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Ghosn J, Fouquet B, Quertainmont Y, Salmon D, Sahali S, Rioux C, Duvivier C, Mole M, Delfraissy JF, Misrahi M. Claudin-1 gene variants and susceptibility to hepatitis C infection in HIV-1 infected intravenous drug users (an ANRS case-control study). J Med Virol 2015; 87:619-24. [PMID: 25611191 DOI: 10.1002/jmv.24088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus (HCV) seroprevalence is highly diverse among human immunodeficiency virus-1 (HIV-1) infected patients, ranging between 10% of HIV-1 infected homo-bisexuel men, to >92% in patients infected with HIV-1 who acquired HIV-1 through intravenous drug use. Thus, being HCV-free while having acquired HIV-1 via intravenous drug use is a rare situation. Claudin-1 is a protein involved in intracellular tight-junctions and has been identified as a major cellular co-receptor for HCV infection. Our objective was to determine whether Claudin-1 gene (CLDN1) mutations might be involved in natural resistance to HCV infection. We conducted a case-control study. All recruited patients acquired HIV-1 infection via intravenous drug use route before 1995. The case study patients remained free from HCV infection (negative anti-HCV antibodies and HCV-RNA). The control study patients was co-infected with HCV (positive anti-HCV antibodies). Direct genomic sequencing of the CLDN1 gene coding region and adjacent intron/exons junctions was performed from peripheral blood mononuclear cells. A total of 138 Caucasian patients were enrolled. Twenty-two patients (cases) were free from HCV infection and 116 (controls) were co-infected with HCV. We found single nucleotide polymorphisms (SNPs) described previously with no significant differences in allele frequencies between cases and controls. In conclusion, despite being a major cellular co-receptor for HCV entry in vitro, we did not identify any specific substitution in CLDN1 gene coding region in our study patients highly exposed but resistant to HCV infection in vivo. Other cellular co-factors involved in HCV infection should be investigated in this highly-exposed intravenous drug users patients.
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Affiliation(s)
- Jade Ghosn
- APHP, Department of Internal Medicine and Infectious Diseases, Bicetre University Hospital, Le Kremlin-Bicêtre, France; Paris Descartes, Universiy, Necker Medical School, Sorbonne Paris Cité, Paris, France
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Sahali S, Carcelain G, Goujard C, Delfraissy JF, Ghosn J. [Enhancing immune restoration in human immunodeficiency virus infection]. Rev Med Interne 2011; 32:425-31. [PMID: 21440340 DOI: 10.1016/j.revmed.2011.02.011] [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: 04/27/2010] [Revised: 11/22/2010] [Accepted: 02/07/2011] [Indexed: 11/17/2022]
Abstract
The primary objective of antiretroviral therapy has recently evolved from a virologic endpoint towards the achievement of normal CD4T cell count (greater than 500/mm(3)) to avoid progression to AIDS. This shift in the primary objective is supported by many clinical and epidemiological studies. Recent data have shown that HIV-infected adults with a CD4T cell count greater than 500cells/mm(3) on long-term combination antiretroviral therapy reach same mortality rates as the general population. However, less than 50% of patients receiving long-term suppressive antiretroviral combination reach such a CD4T cell level. New antiretroviral strategies to improve immune reconstitution, such as specific or non-specific immune-based therapy on one hand and the use of novel antiretroviral drugs from new classes on the other hand are currently under investigation. Here we review several current strategies that may improve immune reconstitution, keeping in mind that the best way to reach normal CD4T cell count is an early treatment initiation.
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Affiliation(s)
- S Sahali
- AP-HP, service de médecine interne et maladies infectieuses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Sahali S, Bichet JC, Delfraissy JF, Ghosn J. Breast enlargement in an HIV-infected man on combined antiretroviral therapy: what if it was carcinoma? Int J STD AIDS 2010; 21:373-4. [DOI: 10.1258/ijsa.2009.008473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of an HIV-infected man on effective combined antiretroviral therapy, presenting with bilateral gynaecomastia revealing breast carcinoma. Gynaecomastia was first considered to be related to efavirenz and/or didanosine. Although breast carcinoma is rare among HIV-infected men, it should be considered as a potential cause of breast enlargement.
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Affiliation(s)
- S Sahali
- AP-HP, Department of Internal Medicine and Infectious Diseases, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J-C Bichet
- Department of Plastic Surgery, Remusat Hospital, Paris, France
| | - J-F Delfraissy
- AP-HP, Department of Internal Medicine and Infectious Diseases, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - J Ghosn
- AP-HP, Department of Internal Medicine and Infectious Diseases, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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Maigne G, Ferlicot S, Galacteros F, Belenfant X, Ulinski T, Niaudet P, Ronco P, Godeau B, Durrbach A, Sahali S, Lang P, Lambotte O, Audard V. Glomerular lesions in patients with sickle cell disease. Medicine (Baltimore) 2010; 89:18-27. [PMID: 20075701 DOI: 10.1097/md.0b013e3181ca59b6] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sickle cell disease (SCD) is an increasing cause of chronic kidney disease, but the spectrum of glomerular lesions and their underlying mechanisms remain poorly described. We reviewed 18 renal biopsies from patients with SCD and glomerular involvement and studied the expression of hypoxic markers in the biopsy specimens. Four histopathologic variants were distinguished: focal segmental glomerulosclerosis (FSGS) (39%), membranoproliferative glomerulonephritis (28%), thrombotic microangiopathy glomerulopathy (17%), and specific sickle cell disease glomerulopathy (17%). Chronic organ damage and history of acute chest syndrome were associated with the occurrence of SCD glomerulopathy. All patients exhibited macroalbuminuria but only 6 patients displayed impaired renal function. SCD was not associated with a specific FSGS histologic variant. Long-term follow-up analysis revealed that 50% of patients exhibited chronic kidney disease. Regardless of the histologic variants, immunohistochemistry did not reveal a specific induction of hypoxic markers (inducible nitric oxide synthase [iNOS], nitrotyrosine, hypoxia-inducible factor [HIF]-1 alpha) at the time of renal biopsy. This large study shows that a wide spectrum of glomerular lesions is associated with SCD. Whatever lesions are observed, the renal prognosis is poor, and early renoprotective treatment is necessary. Hypoxic state does not seem to play a key role in the progression of glomerular lesions, but its potential role at an early stage of glomerular injury requires further investigation.
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Affiliation(s)
- Gwenola Maigne
- From Internal Medicine Unit (GW, SS, OL), Pathology Department (SF), and Nephrology and Renal Transplantation Department (AD), APHP, Hôpital Kremlin Bicêtre, Université Paris 11, Le Kremlin Bicêtre; Sickle Cell Disease Center (FG) and Internal Medicine Unit (BG), APHP, Hôpital Henri Mondor, Université Paris 12, Créteil; Nephrology and Renal Transplantation Department (PL, VA), APHP, Hôpital Henri Mondor, and Institut Francilien de recherche en Néphrologie et Transplantation (IFRNT), INSERM U 955, Université Paris 12, Créteil; Nephrology Department (XB), Hôpital de Montreuil, Montreuil; Nephrology Department (TU), APHP, Hôpital Trousseau, UPMC Université Paris 06, Paris; Pediatric Nephrology Department (PN), APHP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris; Nephrology Department (PR), APHP, Hôpital Tenon, UPMC Université Paris 06, Paris; France
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Sahali S, Ghosn J, Lazure T, Goujard C, Delfraissy JF, Lambotte O. [Autoimmune myelofibrosis with dermatomyositis]. Rev Med Interne 2008; 30:71-3. [PMID: 18508162 DOI: 10.1016/j.revmed.2008.04.007] [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: 12/29/2007] [Revised: 04/05/2008] [Accepted: 04/14/2008] [Indexed: 11/27/2022]
Abstract
We report a second observation of autoimmune myelofibrosis associated with an inflammatory myositis in a 30-year-old female. The links between myelofibrosis and autoimmunity are discussed.
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Affiliation(s)
- S Sahali
- Service de médecine interne, CHU de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le-Kremlin-Bicêtre, France
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Sahali S, Chaix ML, Delfraissy JF, Ghosn J. Ritonavir-boosted protease inhibitor monotherapy for the treatment of HIV-1 infection. AIDS Rev 2008; 10:4-14. [PMID: 18385776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Guidelines for the use of antiretrovirals for HIV-1 infection recommend combining at least three agents. Toxicities, cost, and the complexity of such regimens warrant the search for other options. Boosted protease inhibitor monotherapy is one of the appealing options being investigated. Herein we review uncontrolled and controlled clinical trials evaluating boosted protease inhibitor monotherapy in several clinical settings: maintenance therapy, induction-maintenance strategies, and first-line treatment. Boosted lopinavir monotherapy has been largely investigated in maintenance and induction-maintenance strategies, showing its ability to maintain viral suppression in the majority of participants. The major concern is the higher proportion of patients experiencing transient episodes of low-level viremia (HIV-RNA 50-500 copies/ml) when compared to classical triple regimens. No protease inhibitor-associated resistance mutation was detected in patients who failed on boosted lopinavir monotherapy. Three uncontrolled maintenance strategy studies with boosted atazanavir monotherapy showed conflicting results. Thus, the reassuring results obtained with lopinavir might not be extended to the whole protease inhibitor class, warranting further studies with new generation protease inhibitors such as darunavir. Finally, one controlled trial comparing first-line boosted lopinavir monotherapy to a standard triple combination showed that the latter outperformed the boosted protease inhibitor monotherapy in this clinical setting. In summary, a boosted protease inhibitor single-agent strategy can maintain continuous plasma HIV-RNA suppression in a large proportion of patients already suppressed on a standard triple combination. The more frequent occurrence of low-level viremia, however, does not allow the widespread use of such a strategy outside of clinical studies at this time.
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Affiliation(s)
- Sabrinel Sahali
- AP-HP, Bicêtre University Hospital, Department of Internal Medicine and Infectious Diseases, Paris-Sud University, Le Kremlin-Bicêtre, France
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Méchai F, Quertainmont Y, Sahali S, Delfraissy JF, Ghosn J. Post-exposure prophylaxis with a maraviroc-containing regimen after occupational exposure to a multi-resistant HIV-infected source person. J Med Virol 2007; 80:9-10. [DOI: 10.1002/jmv.21000] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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