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Lutaud R, Cortaredona S, Delorme L, Peretti-Watel P, Mirouse J, Borg M, Cattaneo L, Thery D, Gentile G, Pradier C, Irit T, Brouqui P, Tardieu S, Carles M, Gentile S. COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays. Fam Med Community Health 2024; 12:e002447. [PMID: 38216208 PMCID: PMC10806557 DOI: 10.1136/fmch-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES To our best knowledge, no study in France has comprehensively investigated the prehospital history of patients admitted for severe cases of COVID-19. 'Patients' voice is an excellent means to capture data on primary care pathways.We aimed to identify clusters of COVID-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes. DESIGN Cross-sectional online survey using life-event calendars. SETTING All patients hospitalised for COVID-19 between September 2020 and May 2021 in the Infectious Disease Departments in Nice and in Marseilles in France. PARTICIPANTS 312 patients responded to the survey. MAIN OUTCOME MEASURES From the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). State sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. Multivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit (ICU) and COVID-19 sequelae after hospitalisation. RESULTS Three clusters of symptom sequences were identified among 312 complete prehospital pathways. A specific group of patients (29%) experienced extended symptoms of severe COVID-19, persisting for an average duration of 7.5 days before hospitalisation. This group had a significantly higher probability of being admitted to ICU (adjusted OR 2.01). They were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. Similarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.Their relatives played a decisive role in their hospitalisation. CONCLUSION AND RELEVANCE This study highlights the negative impact of delayed hospitalisation on the health outcomes of French patients with severe COVID-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.
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Affiliation(s)
- Romain Lutaud
- Department of General Practice, Aix-Marseille University, Marseille, France
- ADES, Marseille, France
| | | | - Lea Delorme
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Juliette Mirouse
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Manon Borg
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Lucie Cattaneo
- Assistance Publique- Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Didier Thery
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Gaetan Gentile
- Department of General Practice, Aix-Marseille University, Marseille, France
| | - Christian Pradier
- Department of Public Health, Archet University Hospital, Nice, France
| | - Touitou Irit
- Department of Public Health, Archet University Hospital, Nice, France
| | | | - Sophie Tardieu
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - Michel Carles
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Stéphanie Gentile
- CEReSS - Health Service Research and Quality of life Center, Marseille, France
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Graça D, Brglez V, Allouche J, Zorzi K, Fernandez C, Teisseyre M, Cremoni M, Benzaken S, Pradier C, Seitz-Polski B. Both Humoral and Cellular Immune Responses to SARS-CoV-2 Are Essential to Prevent Infection: a Prospective Study in a Working Vaccinated Population from Southern France. J Clin Immunol 2023; 43:1724-1739. [PMID: 37606852 PMCID: PMC10660913 DOI: 10.1007/s10875-023-01558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Abstract
COVID-19 vaccines have significantly decreased the number of severe cases of the disease, but the virus circulation remains important, and questions about the need of new vaccination campaigns remain unanswered. The individual's protection against SARS-CoV-2 infection is most commonly measured by the level and the neutralizing capacity of antibodies produced against SARS-CoV-2. T cell response is a major contributor in viral infection, and several studies have shown that cellular T cell response is crucial in fighting off SARS-CoV-2 infection. Actually, no threshold of protective immune response against SARS-CoV2 infection has been identified. To better understand SARS-CoV-2-mediated immunity, we assessed both B cell (measuring anti-Spike IgG titer and neutralization capacity) and T cell (measuring IFNγ release assay after specific SARS-CoV2 stimulation) responses to SARS-CoV-2 vaccination with or without virus encounter in a cohort of 367 working volunteers. Vaccinated individuals who had previously been infected had a stronger and more lasting immunity in comparison to vaccinated individuals naive to infection whose immunity started to decline 3 months after vaccination. IFNγ release ≥ 0.285 IU/mL and anti-Spike IgG antibodies ≥ 244 BAU/mL were associated with a sufficient immune response following vaccination preventing future infections. Individuals with comorbidities had a lower chance of reaching the protective thresholds of T cell and B cell responses as identified in multivariate analysis. A combined B cell and T cell analysis of immune responses to determine protective thresholds after SARS-CoV-2 vaccination will allow us to identify individuals in need of a booster vaccine dose, particularly in comorbid subjects.
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Affiliation(s)
- Daisy Graça
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Vesna Brglez
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Jonathan Allouche
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France
| | - Kévin Zorzi
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Céline Fernandez
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Maxime Teisseyre
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Marion Cremoni
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
| | - Sylvia Benzaken
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France
| | - Christian Pradier
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France
- Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France
| | - Barbara Seitz-Polski
- Centre Hospitalier Universitaire de Nice, Laboratoire d'immunologie, Nice, France.
- Université Côte d'Azur - Centre Hospitalier Universitaire de Nice, UR2CA, Nice, France.
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Vassallo M, Fabre R, Bolla G, Manni S, Durant J, Pradier C. Prevalence of osteoporosis in people living with HIV and risk factors associated in the cART era. HIV Med 2023; 24:1088-1090. [PMID: 37264776 DOI: 10.1111/hiv.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Matteo Vassallo
- Centre hospitalier de Cannes, Cannes, France
- CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice, France
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Pradier C, Balinska MA, Bailly L. Enhancing multi-sectoral collaboration in health: the open arena for public health as a model for bridging the knowledge-translation gap. Front Health Serv 2023; 3:1216234. [PMID: 37790087 PMCID: PMC10544995 DOI: 10.3389/frhs.2023.1216234] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Effective public health interventions at local level must involve communities and stakeholders beyond the health services spectrum. A dedicated venue for structured discussion will ensure ongoing multi-sectoral collaboration more effectively than convening ad hoc meetings. Such a venue can be created using existing resources, at minimal extra cost. The University Hospital in Nice (France) has established an Open Arena for Public Health which can serve as a model for promoting collaborative partnerships at local level. The Arena has been successful in implementing sustainable interventions thanks to a set of principles, including: non-hierarchical governance and operating, fair representation of stakeholders, consensus as to best available evidence internationally and locally, policy dialogues: open, free-flowing discussions without preconceived solutions, and an experimental approach to interventions.
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Affiliation(s)
- Christian Pradier
- Department of Public Health, Nice University Hospital, University of Côte D'Azur, Nice, France
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
| | - Marta A. Balinska
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
| | - Laurent Bailly
- Department of Public Health, Nice University Hospital, University of Côte D'Azur, Nice, France
- Clinical Research Unit (UR2CA), Nice University Hospital, University of Côte D'Azur, Nice, France
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Lareyre F, Behrendt CA, Pradier C, Settembre N, Chaudhuri A, Fabre R, Raffort J, Bailly L. Nationwide Study in France To Predict One Year Major Bleeding and Validate the OAC3-PAD Score in Patients Undergoing Revascularisation for Lower Extremity Arterial Disease. Eur J Vasc Endovasc Surg 2023; 66:213-219. [PMID: 37121388 DOI: 10.1016/j.ejvs.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Antithrombotic strategies are currently recommended for the treatment of lower extremity artery disease (LEAD) but specific scores to assess the risk of bleeding in these patients are scarce. To fill the gap, the OAC3-PAD bleeding score was recently developed and validated in German cohorts. The aim of this study was to determine whether this score performs appropriately in another real world nationwide cohort. METHODS This 10 year retrospective, multicentre study based on French national electronic health data included patients who underwent revascularisation for LEAD between January 2013 and June 2022. The OAC3-PAD score was calculated and from this, the population was classified into four groups: low, low to moderate, moderate to high and high risk. A binary logistic regression model was applied, with major bleeding occurring at one year (defined using the International Classification of Diseases ICD-10) as the dependent variable. The performance of the OAC3-PAD bleeding score was investigated using a receiver operating characteristic curve. RESULTS Among 161 205 patients hospitalised for LEAD treatment in French institutions, the one year incidence of major bleeding was 13 672 patients (8.5%). The distribution of the population according to the OAC3-PAD bleeding score was: 88 835 patients (55.1%), 34 369 (21.3%), 27 914 (17.3%), and 10 087 (6.3%) in the low, low to moderate, moderate to high, and high risk groups, respectively; with an incidence of one year major bleeding of 5.0%, 9.8%, 13.2%, and 21.3%. The OAC3-PAD model achieved an AUC of 0.650 to predict one year major bleeding following LEAD repair (95% CI 0.645 - 0.655), with a sensitivity of 0.67 and a specificity of 0.57. CONCLUSION This nationwide analysis confirmed the accuracy of the OAC3-PAD model to predict one year major bleeding and served as external validation. Although further studies are required, it adds evidence and perspectives to further generalise its use to guide the management of patients with LEAD.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, Inserm U1065, C3M, Nice, France.
| | - Christian-Alexander Behrendt
- Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; Asklepios Medical School Hamburg, Asklepios Clinic Wandsbek, Department of Vascular and Endovascular Surgery, Hamburg, Germany
| | - Christian Pradier
- Public Health Department, University Hospital of Nice, Université Côte d'Azur, Nice, France; Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Nicla Settembre
- Department of Vascular Surgery, University Hospital of Nancy, Université de Lorraine, Nancy, France
| | - Arindam Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Roxane Fabre
- Public Health Department, University Hospital of Nice, Université Côte d'Azur, Nice, France; Fédération Hospitalo-Universitaire INOVPAIN, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Juliette Raffort
- Université Côte d'Azur, Inserm U1065, C3M, Nice, France; 3IA Institute, Université Côte d'Azur, France; Department of clinical Biochemistry, University Hospital of Nice, France
| | - Laurent Bailly
- Public Health Department, University Hospital of Nice, Université Côte d'Azur, Nice, France; Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
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6
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Greenberg L, Ryom L, Bakowska E, Wit F, Bucher HC, Braun DL, Phillips A, Sabin C, d'Arminio Monforte A, Zangerle R, Smith C, De Wit S, Bonnet F, Pradier C, Mussini C, Muccini C, Vehreschild JJ, Hoy J, Svedhem V, Miró JM, Wasmuth JC, Reiss P, Llibre JM, Chkhartishvili N, Stephan C, Hatleberg CI, Neesgaard B, Peters L, Jaschinski N, Dedes N, Kuzovatova E, Van Der Valk M, Menozzi M, Lehmann C, Petoumenos K, Garges H, Rooney J, Young L, Lundgren JD, Bansi-Matharu L, Mocroft A, On Behalf Of The Respond And D A D Study Groups. Trends in Cancer Incidence in Different Antiretroviral Treatment-Eras amongst People with HIV. Cancers (Basel) 2023; 15:3640. [PMID: 37509301 PMCID: PMC10377704 DOI: 10.3390/cancers15143640] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Despite cancer being a leading comorbidity amongst individuals with HIV, there are limited data assessing cancer trends across different antiretroviral therapy (ART)-eras. We calculated age-standardised cancer incidence rates (IRs) from 2006-2021 in two international cohort collaborations (D:A:D and RESPOND). Poisson regression was used to assess temporal trends, adjusted for potential confounders. Amongst 64,937 individuals (31% ART-naïve at baseline) and 490,376 total person-years of follow-up (PYFU), there were 3763 incident cancers (IR 7.7/1000 PYFU [95% CI 7.4, 7.9]): 950 AIDS-defining cancers (ADCs), 2813 non-ADCs, 1677 infection-related cancers, 1372 smoking-related cancers, and 719 BMI-related cancers (groups were not mutually exclusive). Age-standardised IRs for overall cancer remained fairly constant over time (8.22/1000 PYFU [7.52, 8.97] in 2006-2007, 7.54 [6.59, 8.59] in 2020-2021). The incidence of ADCs (3.23 [2.79, 3.72], 0.99 [0.67, 1.42]) and infection-related cancers (4.83 [4.2, 5.41], 2.43 [1.90, 3.05]) decreased over time, whilst the incidence of non-ADCs (4.99 [4.44, 5.58], 6.55 [5.67, 7.53]), smoking-related cancers (2.38 [2.01, 2.79], 3.25 [2.63-3.96]), and BMI-related cancers (1.07 [0.83, 1.37], 1.88 [1.42, 2.44]) increased. Trends were similar after adjusting for demographics, comorbidities, HIV-related factors, and ART use. These results highlight the need for better prevention strategies to reduce the incidence of NADCs, smoking-, and BMI-related cancers.
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Affiliation(s)
- Lauren Greenberg
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Department of Infectious Diseases 144, Hvidovre University Hospital, DK-2650 Copenhagen, Denmark
| | | | - Ferdinand Wit
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
| | - Heiner C Bucher
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8001 Zurich, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8001 Zurich, Switzerland
| | - Andrew Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, 6020 Innsbruch, Austria
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London NW3 2PF, UK
| | - Stéphane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., 1000 Brussels, Belgium
| | - Fabrice Bonnet
- CHU de Bordeaux and Bordeaux University, BPH, INSERM U1219, 33076 Bordeaux, France
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, 06000 Nice, France
| | - Cristina Mussini
- Modena HIV Cohort, Università Degli Studi Di Modena and Reggio Emilia, 41125 Modena, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | | | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne 3004, Australia
- The Australian HIV Observational Database (AHOD), Kirby Institute, UNSW, Sydney 2052, Australia
| | - Veronica Svedhem
- Swedish InfCareHIV Cohort, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Peter Reiss
- Amsterdam UMC Location, Department of Global Health, University of Amsterdam, Global Health, Meibergdreef 9, 1105 Amsterdam, The Netherlands
| | - Josep M Llibre
- Department of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Christoph Stephan
- HIV Center, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt, Germany
| | - Camilla I Hatleberg
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lars Peters
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Nadine Jaschinski
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Nikos Dedes
- European AIDS Treatment Group, 1000 Brussels, Belgium
| | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute, 603155 Nizhny Novgorod, Russia
| | - Marc Van Der Valk
- Stichting HIV Monitoring, 1105 BD Amsterdam, The Netherlands
- Amsterdam University Medical Centers, University of Amsterdam, 1117 Amsterdam, The Netherlands
| | - Marianna Menozzi
- Modena HIV Cohort, Università Degli Studi Di Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Kathy Petoumenos
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne 3004, Australia
- The Australian HIV Observational Database (AHOD), Kirby Institute, UNSW, Sydney 2052, Australia
| | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, Durham, NC 27709, USA
| | - Jim Rooney
- Gilead Science, Foster City, CA 94404, USA
| | | | - Jens D Lundgren
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
| | - Amanda Mocroft
- CHIP, Centre of Excellence for Health, Immunity and Infections Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK
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Mariné Barjoan E, Chaarana A, Festraëts J, Géloen C, Prouvost-Keller B, Legueult K, Pradier C. Impact of social and demographic factors on the spread of the SARS-CoV-2 epidemic in the town of Nice. BMC Public Health 2023; 23:1098. [PMID: 37280635 DOI: 10.1186/s12889-023-15917-z] [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: 07/25/2022] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Socio-demographic factors are known to influence epidemic dynamics. The town of Nice, France, displays major socio-economic inequalities, according to the National Institute of Statistics and Economic Studies (INSEE), 10% of the population is considered to live below the poverty threshold, i.e. 60% of the median standard of living. OBJECTIVE To identify socio-economic factors related to the incidence of SARS-CoV-2 in Nice, France. METHODS The study included residents of Nice with a first positive SARS-CoV-2 test (January 4-February 14, 2021). Laboratory data were provided by the National information system for Coronavirus Disease (COVID-19) screening (SIDEP) and socio-economic data were obtained from INSEE. Each case's address was allocated to a census block to which we assigned a social deprivation index (French Deprivation index, FDep) divided into 5 categories. For each category, we computed the incidence rate per age and per week and its mean weekly variation. A standardized incidence ratio (SIR) was calculated to investigate a potential excess of cases in the most deprived population category (FDep5), compared to the other categories. Pearson's correlation coefficient was computed and a Generalized Linear Model (GLM) applied to analyse the number of cases and socio-economic variables per census blocks. RESULTS We included 10,078 cases. The highest incidence rate was observed in the most socially deprived category (4001/100,000 inhabitants vs 2782/100,000 inhabitants for the other categories of FDep). The number of observed cases in the most social deprivated category (FDep5: N = 2019) was significantly higher than in the others (N = 1384); SIR = 1.46 [95% CI:1.40-1.52; p < 0.001]. Socio-economic variables related to poor housing, harsh working conditions and low income were correlated with the new cases of SARS-CoV-2. CONCLUSION Social deprivation was correlated with a higher incidence of SARS-CoV-2 during the 2021 epidemic in Nice. Local surveillance of epidemics provides complementary data to national and regional surveillance. Mapping socio-economic vulnerability indicators at the census block level and correlating these with incidence could prove highly useful to guide political decisions in public health.
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Affiliation(s)
- Eugènia Mariné Barjoan
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France.
| | - Amel Chaarana
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
| | - Julie Festraëts
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
| | - Carole Géloen
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
| | - Bernard Prouvost-Keller
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
| | - Kevin Legueult
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
| | - Christian Pradier
- Public Health Department, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière. Niveau 1, CS23079, Nice cedex 3, 06202, France
- Université Côte d'Azur, UR2CA, Nice, France
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Manni S, Ruetsch C, Fabre R, Ticchioni M, Graça D, Pradier C, Seitz-Polski B, Lotte L, Brglez V, Vassallo M. Immune response to BNT162b2 SARS-CoV-2 vaccine in patients living with HIV: The COVIH-DAPT study. Front Immunol 2023; 14:1136723. [PMID: 36949938 PMCID: PMC10025349 DOI: 10.3389/fimmu.2023.1136723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Data on immune response to SARS-CoV-2 vaccine in patients living with HIV (PLWH) over a period longer than 3 months are currently limited. We measured the immune response after BNT162b2 vaccination against SARS-CoV-2 in this population. Methods We prospectively enrolled PLWH on successful antiretroviral therapy, initiating vaccination with two doses of the BNT162b2 SARS-CoV-2 vaccine administered at six-week interval. SARS-CoV-2 humoral and cellular responses and lymphocyte cell subsets were recorded at inclusion and 6 weeks (W6), 3 months (M3) and 6 months (M6) later. Humoral, humoral strong and cellular responders were defined by IgG titers >10, ≥264BAU/mL and IFN-γ T cell release, respectively. Results Nineteen subjects without SARS-CoV-2 infection were included (74% men, mean age 51 years, CD4 nadir 399/mm3). All subjects were humoral responders, their antibody titer peak reached at M3. Strong responders' rates were 63% and 21% at M3 and M6, respectively. CD19+CD10+ B cells had increased significantly at W6 then decreased at M3, while CD19+CD27+ B cells remained unchanged. Rates of patients with a cellular response increased from 39% at W6 to 69% at M6. Cellular responders had significantly higher CD3+, CD4+ and CD8+ Effector Memory cells at inclusion (p=0.048, p=0.024, p=0.012, respectively) and CD4+ Terminally Differentiated Effector Memory cells at M3 (p=0.044). Discussion PLWH have a robust immune response after SARS-CoV-2 vaccination, but a rapid decline in humoral response from 3 months onwards, due to a blunted memory B cell response. Analysis of lymphocyte subsets may help identify optimal times for vaccine boosters.
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Affiliation(s)
- Sabrina Manni
- Department of Infectious Diseases, Cannes General Hospital, Cannes, France
- *Correspondence: Sabrina Manni, ; Matteo Vassallo,
| | - Caroline Ruetsch
- Immunology Department, Nice University Hospital, Côte d’Azur University, Nice, France
- Mediterranean Centre for Molecular Medicine (C3M), Institut National de la Santé Et de la Recherche Médicale (INSERM) U1065, Côte d’Azur University, Nice, France
| | - Roxane Fabre
- Public Health Department, Nice University Hospital, Côte d'Azur Université, Nice, France
| | - Michel Ticchioni
- Immunology Department, Nice University Hospital, Côte d’Azur University, Nice, France
| | - Daisy Graça
- Immunology Department, Nice University Hospital, Côte d’Azur University, Nice, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Côte d’Azur University, Nice, France
| | - Christian Pradier
- Public Health Department, Nice University Hospital, Côte d'Azur Université, Nice, France
| | - Barbara Seitz-Polski
- Immunology Department, Nice University Hospital, Côte d’Azur University, Nice, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Côte d’Azur University, Nice, France
| | - Laurene Lotte
- Multipurpose Laboratory, Cannes General Hospital, Cannes, France
| | - Vesna Brglez
- Immunology Department, Nice University Hospital, Côte d’Azur University, Nice, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Côte d’Azur University, Nice, France
| | - Matteo Vassallo
- Department of Infectious Diseases, Cannes General Hospital, Cannes, France
- Unité de Recherche Clinique Côte d’Azur (UR2CA), Côte d’Azur University, Nice, France
- *Correspondence: Sabrina Manni, ; Matteo Vassallo,
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Bailly L, Jobert T, Petrovic M, Pradier C. Factors influencing participation in breast cancer screening in an urban setting. A study of organized and individual opportunistic screening among potentially active and retired women in the city of Nice. Prev Med Rep 2022; 31:102085. [PMID: 36820373 PMCID: PMC9938307 DOI: 10.1016/j.pmedr.2022.102085] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Participation in breast cancer screening in urban settings is poor. Identifying factors accounting for participation and non-participation is essential to target priority areas, tackle health inequalities and suggest innovative approaches. We studied organized and individual opportunistic participation in breast cancer screening within the 144 aggregated units for statistical information (Ilôts regroupés pour l'information statistique: IRIS) of the city of Nice from 2019 to 2021. In each IRIS was assessed a local human development index, among potentially active women aged 50 to 59 years and retired women aged 60 to 74 years. Modelling participation and non-participation in screening according to the IRIS units' socio-economical characteristics was performed using the SURE method (Seemingly Unrelated Regression Equations). Over a 2-year period, 24,396 breast screening tests were conducted (11,173 as organised screening, 13,223 as individual opportunistic screening). The local human development index was positively correlated with the two types of screening, respectively. Access to public transport facilitated participation. Managerial status was negatively correlated with organised screening. Single working women had a higher risk of non-participation. With regard to their socio-economic characteristics, screening rates were lower than expected in 16 IRIS units in the city of Nice. Local human development index, access to public transport, family and professional context appear to be associated with breast cancer screening in an urban setting. An innovative approach targeting these factors is called for to reduce health inequalities.
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Affiliation(s)
- Laurent Bailly
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
- Corresponding author.
| | - Thomas Jobert
- Université Côte d'Azur, CNRS, GREDEG, 250 rue Albert Einstein, Valbonne 06560, France
| | - Mirko Petrovic
- Université Côte d’Azur, EUR ELMI, Rue du 22ème B.C.A., Nice 06300, France
| | - Christian Pradier
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
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Allouche J, Cremoni M, Brglez V, Graça D, Benzaken S, Zorzi K, Fernandez C, Esnault V, Levraut M, Oppo S, Jacquinot M, Armengaud A, Pradier C, Bailly L, Seitz-Polski B. Air pollution exposure induces a decrease in type II interferon response: A paired cohort study. EBioMedicine 2022; 85:104291. [PMID: 36183487 PMCID: PMC9525814 DOI: 10.1016/j.ebiom.2022.104291] [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: 05/10/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/01/2022] Open
Abstract
Background While air pollution is a major issue due to its harmful effects on human health, few studies focus on its impact on the immune system and vulnerability to viral infections. The lockdown declared following the COVID-19 pandemic represents a unique opportunity to study the large-scale impact of variations in air pollutants in real life. We hypothesized that variations in air pollutants modify Th1 response represented by interferon (IFN) γ production. Methods We conducted a single center paired pilot cohort study of 58 participants, and a confirmation cohort of 320 participants in Nice (France), with for each cohort two samplings at six months intervals. We correlated the variations in the production of IFNγ after non-specific stimulation of participants’ immune cells with variations in key regulated pollutants: NO2, O3, PM2.5, and PM10 and climate variables. Using linear regression, we studied the effects of variations of each pollutant on the immune response. Findings In the pilot cohort, IFNγ production significantly decreased by 25.7% post-lockdown compared to during lockdown, while NO2 increased significantly by 46.0%. After the adjustment for climate variations during the study period (sunshine and temperature), we observed a significant effect of NO2 variation on IFNγ production (P=0.03). In the confirmation cohort IFNγ decreased significantly by 47.8% and after adjustment for environmental factors and intrinsic characteristics we observed a significant effect of environmental factors: NO2, PM10, O3, climatic conditions (sunshine exposure, relative humidity) on variation in IFNγ production (P=0.005, P<0.001, P=0.001, P=0.002 and P<0.001 respectively) but not independently from the BMI at inclusion and the workplace P=0.007 and P<0.001 respectively). Interpretation We show a weakening of the antiviral cellular response in correlation with an increase of pollutants exposition. Funding Agence Nationale de la Recherche, Conseil Départemental des Alpes-Maritimes and Region Sud.
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Affiliation(s)
- Jonathan Allouche
- Department of Public Health, University Hospital of Nice, University Côte, France; Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Marion Cremoni
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France; Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Vesna Brglez
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France; Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Daisy Graça
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France; Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Sylvia Benzaken
- Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Kévin Zorzi
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Céline Fernandez
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France; Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France
| | - Vincent Esnault
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Michaël Levraut
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Sonia Oppo
- AtmoSud, Air Quality Observatory for Southern Region, Marseille, France
| | - Morgan Jacquinot
- AtmoSud, Air Quality Observatory for Southern Region, Marseille, France
| | | | - Christian Pradier
- Department of Public Health, University Hospital of Nice, University Côte, France; Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Laurent Bailly
- Department of Public Health, University Hospital of Nice, University Côte, France; Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Barbara Seitz-Polski
- Clinical Research Unit of the Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France; Immunology Department, University Hospital of Nice, Université Côte d'Azur, Nice, France.
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Payen M, Gaudart A, Legueult K, Kasprzak J, Emery A, Mutambayi G, Pradier C, Robin F, Lotte R, Ruimy R. Evaluation of an Antibiotic Susceptibility Testing Method on Enterobacterales-Positive Blood Cultures in Less Than 8 h Using the Rapid Mueller-Hinton Diffusion Method in Conjunction with the SIRscan 2000 Automatic Reading Device. Microorganisms 2022; 10:microorganisms10071377. [PMID: 35889096 PMCID: PMC9320083 DOI: 10.3390/microorganisms10071377] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023] Open
Abstract
Enterobacterales bloodstream infections are life-threatening and require rapid, targeted antibiotherapy based on antibiotic susceptibility testing (AST). A new method using Muller-Hinton Rapid-SIR (MHR-SIR) agar (i2a, Montpellier, France) allows complete direct AST (dAST) to be read from positive blood culture bottles (BCBs) for all Enterobacterales species after 6-8 h of incubation. We evaluated (i) the performance of dAST from positive BCBs on MHR-SIR agar using two different inoculum protocols; (ii) the categorical agreement between dAST results obtained with MHR-SIR agar vs. those obtained with Muller-Hinton (MH) agar; and (iii) the ability of the MHR-SIR medium to detect β-lactam resistant Enterobacterales. Finally, we estimated the saved turnaround time (TAT) with MHR-SIR compared with MH agar in our 24/7 laboratory. Our results showed that the most suitable inoculation protocol for dAST on MHR-SIR agar was 1 drop of BCB/5 mL H2O. For monomicrobial Enterobacterales BCBs, dAST performed on MHR-SIR medium showed 99.3% categorical agreement with AST on MH agar. Furthermore, MHR-SIR agar allows early detection of β-lactam resistance mechanisms, including AmpC hyperproduction, extended-spectrum β-lactamase, and carbapenemase. Finally, TAT reduction in our 24/7 laboratory was 16 h, enabling a significantly faster provision of antibiotic advice.
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Affiliation(s)
- Mathilde Payen
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
- Institut National de la Santé et de la Recherche Médicale U1065, Centre Méditerranéen de Médecine Moléculaire, Équipe 6, 06200 Nice, France
- Faculté de Médecine, Université Côte d’Azur, 06200 Nice, France
| | - Alice Gaudart
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
| | - Kevin Legueult
- Département de Santé Publique, UR2CA, Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (K.L.); (C.P.)
| | - James Kasprzak
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
| | - Audrey Emery
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
| | - Grégoire Mutambayi
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
| | - Christian Pradier
- Département de Santé Publique, UR2CA, Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (K.L.); (C.P.)
| | - Frédéric Robin
- Laboratoire de Bactériologie Clinique, Institut National de la Santé et de la Recherche Médicale U1071, INRA USC2018, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
- Centre National de Référence de la Résistance aux Antibiotiques, Laboratoire Associé, 63000 Clermont-Ferrand, France
| | - Romain Lotte
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
- Institut National de la Santé et de la Recherche Médicale U1065, Centre Méditerranéen de Médecine Moléculaire, Équipe 6, 06200 Nice, France
- Faculté de Médecine, Université Côte d’Azur, 06200 Nice, France
| | - Raymond Ruimy
- Laboratoire de Bactériologie, Hôpital L’Archet 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France; (M.P.); (A.G.); (J.K.); (A.E.); (G.M.); (R.L.)
- Institut National de la Santé et de la Recherche Médicale U1065, Centre Méditerranéen de Médecine Moléculaire, Équipe 6, 06200 Nice, France
- Faculté de Médecine, Université Côte d’Azur, 06200 Nice, France
- Correspondence:
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Neesgaard B, Greenberg L, Miró JM, Grabmeier-Pfistershammer K, Wandeler G, Smith C, De Wit S, Wit F, Pelchen-Matthews A, Mussini C, Castagna A, Pradier C, d'Arminio Monforte A, Vehreschild JJ, Sönnerborg A, Anne AV, Carr A, Bansi-Matharu L, Lundgren JD, Garges H, Rogatto F, Zangerle R, Günthard HF, Rasmussen LD, Necsoi C, van der Valk M, Menozzi M, Muccini C, Peters L, Mocroft A, Ryom L. Associations between integrase strand-transfer inhibitors and cardiovascular disease in people living with HIV: a multicentre prospective study from the RESPOND cohort consortium. Lancet HIV 2022; 9:e474-e485. [PMID: 35688166 DOI: 10.1016/s2352-3018(22)00094-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [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: 09/23/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although associations between older antiretroviral drug classes and cardiovascular disease in people living with HIV are well described, there is a paucity of data regarding a possible association with integrase strand-transfer inhibitors (INSTIs). We investigated whether exposure to INSTIs was associated with an increased incidence of cardiovascular disease. METHODS RESPOND is a prospective, multicentre, collaboration study between 17 pre-existing European and Australian cohorts and includes more than 32 000 adults living with HIV in clinical care after Jan 1, 2012. Individuals were eligible for inclusion in these analyses if they were older than 18 years, had CD4 cell counts and HIV viral load measurements in the 12 months before or within 3 months after baseline (latest of cohort enrolment or Jan 1, 2012), and had no exposure to INSTIs before baseline. These individuals were subsequently followed up to the earliest of the first cardiovascular disease event (ie, myocardial infarction, stroke, or invasive cardiovascular procedure), last follow-up, or Dec 31, 2019. We used multivariable negative binomial regression to assess associations between cardiovascular disease and INSTI exposure (0 months [no exposure] vs >0 to 6 months, >6 to 12 months, >12 to 24 months, >24 to 36 months, and >36 months), adjusted for cardiovascular risk factors. RESPOND is registered with ClinicalTrials.gov, NCT04090151, and is ongoing. FINDINGS 29 340 people living with HIV were included in these analyses, of whom 7478 (25·5%) were female, 21 818 (74·4%) were male, and 44 (<1%) were transgender, with a median age of 44·3 years (IQR 36·2-51·3) at baseline. As of Dec 31, 2019, 14 000 (47·7%) of 29 340 participants had been exposed to an INSTI. During a median follow-up of 6·16 years (IQR 3·87-7·52; 160 252 person-years), 748 (2·5%) individuals had a cardiovascular disease event (incidence rate of 4·67 events [95% CI 4·34-5·01] per 1000 person-years of follow-up). The crude cardiovascular disease incidence rate was 4·19 events (3·83-4·57) per 1000 person-years in those with no INSTI exposure, which increased to 8·46 events (6·58-10·71) per 1000 person-years in those with more than 0 months to 6 months of exposure, and gradually decreased with increasing length of exposure, until it decreased to similar levels of no exposure at more than 24 months of exposure (4·25 events [2·89-6·04] per 1000 person-years among those with >24 to 36 months of exposure). Compared with those with no INSTI exposure, the risk of cardiovascular disease was increased in the first 24 months of INSTI exposure and thereafter decreased to levels similar to those never exposed (>0 to 6 months of exposure: adjusted incidence rate ratio of 1·85 [1·44-2·39]; >6 to 12 months of exposure: 1·19 [0·84-1·68]; >12 to 24 months of exposure: 1·46 [1·13-1·88]; >24 to 36 months of exposure: 0·89 [0·62-1·29]; and >36 months of exposure: 0·96 [0·69-1·33]; p<0·0001). INTERPRETATION Although the potential for unmeasured confounding and channelling bias cannot fully be excluded, INSTIs initiation was associated with an early onset, excess incidence of cardiovascular disease in the first 2 years of exposure, after accounting for known cardiovascular disease risk factors. These early findings call for analyses in other large studies, and the potential underlying mechanisms explored further. FUNDING The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands National Observational HIV cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort and The University of Cologne HIV Cohorts, ViiV Healthcare, and Gilead Sciences.
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Affiliation(s)
- Bastian Neesgaard
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Lauren Greenberg
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, UK
| | - Stéphane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Cristina Mussini
- Modena HIV Cohort, Università Degli Studi di Modena, Modena, Italy
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | | | - Jörg J Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany; Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Alain V Anne
- European AIDS Treatment Group (EATG), Brussels, Belgium
| | - Andrew Carr
- HIV and Immunology Unit, St Vincent's Hospital, Sydney, NSW, Australia; The Australian HIV Observational Database (AHOD), UNSW Sydney, Sydney, NSW, Australia
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Marc van der Valk
- AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Marianna Menozzi
- Modena HIV Cohort, Università Degli Studi di Modena, Modena, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Lars Peters
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Barjoan EM, Allouche J, Legueult K, Géloen C, Prouvost-Keller B, Pradier C. [Hospitalization with or for COVID-19: which surveillance indicator to choose?]. Sante Publique 2022; Vol. 33:725-728. [PMID: 35485129 DOI: 10.3917/spub.215.0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In the SARS-CoV-2 epidemic, the monitoring of epidemiological surveillance indicators is a central issue. OBJECTIVE We were able to describe the monitoring of the epidemic of hospitalized patients in the department of Alpes-Maritimes from three data sources: 1) Santé Publique France (SPF) via the SI-VIC software, 2) the Regional Health Agency (ARS Paca) with conventional hospitalization or department critical care data taken from SI-VIC, adjusting them to those of the Health Establishments (ES), 3) The ES of Alpes-Maritimes associated with the ARS of Alpes-Maritimes and the Department of Public Health (DSP) of the CHU, with the collection of patients hospitalized in the conventional sector or in critical/intensive care in the dedicated COVID-19 beds. The aim of this study was to verify the consistency of these three information systems. RESULTS We observed disparities between the number of cases of hospitalization of SPF and the data from ES/ARS/DSP. We did not observe any differences in patients hospitized in intensive care/critical care units. The Scientific Council uses SPF data on the number of hospitalizations or intensive/critical beds to justify its recommendations.However, SPF data from SI-VIC have associated patients hospitalized for COVID and patients who tested positive for PCR, but whose reason for hospitalization is not related to SARS-CoV2 infection (formerly infected or asymptomatic patients). CONCLUSIONS We believe that hospital surveillance indicators should only take into account the number of patients in conventional hospitalization or resuscitation for a COVID-19 infection.
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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15
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Greenberg L, Ryom L, Neesgaard B, Miró JM, Dahlerup Rasmussen L, Zangerle R, Grabmeier-Pfistershammer K, Günthard HF, Kusejko K, Smith C, Mussini C, Menozzi M, Wit F, Van Der Valk M, d’Arminio Monforte A, De Wit S, Necsoi C, Pelchen-Matthews A, Lundgren J, Peters L, Castagna A, Muccini C, Vehreschild JJ, Pradier C, Bruguera Riera A, Sönnerborg A, Petoumenos K, Garges H, Rogatto F, Dedes N, Bansi-Matharu L, Mocroft A. Integrase strand transfer inhibitor use and cancer incidence in a large cohort setting. Open Forum Infect Dis 2022; 9:ofac029. [PMID: 35198646 PMCID: PMC8860165 DOI: 10.1093/ofid/ofac029] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Limited data exist examining the association between incident cancer and cumulative integrase inhibitor (INSTI) exposure. Methods Participants were followed from baseline (latest of local cohort enrollment or January 1, 2012) until the earliest of first cancer, final follow-up, or December 31, 2019. Negative binomial regression was used to assess associations between cancer incidence and time-updated cumulative INSTI exposure, lagged by 6 months. Results Of 29 340 individuals, 74% were male, 24% were antiretroviral treatment (ART)-naive, and median baseline age was 44 years (interquartile range [IQR], 36–51). Overall, 13 950 (48%) individuals started an INSTI during follow-up. During 160 657 person-years of follow-up ([PYFU] median 6.2; IQR, 3.9–7.5), there were 1078 cancers (incidence rate [IR] 6.7/1000 PYFU; 95% confidence interval [CI], 6.3–7.1). The commonest cancers were non-Hodgkin lymphoma (n = 113), lung cancer (112), Kaposi’s sarcoma (106), and anal cancer (103). After adjusting for potential confounders, there was no association between cancer risk and INSTI exposure (≤6 months vs no exposure IR ratio: 1.15 [95% CI, 0.89–1.49], >6–12 months; 0.97 [95% CI, 0.71–1.32], >12–24 months; 0.84 [95% CI, 0.64–1.11], >24–36 months; 1.10 [95% CI, 0.82–1.47], >36 months; 0.90 [95% CI, 0.65–1.26] [P = .60]). In ART-naive participants, cancer incidence decreased with increasing INSTI exposure, mainly driven by a decreasing incidence of acquired immune deficiency syndrome cancers; however, there was no association between INSTI exposure and cancer for those ART-experienced (interaction P < .0001). Conclusions Cancer incidence in each INSTI exposure group was similar, despite relatively wide CIs, providing reassuring early findings that increasing INSTI exposure is unlikely to be associated with an increased cancer risk, although longer follow-up is needed to confirm this finding.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- Correspondence: Lauren Greenberg, PhD, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, Rowland Hill Street, NW3 2PF, United Kingdom ()
| | - Lene Ryom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jose M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Colette Smith
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | | | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Marc Van Der Valk
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), HIV Monitoring Foundation, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Stéphane De Wit
- CHU Saint-Pierre, Infectious Diseases, Saint-PIerre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Jens Lundgren
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Camilla Muccini
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d’Azur et Centre Hospitalier Universitaire, Nice, France
| | - Andreu Bruguera Riera
- PISCIS Cohort Study, Centre Estudis Epidemiologics de ITS i VIH de Catalunya, Badalona, Spain
| | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Harmony Garges
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | - Nikos Dedes
- European AIDS Treatment Group, Brussels, Belgium
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, United Kingdom
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Tran A, Hérissé AL, Isoardo M, Valo P, Maillotte AM, Haas H, Donzeau D, Freyssinet E, Pradier C, Gentile S. Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children's Hospital in Nice. BMJ Open 2022; 12:e056476. [PMID: 34992122 PMCID: PMC8739427 DOI: 10.1136/bmjopen-2021-056476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate compliance with the French National Authority for Health's (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation. DESIGN Prospective, single centre. SETTING Fourth biggest PED in France in terms of attendance (CHU-Lenval). PATIENTS 280 patients of whom 249 were included in the statistical analysis. MAIN OUTCOME MEASURES The primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviews RESULTS: 77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS's postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS's postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1). CONCLUSION Postbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits. TRIAL REGISTRATION NUMBER The study bears the clinical trial number NCT02863627.
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Affiliation(s)
- Antoine Tran
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
- Medical School, Université Côte d'Azur, Nice, France
- Equipe de Recherche EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Anne-Laure Hérissé
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
| | - Marion Isoardo
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
| | - Petri Valo
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
- School of computing, University of Eastern Finland, Joensuu, Pohjois-Karjala, Finland
| | - Anne-Marie Maillotte
- Neonatology, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Hervé Haas
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
- Paediatric Department, Princess Grace Hospital Centre, Monaco
| | - Dominique Donzeau
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Emma Freyssinet
- Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, Provence-Alpes-Côte d'Azur, France
| | - Christian Pradier
- Medical School, Université Côte d'Azur, Nice, France
- Department of Public Health, Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | - Stéphanie Gentile
- Equipe de Recherche EA 3279 - Centre d'Études et de Recherche sur les Services de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
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Tran A, Valo P, Rouvier C, Dos Ramos E, Freyssinet E, Baranton E, Haas O, Haas H, Pradier C, Gentile S. Validation of the Computerized Pediatric Triage Tool, pediaTRI, in the Pediatric Emergency Department of Lenval Children's Hospital in Nice: A Cross-Sectional Observational Study. Front Pediatr 2022; 10:840181. [PMID: 35592843 PMCID: PMC9113392 DOI: 10.3389/fped.2022.840181] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION A reliable pediatric triage tool is essential for nurses working in pediatric emergency departments to quickly identify children requiring priority care (high-level emergencies) and those who can wait (low-level emergencies). In the absence of a gold standard in France, the objective of our study was to validate our 5-level pediatric triage tool -pediaTRI- against the reference tool: the Pediatric Early Warning Score (PEWS) System. MATERIALS AND METHODS We prospectively included 100,506 children who visited the Pediatric Emergency Department at Lenval Children's Hospital (Nice, France) in 2016 and 2017. The performance of pediaTRI to identify high-level emergencies (severity levels 1 and 2) was evaluated in comparison with a PEWS ≥ 4/9. Data from 2018-19 was used as an independent validation cohort. RESULTS pediaTRI agreed with the PEWS score for 84,896 of the patients (84.5%): 15.0% (14.8-15.2) of the patients were over-triaged and 0.5% (0.5-0.6) under-triaged compared with the PEWS score. pediaTRI had a sensitivity of 76.4% (74.6-78.2), a specificity of 84.7% (84.4-84.9), and positive and negative likelihood ratios of 5.0 (4.8-5.1) and 0.3 (0.3-0.3), respectively, for the identification of high-level emergencies. However, the positive likelihood ratios were lower for patients presenting with a medical complaint [4.1 (4.0-4.2) v 10.4 (7.9-13.7 for trauma), and for younger children [1.2 (1.1-1.2) from 0 to 28 days, and 1.9 (1.8-2.0) from 28 days to 3 months]. CONCLUSION pediaTRI has a moderate to good validity to triage children in a Pediatric Emergency Department with a tendency to over-triage compared with the PEWS system. Its validity is lower for younger children and for children consulting for a medical complaint.
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Affiliation(s)
- Antoine Tran
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France.,School of Medicine, Université Côte d'Azur, Nice, France.,Research Team EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", School of Medicine, Aix-Marseille Université, Marseille, France
| | - Petri Valo
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France.,School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Camille Rouvier
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Emmanuel Dos Ramos
- Department of Medical Computing, General Hospital "les Palmiers", Hyères, France.,Innovation e-Santé Sud, Groupement d'Intérêt Public, Hyères, France
| | - Emma Freyssinet
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Emma Baranton
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Olivier Haas
- Pediatric Emergency Department, Lenval University Children's Hospital, Nice, France
| | - Hervé Haas
- Department of Pediatrics, Centre Hospitalier Princesse-Grace, Monaco, Monaco
| | - Christian Pradier
- School of Medicine, Université Côte d'Azur, Nice, France.,Department of Public Health, Archet University Hospital, Nice, France
| | - Stéphanie Gentile
- Research Team EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", School of Medicine, Aix-Marseille Université, Marseille, France
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Rios G, Lacoux C, Leclercq V, Diamant A, Lebrigand K, Lazuka A, Soyeux E, Lacroix S, Fassy J, Couesnon A, Thiery R, Mari B, Pradier C, Waldmann R, Barbry P. Monitoring SARS-CoV-2 variants alterations in Nice neighborhoods by wastewater nanopore sequencing. Lancet Reg Health Eur 2021. [PMID: 34423327 DOI: 10.1101/2021.07.09.21257475] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Wastewater surveillance was proposed as an epidemiological tool to define the prevalence and evolution of the SARS-CoV-2 epidemics. However, most implemented SARS-CoV-2 wastewater surveillance projects were based on qPCR measurement of virus titers and did not address the mutational spectrum of SARS-CoV-2 circulating in the population. METHODS We have implemented a nanopore RNA sequencing monitoring system in the city of Nice (France, 550,000 inhabitants). Between October 2020 and March 2021, we monthly analyzed the SARS-CoV-2 variants in 113 wastewater samples collected in the main wastewater treatment plant and 20 neighborhoods. FINDINGS We initially detected the lineages predominant in Europe at the end of 2020 (B.1.160, B.1.177, B.1.367, B.1.474, and B.1.221). In January, a localized emergence of a variant (Spike:A522S) of the B.1.1.7 lineage occurred in one neighborhood. It rapidly spread and became dominant all over the city. Other variants of concern (B.1.351, P.1) were also detected in some neighborhoods, but at low frequency. Comparison with individual clinical samples collected during the same week showed that wastewater sequencing correctly identified the same lineages as those found in COVID-19 patients. INTERPRETATION Wastewater sequencing allowed to document the diversity of SARS-CoV-2 sequences within the different neighborhoods of the city of Nice. Our results illustrate how sequencing of sewage samples can be used to track pathogen sequence diversity in the current pandemics and in future infectious disease outbreaks. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Géraldine Rios
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Caroline Lacoux
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | | | - Anna Diamant
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Kévin Lebrigand
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Adèle Lazuka
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Emmanuel Soyeux
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Sébastien Lacroix
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Julien Fassy
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Aurélie Couesnon
- ANSES, Sophia Antipolis Laboratory, F06902 Sophia Antipolis, France
| | - Richard Thiery
- ANSES, Sophia Antipolis Laboratory, F06902 Sophia Antipolis, France
| | - Bernard Mari
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Christian Pradier
- Université Côte d'Azur and Nice University Hospital, Public Health Department, F06560 Nice, France
| | - Rainer Waldmann
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Pascal Barbry
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
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Kowalska JD, Pelchen-Matthews A, Ryom L, Losso MH, Trofimova T, Mitsura VM, Khromova I, Paduta D, Stephan C, Domingo P, Bakowska E, Monforte AD, Oestergaard L, Jablonowska E, Kuznetsova A, Moreno S, Vasylyev M, Pradier C, Battegay M, Vandekerckhove L, Castagna A, Raben D, Mocroft A. Prevalence and outcomes of pregnancies in women with HIV over a 20-year period. AIDS 2021; 35:2025-2033. [PMID: 34033590 DOI: 10.1097/qad.0000000000002954] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate time trends in pregnancies and pregnancy outcomes among women with HIV in Europe. DESIGN European multicentre prospective cohort study. METHODS EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalized estimating equations. RESULTS Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4+ cell count or with prior AIDS, and higher in those with a previous pregnancy or who were hepatitis C virus positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Tatiana Trofimova
- Novgorod Centre for AIDS prevention and control, Novgorod the Great, Russian Federation
| | | | - Irina Khromova
- Centre for HIV/AIDS & Infectious Diseases, Kaliningrad, Russian Federation
| | | | | | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Elzbieta Jablonowska
- Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland
| | | | - Santiago Moreno
- Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Vasylyev
- Lviv Regional HIV/AIDS Prevention and Control Center, Lviv, Ukraine
| | | | - Manuel Battegay
- Department of Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Dorthe Raben
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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20
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Bailly L, Fabre R, Courjon J, Carles M, Dellamonica J, Pradier C. Obesity, diabetes, hypertension and severe outcomes among inpatients with coronavirus disease 2019: a nationwide study. Clin Microbiol Infect 2021; 28:114-123. [PMID: 34537362 PMCID: PMC8444420 DOI: 10.1016/j.cmi.2021.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 05/14/2021] [Revised: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023]
Abstract
Objectives Initial studies of individuals with coronavirus disease 2019 (COVID-19) revealed that obesity, diabetes and hypertension were associated with severe outcomes. Subsequently, some authors showed that the risk could vary according to age, gender, co-morbidities and medical history. In a nationwide retrospective cohort, we studied the association between these co-morbidities and patients' requirement for invasive mechanical ventilation (IMV) or their death. Methods All French adult inpatients with COVID-19 admitted during the first epidemic wave (February to September 2020) were included. When patients were diagnosed with obesity, diabetes or hypertension for the first time in 2020, these conditions were considered as incident co-morbidities, otherwise they were considered prevalent. We compared outcomes of IMV and in-hospital death according to obesity, diabetes and hypertension, taking age, gender and Charlson's co-morbidity index score (CCIS) into account. Results A total of 134 209 adult inpatients with COVID-19 were included, half of them had hypertension (n = 66 613, 49.6%), one in four were diabetic (n = 32 209, 24.0%), and one in four were obese (n = 32 070, 23.9%). Among this cohort, IMV was required for 13 596 inpatients, and 19 969 patients died. IMV and death were more frequent in male patients (adjusted oods ratio (aOR) 2.0, 95% CI 1.9–2.1 and aOR 1.5, 95% CI 1.4–1.5, respectively), IMV in patients with co-morbidities (aOR 2.1, 95% CI 2.0–2.2 for CCIS = 2 and aOR 3.0, 95% CI 2.8–3.1 for CCIS ≥5), and death in patients aged 80 or above (aOR 17.0, 95% CI 15.5–18.6). Adjusted on age, gender and CCIS, death was more frequent among inpatients with obesity (aOR 1.2, 95% CI 1.1–1.2) and diabetes (aOR 1.2, 95% CI 1.1–1.2). IMV was more frequently necessary for inpatients with obesity (aOR 1.9, 95% CI 1.8–2.0), diabetes (aOR 1.4, 95% CI 1.3–1.4) and hypertension (aOR 1.7, 95% CI 1.6–1.8). Comparatively, IMV was more often required for patients with the following incident co-morbidities: obesity (aOR 3.5, 95% CI 3.3–3.7), diabetes (aOR 2.0, 95% CI 1.8–2.1) and hypertension (aOR 2.5, 95% CI 2.4–2.6). Conclusions Among 134 209 inpatients with COVID-19, mortality was more frequent among patients with obesity and diabetes. IMV was more frequently necessary for inpatients with obesity, diabetes and hypertension. Patients for whom these were incident co-morbidities were particularly at risk. Specific medical monitoring and vaccination should be priorities for patients with these co-morbidities.
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Affiliation(s)
- Laurent Bailly
- Department of Public Health, University Hospital of Nice, Nice, France; Université Côte d'Azur, CHU Nice, Nice, France.
| | - Roxane Fabre
- Department of Public Health, University Hospital of Nice, Nice, France; CoBTeK Lab, Université Côte d'Azur, Nice, France
| | - Johan Courjon
- Université Côte d'Azur, Inserm, C3M, Nice, France; Department of Infectious Diseases, University Hospital of Nice, Nice, France
| | - Michel Carles
- Université Côte d'Azur, CHU Nice, Nice, France; Department of Infectious Diseases, University Hospital of Nice, Nice, France
| | - Jean Dellamonica
- Université Côte d'Azur, CHU Nice, Nice, France; Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Nice, France; UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Christian Pradier
- Department of Public Health, University Hospital of Nice, Nice, France; Université Côte d'Azur, CHU Nice, Nice, France
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21
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Vassallo M, Durant J, Fabre R, Ticchioni M, Lotte L, Sindt A, Puchois A, De Monte A, Cezar R, Corbeau P, Pradier C. Switching to a Dual-Drug Regimen in HIV-Infected Patients Could Be Associated With Macrophage Activation? Front Med (Lausanne) 2021; 8:712880. [PMID: 34458287 PMCID: PMC8387698 DOI: 10.3389/fmed.2021.712880] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the effect on immune activation of switching from a triple-drug to a dual-drug regimen in HIV-1 infected patients on successful combination antiretroviral treatment (cART). Immunadapt is a prospective study evaluating the impact of cART simplification on immune activation. Methods: We prospectively collected blood samples in HIV-1 infected patients on stable and successful cART switching from triple to dual regimens as a simplifying strategy. We compared immune activation markers: high sensitivity CRP, IL-1, IL-6, IL-8, IP-10, MCP-1, TNF-alpha, soluble CD14 (sCD14), soluble CD163 (sCD163), lipopolysaccharide binding protein, and D-dimer before cART change and at least 6 months after the switch. Patients were stratified according to low or high risk factors of immune activation (low CD4 nadir, previous AIDS-defining condition or very-low-level viremia during follow-up). Results: From April 2019 to May 2020, 20 subjects were included (mean age 57 years, 25 years since HIV infection, CD4 666 cells/mm3, CD8 766 cells/mm3, CD4/CD8 0.94, CD4 nadir 326 cells/mm3, 15% with AIDS, 18 years on cART, 6 cART regimens received, current cART duration: 56 months). Fourteen patients were prescribed Dolutegravir + Rilpivirine and six received Dolutegravir + Lamivudine. After 6.9 months, a significant sCD163 increase (+ 25.5% vs. + 0.5%, p = 0.02) was observed in subjects with high risk factors, despite maintaining a viral load <50 cp/ml. Conclusion: cART simplification in favor of dual therapy is associated with macrophage activation in patients at risk of immune activation despite sustained virological control. Risk factors should thus be considered before generalizing such strategies.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France.,Unité de Recherche Clinique Cote d'Azur (UR2CA), Centre Hospitalier Universitaire Pasteur 2, Nice, France
| | - Jacques Durant
- Infectious Diseases Department, Université Côte d'Azur, Nice, France
| | - Roxane Fabre
- Public Health Department, Nice University Hospital, Côte d'Azur University, Nice, France.,CoBTeK Lab, Nice University Hospital, Centre Memoire de Ressource et de Recherche, Côte d'Azur University, Nice, France
| | - Michel Ticchioni
- Laboratory of Immunology, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Laurene Lotte
- Multipurpose Laboratory, Cannes General Hospital, Cannes, France
| | - Audrey Sindt
- Multipurpose Laboratory, Cannes General Hospital, Cannes, France
| | - Annick Puchois
- Multipurpose Laboratory, Cannes General Hospital, Cannes, France
| | - Anne De Monte
- Laboratory of Virology, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Renaud Cezar
- Laboratory of Immunology, Nimes University Hospital, Nimes, France
| | - Pierre Corbeau
- Laboratory of Immunology, Nimes University Hospital, Nimes, France
| | - Christian Pradier
- Public Health Department, Nice University Hospital, Côte d'Azur University, Nice, France
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22
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Rios G, Lacoux C, Leclercq V, Diamant A, Lebrigand K, Lazuka A, Soyeux E, Lacroix S, Fassy J, Couesnon A, Thiery R, Mari B, Pradier C, Waldmann R, Barbry P. Monitoring SARS-CoV-2 variants alterations in Nice neighborhoods by wastewater nanopore sequencing. Lancet Reg Health Eur 2021; 10:100202. [PMID: 34423327 PMCID: PMC8372489 DOI: 10.1016/j.lanepe.2021.100202] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Wastewater surveillance was proposed as an epidemiological tool to define the prevalence and evolution of the SARS-CoV-2 epidemics. However, most implemented SARS-CoV-2 wastewater surveillance projects were based on qPCR measurement of virus titers and did not address the mutational spectrum of SARS-CoV-2 circulating in the population. Methods We have implemented a nanopore RNA sequencing monitoring system in the city of Nice (France, 550,000 inhabitants). Between October 2020 and March 2021, we monthly analyzed the SARS-CoV-2 variants in 113 wastewater samples collected in the main wastewater treatment plant and 20 neighborhoods. Findings We initially detected the lineages predominant in Europe at the end of 2020 (B.1.160, B.1.177, B.1.367, B.1.474, and B.1.221). In January, a localized emergence of a variant (Spike:A522S) of the B.1.1.7 lineage occurred in one neighborhood. It rapidly spread and became dominant all over the city. Other variants of concern (B.1.351, P.1) were also detected in some neighborhoods, but at low frequency. Comparison with individual clinical samples collected during the same week showed that wastewater sequencing correctly identified the same lineages as those found in COVID-19 patients. Interpretation Wastewater sequencing allowed to document the diversity of SARS-CoV-2 sequences within the different neighborhoods of the city of Nice. Our results illustrate how sequencing of sewage samples can be used to track pathogen sequence diversity in the current pandemics and in future infectious disease outbreaks. Translation For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Géraldine Rios
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Caroline Lacoux
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | | | - Anna Diamant
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Kévin Lebrigand
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Adèle Lazuka
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Emmanuel Soyeux
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Sébastien Lacroix
- Veolia, Scientific & Technological Expertise Department, Chemin de la Digue, F-78600 Maisons-Laffitte, France
| | - Julien Fassy
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Aurélie Couesnon
- ANSES, Sophia Antipolis Laboratory, F06902 Sophia Antipolis, France
| | - Richard Thiery
- ANSES, Sophia Antipolis Laboratory, F06902 Sophia Antipolis, France
| | - Bernard Mari
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Christian Pradier
- Université Côte d'Azur and Nice University Hospital, Public Health Department, F06560 Nice, France
| | - Rainer Waldmann
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
| | - Pascal Barbry
- Université Côte d'Azur and CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, F06560 Sophia Antipolis, France
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23
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Hayotte M, Iannelli A, Nègre V, Pradier C, Thérouanne P, Fuch A, Diagana O, Garbarino JM, Vuillemin A, Colson SS, Chevalier N, d'Arripe-Longueville F. Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial. BMJ Open 2021; 11:e046184. [PMID: 34330855 PMCID: PMC8327817 DOI: 10.1136/bmjopen-2020-046184] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined.The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators. METHODS AND ANALYSIS One hundred and twenty young women who have undergone bariatric surgery in the last 3-6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio's theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04478331.
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Affiliation(s)
- Meggy Hayotte
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Centre Spécialisé Obésité PACA Est, Centre Hospitalier Universitaire de Nice Pole Digestif Addictologie Reanimation chirurgicale Endocrinologie, Nice, France
| | - Véronique Nègre
- Centre Spécialisé Obésité PACA Est, Centre Hospitalier Universitaire de Nice Pole Digestif Addictologie Reanimation chirurgicale Endocrinologie, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Pierre Thérouanne
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales (LAPCOS), Université Côte d'Azur, Nice, France
| | - Alain Fuch
- Association Azur Sport Santé, Nice, France
| | | | - Jean-Marie Garbarino
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Anne Vuillemin
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Serge S Colson
- Laboratoire Motricité Humaine Expertise Sport Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Nicolas Chevalier
- Centre Spécialisé Obésité PACA Est, Centre Hospitalier Universitaire de Nice Pole Digestif Addictologie Reanimation chirurgicale Endocrinologie, Nice, France
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24
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Bentz L, Vandentorren S, Fabre R, Bride J, Pirard P, Doulet N, Baubet T, Motreff Y, Pradier C. Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study. BMC Public Health 2021; 21:1372. [PMID: 34246247 PMCID: PMC8272451 DOI: 10.1186/s12889-021-11438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources. METHOD An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis. RESULTS 804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support. CONCLUSION Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks. STUDY REGISTRATION Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51).
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Affiliation(s)
- Laurence Bentz
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
| | - Stéphanie Vandentorren
- Santé publique France, French national public health agency, Direction scientifique et internationale, F-94415 Saint-Maurice, France
- Université Bordeaux, INSERM UMR 1219, Vintage team, F-33000 Bordeaux, France
| | - Roxane Fabre
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
- Côte d’Azur University, CoBTeK lab, Nice University Hospital, CMRR, Nice, France
| | - Jeremy Bride
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
- Côte d’Azur University, Nice University Hospital, Policlinique, Medical and psychological emergency unit (CUMP 06), Nice, France
- Paris 13 Sorbonne University - Paris Cité, Laboratoire UTRPP (EA 4403), Villetaneuse, France
| | - Philippe Pirard
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, F-94415 Saint-Maurice, France
- Team MOODS, CESP, Inserm 1178, Paris-Saclay University, UVSQ, Villejuif, France
| | - Nadège Doulet
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
| | - Thierry Baubet
- Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
- UTRPP ER 4403, Sorbonne Paris Nord University, Villetaneuse, France
- Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Child and adolescent psychopathology, psychiatry and addiction, Bobigny, France
| | - Yvon Motreff
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, F-94415 Saint-Maurice, France
- Sorbonne Université, Inserm, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F-75012 Paris, France
| | - Christian Pradier
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
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25
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Pelchen-Matthews A, Borges ÁH, Reekie J, Rasmussen LD, Wiese L, Weber J, Pradier C, Degen O, Paredes R, Tau L, Flamholc L, Gottfredsson M, Kowalska J, Jablonowska E, Mozer-Lisewska I, Radoi R, Vasylyev M, Kuznetsova A, Begovac J, Svedhem V, Clark A, Cozzi-Lepri A. Prevalence and Outcomes for Heavily Treatment-Experienced Individuals Living With Human Immunodeficiency Virus in a European Cohort. J Acquir Immune Defic Syndr 2021; 87:806-817. [PMID: 33587506 DOI: 10.1097/qai.0000000000002635] [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: 07/15/2020] [Accepted: 12/01/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE. SETTING EuroSIDA, a European multicenter prospective cohort study. METHODS A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with 3 randomly selected controls who never became HTE. RESULTS Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI: 9.9% to 10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI: 1.66 to 1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/mL), many had low CD4 counts (≤350 cells/µL). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI: 0.86 to 2.40, P = 0.16) or non-AIDS clinical events (aIRR 0.96, CI: 0.74 to 1.25, P = 0.77). CONCLUSIONS HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals.
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Affiliation(s)
- Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Álvaro H Borges
- Department of Infectious Diseases Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Joanne Reekie
- Department of Infectious Diseases, Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Lothar Wiese
- Sjællands Universitetshospital, Roskilde, Denmark
| | | | | | - Olaf Degen
- University Clinic Hamburg Eppendorf, Hamburg, Germany
| | - Roger Paredes
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luba Tau
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Elzbieta Jablonowska
- Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland
| | | | - Roxana Radoi
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Marta Vasylyev
- HIV Unit, Lviv Regional Public Health Center, Lviv, Ukraine
| | | | - Josip Begovac
- University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia
| | - Veronica Svedhem
- Infectious Diseases Department, Karolinska University Hospital, Infectious Diseases Department, Stockholm, Sweden ; and
| | | | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
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Chammartin F, Lodi S, Logan R, Ryom L, Mocroft A, Kirk O, d'Arminio Monforte A, Reiss P, Phillips A, El-Sadr W, Hatleberg CI, Pradier C, Bonnet F, Law M, De Wit S, Sabin C, Lundgren JD, Bucher HC. Risk for Non-AIDS-Defining and AIDS-Defining Cancer of Early Versus Delayed Initiation of Antiretroviral Therapy : A Multinational Prospective Cohort Study. Ann Intern Med 2021; 174:768-776. [PMID: 33721519 DOI: 10.7326/m20-5226] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Immediate initiation of antiretroviral therapy (ART) regardless of CD4 cell count reduces risk for AIDS and non-AIDS-related events in asymptomatic, HIV-positive persons and is the standard of care. However, most HIV-positive persons initiate ART when their CD4 count decreases below 500 × 109 cells/L. Consequences of delayed ART on risk for non-AIDS-defining and AIDS-defining cancer, one of the most common reasons for death in HIV, are unclear. OBJECTIVE To estimate the long-term risk difference for cancer with the immediate ART strategy. DESIGN Multinational prospective cohort study. SETTING The D:A:D (Data collection on Adverse events of anti-HIV Drugs) study, which included HIV-positive persons from Europe, Australia, and the United States. PARTICIPANTS 8318 HIV-positive persons with at least 1 measurement each of CD4 cell count and viral load while ART-naive (study period, 2006 to 2016). MEASUREMENTS The parametric g-formula was used, with adjustment for baseline and time-dependent confounders (CD4 cell count and viral load), to assess the 10-year risk for non-AIDS-defining and AIDS-defining cancer of immediate versus deferred (at CD4 counts <350 and <500 × 109 cells/L) ART initiation strategies. RESULTS During 64 021 person-years of follow-up, 231 cases of non-AIDS-defining cancer and 272 of AIDS-defining cancer occurred among HIV-positive persons with a median age of 36 years (interquartile range, 29 to 43 years). With immediate ART, the 10-year risk for non-AIDS-defining cancer was 2.97% (95% CI, 2.37% to 3.50%) and that for AIDS-defining cancer was 2.50% (CI, 2.37% to 3.38%). Compared with immediate ART initiation, the 10-year absolute risk differences when deferring ART to CD4 counts less than 500 × 109 cells/L and less than 350 × 109 cells/L were 0.12 percentage point (CI, -0.01 to 0.26 percentage point) and 0.29 percentage point (CI, -0.03 to 0.73 percentage point), respectively, for non-AIDS-defining cancer and 0.32 percentage point (CI, 0.21 to 0.44 percentage point) and 1.00 percentage point (CI, 0.67 to 1.44 percentage points), respectively, for AIDS-defining cancer. LIMITATION Potential residual confounding due to observational study design. CONCLUSION In this young cohort, effects of immediate ART on 10-year risk for cancer were small, and further supportive data are needed for non-AIDS-defining cancer. PRIMARY FUNDING SOURCE Highly Active Antiretroviral Therapy Oversight Committee.
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Affiliation(s)
- Frédérique Chammartin
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
| | - Sara Lodi
- Boston University School of Public Health, Boston, Massachusetts (S.L.)
| | - Roger Logan
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.L.)
| | - Lene Ryom
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Amanda Mocroft
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Ole Kirk
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands (P.R.)
| | - Andrew Phillips
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Wafaa El-Sadr
- ICAP at Columbia University and Harlem Hospital, New York, New York (W.E.)
| | - Camilla I Hatleberg
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | | | - Fabrice Bonnet
- Hôpital Saint-André and Université de Bordeaux, Bordeaux, France (F.B.)
| | - Matthew Law
- University of New South Wales Sydney, Sydney, Australia (M.L.)
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium (S.D.)
| | - Caroline Sabin
- University College London, London, United Kingdom (A.M., A.P., C.S.)
| | - Jens D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (L.R., O.K., C.I.H., J.D.L.)
| | - Heiner C Bucher
- University Hospital Basel and University of Basel, Basel, Switzerland (F.C., H.C.B.)
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Petoumenos K, Kuwanda L, Ryom L, Mocroft A, Reiss P, De Wit S, Pradier C, Bonnet F, Phillips A, Hatleberg CI, d’Arminio Monforte A, Weber R, Sabin CA, Lundgren J, Law MG. Effect of Changes in Body Mass Index on the Risk of Cardiovascular Disease and Diabetes Mellitus in HIV-Positive Individuals: Results From the D:A:D Study. J Acquir Immune Defic Syndr 2021; 86:579-586. [PMID: 33351531 PMCID: PMC10581947 DOI: 10.1097/qai.0000000000002603] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Weight gain is common among people with HIV once antiretroviral treatment is commenced. We assess the effect of changes in body mass index (BMI), from different baseline BMI levels, on the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). METHODS D:A:D participants receiving antiretroviral treatment were followed from their first BMI measurement to the first of either CVD or DM event, or earliest of January 2, 2016 or 6 months after last follow-up. Participants were stratified according to their baseline BMI, and changes from baseline BMI were calculated for each participant. Poisson regression models were used to assess the effects of changes on BMI on CVD or DM events. RESULTS There were 2104 CVD and 1583 DM events over 365,287 and 354,898 person-years [rate: CVD 5.8/1000 (95% confidence interval: 5.5 to 6.0); DM 4.5/1000 (95% confidence interval: 4.2 to 4.7)]. Participants were largely men (74%), baseline mean age of 40 years, and median BMI of 23.0 (IQR: 21.0-25.3). A risk of CVD by change in BMI from baseline, stratified by baseline BMI strata showed little evidence of an increased risk of CVD with an increased BMI in any baseline BMI strata. An increase in BMI was associated with an increased risk of DM across all baseline BMI strata. CONCLUSIONS Although increases in BMI across all levels of baseline BMI were not associated with an increased risk of CVD, such changes were consistently associated with an increased risk of DM. There was also some evidence of an increased risk of CVD with a decrease in BMI.
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Affiliation(s)
| | | | - Lene Ryom
- Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Peter Reiss
- Amsterdam University Medical Centers (location AMC), Dept. of Global Health and Div. of Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands and HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Stephane De Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice Bonnet
- CHU de Bordeaux and Université de Bordeaux, Bordeaux Population Health Center, INSERM U1219, 33000 Bordeaux, France
| | - Andrew Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Camilla I Hatleberg
- Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen, Denmark
| | - Antonella d’Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Jens Lundgren
- Rigshospitalet, University of Copenhagen, CHIP, Department of Infectious Diseases, Section 2100, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen, Denmark
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney NSW Australia
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Vassallo M, Michelangeli C, Fabre R, Manni S, Genillier PL, Weiss N, Blanchouin E, Saudes L, Kaphan R, Puchois A, Pradier C, Montagne N. Procalcitonin and C-Reactive Protein/Procalcitonin Ratio as Markers of Infection in Patients With Solid Tumors. Front Med (Lausanne) 2021; 8:627967. [PMID: 33777975 PMCID: PMC7994271 DOI: 10.3389/fmed.2021.627967] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/18/2021] [Indexed: 01/09/2023] Open
Abstract
Objectives: The roles of procalcitonin (PCT) and C-reactive protein (CRP) in febrile cancer patients is currently unclear. Our aim was to assess these in febrile patients with solid tumors and to identify cut-off values for ruling out infection. Methods: We retrospectively evaluated patients with solid tumors admitted to hospital due to fever. They were divided into those with Fever with microbiologically documented infection (FMDI), Fever with clinically documented infection (FCDI) and Tumor-related fever (TRF). PCT and CRP levels were compared. Receiver-operating curves were plotted to define the best cut-off values for discriminating between infection-related and cancer-related fever. Results: Between January 2015 to November 2018, 131 patients were recorded (mean age 68 years, 67% male, 86% with metastasis). Patients with FMDI or FCDI had significantly higher baseline levels of PCT and lower CRP/PCT than those with TRF. A PCT cut-off value of 0.52 ng/mL for discriminating between infection and cancer-associated fever yielded 75% sensitivity, 55% specificity, 77% positive predictive value (PPV), and 52% negative predictive value (NPV). A CRP/PCT ratio with a cut-off value of 95 showed 56% sensitivity, 70% specificity, 79% NPV, and 44% PPV. Discussion: PCT is a sensitive marker of sepsis or localized infection in patients with solid tumors, but its specificity is poor. The CRP/PCT ratio improves specificity, thus providing a reliable means of ruling out infection for values above 95.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Celine Michelangeli
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Roxane Fabre
- Department of Public Health, L'Archet Hospital, University of Nice, Nice, France
| | - Sabrina Manni
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Pierre L Genillier
- Department of Medical Informatics, Cannes General Hospital, Cannes, France
| | - Nicolas Weiss
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Elea Blanchouin
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Laurence Saudes
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Regis Kaphan
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Annick Puchois
- Multipurpose Laboratory, Bacteriology and Virology Unit, Cannes General Hospital, Cannes, France
| | - Christian Pradier
- Department of Public Health, L'Archet Hospital, University of Nice, Nice, France
| | - Nathalie Montagne
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
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Boettiger DC, Newall AT, Phillips A, Bendavid E, Law MG, Ryom L, Reiss P, Mocroft A, Bonnet F, Weber R, El‐Sadr W, d’Arminio Monforte A, de Wit S, Pradier C, Hatleberg CI, Lundgren J, Sabin C, Kahn JG, Kazi DS. Cost-effectiveness of statins for primary prevention of atherosclerotic cardiovascular disease among people living with HIV in the United States. J Int AIDS Soc 2021; 24:e25690. [PMID: 33749164 PMCID: PMC7982504 DOI: 10.1002/jia2.25690] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Expanding statin use may help to alleviate the excess burden of atherosclerotic cardiovascular disease in people living with HIV (PLHIV). Pravastatin and pitavastatin are preferred agents due to their lack of substantial interaction with antiretroviral therapy. We aimed to evaluate the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of atherosclerotic cardiovascular disease among PLHIV in the United States. METHODS We developed a microsimulation model that randomly selected (with replacement) individuals from the Data-collection on Adverse Effects of Anti-HIV Drugs study with follow-up between 2013 and 2016. Our study population was PLHIV aged 40 to 75 years, stable on antiretroviral therapy, and not currently using lipid-lowering therapy. Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles and discounted at 3% per year. We assumed a willingness-to-pay threshold of $100,000/QALY gained. The interventions assessed were as follows: (1) treating no one with statins; (2) treating everyone with generic pravastatin 40 mg/day (drug cost $236/year) and (3) treating everyone with branded pitavastatin 4 mg/day (drug cost $2,828/year). The model simulated each individual's probability of experiencing atherosclerotic cardiovascular disease over 20 years. RESULTS Persons receiving pravastatin accrued 0.024 additional QALYs compared with those not receiving a statin, at an incremental cost of $1338, giving an incremental cost-effectiveness ratio of $56,000/QALY gained. Individuals receiving pitavastatin accumulated 0.013 additional QALYs compared with those using pravastatin, at an additional cost of $18,251, giving an incremental cost-effectiveness ratio of $1,444,000/QALY gained. These findings were most sensitive to the pill burden associated with daily statin administration, statin costs, statin efficacy and baseline atherosclerotic cardiovascular disease risk. In probabilistic sensitivity analysis, no statin was optimal in 5.2% of simulations, pravastatin was optimal in 94.8% of simulations and pitavastatin was never optimal. CONCLUSIONS Pravastatin was projected to be cost-effective compared with no statin. With substantial price reduction, pitavastatin may be cost-effective compared with pravastatin. These findings bode well for the expanded use of statins among PLHIV in the United States. To gain greater confidence in our conclusions it is important to generate strong, HIV-specific estimates on the efficacy of statins and the quality-of-life burden associated with taking an additional daily pill.
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Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
- Kirby InstituteUNSW SydneySydneyNSWAustralia
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonLondonUK
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - Lene Ryom
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Peter Reiss
- Amsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- HIV Monitoring FoundationAmsterdamThe Netherlands
| | - Amanda Mocroft
- Institute for Global HealthUniversity College LondonLondonUK
| | | | - Rainer Weber
- University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Wafaa El‐Sadr
- ICAP‐Columbia University and Harlem HospitalNew YorkNYUSA
| | | | - Stephane de Wit
- Saint Pierre University HospitalUniversité Libre de BruxellesBrusselsBelgium
| | | | | | - Jens Lundgren
- RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Caroline Sabin
- Institute for Global HealthUniversity College LondonLondonUK
| | - James G Kahn
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Dhruv S Kazi
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolHarvard UniversityBostonMAUSA
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30
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Durand M, Bentellis I, Barthe F, Tibi B, Shaikh A, Mellouki A, Berthet JP, Legueult K, Pradier C, Piche T, Ahallal Y, Chevallier D. [Outcomes following the triage of patients for urological cancer and non-cancer surgery during Covid-19 pandemic peak]. Prog Urol 2021; 31:716-724. [PMID: 34256992 PMCID: PMC7914008 DOI: 10.1016/j.purol.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
Introduction Lors de la première vague épidémique Covid-19, des mesures de triage, sans PCR systématique, étaient mises en place pour sélectionner les patients à opérer. Notre étude a comparé leurs résultats chirurgicaux après triage à ceux d’un groupe contrôle. Matériel L’analyse portait sur l’ensemble des patients initialement programmés dans un centre Covid de référence et inclus consécutivement, du 15 mars au 1er mai 2020 (NCT04352699). Leurs données étaient recueillies prospectivement et ultérieurement comparées à celles des patients opérés 1 an auparavant sur la même période dans ce centre. Le critère d’évaluation principal était l’admission post-opératoire en unité de soins intensifs (USI). La morbidité, la mortalité postopératoire, le report d’interventions, les tests PCR étaient évalués. Des analyses de sous-groupes étaient réalisés pour les patients opérés de cancer. Résultats Après triage, 96 des 142 interventions programmées ont dû être reportées. Sur les opérés, 48 (68 %) l’étaient pour cancer. Au total, aucun cas de pneumonie Covid-19 post-opératoire n’a été identifié. Trois patients (4 %) ont été admis en USI, dont un finalement décédé pour sepsis urinaire. Chez ces patients, les RT-PCR étaient négatives. Globalement, comparativement au groupe contrôle, aucune différence d’admission en USI, ni de taux de mortalité post-opératoire n’ont été rapportées. Conclusions Le triage de la première vague n’a pas surexposé les patients sélectionnés à un risque de complication ou de décès post-opératoire, particulièrement pas pour ceux opérés pour cancer. En revanche, 67 % des patients ont été reportés, avec un risque associé à des retard de soins pouvant conduire au décès. Niveau de preuve 3.
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Affiliation(s)
- M Durand
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France; Inserm U1081 - CNRS UMR 7284, université de Nice Côte d'Azur, France.
| | - I Bentellis
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - F Barthe
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - B Tibi
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - A Shaikh
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - A Mellouki
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - J-P Berthet
- Service de Chirurgie Thoracique, Hôpital Pasteur, CHU de Nice, Nice, France
| | - K Legueult
- Service de santé publique, hôpital de L'Archet, université de Nice, Nice, France
| | - C Pradier
- Service de santé publique, hôpital de L'Archet, université de Nice, Nice, France
| | - T Piche
- Université Nice Côte d'Azur, CHU Nice, Inserm, U1065, C3M, France
| | - Y Ahallal
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
| | - D Chevallier
- Service d'urologie, andrologie, transplantation rénale, hôpital Pasteur 2, France
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Bailly L, Fabre R, Pradier C, Iannelli A. Colorectal Cancer Risk Following Bariatric Surgery in a Nationwide Study of French Individuals With Obesity. JAMA Surg 2021; 155:395-402. [PMID: 32159744 DOI: 10.1001/jamasurg.2020.0089] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Although bariatric surgery is effective against morbid obesity, the association of this surgery with the risk of colorectal cancer remains controversial. Objective To assess whether bariatric surgery is associated with altered risk of colorectal cancer among individuals with obesity. Design, Setting, and Participants This retrospective, population-based, multicenter, cohort study based on French electronic health data included 1 045 348 individuals with obesity, aged 50 to 75 years, and free of colorectal cancer at baseline. All inpatients with obesity having data recorded during a hospital stay between 2009 and 2018 by the French national health insurance information system database were followed up for a mean (SD) of 5.3 (2.1) years for those who did not undergo bariatric surgery and 5.7 (2.2) years for those who underwent bariatric surgery. Two groups of patients comparable in terms of age, sex, body mass index, follow-up, comorbidities, and conditions who did or did not undergo surgery were also obtained by propensity score matching. Exposures Bariatric surgery (n = 74 131), including adjustable gastric banding, sleeve gastrectomy, gastric bypass; or no bariatric surgery (n = 971 217). Main Outcomes and Measures Primary outcome was incident colorectal cancer. Standardized incidence ratios were calculated using age-, sex-, and calendar year-matched colorectal cancer incidence among the general French population during the corresponding years. Secondary outcome was incident colorectal benign polyps. Results Among a total of 1 045 348 patients, the mean (SD) age was 57.3 (5.5) years for the 74 131 patients in the surgical cohort vs 63.4 (7.0) years for the 971 217 patients in the nonsurgical cohort. The mean (SD) follow-up was 6.2 (2.1) years for patients who underwent adjustable gastric banding, 5.5 (2.1) years for patients who underwent sleeve gastrectomy, and 5.7 (2.2) years for patients who underwent gastric bypass. In total, 13 052 incident colorectal cancers (1.2%) and 63 649 colorectal benign polyps were diagnosed. The rate of colorectal cancer was 0.6% in the bariatric surgery cohort and 1.3% in the cohort without bariatric surgery. In the latter cohort, 9417 cases were expected vs 12 629 observed, a standardized incidence ratio of 1.34 (95% CI, 1.32-1.36). In the bariatric surgery cohort, 428 cases were expected and 423 observed, a standardized incidence ratio of 1.0 (95% CI, 0.90-1.09). Propensity score-matched hazard ratios in comparable operated vs nonoperated groups were 0.68 (95% CI, 0.60-0.77) for colorectal cancer and 0.56 (95% CI, 0.53-0.59) for colorectal benign polyp. There were fewer new diagnoses of colorectal cancer after gastric bypass (123 of 22 343 [0.5%]) and sleeve gastrectomy (185 of 35 328 [0.5%]) than after adjustable gastric banding (115 of 16 460 [0.7%]), and more colorectal benign polyps after adjustable gastric banding (775 of 15 647 [5.0%]) than after gastric bypass (639 of 20 863 [3.1%]) or sleeve gastrectomy (1005 of 32 680 [3.1%]). Conclusion and Relevance The results of this nationwide cohort study suggested that following bariatric surgery, patients with obesity share the same risk of colorectal cancer as the general population, whereas for patients with obesity who do not undergo bariatric surgery, the risk is 34% above that of the general population.
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Affiliation(s)
- Laurent Bailly
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,EA Cobtek, Université Côte d'Azur, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity," Université Côte d'Azur, Nice, France
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32
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Favre G, Legueult K, Pradier C, Raffaelli C, Ichai C, Iannelli A, Redheuil A, Lucidarme O, Esnault V. Visceral fat is associated to the severity of COVID-19. Metabolism 2021; 115:154440. [PMID: 33246009 PMCID: PMC7685947 DOI: 10.1016/j.metabol.2020.154440] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Excess visceral fat (VF) or high body mass index (BMI) is risk factors for severe COVID-19. The receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is expressed at higher levels in the VF than in the subcutaneous fat (SCF) of obese patients. AIM To show that visceral fat accumulation better predicts severity of COVID-19 outcome compared to either SCF amounts or BMI. METHODS We selected patients with symptomatic COVID-19 and a computed tomography (CT) scan. Severe COVID-19 was defined as requirement for mechanical ventilation or death. Fat depots were quantified on abdominal CT scan slices and the measurements were correlated with the clinical outcomes. ACE 2 mRNA levels were quantified in fat depots of a separate group of non-COVID-19 subjects using RT-qPCR. RESULTS Among 165 patients with a mean BMI of 26.1 ± 5.4 kg/m2, VF was associated with severe COVID-19 (p = 0.022) and SCF was not (p = 0.640). Subcutaneous fat was not different in patients with mild or severe COVID-19 and the SCF/VF ratio was lower in patients with severe COVID-19 (p = 0.010). The best predictive value for severe COVID-19 was found for a VF area ≥128.5 cm2 (ROC curve), which was independently associated with COVID-19 severity (p < 0.001). In an exploratory analysis, ACE 2 mRNA positively correlated with BMI in VF but not in SCF of non-COVID-19 patients (r2 = 0.27 vs 0.0008). CONCLUSION Severe forms of COVID-19 are associated with high visceral adiposity in European adults. On the basis of an exploratory analysis ACE 2 in the visceral fat may be a trigger for the cytokine storm, and this needs to be clarified by future studies.
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Affiliation(s)
- Guillaume Favre
- University of Côte d'Azur, CNRS-UMR 7073 (LP2M), Department of Nephrology-Dialysis-Transplantation, Pasteur University Hospital, F-06002 CD1 Nice, France.
| | - Kevin Legueult
- University of Côte d'Azur, Department of Public Health, Archet University Hospital, F-06202 Nice, France
| | - Christian Pradier
- University of Côte d'Azur, Department of Public Health, Archet University Hospital, F-06202 Nice, France
| | - Charles Raffaelli
- Radiology Department, Pasteur University Hospital, F-06002 Nice, France
| | - Carole Ichai
- University of Côte d'Azur, Intensive Care Unit, Pasteur University Hospital, Nice F-06002, France
| | - Antonio Iannelli
- University of Côte d'Azur, INSERM-U1065, Digestive Surgery and Liver Transplantation Unit, Archet University Hospital, F-06202 Nice, France
| | - Alban Redheuil
- Sorbonne University, Pitié-Salpêtrière Hospital (AP-HP), ICT Cardiothoracic Imaging Unit & Radiology Department, LIB Biomedical Imaging Laboratory INSERM, CNRS, ICAN Institute of Cardiometabolism and Nutrition, Paris, France
| | - Olivier Lucidarme
- Sorbonne University, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, APHP, Pitié-Salpêtrière Hospital, F-750013 Paris, France
| | - Vincent Esnault
- University of Côte d'Azur, CNRS-UMR 7073 (LP2M), Department of Nephrology-Dialysis-Transplantation, Pasteur University Hospital, F-06002 CD1 Nice, France
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Mocroft A, Lundgren J, Gerstoft J, Rasmussen LD, Bhagani S, Aho I, Pradier C, Bogner JR, Mussini C, Uberti Foppa C, Maltez F, Laguno M, Wandeler G, Falconer K, Trofimova T, Borodulina E, Jevtovic D, Bakowska E, Kase K, Kyselyova G, Haubrich R, Rockstroh JK, Peters L. Clinical Outcomes in Persons Coinfected With Human Immunodeficiency Virus and Hepatitis C Virus: Impact of Hepatitis C Virus Treatment. Clin Infect Dis 2021; 70:2131-2140. [PMID: 31504296 DOI: 10.1093/cid/ciz601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/14/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A hepatitis C (HCV) cure is associated with changes in lipids and inflammatory biomarkers, but its impact on clinical endpoints among treated human immunodeficiency virus (HIV)/HCV coinfected persons is unclear. METHODS People living with HIV from EuroSIDA with a known HCV status after January 2001 were classified into strata based on time-updated HCV RNA measurements and HCV treatment, as either HCV antibody-negative; spontaneously resolved HCV; chronic, untreated HCV; cured HCV (HCV RNA-negative); or HCV treatment failures (HCV RNA-positive). Poisson regression was used to compare incidence rates between HCV groups for end-stage liver disease (ESLD; including hepatocellular carcinoma [HCC]), non-acquired immunodeficiency virus defining malignancy (NADM; excluding HCC), and cardiovascular disease (CVD). RESULTS There were 16 618 persons included (median follow-up 8.3 years, interquartile range 3.1-13.7). There were 887 CVD, 902 NADM, and 436 ESLD events; crude incidence rates/1000 person-years follow-up were 6.4 (95% confidence interval [CI] 6.0-6.9) for CVD, 6.5 (95% CI 6.1-6.9) for NADM, and 3.1 (95% CI 2.8-3.4) for ESLD. After adjustment, there were no differences in incidence rates of NADM or CVD across the 5 groups. HCV-negative individuals (adjusted incidence rate ratio [aIRR] 0.22, 95% CI 0.14-0.34) and those with spontaneous clearance (aIRR 0.61, 95% CI 0.36-1.02) had reduced rates of ESLD compared to cured individuals. Persons with chronic, untreated HCV infections (aIRR 1.47, 95% CI 1.02-2.13) or treatment failure (aIRR 1.80, 95% CI 1.22-2.66) had significantly raised rates of ESLD, compared to those who were cured. CONCLUSIONS Incidences of NADM or CVD were independent of HCV group, whereas those cured had substantially lower incidences of ESLD, underlining the importance of successful HCV treatment for reducing ESLD.
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Affiliation(s)
- Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, and Department of Infectious Diseases, Copenhagen
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen
| | - Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Denmark
| | - Sanjay Bhagani
- Department of Infectious Diseases, Royal Free Hospital, London, United Kingdom
| | - Inka Aho
- Division of Infectious Diseases, Helsinki University Hospital, Finland
| | - Christian Pradier
- Department of Public Health, Centre Hospitalier Universitaire de Nice, France
| | - Johannes R Bogner
- Division of Infectious Diseases, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University of Munich, Germany
| | - Christina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Milan, Italy
| | - Caterina Uberti Foppa
- Vita-Salute San Raffaele University, San Raffaele Scientific Institue, Clinic of Infectious Diseases, Milan, Italy
| | - Fernando Maltez
- Hospital de Curry Cabral, Serviço de Doenças Infecciosas, Lisbon, Portugal
| | - Montse Laguno
- Infectious Diseases Service, Hospital Clinic-L'Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Karolin Falconer
- Infectious Diseases Department, Karolinska University Hospital, Stockholm, Sweden
| | - Tatyana Trofimova
- Novgorod Centre for Acquired Immunodeficiency Syndrome Prevention and Control, Novgorod the Great, Russia
| | | | - Djordje Jevtovic
- Belgrade University School of Medicine, Infectious & Tropical Diseases Hospital, Serbia
| | | | - Kerstin Kase
- Centre of Infectious Diseases, West-Tallin Central Hospital, Tallin, Estonia
| | - Galina Kyselyova
- Crimean Republican Acquired Immunodeficiency Syndrome Centre, Simferopol
| | | | | | - Lars Peters
- Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, Copenhagen, and Department of Infectious Diseases, Copenhagen
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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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Neesgaard B, Mocroft A, Zangerle R, Wit F, Lampe F, Günthard HF, Necsoi C, Law M, Mussini C, Castagna A, Monforte AD, Pradier C, Chkhartisvilli N, Reyes-Uruena J, Vehreschild JJ, Wasmuth JC, Sönnerborg A, Stephan C, Greenberg L, Llibre JM, Volny-Anne A, Peters L, Pelchen-Matthews A, Vannappagari V, Gallant J, Rieger A, Youle M, Braun D, De Wit S, Petoumenos K, Borghi V, Spagnuolo V, Tsertsvadze T, Lundgren J, Ryom L. Virologic and immunologic outcomes of treatment with integrase inhibitors in a real-world setting: The RESPOND cohort consortium. PLoS One 2020; 15:e0243625. [PMID: 33382756 PMCID: PMC7774984 DOI: 10.1371/journal.pone.0243625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare virologic and immunologic outcomes of integrase inhibitor (INSTI)-containing, contemporary boosted protease inhibitor (PI/b)-containing and non-nucleotide reverse transcriptase inhibitor (NNRTI)-containing regimens in a real-life setting. Methods Using logistic regression, virologic and immunologic outcomes of INSTI use were compared to outcomes of PI/b or NNRTI treatment 12 months after treatment start or switch, for participants in the RESPOND cohort consortium. A composite treatment outcome (cTO) was used, defining success as viral load (VL) <200 copies/mL and failure as at least one of: VL ≥200 copies/mL, unknown VL in the time window, any changes of antiretroviral therapy (ART) regimen, AIDS, or death. In addition, on-treatment analysis including only individuals with known VL and no regimen changes was performed. Favorable immunologic response was defined as a 25% increase in CD4 count or as reaching ≥750 CD4 cells/μL. Results Between January 2012 and January 2019, 13,703 (33.0% ART-naïve) individuals were included, of whom 7,147 started/switched to a regimen with an INSTI, 3,102 to a PI/b and 3,454 to an NNRTI-containing regimen. The main reason for cTO failure in all treatment groups were changes in ART regimen. Compared to INSTIs, the adjusted odds ratio (aOR) of cTO success was significantly lower for PI/b (0.74 [95% confidence interval, CI 0.67–0.82], p <0.001), but similar for NNRTIs (1.07 [CI 0.97–1.17], p = 0.11). On-treatment analysis and sensitivity analyses using a VL cut-off of 50 copies/mL were consistent. Compared to INSTIs, the aORs of a 25% increase in CD4 count were lower for NNRTIs (0.80 [CI 0.71–0.91], p<0.001) and PI/b (0.87 [CI 0.76–0.99], p = 0.04). Conclusion In this large analysis of a real-world population, cTO and on-treatment success were similar between INSTIs and NNRTIs, but lower for PI/b, though residual confounding cannot be fully excluded. Obtaining favorable immunologic outcomes were more likely for INSTIs than the other drug classes.
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Affiliation(s)
- Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Robert Zangerle
- Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), Stichting HIV Monitoring (SHM), Amsterdam, Netherlands
| | - Fiona Lampe
- Royal Free Hospital, University College London, London, United Kingdom
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Coca Necsoi
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Antonella Castagna
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | | | - Christian Pradier
- Nice HIV Cohort, Université Côte d’Azur et Centre Hospitalier Universitaire, Nice, France
| | | | - Juliana Reyes-Uruena
- PISCIS Cohort, Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), CIBERESP, Badalona, Spain
| | - Jörg Janne Vehreschild
- Medical Department 2, Hematology/Oncology, University Hospital of Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Anders Sönnerborg
- Swedish InfCare HIV Cohort, Karolinska University Hospital, Stockholm, Sweden
| | - Christoph Stephan
- Infectious Diseases Unit, Medical Dept. no.2, Frankfurt University Hospital, Goethe-University, Frankfurt, Germany
| | - Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Josep M. Llibre
- Infectious Diseases and Fight AIDS Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Vani Vannappagari
- ViiV Healthcare, Research Triangle, North Carolina, United States of America
| | - Joel Gallant
- Gilead Sciences, Foster City, California, United States of America
| | - Armin Rieger
- Wiener Medizinische Universität, Vienna, Austria
| | - Mike Youle
- Royal Free Hospital, University College London, London, United Kingdom
| | - Dominique Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Stephane De Wit
- CHU Saint-Pierre, Centre de Recherche en Maladies Infectieuses a.s.b.l., Brussels, Belgium
| | - Kathy Petoumenos
- The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia
| | - Vanni Borghi
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Vincenzo Spagnuolo
- San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milano, Italy
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Greenberg L, Ryom L, Neesgaard B, Wandeler G, Staub T, Gisinger M, Skoll M, Günthard HF, Scherrer A, Mussini C, Smith C, Johnson M, De Wit S, Necsoi C, Pradier C, Wit F, Lehmann C, d'Arminio Monforte A, Miró JM, Castagna A, Spagnuolo V, Sönnerborg A, Law M, Hutchinson J, Chkhartishvili N, Bolokadze N, Wasmuth JC, Stephan C, Vannappagari V, Rogatto F, Llibre JM, Duvivier C, Hoy J, Bloch M, Bucher HC, Calmy A, Volny Anne A, Pelchen-Matthews A, Lundgren JD, Peters L, Bansi-Matharu L, Mocroft A. Clinical outcomes of two-drug regimens vs. three-drug regimens in antiretroviral treatment-experienced people living with HIV. Clin Infect Dis 2020; 73:e2323-e2333. [PMID: 33354721 DOI: 10.1093/cid/ciaa1878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Limited data exist comparing clinical outcomes of two-drug regimens (2DRs) and three-drug regimens (3DRs) in people living with HIV. METHODS Antiretroviral treatment-experienced individuals in RESPOND switching to a new 2DR or 3DR from 1/1/12-1/10/18 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. RESULTS Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median 52.6 years [interquartile range 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%).There were 619 events during 27,159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU [95% CI 20.7-24.5]) on 3DRs, 79 (30.9/1000 PYFU [24.8-38.5]) on 2DRs. The most common events were death (7.5/1000 PYFU [95% CI 6.5-8.6]) and non-AIDS cancer (5.8/1000 PYFU [4.9-6.8]). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio: 0.92 [0.72-1.19]; p=0.53). CONCLUSIONS This is the first large, international cohort assessing clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes; further research on resistance barriers and long-term durability of 2DRs is needed.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Therese Staub
- Infectious Diseases, CHL (Centre Hospitalier Luxembourg), Luxembourg
| | | | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Scherrer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Margaret Johnson
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), Stichting HIV Monitoring (SHM), Amsterdam, Netherlands
| | | | | | - Jose M Miró
- Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | | | | | - Anders Sönnerborg
- Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Sweden
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Jolie Hutchinson
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Natalia Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Christoph Stephan
- Medical Department no. 2, Infectious Diseases Unit, Goethe-University Hospital Frankfurt, Frankfurt a.M., Germany
| | | | | | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol · Department of Internal Medicine, HIV Unit, Barcelona, Spain
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark Bloch
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Heiner C Bucher
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit in Geneva University Hospital, Geneva, Switzerland
| | | | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
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Roux CH, Brocq O, Gerald F, Pradier C, Bailly L. Clinical impact of COVID-19 on a French population of spondyloarthritis patients. Clin Rheumatol 2020; 39:3185-3187. [PMID: 32970219 PMCID: PMC7511671 DOI: 10.1007/s10067-020-05413-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
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Roux CH, Brocq O, Gerald F, Pradier C, Bailly L. Impact of Home Confinement During the COVID-19 Pandemic on Medication Use and Disease Activity in Spondyloarthritis Patients. Arthritis Rheumatol 2020; 72:1771-1772. [PMID: 32779880 PMCID: PMC7323330 DOI: 10.1002/art.41397] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- C H Roux
- University Hospital Centre Nice and Cote d'Azur University, Nice, France
| | - O Brocq
- Princess Grace Hospital, Monaco
| | - F Gerald
- University Hospital Centre Nice and Cote d'Azur University, Nice, France
| | - C Pradier
- University Hospital Centre Nice and Cote d'Azur University, Nice, France
| | - L Bailly
- University Hospital Centre Nice and Cote d'Azur University, Nice, France
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Mariné Barjoan E, Doulet N, Chaarana A, Festraëts J, Viot A, Ambrosetti D, Lasalle JL, Mounier N, Bailly L, Pradier C. Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005 and 2014. Environ Res 2020; 188:109681. [PMID: 32562946 DOI: 10.1016/j.envres.2020.109681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Few studies on cancer incidence have been conducted since the adoption of the EU 2000/76/EC waste incineration directive which aimed to limit dioxin emission levels to less than 0.1 ng TEQ/m3 before December 31, 2005. OBJECTIVE To measure cancer incidence among the population exposed to atmospheric emissions from the waste incineration plant near the town of Nice (South-Eastern France), compared to the unexposed population of the Alpes-Maritimes department (A-M). METHODS All primary invasive cancers and haematological malignancies diagnosed among AM residents between 2005 and 2014 were recorded. The exposed surface was modeled on an average dioxin deposition model ≥4.25 ng/m2/year. Each case was geolocated and assigned to one of 36 predefined geographic units of exposed area, or one of 462 units in the unexposed area. The adjusted incidence rate, the standardized incidence ratio and the Comparative Morbidity Figure were calculated for two periods: 2005-2009/2010-2014. RESULTS We recorded 80,865 new cancers in the A-M population. Between 2005 and 2009, we observed a higher incidence among exposed women of acute myeloid leukaemia, myelodysplastic syndromes and myeloma and, among exposed men, of soft tissue sarcomas, myeloma and lung cancer. Between 2010 and 2014, there was no excess incidence among women, while among men incidence of myeloma and lung cancer remained higher. CONCLUSION Only among men, the incidence of myeloma and lung cancer remained higher in the exposed area during the second period. The EU directive resulting in the limitation of atmospheric emissions from incinerators could explain the decrease in incidence of cancers with protracted latency. Consideration of other risk factors and further data collection will be necessary to validate this hypothesis.
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Affiliation(s)
- Eugènia Mariné Barjoan
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France.
| | - Nadège Doulet
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
| | - Amel Chaarana
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
| | - Julie Festraëts
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
| | - Agnès Viot
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
| | - Damien Ambrosetti
- Université Côte d'Azur, Anatomo-Pathology Laboratory, Centre Hospitalier Universitaire de Nice, France; Centre de Regroupement Informatique et Statistique en Anatomie et Cytologie Pathologique (CRISAP PACA), France
| | - Jean-Luc Lasalle
- Santé Publique France, Regional Office Provence-Alpes-Côte d'Azur and Corsica, France
| | - Nicolas Mounier
- Université Côte d'Azur, Clinical Hematology Department, Centre Hospitalier Universitaire de Nice, France
| | - Laurent Bailly
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
| | - Christian Pradier
- Université Côte d'Azur, Public Health Department, Centre Hospitalier Universitaire de Nice, France
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Mocroft A, Neesgard B, Zangerle R, Rieger A, Castagna A, Spagnuolo V, Antinori A, Lampe FC, Youle M, Vehreschild JJ, Mussini C, Borghi V, Begovac J, Duvivier C, Gunthard HF, Rauch A, Tiraboschi J, Chkhartishvili N, Bolokadze N, Wit F, Wasmuth JC, De Wit S, Necsoi C, Pradier C, Svedhem V, Stephan C, Petoumenos K, Garges H, Rogatto F, Peters L, Ryom L. Treatment outcomes of integrase inhibitors, boosted protease inhibitors and nonnucleoside reverse transcriptase inhibitors in antiretroviral-naïve persons starting treatment. HIV Med 2020; 21:599-606. [PMID: 32588958 DOI: 10.1111/hiv.12888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although outcomes of antiretroviral therapy (ART) have been evaluated in randomized controlled trials, experiences from subpopulations defined by age, CD4 count or viral load (VL) in heterogeneous real-world settings are limited. METHODS The study design was an international multicohort collaboration. Logistic regression was used to compare virological and immunological outcomes at 12 ± 3 months after starting ART with an integrase strand transfer inhibitor (INSTI), contemporary nonnucleoside reverse transcriptase inhibitor (NNRTI) or boosted protease inhibitor (PI/b) with two nucleos(t)ides after 1 January 2012. The composite treatment outcome (cTO) defined success as VL < 200 HIV-1 RNA copies/mL with no regimen change and no AIDS/death events. Immunological success was defined as a CD4 count > 750 cells/μL or a 33% increase where the baseline CD4 count was ≥ 500 cells/μL. Poisson regression compared clinical failures (AIDS/death ≥ 14 days after starting ART). Interactions between ART class and age, CD4 count, and VL were determined for each endpoint. RESULTS Of 5198 ART-naïve persons in the International Cohort Consortium of Infectious Diseases (RESPOND), 45.4% started INSTIs, 26.0% PI/b and 28.7% NNRTIs; 880 (17.4%) were aged > 50 years, 2539 (49.4%) had CD4 counts < 350 cells/μL and 1891 (36.8%) had VL > 100 000 copies/mL. Differences in virological and immunological success and clinical failure among ART classes were similar across age groups (≤ 40, 40-50 and > 50 years), CD4 count categories (≤ 350 vs. > 350 cells/μL) and VL categories at ART initiation (≤ 100 000 vs. > 100 000 copies/mL), with all investigated interactions being nonsignificant (P > 0.05). CONCLUSIONS Differences among ART classes in virological, immunological and clinical outcomes in ART-naïve participants were consistent irrespective of age, immune suppression or VL at ART initiation. While confounding by indication cannot be excluded, this provides reassuring evidence that such subpopulations will equally benefit from contemporary ART.
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Affiliation(s)
- A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - B Neesgard
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Zangerle
- Medical University of Innsbruck, Innsbruch, Austria
| | - A Rieger
- Medical University of Vienna, Vienna, Austria
| | - A Castagna
- Vita-Salute San Raffaele University, Milano, Italy
| | - V Spagnuolo
- Vita-Salute San Raffaele University, Milano, Italy
| | - A Antinori
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - F C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - M Youle
- Royal Free Hospital, London, UK
| | | | | | - V Borghi
- University of Modena, Modena, Italy
| | - J Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - C Duvivier
- Necker University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - H F Gunthard
- University of Zurich, Zurich, Switzerland.,University Hospital of Zurich, Zurich, Switzerland
| | - A Rauch
- University Hospital Berne, Bern, Switzerland
| | - J Tiraboschi
- PISCIS Cohort Study, Bellvitge Hospital, Barcelona, Spain
| | | | - N Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - F Wit
- Stichting HIV Monitoring (SHM), Amsterdam, the Netherlands
| | | | - S De Wit
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Necsoi
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Pradier
- Côte d'Azur University and University Hospital Center, Nice, France
| | - V Svedhem
- Karolinska University Hospital, Stockholm, Sweden
| | - C Stephan
- Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | | | | | - F Rogatto
- Gilead Sciences, Foster City, CA, USA
| | - L Peters
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Ryom
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Shepherd L, Ryom L, Law M, Petoumenos K, Hatleberg CI, d'Arminio Monforte A, Sabin C, Bower M, Bonnet F, Reiss P, de Wit S, Pradier C, Weber R, El-Sadr W, Lundgren J, Mocroft A. Cessation of Cigarette Smoking and the Impact on Cancer Incidence in Human Immunodeficiency Virus-infected Persons: The Data Collection on Adverse Events of Anti-HIV Drugs Study. Clin Infect Dis 2020; 68:650-657. [PMID: 29912335 DOI: 10.1093/cid/ciy508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Cancers are a major source of morbidity and mortality for human immunodeficiency virus (HIV)-infected persons, but the clinical benefits of smoking cessation are unknown. Methods Participants were followed from 1 January 2004 until first cancer diagnosis, death, or 1 February 2016. Smoking status was defined as ex-smoker, current smoker, and never smoker. Adjusted incidence rate ratios (aIRRs) were calculated using Poisson regression, adjusting for demographic and clinical factors. Results In total 35442 persons from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study contributed 309803 person-years of follow-up. At baseline, 49% were current smokers, 21% were ex-smokers, and 30% had never smoked. Incidence of all cancers combined (n = 2183) was highest <1 year after smoking cessation compared to never smokers (aIRR, 1.66 [95% confidence interval {CI}, 1.37-2.02]) and not significantly different from never smokers 1-1.9 years after cessation. Lung cancer incidence (n = 271) was elevated <1 year after cessation (aIRR, 19.08 [95% CI, 8.10-44.95]) and remained 8-fold higher 5 years after smoking cessation (aIRR, 8.69 [95% CI, 3.40-22.18]). Incidence of other smoking-related cancers (n = 622) was elevated in the first year after cessation (aIRR, 2.06 [95% CI, 1.42-2.99]) and declined to a level similar to nonsmokers thereafter. Conclusions Lung cancer incidence in HIV-infected individuals remained elevated >5 years after smoking cessation. Deterring uptake of smoking and smoking cessation efforts should be prioritised to reduce future cancer risk.
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Affiliation(s)
- Leah Shepherd
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
| | - Lene Ryom
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Camilla Ingrid Hatleberg
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Caroline Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire de Bordeaux and Institut National de la Santé et de la Recherche Médicale, Université de Bordeaux, France
| | - Peter Reiss
- Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam.,HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Stephane de Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Wafaa El-Sadr
- ICAP-Columbia University and Harlem Hospital, New York, New York
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section, Rigshospitalet, University of Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, United Kingdom
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Joly H, Vassallo M, Issaurat M, Fabre R, Pradier C, Lebrun-Frenay C. Validation of a rapid and easy-to-perform screening test for neurocognitive impairment in HIV+ patients. J Neurol Sci 2019; 410:116664. [PMID: 31911282 DOI: 10.1016/j.jns.2019.116664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/04/2019] [Revised: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Information Processing Speed (IPS) is one of the earliest cognitive domains impaired in both multiple sclerosis (MS) and HIV-infected patients. Our aim was to study whether the Computerized Speed Cognitive Test (CSCT), an ultra-rapid tool which detects IPS impairment and is already used in MS subjects, could also be useful to screen for HIV-associated neurocognitive disorders (HAND). METHODS The Neuracog study was an open-label prospective trial conducted in Nice and Cannes hospitals. Each patient performed a wide range of neuropsychological (NP) tests. Patients were defined as no-HAND or HAND. Groups were compared to measure sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CSCT for detecting HAND. RESULTS Eighty-six subjects were included (26 women, 60 men, mean age: 53.1 years). HAND was diagnosed in 67/86 patients. The CSCT z-score showed a highly significant difference between the no-HAND and the HAND groups (No HAND mean: -0.1, SD: 1.0 versus HAND mean: -1.1, SD: 1.6; p = .002). The sensitivity, specificity, PPV and NPV were 81%, 53%, 86% and 43%, respectively. CONCLUSIONS The CSCT is an easy-to-perform test allowing detection of mild forms of HAND, to be considered among screening tools for neurocognitive impairment.
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Affiliation(s)
- Heloise Joly
- Centre de Ressources et de Compétences sclérose en plaques (CRCSEP), Department of Neurology, Pasteur 2 Hospital, Côte d'Azur University of Nice, France
| | - Matteo Vassallo
- Service de Medicine Interne, Centre hospitalier de Cannes, Cannes, France.
| | - Margaux Issaurat
- Centre de Ressources et de Compétences sclérose en plaques (CRCSEP), Department of Neurology, Pasteur 2 Hospital, Côte d'Azur University of Nice, France
| | - Roxane Fabre
- Université Côte d'Azur, CoBTeK lab, Centre Hospitalier Universitaire de Nice, Department de Santé Publique, Nice, France
| | - Christian Pradier
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Département de Santé Publique, Nice, France
| | - Christine Lebrun-Frenay
- Centre de Ressources et de Compétences sclérose en plaques (CRCSEP), Department of Neurology, Pasteur 2 Hospital, Côte d'Azur University of Nice, France
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Mariné Barjoan E, Doulet N, Chaarana A, Festraëts J, Viot A, Géloen C, Ambrosetti D, Mounier N, Bailly L, Pradier C. Cancer incidence in the vicinity of a waste incineration plant in the Nice area between 2005-2014. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.245] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive.
Objective
To measure cancer incidence among the population exposed to atmospheric emissions from the Ariane waste incineration plant near Nice, in the Alpes-Maritimes (AM), compared to the unexposed AM population.
Methods
All primary invasive cancers and malignant haematological conditions diagnosed among AM residents from 01/01/2005 to 31/12/2014 recorded by the CRISAPPACA Cancer Observatory, public and private hospitals and the ONCOPACA-Corsica Network were included. The exposed area, based on an average dioxin deposition model, was that with a concentration ≥4.25ng/m2/year. Each case was geolocated and assigned to a predefined geographic unit (IRIS): 36 units in the exposed area, 462 in the unexposed area. The adjusted incidence rate, the standardized incidence ratio (SIR) and the Comparative Morbidity Figure (CMF) were calculated for two periods: 2005-2009/2010-2014.
Results
We recorded 80,865 new cancers in the AM population (1,083,974 residents; 87,462 exposed). For the 2005-2009 period, among exposed women, excess SIR were recorded of acute myeloid leukaemia (SIR = 1.81 [1.03-2.93]), myelodysplastic syndromes (SIR = 2.58 [1.70-3.76]) and myeloma (SIR = 1.64 [1.09-2.37]); in exposed men, of soft tissue sarcomas (SIR = 1.65 [1.05-2, 48]), myeloma (SIR = 2.04 [1.39-2.90]) and lung cancer (SIR = 1.19 [1.03-1.36]). For the 2010-2014 period, there was no excess SIR among women, while among men an excess SIR of myeloma (SIR = 1.76 [1.21-2.47]) and lung cancer (SIR = 1.24 [1.08-1.41]) was observed.
Conclusions
The higher incidence of myeloma and lung cancer in both periods can be explained by their long latency and by other risk factors. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.
Study funded by the Nice Côte d’Azur Metropolis and with the support of the South-PACA Regional Health Agency.
Key messages
Few studies on cancer incidence have been conducted since the EU 2000/76/EC Waste incineration directive. The EU Directive appears to have resulted in limiting atmospheric emissions from the incinerator.
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Affiliation(s)
| | - N Doulet
- Public Health Department, University Hospital, Nice, France
| | - A Chaarana
- Public Health Department, University Hospital, Nice, France
| | - J Festraëts
- Public Health Department, University Hospital, Nice, France
| | - A Viot
- Public Health Department, University Hospital, Nice, France
| | - C Géloen
- Public Health Department, University Hospital, Nice, France
| | | | - N Mounier
- Hematology Service, University Hospital, Nice, France
| | - L Bailly
- Public Health Department, University Hospital, Nice, France
| | - C Pradier
- Public Health Department, University Hospital, Nice, France
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Laut K, Kirk O, Rockstroh J, Phillips A, Ledergerber B, Gatell J, Gazzard B, Horban A, Karpov I, Losso M, d'Arminio Monforte A, Pedersen C, Ristola M, Reiss P, Scherrer AU, de Wit S, Aho I, Rasmussen LD, Svedhem V, Wandeler G, Pradier C, Chkhartishvili N, Matulionyte R, Oprea C, Kowalska JD, Begovac J, Miró JM, Guaraldi G, Paredes R, Raben D, Podlekareva D, Peters L, Lundgren JD, Mocroft A. The EuroSIDA study: 25 years of scientific achievements. HIV Med 2019; 21:71-83. [PMID: 31647187 DOI: 10.1111/hiv.12810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 01/19/2023]
Abstract
The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long-term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS- and non-AIDS-related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person-years of follow-up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer-reviewed journals (h-index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas.
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Affiliation(s)
- K Laut
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O Kirk
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - A Phillips
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Gatell
- Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Gazzard
- St Stephen's Clinic, Chelsea and Westminster Hospital, London, UK
| | - A Horban
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - I Karpov
- Department of Infectious Diseases, Belarus State Medical University, Minsk, Belarus
| | - M Losso
- Latin America Coordination of Academic Clinical Research, Buenos Aires, Argentina
| | - A d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, ASST Saint Paul and Charles, University of Milan, Milan, Italy
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M Ristola
- Helsinki University Hospital, Helsinki, Finland
| | - P Reiss
- Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam and Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - A U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S de Wit
- CHU Saint-Pierre, Brussels, Belgium
| | - I Aho
- Helsinki University Hospital, Helsinki, Finland
| | - L D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - V Svedhem
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - N Chkhartishvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - C Oprea
- 'Victor Babes' Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - J D Kowalska
- Hospital for Infectious Diseases in Warsaw, Medical University of Warsaw, Warsaw, Poland
| | - J Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - J M Miró
- Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - G Guaraldi
- Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - R Paredes
- Infectious Diseases Unit &, IrsiCaixa AIDS Research Institute, Germans Trias Hospital, Badalona, Spain
| | - D Raben
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Podlekareva
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Peters
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J D Lundgren
- Department of Infectious Diseases, CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global health, University College London, London, UK
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Bailly L, Schiavo L, Sebastianelli L, Fabre R, Pradier C, Iannelli A. Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016. Obes Surg 2019. [PMID: 29516395 DOI: 10.1007/s11695-018-3143-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery (BS) has grown exponentially in France, and long-term anemia due to micronutrient deficiencies has become common. OBJECTIVES The objective of this study was to assess the long-term risk of anemia after BS and to investigate the factors associated with the occurrence of this complication. MATERIALS AND METHODS Data from the French National Health Service database on patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB), between 2008 and 2016 were extracted. Only patients with a primary intervention were considered. RESULTS Data from 306,298 patients (143.733 SG, 79.188 GB, and 36.413 AGB) were analyzed. Overall, 12.930 of them (5.0%) had a diagnosis of anemia due to micronutrient deficiencies as main diagnosis or related diagnosis at time of a hospital stay between 2008 and 2016. In multivariate analysis, GB surgery, female gender, age younger than 52 years, and 25-OH vitamin D deficiency were positively associated with the occurrence of anemia whereas hospital procedural volume was negatively associated. The risk to be diagnosed with anemia after BS was 13.0% after a GB, 5.6% after a SG and 4.0% after an AGB (Log-rank p < 0.0001). The hazard ratio for anemia after GB compared to SG was 2.0 (95% CI 1.9-2.1), adjusted for age and gender. CONCLUSION In France, between 2008 and 2016, 5% of patients had anemia after BS. The risk to develop anemia was 2-fold higher after a GB than after a SG. Young women should be particularly aware of this long-term risk.
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Affiliation(s)
- Laurent Bailly
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy
- IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Lionel Sebastianelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
- EA CoBTek, University of Nice Sophia-Antipolis, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity", 06204, Nice, France.
- University of Nice Sophia Antipolis, 06107, Nice, France.
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Bentz L, Pirard P, Motreff Y, Vandentorren S, Baubet T, Fabre R, Touboul Lundgren P, Pradier C. Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice » health survey protocol. BMC Public Health 2019; 19:1163. [PMID: 31443708 PMCID: PMC6708198 DOI: 10.1186/s12889-019-7489-3] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered. METHOD ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data. DISCUSSION The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.
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Affiliation(s)
- Laurence Bentz
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.
| | - Philippe Pirard
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France
| | - Yvon Motreff
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France
| | - Stéphanie Vandentorren
- Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France.,French National Public Health Agency (Santé Publique France), Regional Office of Nouvelle Aquitaine, F-94415, Saint-Maurice, France
| | - Thierry Baubet
- Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France.,Paris-Seine-Saint-Denis University Hospitals (AP-HP), Hôpital Avicenne, Paris 13 University, F-93000, Bobigny, France.,National Resources and Resilience Centre (CNRR), F-93000, Bobigny, France
| | - Roxane Fabre
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.,CoBTeK lab, Nice University Hospital, CMRR, Cote d'Azur University, F-06200, Nice, France
| | - Pia Touboul Lundgren
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
| | - Christian Pradier
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
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Hatleberg CI, Ryom L, Kamara D, De Wit S, Law M, Phillips A, Reiss P, D'Arminio Monforte A, Mocroft A, Pradier C, Kirk O, Kovari H, Bonnet F, El-Sadr W, Lundgren JD, Sabin C. Predictors of Ischemic and Hemorrhagic Strokes Among People Living With HIV: The D:A:D International Prospective Multicohort Study. EClinicalMedicine 2019; 13:91-100. [PMID: 31517266 PMCID: PMC6737207 DOI: 10.1016/j.eclinm.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hypertension is a stronger predictor of hemorrhagic than ischemic strokes in the general population. We aimed to identify whether hypertension or other risk factors, including HIV-related factors, differ in their associations with stroke subtypes in people living with HIV (PLWHIV). METHODS HIV-1-positive individuals from the Data collection on Adverse events of anti-HIV Drugs (D:A:D) study were followed from the time of first blood pressure (BP) measurement after 1/1/1999 or study entry until the first of a validated stroke, 6 months after last follow-up or 1/2/2014. Stroke events were centrally validated using standardized criteria. Hypertension was defined as one systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg. Poisson and Cox proportional hazards regression models determined associations of established cerebro/cardiovascular disease and HIV-related risk factors with stroke and tested whether these differed by stroke subtype. FINDINGS 590 strokes (83 hemorrhagic, 296 ischemic, 211 unknown) occurred over 339,979 person-years (PYRS) (incidence rate/1000 PYRS 1.74 [95% confidence interval (CI) 1.60-1.88]). Common predictors of both hemorrhagic and ischemic strokes were hypertension (relative hazard 3.55 [95% CI 2.29-5.50] and 2.24 [1.77-2.84] respectively) and older age (1.28 [1.17-1.39] and 1.19 [1.12-1.25]). Male gender (1.62 [1.14-2.31] and 0.60 [0.35-0.91]), previous cardiovascular events (4.03 [2.91-5.57] and 1.44 [0.66-3.16]) and smoking (1.90 [1.41-2.56] and 1.08 [0.68-1.71]) were stronger predictors of ischemic then hemorrhagic strokes, whereas hypertension, hepatitis C (1.32 [0.72-2.40] and 0.46 [0.30-0.70]) and estimated glomerular filtration rate < 60 mL/min/1.72 m3 (4.80 [2.47-9.36] and 1.04 [0.67-1.60]) were stronger predictors of hemorrhagic than ischemic strokes. A CD4 count < 200 cells/μL was associated with an increased risk of hemorrhagic stroke only. INTERPRETATION Risk factors for stroke may differ by subtype in PLWHIV, emphasizing the importance of further research to increase the precision of stroke risk estimation.
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Affiliation(s)
- Camilla Ingrid Hatleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Denmark
- Corresponding author at: Dept. of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - Lene Ryom
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Denmark
| | - David Kamara
- Institute for Global Health, UCL, London, United Kingdom
| | - Stephane De Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | | | - Peter Reiss
- Amsterdam University Medical Center (location AMC), Dept. of Global Health and Div. of Infectious Diseases, University of Amsterdam, Amsterdam, the Netherlands
- HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Antonella D'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Amanda Mocroft
- Institute for Global Health, UCL, London, United Kingdom
| | | | - Ole Kirk
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Denmark
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Switzerland
| | - Fabrice Bonnet
- Université de Bordeaux, ISPED, INSERM U1219, CHU de Bordeaux, Bordeaux, France
| | - Wafaa El-Sadr
- ICAP-Columbia University, Harlem Hospital, New York, USA
| | - Jens D. Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Denmark
| | - Caroline Sabin
- Institute for Global Health, UCL, London, United Kingdom
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Shepherd L, Ryom L, Law M, Hatleberg CI, de Wit S, Monforte AD, Battegay M, Phillips A, Bonnet F, Reiss P, Pradier C, Grulich A, Sabin C, Lundgren J, Mocroft A. Differences in Virological and Immunological Risk Factors for Non-Hodgkin and Hodgkin Lymphoma. J Natl Cancer Inst 2019; 110:598-607. [PMID: 29267895 DOI: 10.1093/jnci/djx249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) are increased in populations with immune dysfunction, including people living with HIV; however, there is little evidence for to what degree immunological and virological factors differently affect NHL and HL risk. Methods Data from the Data Collection on Adverse events of Anti-HIV Drugs Study cohort were analyzed to identify independent risk factors for NHL and HL using hazard ratios (HRs), focusing on current and cumulative area under the curve (AUC) measures of immunological and virological status. Variables with different associations with NHL and HL were identified using marginal Cox models. All statistical tests were two-sided. Results Among 41 420 people followed for 337 020 person-years, 392 developed NHL (incidence rate = 1.17/1000 person-years of follow-up [PYFU], 95% confidence interval [CI] = 1.06 to 1.30) and 149 developed HL (incidence rate = 0.44/1000 PYFU, 95% CI = 0.38 to 0.52). Higher risk of both NHL and HL was associated with lower current CD4 cell count (adjusted HR [aHR] of NHL for CD4 <100 vs > 599 cells/mm3 = 8.08, 95% CI = 5.63 to 11.61; HL = 4.58, 95% CI = 2.22 to 9.45), whereas higher current HIV viral load (aHR of NHL for HIV-VL >1000 vs < 50 copies/mL = 1.97, 95% CI = 1.50 to 2.59) and higher AUC of HIV-VL (aHR of NHL for highest vs lowest quintile = 2.91, 95% CI = 1.92 to 4.41) were associated with NHL only. Both current and AUC of HIV-VL were factors that had different associations with NHL and HL, where the hazard ratio for NHL was progressively higher than for HL with increasing HIV-VL category. Lower current CD4 cell count had a strong but similar association with both NHL and HL. Conclusions CD4 depletion increased risk of both types of lymphomas while current and accumulated HIV-VL was associated with NHL only. This suggests that NHL development is related to both CD4 cell depletion and added immune dysfunction derived from ongoing HIV replication. This latter factor was not associated with HL risk.
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Affiliation(s)
- Leah Shepherd
- Research Department of Infection and Population Health, UCL, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthew Law
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Camilla Ingrid Hatleberg
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stephane de Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antonella d'Arminio Monforte
- Dipartimento di Scienze della Salute, Clinica di Malattie Infectitive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, Italy
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrew Phillips
- Research Department of Infection and Population Health, UCL, London, UK
| | - Fabrice Bonnet
- CHU de Bordeaux and INSERM U1219, Université de Bordeaux, Bordeaux, France
| | - Peter Reiss
- Academic Medical Center, Division of Infectious Diseases, Department of Global Health, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, the Netherlands
| | | | | | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
| | - Jens Lundgren
- CHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Research Department of Infection and Population Health, UCL, London, UK
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Ferré N, Racine AN, Fuente D, Pjevac D, Fuch A, Garbarino JM, Pradier C. [Feedback on the implementation of a departmental physical activity project for the elderly]. Sante Publique 2019; Vol. 31:53-60. [PMID: 31210517 DOI: 10.3917/spub.191.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Regular physical activity is nowadays recognized as one of the keys for ageing well. A number of interventions are therefore developed for this target group. The goal of this study was to examine the establishment and impact of a structured physical activity program for subjects aged 60 or more on a departmental scale and according to the point of view of different actors engaged. METHODS The PAS Project (Prévention Active Senior), coordinated by a resource and expertise center, consisted of conceiving and implementing a structured physical activity program for subjects aged 60 or more. In every municipality, the program was conducted by a local sports instructor in partnership with a municipal representative. It consisted of 3 weekly sessions of physical activity (2 supervised and 1 individual) over a period of 3 months. The data was collected thanks to the tools developed for the evaluation. RESULTS The program was conducted in 27 municipalities. A total of 586 participants enrolled in the program and 439 completed the final evaluation. This project allowed for the improvement of three main physical capacities (endurance, muscular strength, and balance) for most of the participants. At the end of the program, more than 50% of municipalities created or supported a long term physical activity offer for elderly. DISCUSSION This study highlights the need of adapting this kind of intervention to the local context. It confirmed the interest of a combined individual and more general approach, as well as a cross-sectorial work in order to create the conditions for sustainable daily physical activity for the target group.
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Bergamaschi A, d'Arripe-Longueville F, Gray LL, Colson SS, Goujard C, Ferez S, Rouanet I, Durant J, Rosenthal E, Pradier C, Duracinsky M, Schuft L. Perceived HIV-related physical fatigue, sociodemographic characteristics and physical activity: A cross-sectional study. J Clin Nurs 2019; 28:2147-2156. [PMID: 30667107 DOI: 10.1111/jocn.14793] [Citation(s) in RCA: 5] [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: 02/02/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To get a deeper understanding of correlates of perceived HIV-related fatigue by exploring its associations with sociodemographic characteristics and physical activity level of HIV-infected people. BACKGROUND Previous studies on HIV-related fatigue have mainly focused on physiological and psychological characteristics, but few have considered its associations with sociodemographic variables. In addition, while physical activity has been found to reduce acute fatigue among HIV-infected people, its links with chronic HIV-related fatigue remain to be explored. DESIGN The study employed an observational and cross-sectional survey design. The manuscript was organised according to STROBE guidelines. METHOD A total of 560 people living with HIV in France completed a measure of perceived physical fatigue using the Fatigue Intensity Scale. The predictors targeted sociodemographic characteristics and two measures of individuals' reported level of physical activity. Data were analysed by a stepwise multiple regression model. RESULTS The results showed that lower age, higher physical activity level and socio-economic status were significantly associated with reduced perceived physical fatigue, explaining 25% of the variance. CONCLUSIONS The results highlighted the importance of considering sociodemographic and lifestyle characteristics to better characterise HIV-related fatigue, in particular in an era where HIV as a chronic illness challenges questions of quality of life throughout increasingly longer lifespans. RELEVANCE TO CLINICAL PRACTICE The results of this study have implications for HIV care professionals in terms of improving strategies for managing chronic fatigue or promoting physical activity according to more specific profiles of HIV-infected people.
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Affiliation(s)
| | | | | | | | - Cecile Goujard
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France
| | - Sylvain Ferez
- Laboratory Health, Education, Handicap Situations (EA 4614 SANTESIH), University of Montpellier, Montpellier, France
| | - Isabelle Rouanet
- Department of Infectious Diseases, Hospital of Nîmes, Nîmes, France
| | - Jacques Durant
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Eric Rosenthal
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Infectious Diseases, Université Côte d'Azur, CHU, Nice, France
| | - Christian Pradier
- LAMHESS, Université Côte d'Azur, Nice, France.,Department of Public Health, Université Côte d'Azur, CHU, Nice, France
| | - Martin Duracinsky
- Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, AP-HP, Paris, France.,Patient-Centered Outcomes Research (EA 7334 REMES), University of Paris-Diderot, Paris, France
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