No Association Between HLA-B*57:01 and Prevalence and/or Outcome of Progressive Multifocal Leukoencephalopathy in a French Nationwide Human Immunodeficiency Virus Cohort

Among 34,351 patients living with human immunodeficiency virus with available HLA-B*57:01 included in the Dat'AIDS cohort, 194 patients (0.56%) had a history of progressive multifocal leukoencephalopathy (PML) and 1,746 (5.08%) were carriers of HLA-B*57:01. The frequency of HLA-B*57:01 was similar among patients with history of PML compared with patients without a history of PML (6.19% [95% confidence interval, CI 2.8%-9.6%] vs. 5.08% [95% CI 4.8%-5.3%]; p = .48). Among patients with PML, clinical and biological characteristics at PML diagnosis and the PML outcome were not different according to HLA-B*57:01 status.

Vγ9Vδ2 T-cells are potent inhibitors of SARS-CoV-2 replication and represent effector phenotypes in COVID-19 patients

Vγ9Vδ2 T-cells play a key role in the innate immune response to viral infections through butyrophilin (BTN)-3A. Here, we reported that blood Vγ9Vδ2 T-cells decreased in clinically mild COVID-19 compared to healthy volunteers (HV), and was maintained up to 28-days and in the recovery period. Terminally differentiated Vγ9Vδ2 T-cells tend to be enriched on the day of diagnosis, 28-days after and during the recovery period. These cells showed cytotoxic and inflammatory activities following anti-BTN3A activation. BTN3A upregulation and Vγ9Vδ2 T-cell infiltration were observed in a lung biopsy from a fatal SARS-CoV-2 infection. In vitro, SARS-CoV-2 infection increased BTN3A expression in macrophages and lung cells that enhanced the anti-SARS-CoV-2 Vγ9Vδ2 T-cells cytotoxicity and IFNγ and TNFα. Increasing concentrations of anti-BTN3A lead to viral replication inhibition. Altogether, we report that Vγ9Vδ2 T-cells are important in the immune response against SARS-CoV-2 infection and that activation by an anti-BTN3A antibody may enhance their response.

Doravirine plus lamivudine two-drug regimen as maintenance antiretroviral therapy in people living with HIV: a French observational study

BACKGROUND

Two-drug regimens based on integrase strand transfer inhibitors (INSTIs) and boosted PIs have entered recommended ART. However, INSTIs and boosted PIs may not be suitable for all patients. We aimed to report our experience with doravirine/lamivudine as maintenance therapy in people living with HIV (PLWH) followed in French HIV settings.

METHODS

This observational study enrolled all adults who initiated doravirine/lamivudine between 1 September 2019 and 31 October 2021, in French HIV centres participating in the Dat'AIDS cohort. The primary outcome was the rate of virological success (plasma HIV-RNA < 50 copies/mL) at Week (W)48. Secondary outcomes included: rate of treatment discontinuation for non-virological reasons, evolution of CD4 count and CD4/CD8 ratio over follow-up.

RESULTS

Fifty patients were included, with 34 (68%) men; median age: 58 years (IQR 51-62), ART duration: 20 years (13-23), duration of virological suppression: 14 years (8-19), CD4 count: 784 cells/mm3 (636-889). Prior to switching, all had plasma HIV-RNA < 50 copies/mL. All but three were naive to doravirine, and 36 (72%) came from a three-drug regimen. Median follow-up was 79 weeks (IQR 60-96). Virological success rate at W48 was 98.0% (95% CI 89.4-99.9). One virological failure occurred at W18 (HIV-RNA = 101 copies/mL) in a patient who briefly discontinued doravirine/lamivudine due to intense nightmares; there was no resistance at baseline and no resistance emergence. There were three strategy discontinuations for adverse events (digestive disorders: n = 2; insomnia: n = 1). There was no significant change in CD4/CD8 ratio, while CD4 T cell count significantly increased.

CONCLUSIONS

These preliminary findings suggest that doravirine/lamivudine regimens can maintain high levels of viral suppression in highly ART-experienced PLWH with long-term viral suppression, and good CD4+ T cell count.

Weight gain following the single substitution of tenofovir disoproxil fumarate by tenofovir alafenamide in HIV-infected people from the French Dat'AIDS cohort: A propensity score-matched analysis

OBJECTIVES

To minimize confounding factors, we aimed to describe the changes in weight and body mass index (BMI) following the single substitution of tenofovir disoproxil fumarate (TDF) by tenofovir alafenamide (TAF) in people living with HIV (PLWH).

METHODS

We designed a retrospective study in a large French cohort. We included all HIV-suppressed adults under TDF + emtricitabine + rilpivirine or elvitegravir/cobistat, who experienced a first switch from TDF to TAF, while other antiretrovirals remained unchanged (Switch group). We compared this population to a propensity score-matched Control group (1:1) who stayed on the same TDF-based regimen. Changes were evaluated after 6 (M6) and 12 months (M12).

RESULTS

Some 1260 and 468 PLWH were evaluable per group at M6 and M12, respectively. In the Switch group, there was a mean (95% confidence interval [95% CI]) weight gain of +1014 g (+826 to +1201) at M6 (p < 0.0001) and +1365 g (+910 to +1820) at M12 (p < 0.0001), as compared with baseline. Meanwhile, there was no significant weight gain at M6 (+139 g [-50 to +328]) and M12 (-32 g [-413 to +350]) in the matched Control group. Similarly, mean BMI increased significantly in the Switch group at M6 (+0.35, 95% CI: +0.29 to +0.41, p < 0.0001) and M12 (+0.49, 95% CI: +0.32 to +0.65, p < 0.0001), while it was stable at M6 (+0.05, 95% CI: -0.01 to +0.12, p = 0.11) and M12 (+0.01, 95% CI: -0.12 to +0.14, p = 0.89) in the No Switch group.

CONCLUSIONS

Although modest, there is a significant weight gain following the substitution of TDF by TAF. This should be anticipated in certain at-risk populations.

Symptômes cardiaques en Post Covid : bilan cardiaque ? Pour qui ? Quand ? Comment ?

Introduction

Dans le contexte de pandémie de Sars-Cov-19 avec des atteintes cardiovasculaires mal caractérisées, nous réalisons depuis mai 2020 une étude prospective, observationnelle, de cohorte centrée sur une évaluation et un suivi cardiovasculaire systématique chez des patients, quel que soit leur profil cardiovasculaire, ayant survécu à un épisode de Covid-19 modéré ou sévère (IDRCB: 2020-A01576-33)

Matériels et méthodes

A S4, S24 et S48 d'une infection avec PCRSars-Cov-19 positive, les patients inclus bénéficient d'une consultation clinique de cardiologie avec 1) ECG 2)Prélèvement sanguin troponine T, NT-proBNP, D-Dimères, bilan d'hémostase 3)Échocardiographie trans-thoracique (ETT) + écho-doppler veineux « 3 points » à 1 et 12 mois 4)IRM cardiaque et Angioscanner thoracique selon les recommandations internationales. Nous proposons ici une analyse intermédiaire de nos résultats après 18 mois du début de l'etude.

Résultats

124 patients ont été inclus, avec un sex ratio de 1/2, d'âge médian de 55 ans, 58% avec une comorbidité à risque de forme sévère dont 38% de pathologie cardio-vasculaire, tabagisme actif dans 13% des cas .La prise en charge initiale était en ambulatoire (42.2%)en hospitalisation conventionnelle(37.8%) ou en soins intensif/réanimation(20%). Une maladie chronique a décompensé chez 24.4%des patients ou a été découverte chez 7% et 8% ont présenté une maladie thrombo-embolique et 2 patients une pericardite et 3 un trouble du rythme en phase aigüe. Dans le suivi, la présence de signes cardiologiques (douleur thoracique, syncope, palpitation, dyspnée de classe III ou IV NYHA, signes congestifs d'insuffisance cardiaque gauche ou droite, frottement péricardique, anomalies ECG du segment ST, des ondes T, élargissement du QRS, bloc atrio-ventriculaire du 2ème ou 3ème degré) était retrouvée chez 33% des patients à S4, 28% àS12, 22% àS24 et 14% à S48. Une ETT a été réalisée chez 60 patients et anormale chez 12 (20%) avec hypokinésie septale (8) une pericardite (2) ou HVG (2), une IRM cardiaque chez 41 patients et anormale chez 12 (29%) avec 10 myocardites et 2 péricardites. Tous les holter-ECG étaient normaux (4/4). Entre S4 etS12, 28% des patients avaient des D-Dimeres élevés (>0,5) et 25% une anomalie de la tropo/ NT-proBNP. Tous les patients avec une elevation des DDimeres avec une imagerie cardiaque anormale. Aucun lien n'est retrouvé entre le degré de sévérité initial, les co morbidités et les complications cardio-vasculaires post Covid sur le long terme.

Conclusion

Notre étude retrouve une importante prévalence des symptômes cardiaques même si ces derniers semblent disparaitre spontanément après 1 an de suivi. Nous ne disposons pas, à ce jour, de stratégie rentable pour exclure une pathologie CV sévére (myocadite pericardite) mais les consensus d'expert (https://doi.org/10.1093/eurheartj/ehac031) considèrent comme raisonnable de dépister les personnes à haut risque d'atteinte cardiaque ou avec un nouveau diagnostic CVpost-COVID-19 ainsi que les athlètes.

Aucun lien d'intérêt

[Ocular syphilis, a re-emergent pathology: Series of 12 patients in one Hospital, 2017]

INTRODUCTION

Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017.

PATIENTS AND METHODS

This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected.

RESULTS

Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases.

DISCUSSION

Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.

Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing

Splenic abscess is a rare disease that primarily occurs in patients with splenic trauma, endocarditis, sickle cell anemia, or other diseases that compromise the immune system. This report describes a culture-negative splenic abscess in an immunocompetent patient caused by Campylobacter jejuni, as determined by 16S rRNA gene sequencing.

Significant reduction in HIV virologic failure during a 15-year period in a setting with free healthcare access

BACKGROUND

Calendar trends in virologic failure (VF) among human immunodeficiency virus (HIV)-infected patients can help to evaluate the performance of healthcare systems and the need for new antiretroviral therapy (ART). We examined the time trend in the rate of VF beyond 6 months of ART between 1997 and 2011 in France.

METHODS

We included patients from the French Hospital Database on HIV who received at least 6 months of ART. VF was defined as 2 consecutive plasma HIV-RNA values >500 copies/mL or as 1 value >500 copies/mL followed by a treatment switch. We adjusted for patients' characteristics by fitting a multivariable generalized estimating equation logistic regression model with an exchangeable covariance matrix.

RESULTS

A total of 81 738 patients were enrolled, and median follow-up was 112.4 months. Median CD4 count was 333 cells/µL, and 23% of patients had HIV infection classified as Centers for Disease Control and Prevention stage C. Overall, 29.3% of patients received single/dual-drug ART initially, and 45.4% of patients experienced at least 1 episode of VF during follow-up. The percentage of patients with VF fell from 61.5% in 1997-1998 to 9.7% in 2009-2011 (P < .0001). Factors associated with the lower frequency of VF were recent calendar period, a higher contemporary CD4 cell count, and first-line regimens based on nonnucleoside reverse transcriptase inhibitors or integrase inhibitors.

CONCLUSIONS

The proportion of HIV-infected patients experiencing VF during routine care fell markedly between 1997 and 2009-2011, to only 9.7%. This was attributed to the advent of fully active and better-tolerated antiretroviral drugs, and to national guidelines recommending rapid management of VF after mid-2000.

Prevalence of skin infections in sheltered homeless

In an attempt to determine the prevalence of various skin infections in the homeless population in Marseilles, France, we undertook a case control study. Cases were recruited among institutionalized homeless subjects during two snapshot investigations conducted in January 2002 and 2003 respectively. The control subjects were recruited from among those who presented at a clinic for pre-travel advice. We recruited 498 cases and 200 control subjects. Compared to control subjects, a significantly higher proportion of cases had skin diseases (38% versus 0.5%; p < 0.0001). Pruritus, body-lice infestation, scratching lesions, folliculitis, tinea pedis, scabies and impetigo (ecthyma) were strongly significantly associated with homelessness. The higher prevalence of skin infections in the homeless people mainly results from the body-louse infestation, scabies, bacterial super-infection of skin surfaces that have been breached by frequent scratching and tinea pedis due to poor foot hygiene.

Dermatoses associated with travel to Burkina Faso and diagnosed by means of teledermatology

BACKGROUND

The pattern of dermatoses occurring in travellers to tropical areas is poorly documented.

OBJECTIVES

To diagnose skin diseases in travellers to Burkina Faso by means of teledermatology; to assess the educational value of teledermatology for the local general practitioner (GP).

METHODS

Patients (Westerners and Burkinabese nationals) were included in the study if they presented with a cutaneous disease to the GP based in Ouagadougou, Burkina Faso. Images of the skin lesions were acquired with a point-and-shoot digital camera and sent via the Internet, together with the clinical history. Diagnostic concordance between dermatologists in France and the GP in Ouagadougou was analysed as a simple proportion of agreement and 95% confidence interval.

RESULTS

One hundred and twenty-four patients (M/F ratio 1.17; 80.6% Westerners) were included in the study. One hundred and thirty dermatoses were identified: 73 (56%) were of infectious origin, and 19 (15%) were related to eczematous dermatitis. The skin infections were mainly due to bacteria (18%), fungi (14%) or arthropods (13%). Parasitic dermatoses were observed only in Burkinabese nationals. Among Westerners, fungal dermatoses were observed only in long-term residents. The diagnostic agreement between the local GP and the remote dermatologists was 49% overall (95% confidence interval 41-58). Agreement between the GP and the dermatologists on the dermatological category improved significantly over time (P<0.05).

CONCLUSIONS

Telemedecine can improve the management of cutaneous diseases among Western travellers. Most dermatoses observed in Western travellers to Burkina Faso are of infectious origin. Teledermatology has educational value for local GPs.

Role of the coypu (Myocastor coypus) in the epidemiology of leptospirosis in domestic animals and humans in France

The coypu (Myocastor coypus), a rodent whose natural habitat is stagnant freshwater, has become a widespread pest in France within the last decade. This study investigated the prevalence of seropositivity and the renal carriage of leptospires in coypus in order to evaluate their role in terms of the risk of infection by Leptospira interrogans in domestic animals and humans. The study involved the application of serological and bacteriological methods to identify leptospires infection and/or carriage in 738 coypus trapped from 1996 to 1999 in six areas of France. Seroprevalence in samples ranged from 16.5 to 66%, and three field strains were isolated (two L. interrogans Icterohaemorrhagiae and one L. interrogans Sejroe). This first report on the isolation of leptospires from coypus in France emphasises the role of this animal in the epidemiology of leptospirosis.

A 1-kb Bcl-2-PCR fragment detection in a patient with follicular lymphoma and development of a new diagnostic PCR method

The t(14;18) translocation is a useful marker to characterize follicular lymphoma and to monitor residual disease. The polymerase chain reaction (PCR) is a powerful technique to detect this translocation. Located on chromosome 18, within the Bcl-2 gene, breakpoints occur mainly in the 3; untranslated region, in the third exon of Bcl-2 (MBR region). In this study, the authors amplified MBR breakpoints by PCR and found an unexpectedly large fragment of 1 Kb that corresponds to a recently described new breakpoint in the Bcl-2 gene. With a new primer set, a further previously considered t(14;18)-unrelated tumor was in fact positive for this new breakpoint.

Bulbospinal control of spinal cord pathways generating locomotor extensor activities in the cat

Intracellular recording of lumbosacral motoneurones in the decerebrate and partially spinalized cat injected with nialamide and L-dihydroxyphenylalanine (l-DOPA) was used to investigate the interneuronal convergence of two bulbospinal pathways and of the segmental pathways involved with the generation of extensor activities during locomotion. Deiter's nucleus (DN) or the medial longitudinal fasciculus (MLF) was stimulated in alternation with, and in combination with, stimulation of group I afferents from extensor muscles or of contralateral flexor reflex afferents (coFRA). The evoked polysynaptic EPSPs were recorded in extensor motoneurones when long-latency, long-lasting discharges were evoked by the stimulation of coFRA and when the group I autogenetic inhibition in extensors was reversed to polysynaptic excitation. Spatial facilitation was inferred when the amplitude of the EPSPs evoked by the combined stimuli was notably larger than the algebraic sum of the EPSPs evoked by individual stimulation. Both DN (16 motoneurones) and MLF inputs (8 motoneurones) showed spatial facilitation when preceded by coFRA stimuli and both could reset the rhythm of fictive stepping by triggering a precocious extensor phase. MLF showed spatial facilitation with extensor group I inputs in 69% of trials but DN failed to show spatial facilitation in any cells. These results indicate that DN and MLF project to the coFRA pathways of the extensor half-centre for locomotion and MLF, but not DN, converge on segmental interneurones of the extensor group I pathways. The implications of such convergence patterns on the functional organization of the extensor half-centre are discussed.

The cytotoxic activity of Bacillus anthracis lethal factor is inhibited by leukotriene A4 hydrolase and metallopeptidase inhibitors

The lethal factor of Bacillus anthracis is central to the pathogenesis of anthrax. Its mechanism of action is still unknown. Recently, on the basis of sequence similarities, we suggested that lethal factor might act similarly to leukotriene A4 hydrolase (LTA4), a bifunctional enzyme also endowed with a metallopeptidase activity. Here we show that some inhibitors of the LTA4 hydrolase and metallopeptidase activities of LTA4 hydrolase also affect the cytotoxicity of the anthrax lethal factor on macrophage cell lines, without interfering with the ability of the lethal factor to enter cells. These results support the proposal that anthrax lethal factor might display in the cytosol of intoxicated cells a peptidase activity similar to that of LTA4 hydrolase.

Bovine leukemia virus: purification and characterization of the aspartic protease

To develop efficient bovine leukemia virus (BLV) protease (PR) inhibitors, pure enzyme is required. For this, we have developed a two-step chromatographic nondenaturing purification protocol of PR from virions. As expected, the purified protein presents a molecular weight (14 kDa) and a NH2 terminal end fitting with previously reported data. The enzymatic activity of BLV PR was characterized using a synthetic peptide containing a potential cleavage site of the BLV gag-pro polypeptide precursor as substrate. The protease was most active at pH 6, 40 degrees, and high salt concentration (1-2 M NaCl or ammonium sulfate). In contrast, using a natural substrate such as a human T-cell leukemia virus recombinant gag precursor, BLV PR activity was higher at a low salt concentration (0.5 M NaCl). Besides, the use of different potentially cleavable molecules revealed that PR activity may be influenced by the substrate conformational structure around the cleavage site. Replacement of the two amino acids of a synthetic substrate cleavable site by a statin residue completely inhibited the enzymatic activity of the BLV PR.

IL6 and acute phase plasma proteins in peritoneal fluid of women with endometriosis

Several authors have documented signs of chronic inflammation in the pelvis of women with endometriosis. We investigated the possible involvement of interleukin 6 (IL6), an important regulator of inflammation and immunity, in minimal and mild endometriosis by measuring levels of IL6 and proteins (alpha 1-acid glycoprotein, alpha 1-antitrypsin, alpha 2-HS glycoprotein and albumin) the synthesis of which is regulated by IL6, in peritoneal fluid (PF) from infertile women with histologically confirmed endometriosis (stage I and II; n = 28) and from endometriosis-free fertile (n = 14) and infertile women (n = 13). Spontaneous and LPS-induced IL6 secretion by cultured PF macrophages from women with endometriosis (n = 12) and without endometriosis (n = 9) were also studied. No significant differences were observed in the concentrations of the four proteins studied. Immunoreactive IL6 was detected in all three groups, with no significant differences. In contrast, significantly higher levels of IL6 were released by both unstimulated (P = 0.01) and LPS-stimulated (P = 0.006) peritoneal macrophages from the women with endometriosis. We conclude that local IL6 synthesis by activated macrophages may play a role in the endometriosis process.

Peritoneal fluid and infertility: a comparison of in-vitro fertilization of oocytes in peritoneal fluid and B2-Menezo medium

Peritoneal fluid probably has an important and complex role in fertility and infertility. In this study, in-vitro fertilization was attempted in peritoneal fluid and the classical B2-Menezo medium. Clinical criteria concerning male and female fertility and biological factors such as fresh semen quality, sperm survival, sperm-zona pellucida binding, cleavage and pregnancy rates were analysed for each infertile couple. The following results have been obtained. The quality of peritoneal fluid appears to fluctuate greatly from one woman to another. Routine use of peritoneal fluid as a culture medium during in-vitro fertilization should not be encouraged. Peritoneal fluid toxicity may explain some cases of 'unexplained' infertility.

Treatment of flail chest with Judet's struts

This report describes our experience with the operative stabilization of flail chest with the use of Judet's struts. In a series of 18 patients with flail chest, the method allowed shorter duration of artificial ventilation and decreased functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and thus obviates the need for artificial ventilation.