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<publisher>HAL CCSD</publisher>
<title lang=en>Critical Importance of Long-Term Adherence to Care in HIV Infected Patients in the cART Era: New Insights from Pneumocystis jirovecii Pneumonia Cases over 2004–2011 in the FHDH-ANRS CO4 Cohort</title>
<creator>Denis, Blandine</creator>
<creator>Guiguet, Marguerite</creator>
<creator>De Castro, Nathalie</creator>
<creator>Mechaï, Frédéric</creator>
<creator>Revest, Matthieu</creator>
<creator>Mahamat, Aba</creator>
<creator>Gregoire, Giovanna Melica</creator>
<creator>Lortholary, Olivier</creator>
<creator>Costagliola, Dominique</creator>
<contributor>Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP) ; Université Pierre et Marie Curie - Paris 6 (UPMC) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Université Paris Diderot - Paris 7 (UPD7)</contributor>
<contributor>Service des maladies infectieuses [CHU St Louis] ; Groupe Hospitalier Saint-Louis-Lariboisière- Fernand-Widal</contributor>
<contributor>Service de maladies infectieuses et tropicales [CHU Avicenne] ; Hôpital Avicenne</contributor>
<contributor>Services de maladies infectieuses et tropicales [CHU Rennes] ; CHU Pontchaillou [Rennes]</contributor>
<contributor>Unité des Maladies Infectieuses et Tropicale, Centre Hospitalier de Cayenne ; Centre Hospitalier de Cayenne</contributor>
<contributor>Groupe de Recherche en Informatique et Mathématiques Appliquées Antilles-Guyane (GRIMAAG) ; Université des Antilles et de la Guyane (UAG)</contributor>
<contributor>Centre d’Infectiologie Necker Pasteur ; Assistance publique - Hôpitaux de Paris (AP-HP) - Université Paris Descartes - Paris 5 (UPD5) - CHU Necker - Enfants Malades [AP-HP]</contributor>
<contributor>Imagine - Institut des maladies génétiques (IMAGINE - U1163) ; Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS)</contributor>
<contributor>Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA) ; Institut Pasteur [Paris] - Centre National de la Recherche Scientifique (CNRS)</contributor>
<description>International audience</description>
<source>ISSN: 1932-6203</source>
<source>PLoS ONE</source>
<publisher>Public Library of Science</publisher>
<identifier>hal-01345090</identifier>
<identifier>http://hal.upmc.fr/hal-01345090</identifier>
<identifier>http://hal.upmc.fr/hal-01345090/document</identifier>
<identifier>http://hal.upmc.fr/hal-01345090/file/journal.pone.0094183.PDF</identifier>
<source>http://hal.upmc.fr/hal-01345090</source>
<source>PLoS ONE, Public Library of Science, 2014, 9 (4), pp.e94183. 〈10.1371/journal.pone.0094183〉</source>
<identifier>DOI : 10.1371/journal.pone.0094183</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.1371/journal.pone.0094183</relation>
<identifier>PUBMED : 24727746</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/24727746</relation>
<identifier>PUBMEDCENTRAL : PMC3984113</identifier>
<language>en</language>
<subject>[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>Objective: To describe characteristics and outcomes of HIV-infected patients with Pneumocystis jirovecii pneumonia (PCP) over 2004–2011 in France, in particular in those previously enrolled (PE) in the French Hospital Database on HIV (FHDH). Methods: PE patients with an incident PCP were compared with patients with an inaugural PCP revealing HIV infection (reference). Adequate adherence to care was defined as a CD4 measurement at least every 6 months. Immune reconstitution (CD4$200/mm 3) and risk of death were studied using Kaplan-Meier estimates and multivariable Cox proportional hazards models. Results: In a context of a decreasing incidence of PCP, 1259 HIV-infected patients had a PCP diagnosis, and 593 (47%) were PE patients of whom 161 (27%) have had a prior history of AIDS-defining clinical illness (prior ADI). Median time since enrolment was 8 years for PE patients; 74% had received cART. Median proportion of time with adequate adherence to care was 85% (IQR, 66–96) for all FHDH enrollees, but only 45% (IQR, 1–81) for PE patients during the 2 years before PCP. Median CD4 cell count (38/mm 3) and HIV viral load (5.2 log10 copies/ml) at PCP diagnosis did not differ between PE patients and the reference group. Three year mortality rate of 25% was observed for PE prior ADI group, higher than in PE non-prior ADI group (8%) and the reference group (9%) (p,0.0001). In the PE prior ADI group, poor prognosis remained even after adjustment for virological control and immune reconstitution (HR, 2.4 [95%CI, 1.5–3.7]). Conclusion: Almost 50% of PCP diagnoses in HIV-infected patients occurred presently in patients already in care, mainly with a previous cART prescription but with waning adherence to care. Having repeated ADI is contributing to the risk of death beyond its impact on immune reconstitution and viral suppression: special efforts must be undertaken to maintain those patients in care.</description>
<rights>http://creativecommons.org/licenses/by/</rights>
<date>2014-04-11</date>
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