rousse, 69317 Lyon, CEDEX 04 France
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45
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Sogni P, Gilbert C, Lacombe K, Piroth L, Rosenthal E, Miailhes P, Gervais A, Esterle L, Chas J, Poizot-Martin I, Dominguez S, Simon A, Morlat P, Neau D, Zucman D, Bouchaud O, Lascoux-Combe C, Bani-Sadr F, Alric L, Goujard C, Vittecoq D, Billaud E, Aumaître H, Boué F, Valantin MA, Dabis F, Salmon D, Wittkop L. All-oral Direct-acting Antiviral Regimens in HIV/Hepatitis C Virus-coinfected Patients With Cirrhosis Are Efficient and Safe: Real-life Results From the Prospective ANRS CO13-HEPAVIH Cohort. Clin Infect Dis 2016; 63:763-770. [PMID: 27317796 DOI: 10.1093/cid/ciw379] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 02/29/2016] [Accepted: 06/06/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients with cirrhosis have long been considered to be difficult to treat, and real-life efficacy and tolerance data with all-oral direct-acting antiviral (DAA) combinations in these patients are scarce. METHODS Cirrhotic HIV/HCV-coinfected patients enrolled in the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) CO13 HEPAVIH cohort initiating an all-oral DAA regimen were consecutively included. A negative HCV RNA result at 12 weeks of follow-up or thereafter was assumed as a sustained virologic response (SVR12). Adjusted exact logistic regression was used to study factors associated with treatment outcome. RESULTS We included 189 patients who initiated an all-oral DAA regimen with the following characteristics: median age 53.2 years; 74.6% male; Centers for Disease Control and Prevention classification A/B/C: 37%/31%/32%; Child-Pugh class A/B/C: 91%/8%/1%; 87% with HIV RNA <50 copies/mL; 99% on antiretrovirals; median CD4 count: 489 cells/µL; HCV treatment naive 29%; HCV genotype 1/2/3/4: 58%/4%/17%/21%. Sofosbuvir (SOF) + daclatasvir ± ribavirin (RBV) was used in 123 patients, SOF + RBV in 30, SOF + simeprevir in 11, and SOF + ledipasvir in 23. An SVR12 was reported in 93.1% of the patients (95% confidence interval, 88.5%-96.3%). In adjusted analyses, no difference was found between 12 or 24 weeks of treatment, in patients receiving RBV or not, and in treatment-naive vs experienced patients. Premature stop of DAA was reported for 8 patients. One patient died during treatment (unknown cause), and 12 other patients developed liver-related events. CONCLUSIONS In this prospective real-life cohort, all-oral DAA regimens were well tolerated and associated with a high virologic efficacy in cirrhotic HIV/HCV-coinfected patients. This should not alleviate the surveillance for liver-related events in these patients.
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Affiliation(s)
- Philippe Sogni
- Service d'Hépatologie, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Cochin.,INSERM U-1223-Institut Pasteur.,Université Paris Descartes
| | - Camille Gilbert
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health
| | - Karine Lacombe
- Service Maladies infectieuses et tropicales, AP-HP, Hôpital Saint-Antoine.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Université Pierre et Marie Curie, UMR S1136, Paris
| | - Lionel Piroth
- Département d'Infectiologie, Centre Hospitalier Universitaire de Dijon.,Université de Bourgogne, Dijon
| | - Eric Rosenthal
- Service de Médecine Interne et Cancérologie, Hôpital l'Archet, Centre Hospitalier Universitaire de Nice.,Université de Nice-Sophia Antipolis, Nice
| | - Patrick Miailhes
- Service des Maladies infectieuses et tropicales, CHU Lyon, Hôpital de la Croix Rousse, Lyon
| | - Anne Gervais
- Service des maladies infectieuses et tropicales, AP-HP, Hôpital Bichat Claude Bernard
| | - Laure Esterle
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health
| | - Julie Chas
- Service Maladies infectieuses et tropicales, AP-HP, Hôpital Tenon, Paris
| | | | - Stéphanie Dominguez
- Service Immunologie clinique et maladies infectieuses, Immunologie clinique, AP-HP, Hôpital Henri Mondor, Créteil
| | - Anne Simon
- Département de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital Pitié-Salpétrière, Paris
| | - Philippe Morlat
- Service de médecine interne, hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux.,Université de Bordeaux
| | - Didier Neau
- Université de Bordeaux.,Service Maladies infectieuses et tropicales Bordeaux, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux
| | | | - Olivier Bouchaud
- Service Maladies infectieuses et tropicales, AP-HP, Hôpital Avicenne.,Université Paris 13 Nord, Bobigny
| | | | - Firouzé Bani-Sadr
- Service de médecine interne, maladies infectieuses et immunologie clinique, Centre Hospitalier Universitaire de Reims.,Université de Reims, Champagne-Ardenne
| | - Laurent Alric
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Médecine interne.,Université Toulouse III, Paul Sabatier
| | - Cécile Goujard
- Service Médecine interne et Immunologie clinique, AP-HP, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud.,Université Paris Sud
| | - Daniel Vittecoq
- Université Paris Sud.,Service Maladies infectieuses et tropicales, AP-HP, Hôpital Bicêtre, Hôpitaux universitaires Paris Sud, Le Kremlin-Bicêtre
| | - Eric Billaud
- Service Maladies infectieuses et tropicales, Centre Hospitalier Universitaire de Nantes
| | - Hugues Aumaître
- Service Maladies infectieuses et tropicales, Centre Hospitalier de Perpignan
| | - François Boué
- Université Paris Sud.,Service Médecine interne et immunologie, AP-HP, Groupe Hospitalier Paris Sud, Hôpital Antoine-Béclère, Clamart
| | | | - François Dabis
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health.,Université Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health.,Centre Hospitalier de Bordeaux Hôpital Pellegrin, Pôle Santé Publique
| | - Dominique Salmon
- Université Paris Descartes.,Service Maladies infectieuses et tropicales, AP-HP, Hôpital Cochin, Paris, France
| | - Linda Wittkop
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health.,Université Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health.,Centre Hospitalier de Bordeaux Hôpital Pellegrin, Pôle Santé Publique
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46
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Caby F, Guihot A, Lambert-Niclot S, Guiguet M, Boutolleau D, Agher R, Valantin MA, Tubiana R, Calvez V, Marcelin AG, Carcelain G, Autran B, Costagliola D, Katlama C. Determinants of a Low CD4/CD8 Ratio in HIV-1–Infected Individuals Despite Long-term Viral Suppression. Clin Infect Dis 2016; 62:1297-1303. [DOI: 10.1093/cid/ciw076] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/05/2016] [Indexed: 01/01/2023] Open
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47
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Salmon D, Bani-Sadr F, Gilbert C, Rosenthal E, Valantin MA, Simon A, Neau D, Morlat P, Loko MA, Wittkop L, Dabis F. HCV viral load at baseline and at week 4 of telaprevir/boceprevir based triple therapies are associated with virological outcome in HIV/hepatitis C co-infected patients. J Clin Virol 2015; 73:32-35. [PMID: 26528903 DOI: 10.1016/j.jcv.2015.10.010] [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: 07/03/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND As first generation HCV-specific protease inhibitors, boceprevir (BOC) or telaprevir (TVR) can achieve 60% to 70% sustained virological response (SVR) for HCV infected patients with genotype 1 infections, they could remain temporary a therapeutic option in patients living in resources limited countries with limited access to the new anti-HCV direct acting antiviral (DAA) drugs, such as sofosbuvir. OBJECTIVES AND STUDY DESIGN Here we evaluated in a routine practice setting, the treatment responses, tolerance and factors associated with SVR of a triple therapy with BOC or TVR, combined with pegylated interferon and ribavirin (PegIFN/RBV) in HIV/HCV co-infected patients, included in a large cohort of HIV/HCV coinfected patients (ANRS CO13-HEPAVIH). RESULTS Among the 89 HIV/HCV coinfected patients treated, 65% of whom were previous non-responders to PegIFN/RBV therapy, 65%, 55% and 41% had at baseline genotype 1a, a high baseline HCV-RNA (≥800,000 IU/ml) and a cirrhosis, respectively. The SVR12 rate was 63% overall, 53% for BOC-based regimen and 66% for TVR-based regimen. In multivariate analysis, two factors were significantly associated with HCV SVR: HCV viral load <800,000 IU/mL at treatment initiation versus ≥800,000 IU/mL (OR 4.403, 95% CI 1.29-15.04; p=0.018) and virological response at W4 (HCV-RNA undetectable after 4 weeks of triple therapy) (OR 3.35, 95% CI 1.07-10.48; p=0.038). CONCLUSIONS Overall SVR12 was 63% and our results suggest that HIV/HCV coinfected patients with low HCV viral load (<800,000 IU/mL) and undetectable HCV-RNA after 4 weeks of triple therapy with TVR or BOC-based regimen have a higher probability of treatment success.
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Affiliation(s)
- D Salmon
- Service des Maladies Infectieuses et Tropicales, Hôpital Cochin, APHP-Université Paris Descartes, Paris, France
| | - F Bani-Sadr
- Service des Maladies Infectieuses et Tropicales, CHU Reims, Université Champagne Ardenne, Reims, France.
| | - C Gilbert
- INSERM, ISPED, Center INSERM U897-Epidémiologie-Biostatistiques, F-33000 Bordeaux, France
| | - E Rosenthal
- Service de Médecine Interne, Hôpital de l'Archet, Nice, France
| | - M A Valantin
- Service des Maladies Infectieuses et Tropicales, Hôpital Pitié Salpêtrière-APHP, Paris, France
| | - A Simon
- Service de Médecine Interne, Hôpital Pitié Salpêtrière-APHP, Paris, France
| | - D Neau
- Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France
| | - P Morlat
- Service de Médecine Interne et Maladies Infectieuses, CHU de Bordeaux, Bordeaux, France
| | - M A Loko
- INSERM, ISPED, Center INSERM U897-Epidémiologie-Biostatistiques, F-33000 Bordeaux, France
| | - L Wittkop
- INSERM, ISPED, Center INSERM U897-Epidémiologie-Biostatistiques, F-33000 Bordeaux, France
| | - F Dabis
- INSERM, ISPED, Center INSERM U897-Epidémiologie-Biostatistiques, F-33000 Bordeaux, France
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48
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Soulié C, Assoumou L, Darty M, Rodriguez C, Donati F, Sayon S, Peytavin G, Valantin MA, Caby F, Schneider L, Canestri A, Costagliola D, Katlama C, Calvez V, Marcelin AG. Virological factors associated with outcome of dual maraviroc/raltegravir therapy (ANRS-157 trial). J Antimicrob Chemother 2015; 70:3339-44. [PMID: 26396157 DOI: 10.1093/jac/dkv280] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/10/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES ROCnRAL ANRS-157 was a single-arm study designed to evaluate a switch to a maraviroc (300 mg twice a day) plus raltegravir (400 mg twice a day) regimen in virologically suppressed HIV-1-infected patients (ClinicalTrials.gov: NCT01420523). The aim of this work was to investigate the factors associated with virological failure (VF) (5/44 patients) or virological rebound defined as one viral load (VL) >50 copies/mL or VL >1 copy/mL. METHODS At baseline (BL), ultradeep sequencing (UDS) of DNA gp120 V3 and integrase regions and quantification of HIV DNA were performed in PBMCs. Tropism, VL, BL ultrasensitive HIV RNA VL, BL HIV DNA VL, subtype, age, ethnicity, transmission group, AIDS status, nadir CD4 and BL CD4 cell count, time since HIV diagnosis, duration of ART and suppressed viraemia, VL zenith, CD4/CD8 ratio and BL CD8 cell count were investigated as potential factors associated with virological rebound. RESULTS The proportion of patients with VL <1 copy/mL did not evolve over time. Among the 44 included patients, 3 had minority X4-tropic viruses determined by UDS at BL and one of them presented VF. Minority resistant variants in the integrase gene were detected at BL at two positions (E138 and G140) for three patients who did not have VF. Among all studied factors, none was associated with virological rebound. CONCLUSIONS Maraviroc plus raltegravir failed to maintain virological suppression in virologically suppressed HIV-1-infected patients. However, neither minority viral variants nor ultrasensitive viraemia was found to be a predictive factor of VF or virological rebound in this context.
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Affiliation(s)
- Cathia Soulié
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Lambert Assoumou
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France
| | - Mélanie Darty
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Christophe Rodriguez
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Flora Donati
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Sophie Sayon
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Gilles Peytavin
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, F-75018 Paris, France AP-HP, Hôpital Bichat, Laboratoire de Pharmacologie, F-75018 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Fabienne Caby
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Luminita Schneider
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Ana Canestri
- AP-HP, Hôpital Kremlin-Bicêtre, Service de maladies infectieuses, F-94270 Kremlin-Bicêtre, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France
| | - Christine Katlama
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Vincent Calvez
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
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49
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Wirden M, Todesco E, Valantin MA, Lambert-Niclot S, Simon A, Calin R, Tubiana R, Peytavin G, Katlama C, Calvez V, Marcelin AG. Low-level HIV-1 viraemia in patients on HAART: risk factors and management in clinical practice. J Antimicrob Chemother 2015; 70:2347-53. [PMID: 25921516 DOI: 10.1093/jac/dkv099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/13/2015] [Accepted: 03/22/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Characterization of the conditions favouring HIV-1 low-level viraemia (LLV) during treatment is required to guide strategies for prevention and cure. METHODS The characteristics and treatments of 171 patients experiencing a confirmed LLV of 50-1000 copies/mL (PLLVs) were compared with those of 146 patients with persistently controlled viraemia. We analysed the risk factors for LLV, the parameters affecting the level of viraemia and the presence of resistance-associated mutations (RAMs). We compared outcomes for PLLVs on fully effective HAART as a function of treatment modifications. RESULTS LLV was <500 copies/mL in at least 90% of cases. A higher zenith viral load (VL) (5.27 versus 4.91 log10 copies/mL, OR 2.23; P = 0.0003), a shorter time on continuous HAART (4.3 versus 6.8 years, OR 0.88; P = 0.0003) and previously detected RAMs (43% versus 23%, OR 2.42; P = 0.0033) were independent predictors of LLV. NNRTIs were less frequently used in PLLVs and were associated with more stable treatment. The presence of any RAM during LLV was associated with a lower zenith VL and a higher LLV. In the absence of resistance, virological success was achieved in similar proportions of patients with and without treatment modification. CONCLUSIONS Viraemia >500 copies/mL should no longer be considered to be LLV. In patients with a high zenith VL, several years on continuous HAART may be required to decrease the HIV reservoir and prevent LLV. Resistance testing is useful to detect RAMs, leading if necessary to treatment modifications. In the absence of resistance, treatment changes seemed dispensable.
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Affiliation(s)
- Marc Wirden
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Eve Todesco
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Marc-Antoine Valantin
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, Paris, France
| | - Sidonie Lambert-Niclot
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Anne Simon
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Médecine Interne, Paris, France
| | - Ruxandra Calin
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, Paris, France
| | - Roland Tubiana
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, Paris, France
| | - Gilles Peytavin
- AP-HP, Groupe Hospitalier X Bichat-C Bernard, laboratoire de toxicologie, Paris, France
| | - Christine Katlama
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Maladies Infectieuses, Paris, France
| | - Vincent Calvez
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
| | - Anne-Genevieve Marcelin
- INSERM, UMR S_1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Virologie, Paris, France
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Lê MP, Soulié C, Assoumou L, Valantin MA, Duvivier C, Chas J, Ponscarme D, Marcelin AG, Calvez V, Katlama C, Peytavin G. Plasma concentrations of maraviroc and raltegravir after dual therapy in patients with long-term suppressed viraemia: ROCnRAL ANRS 157 study: Figure 1. J Antimicrob Chemother 2015; 70:2418-20. [DOI: 10.1093/jac/dkv113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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