Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
Diagnosis of toxoplasmic encephalitis (TE) in patients with AIDS is not straightforward because clinicians rely initially on an empiric diagnosis based on clinical and radiographic improvement to specific anti-Toxoplasma gondii therapy. There is therefore a need for biological tools to improve the diagnosis of TE, especially in tropical areas where this diagnosis is likely to be underestimated. The use of PCR testing in blood samples for the diagnosis of TE has been limited by its poor sensitivity in the studies conducted in Europe. In tropical South America, the results of PCR sensitivity in blood samples were controversial. Considering that T. gondii strains from tropical South America have substantial genetic and pathogenic differences with those from USA and Europe, it is therefore important to re-evaluate the performance of the PCR assay in blood samples for the diagnosis of TE in AIDS patients from this region. Our results showed that the only interest of PCR would be in the most severe forms of TE with altered consciousness because PCR is more likely to be positive. We also provided important genotyping data on T. gondii strains isolated in human cases of toxoplasmosis in the Caribbean and in South America.
ISSN: 1935-2727

hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761/document
https://hal-unilim.archives-ouvertes.fr/hal-01503761/file/journal.pntd.0004790.pdf
DOI : 10.1371/journal.pntd.0004790

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model.Methods: The model was based on epidemiological data from the French Dat’AIDS cohort. Eight risk groups wereconsidered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals,intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence dataobserved in the cohort between 2012 and 2015.Results: On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosedpatients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatmentcoverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalenceamong HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCVprevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalencein HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70%would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients wouldaccount for 34% of HCV infections in 2026.Conclusions: Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most riskgroups, including LR MSM. Elimination in HR MSM will require increased TC.
ISSN: 1741-7015

Droits : info:eu-repo/semantics/OpenAccess
inserm-01685739
http://www.hal.inserm.fr/inserm-01685739
http://www.hal.inserm.fr/inserm-01685739/document
http://www.hal.inserm.fr/inserm-01685739/file/2017%2C%20Virlogeux%20-%20Modeling%20HIV-HCV%20coinfection.pdf
DOI : 10.1186/s12916-017-0979-1

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : National audience
The most recent data on prevalence of chronic hepatitis B and C in the French Overseas Territories (FOT) show great variability among these territories with a prevalence rising from 0.46 to 3.4% for HBs Antigen and from 0.02 to 0.67%for anti HCV antibodies. The modes of transmission rely mainly for HBV on sexual or materno-fetal exposure, especially among people from non-French border endemic areas, and for HCV on blood or nosocomial route. Good adhesion of the treating physicians and pediatricians to vaccination has significantly reduced the prevalence of HBV in the ten past years, with an estimated coverage of 75 to 85%depending on the territories. Although there is still a high prevalence of HBV in some FOT, the screening policy and management are based on those carried out inmetropolitan France, which seems insufficient and inadequate to the situation of these territories. Regarding the therapeutic management of HCV, the means attributed to FOT have been identical to those of metropolitan France but the small number of specialist practitioners and remoteness contributed to provision of new molecules later in certain territories. Medical pluridisciplinary sessions have been implemented and based on the universitary or regional hospitals. Copyright © 2017 John Libbey Eurotext.
ISSN: 2115-3310

hal-01485859
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01485859
DOI : 10.1684/hpg.2016.1379

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
ObjectivesTo compare the efficacy, in current clinical practice, of ă first regimens containing abacavir with lamivudine (ABC/3TC) or ă tenofovir with emtricitabine (TDF/FTC) in patients with baseline viral ă load 100000 HIV-1 RNA copies/mL. ă MethodsUsing a prospective cohort, we selected all patients starting a ă first HIV regimen based either on ABC/3TC or on TDF/FTC. The propensity ă score (PS) method was used to limit the indication bias due to the ă observational nature of the data. Adjusting and weighting methods via PS ă were used to compare the effectiveness of a first regimen containing ă ABC/3TC or TDF/FTC. The primary outcome was treatment failure by month ă 12 (M12). ă ResultsOverall, 2781 patients started an antiretroviral (ARV) regimen ă with ABC/3TC or TDF/FTC each in combination with efavirenz, boosted ă atazanavir or boosted darunavir. Among the 2472 uncensored patients ă before M12, 962 (39%) had a baseline viral load 100000 copies/mL of ă whom 294 were in treatment failure at or before M12. Our analyses showed ă no difference between ABC/3TC and TDF/FTC in the risk of treatment ă failure at M12 in patients starting an ARV regimen with a high viral ă load (100000 copies/mL). ă ConclusionsUsing a large prospectively collected cohort of patients ă seeking care in France, we found no evidence that ABC/3TC based regimens ă led to more failures than TDF/FTC based ones in patients with high ă baseline viral loads.
ISSN: 1464-2662

hal-01482656
https://hal.archives-ouvertes.fr/hal-01482656
DOI : 10.1111/hiv.12306

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
The aim of the study was to investigate the impact of first-line combined antiretroviral therapy (cART) regimen on the course of CD8 + T-cell counts in human immunodeficiency virus (HIV)-infected patients. A retrospective observational study conducted on the French DAT'AIDS Cohort of HIV-infected patients. We selected 605 patients initiating a first-line cART between 2002 and 2009, and which achieved a sustained undetectable HIV plasma viral load (pVL) for at least 12 months without cART modification. The evolution of CD8 + T-cell counts according to cART regimen was assessed. CD8 + T-cell counts were assessed in 572 patients treated with 2NRTIs+1PI/r (n= 297), 2NRTIs+1NNRTI (n= 207) and 3NRTIs (n= 68). In multivariate analysis, after 12 months of follow-up, the 3NRTIs regimen was associated with a significantly smaller decrease of CD8 + T-cell count compared with NNRTI-containing regimens (–10.2 cells/mL in 3NRTIs vs –105.1 cells/mL; P=0.02) but not compared with PI-containing regimens (10.2 vs –60.9 cells/mL; P=0.21). After 24 months, the 3NRTIs regimen was associated with a smaller decrease of CD8 + T-cell count and % compared with PI/r-and NNRTI-containing regimens (0.2 in 3NRTIs vs –9.9 with PI/r-regimens, P=0.001, and vs –11.1 with NNRTI-regimens, p < 0.0001). A focus analysis on 11 patients treated with an INSTI-containing cART regimen during the study period showed after 12 months of follow-up, a median decrease of CD8 + T-cell count of –155 [inter quartile range: –302; –22] cells/mL. Our data highlight the fact that cART regimens have differential effects on CD8 pool down regulation. Abbreviations: cART = combined antiretroviral therapy, HIV = human immunodeficiency virus, INSTI = integrase strand transfer inhibitor, NNRTI = non-nucleotide reverse transcriptase inhibitor, NRTI = nucleotide reverse transcriptase inhibitor, PI/r = Ritonavir-boosted protease inhibitor, pVL = plasma viral load.
ISSN: 0025-7974

inserm-01408002
http://www.hal.inserm.fr/inserm-01408002
http://www.hal.inserm.fr/inserm-01408002/document
http://www.hal.inserm.fr/inserm-01408002/file/2016%2C%20Poizot-Martin%20-%20First-line%20cART%20regimen%20impacts%20the%20course%20of%20CD8%2B%20T-cell%20counts%20in%20HIV-infected%20patients.pdf
DOI : 10.1097/MD.0000000000005087

Éditeur(s) : HAL CCSD Taylor & Francis (Routledge)
Résumé : International audience
The French Antilles (Martinique, Saint Martin and Guadeloupe) and French Guiana are the French territories most affected by the HIV epidemic. Some population groups such as men who have sex with men (MSM), especially those involved in transactional sex, are thought to be particularly vulnerable to HIV but few data exist to help characterize their health-related needs and thus implement relevant prevention interventions. To fill this knowledge gap, we used data collected from an HIV/AIDS Knowledge, Attitudes, Behaviours and Practices survey conducted in 2012 among MSM living in the French Antilles and French Guiana and recruited through snowball sampling. Our objectives were to compare social and demographic characteristics and sexual behaviours between MSM engaging in transactional sex and MSM not engaging in transactional sex and to identify factors associated with transactional sex involvement using a logistic regression model. A total of 733 MSM were interviewed, 21% of whom reported to undergo transactional sex. Their behaviour and social and demographic characteristics were different from other MSMs’ and they were more exposed to factors that are recognized to potentiate HIVvulnerability, at the individual, community, network and structural levels. The variables positively associated with sex trade involvement were having ever consumed drug (OR = 2.84 [1.23–6.52]; p = .002), having a greater number of sex partners than the median (OR = 8.31 [4.84–14.30]; p < .001), having experienced intimate partner violence (OR = 1.72 [0.99–3.00]; p = .053) and having undergone physical aggression because of sexual orientation (OR = 2.84 [1.23–6.52];p = .014). Variables negatively associated with sex trade involvement were being older (OR = 0.93 [0.90–0.97] per year; p = .001), having a stable administrative situation (OR = 0.10 [0.06–0.19]; p < .001), having a stable housing (OR = 0.29 [0.15–0.55]; p < .001) and being employed full-time (OR = 0.29 [1.23–6.52]; p = .002).
ISSN: 0954-0121

inserm-01407263
http://www.hal.inserm.fr/inserm-01407263
http://www.hal.inserm.fr/inserm-01407263/document
http://www.hal.inserm.fr/inserm-01407263/file/AIDS%20Care%20final%20version.pdf
DOI : 10.1080/09540121.2016.1234680

Éditeur(s) : HAL CCSD Saint-Maurice (Val de Marne) : Institut de veille sanitaire
Résumé : International audience
ISSN: 0245-7466

Droits : info:eu-repo/semantics/OpenAccess
hal-01675363
https://hal.archives-ouvertes.fr/hal-01675363
https://hal.archives-ouvertes.fr/hal-01675363/document
https://hal.archives-ouvertes.fr/hal-01675363/file/BEH_lepto.pdf

Éditeur(s) : HAL CCSD American Society of Hematology
Résumé : International audience
Zika fever is an Aedes-borne disease caused by a flavivirus (Zika virus, ZIKV, genus Flavivirus). During the past years ZIKV spread in Polynesia, South-America and the Caribbean. Most ZIKV infections are asymptomatic or result in mild febrile disease with rash and conjunctivitis. Attention was recently drawn to non-vectored ZIKV transmission, including sexual, probable blood-borne and mother-to-fetus transmission, and to severe forms such as Guillain-Barré syndrome, acute neurological infections and fetal abnormalities (including microcephaly). Many aspects of Zika fever natural history remain unknown, e.g. the proportion of asymptomatic cases and the duration of viremia. Estimating the prevalence of Zika infections is difficult because a large proportion of infected individuals do not seek medical attention and seroprevalence studies are hampered by antigenic cross-reactivity with other flaviviruses, e.g. dengue virus. Here, we present a study of ZIKV infection in blooddonors from Martinique island (French West Indies, Caribbean region), with novel epidemiological, biological and clinical information that refine the picture of Zika fever in adults.
ISSN: 0006-4971

inserm-01415646
http://www.hal.inserm.fr/inserm-01415646
http://www.hal.inserm.fr/inserm-01415646/document
http://www.hal.inserm.fr/inserm-01415646/file/2016%2C%20Gallian%20et%20al%20-%20Zika%20virus%20in%20asymptomatic%20blood%20donors%2C%20Martinique%20%281%29.pdf
DOI : 10.1182/blood-2016-09-737981

Éditeur(s) : HAL CCSD
Résumé : International audience
Résumé :Introduction : Les départements Français d’Amérique sont à la fois parmi les territoiresfrançais les plus affectés par le VIH et parmi les territoires français les plus impactés par laconsommation de crack. L’épidémie de VIH en Guyane est une épidémie concentrée quitouche plus spécifiquement certains groupes vulnérables. Parmi ces groupes, les usagers decrack sont particulièrement touchés.Matériel et Méthodes : Une étude a été réalisée simultanément dans les trois départements en2012 dans le but de décrire les connaissances, les attitudes et les pratiques vis-à-vis du VIH etdes IST chez les usagers de crack. Au total 640 personnes ont été interrogées. La méthoded’échantillonnage utilisée était non probabiliste et combinait un échantillonnage deconvenance dans les associations recevant ce public (75% de l’échantillon), et unéchantillonnage en boule de neige en dehors afin d’atteindre les personnes ne fréquentant pasles structures (25% de l’échantillon).Résultats : Un tiers des personnes n’utilisait pas systématiquement le préservatif avec lespartenaires occasionnels (36,2%) ou avec les partenaires commerciaux (32,3%), et 64%n’utilisaient pas le préservatif à chaque fois avec les partenaires réguliers. Différents facteursprédictifs de la non utilisation du préservatif ont été identifiés selon le type de partenaire àl’aide d’un modèle log-binomial. Parmi les différents facteurs repérés, deux étaient communsà chaque type de partenaire : la perception élevée de son risque face au VIH et le fait de nepas se sentir à l’aise pour persuader un partenaire à utiliser le préservatif.Discussion : Dans un contexte de multipartenariat, de violences sexuelles fréquentes et dedépistage insuffisant du VIH, la non utilisation systématique du préservatif peut avoir unimpact non négligeable dans la diffusion de l’épidémie. Bien que la non utilisation dupréservatif soit sensiblement inférieure à ce que l’on retrouve dans la littérature, cesproportions traduisent un réel problème.La capacité à persuader un partenaire sexuel à utiliser un préservatif était négativementcorrélée avec la non utilisation du préservatif quel que soit le type de partenaire. Ainsi, ilsemble que lorsque les personnes se sentaient capables de négocier l'utilisation du préservatif,elles l’utilisaient de manière plus systématique. La capacité personnelle perçue est souventconsidérée comme un levier important pour adapter les comportements de santé. Or, elle peutêtre affectée dans des situations de stigmatisation, d’addiction ou de relation violente. Cesrésultats soulignent l’importance d’interventions spécifiques de prévention parmi les usagersde crack et notamment des interventions visant à améliorer le sentiment d’efficacitépersonnelle (perceived self-efficacy) et d’estime de soi.
Colloque ATHS Biarritz
Biarritz, France

inserm-01621896
http://www.hal.inserm.fr/inserm-01621896
http://www.hal.inserm.fr/inserm-01621896/document
http://www.hal.inserm.fr/inserm-01621896/file/2017%2C%20Parriault%20-%20Comportements%20sexuels%20%C3%A0%20risque%20%26%20crack.pdf

Éditeur(s) : HAL CCSD SAGE Publications
Résumé : International audience
The French overseas territories in the Americas are the French territories most affected by HIV. Crack cocaine users are particularly impacted. The objective of this study was to describe sexual risk behaviors and inconsistent condom use among crack cocaine users. A total of 640 crack cocaine users were interviewed. The sampling method was non-probabilistic. An anonymous standardized questionnaire of 110 questions was used. Over a third of persons did not use condoms systematically with casual sex partners (36.2%) or commercial sex partners (32.3%), and 64% did not use condoms systematically with regular sex partners. In a context of multiple sexual partnerships, frequent forced sex, and insufficient HIV testing, the lack of systematic condom use may favor the spread of HIV. Different predictive factors of inconsistent condom use were identified, depending on the type of partner, with a log binomial regression. However, among the predictor variables identified, two predictive factors frequently occur among the different type of sex partners: high perceived risk of HIV and self-perceived capacity to persuade a sex partner to use condom. These results pointed towards interventions improving access to rights and raising perceived self-efficacy.
ISSN: 0956-4624

inserm-01566193
http://www.hal.inserm.fr/inserm-01566193
http://www.hal.inserm.fr/inserm-01566193/document
http://www.hal.inserm.fr/inserm-01566193/file/2017%2C%20Parriault%20-%20Sexual%20risk%20behaviors.pdf
DOI : 10.1097/COH.0b013e3283536ab2

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction Le chikungunya (CHIKV) est un alphavirus ré-émergent depuis 10 ans responsable de nombreuses épidémies. Chez certains patients, il est à l'origine de troubles musculo-squelettiques et de polyarthropathies inva-lidants et persistants plus de 3 mois, définissant la forme chronique du chikun-gunya (CHIKC). Afin de déterminer la prévalence du CHIKC, nous avons mené une cohorte prospective de patients ambulatoires lors de la dernière épi-démie en outre-mer. Secondairement, nous avons recherché les facteurs de risques associés.
Médecine et maladies infectieuses 46 (2016) 15-16
Lille, France

inserm-01413489
http://www.hal.inserm.fr/inserm-01413489
http://www.hal.inserm.fr/inserm-01413489/document
http://www.hal.inserm.fr/inserm-01413489/file/2016%2C%20Thioune%20-%20COL%207-01%20%281%29.pdf
http://www.hal.inserm.fr/inserm-01413489/file/2016%2C%20Thioune%20-%20COL%207-01.pdf

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction Les données sur l’efficacité virologique et la tolérance à long terme de l’association abacavir/lamivudine (ABC/3TC) et nevirapine (NVP) sont rares.
Médecine et maladies infectieuses 46 (2016) 5-7
Lille, France

Droits : info:eu-repo/semantics/OpenAccess
inserm-01414591
http://www.hal.inserm.fr/inserm-01414591
http://www.hal.inserm.fr/inserm-01414591/document
http://www.hal.inserm.fr/inserm-01414591/file/2016%2C%20de%20Boissieu%20-%20COL%203-04.pdf
PUBMED : 27495405

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction Depuis le début de l’ère des traitements antirétroviraux hautement actifs, les patients vivant avec le VIH (PVVIH) vieillissent. Les comorbidités liées à l’âge (CLA) deviennent des causes grandissantes de mortalité dans cette population.L’objectif de cette étude était d’évaluer leur impact sur la surmortalité liée au VIH sur 5 ans chez les PVVIH âgés de 60 ans ou plus suivis dans le cadre d’une large cohorte prospective multicentrique française (Dat’AIDS) à l’ère tardive des antirétroviraux hautement actifs (du 01/01/2008 au 31/12/2012).
Médecine et maladies infectieuses 46 (2016) 5-7
Lille, France

inserm-01414533
http://www.hal.inserm.fr/inserm-01414533
http://www.hal.inserm.fr/inserm-01414533/document
http://www.hal.inserm.fr/inserm-01414533/file/2016%2C%20Hentzien%20-%20COL%203-02.pdf
PUBMED : 27495402

Éditeur(s) : HAL CCSD European Centre for Disease Prevention and Control
Résumé : International audience
Following of the emergence of Zika virus in Brazil in 2015, an epidemiological surveillance system was quickly implemented in the French overseas Territories of America (FTA) according to previous experience with dengue and chikungunya and has detected first cases of Zika. General practitioners and medical microbiologists were invited to report all clinically suspectedcases of Zika, laboratory investigations were systematically conducted (RT-PCR). On 18 December, the first autochthonous case of Zika virus infection was confirmed by RT-PCR on French Guiana and Martinique, indicating introduction of Zika virus inFTA. The viral circulation of Zika virus was then also confirmed on Guadeloupe and Saint-Martin. We report here early findings on 203 confirmed cases of Zika virus infection identified by RT-PCR or seroneutralisation on Martinique Island between 24 November 2015 and 20 January 2016. All cases were investigated. Common clinical signs were observed (maculopapularrash, arthralgia, fever, myalgia and conjunctival hyperaemia) among these patients, but the rash, the foundation of our case definition, may be absent in a significant proportion of patients (16%). These results are important for the implementation of a suspected case definition, the main tool for epidemiological surveillance, in territories that may be affected by ZIKV emergence, including Europe.
ISSN: 1025-496X

Droits : info:eu-repo/semantics/OpenAccess
inserm-01415215
http://www.hal.inserm.fr/inserm-01415215
http://www.hal.inserm.fr/inserm-01415215/document
http://www.hal.inserm.fr/inserm-01415215/file/2016%2C%20Daudens-Vaysse%20-%20Zika%20emergence%20in%20the%20French%20Territories%20of%20America%20and%20description%20of%20first%20confirmed%20cases%20of%20Zika%20virus%20infection%20on%20Martinique%20.pdf
DOI : 10.2807/1560-7917.ES.2016.21.28.30285

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction En France, la proportion de personnes infectées par le VIH et ignorant leur statut était de 25 % en 2010. On estime que ces personnes seraient à l’origine de 60 % des nouvelles contaminations. Les offres et les moyens de dépistagesont régulièrement élargis et améliorés, sollicitant notamment les médecins généralistes. Cependant, les opportunités manquées de diagnostic sont nombreuses : pour 82 % des nouvelles découvertes de séropositivités VIH en 2009-2010. Une étude des pratiques de dépistage a eu lieu auprès des généralistes de métropole en 2009. Aucune étude de ce type n’a été réalisée en Martinique, département pourtant très touché par l’épidémie de VIH. Nous avons voulu réaliser unétat des lieux des pratiques de dépistage de l’infection par le VIH par les généralistes en Martinique.
17es Journées Nationales d’Infectiologie
Lille, France

Droits : info:eu-repo/semantics/OpenAccess
inserm-01410436
http://www.hal.inserm.fr/inserm-01410436
http://www.hal.inserm.fr/inserm-01410436/document
http://www.hal.inserm.fr/inserm-01410436/file/2016%2C%20Lafon-Desmurs%20-%20VIH02.pdf
PUBMED : 27495683