Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
: In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.
ISSN: 1438-4221

inserm-01065096
http://www.hal.inserm.fr/inserm-01065096
http://www.hal.inserm.fr/inserm-01065096/document
http://www.hal.inserm.fr/inserm-01065096/file/2014_Iriart_-_Complementary_tool_for_managementsur histo_infections_in_AID.pdf
DOI : 10.1016/j.ijmm.2014.07.016

Éditeur(s) : HAL CCSD
Résumé : National audience
Une Brésilienne de 39 ans est adressée à l’hôpital de Cayenne pour des céphalées, une confusion fébrile et une altération de l’état général. Six mois plus tôt, une infection par le VIH avait été révélée (charge virale de 147 615 copies/ ml ; CD4 à 56/ mm3), au Brésil, par un tableau de tuberculose pleuro-pulmonaire non documentée. Elle suit depuis un traitement antirétroviral et une quadrithérapie antituberculeuse, sans cotrimoxazole, traitement toujours en cours à son entrée.
La Lettre de l'Infectiologue

Droits : info:eu-repo/semantics/OpenAccess
inserm-01423104
http://www.hal.inserm.fr/inserm-01423104
http://www.hal.inserm.fr/inserm-01423104/document
http://www.hal.inserm.fr/inserm-01423104/file/2015%2C%20Epelboin%20-%20M%C3%A9ningo-enc%C3%A9phalite%20%C3%A0%20histoplasma%20capsulatum.pdf

Éditeur(s) : HAL CCSD SAGE Publications
Résumé : International audience
In Western French Guiana there was a dramatic increase in HIV-prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between January 1st 2008 and June 30th 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4<200/mm3 the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm3 and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.
ISSN: 0956-4624

inserm-01082409
http://www.hal.inserm.fr/inserm-01082409
http://www.hal.inserm.fr/inserm-01082409/document
http://www.hal.inserm.fr/inserm-01082409/file/2014%2C%20Vantilcke%20-%20Fever%20and%20HIV.pdf
http://www.hal.inserm.fr/inserm-01082409/file/Histoplasmosis_tab_2%5B1%5D%20revised.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience
Background: In French Guiana, a recent study has shown that a major part of the histoplasmosis incidence temporal fluctuations could be explained by climatic factors and thus postulated that disseminated histoplasmosis cases could be in a large proportion due to new infections. The description of the seasonal pattern of histoplasmosis could potentially help to test this new hypothesis. Patients and methods: A study using prospective data from the French Hospital Database for HIV was conducted in order to determine seasonal variations of the incidence of first cases of disseminated histoplasmosis in HIV persons in Cayenne, French Guiana. Single failure Cox proportional hazards models were used. Results: After adjusting for CD4 counts and antiretroviral treatment, the incidence of disseminated histoplasmosis was significantly higher during the Short Wet Season-Long Dry Season than during the Short Dry Season-Long Wet Season (Adjusted Hazard ratio 1.7 (1.1-2.5), P= 0.01). Conclusion: This result gives both valuable epidemiologic information to clinicians and a supplementary argument in favour of the hypothesis that an important proportion of cases were due to recent exposure. Therefore, the use of a primary prophylaxis must be discussed in French Guiana.
J AIDS Clinic Res

Droits : info:eu-repo/semantics/OpenAccess
inserm-00915009
http://www.hal.inserm.fr/inserm-00915009
http://www.hal.inserm.fr/inserm-00915009/document
http://www.hal.inserm.fr/inserm-00915009/file/2012_Hanf_-_Disseminated_Histoplasmosis_seasonal_incidence_variations_a_supplementary_argument_for_recent_infection.pdf
DOI : 10.4172/2155-6113.1000175

Éditeur(s) : HAL CCSD INVS
Résumé : National audience
Context – Cervical cancer is the second most frequent cancer of women in French Guiana. Studies have shown that populations living in remote villages in the interior of the territory have early sexual relations and that multiple sexual partnerships are frequent. Hence, the main objective of the study was to determine the prevalence of Human Papilloma Virus (HPV) in these areas.Methods – This multicentric cross sectional study was conducted in women aged 20 to 65 years, living in theremote villages along the Maroni and Oyapock rivers. Women were included on a voluntary basis after beinginformed of the study team schedule through radio address and key opinion leaders.The search for HPV and cytologic examinations were performed on each sample. HPV infection was defined bythe detection of viral DNA using the Greiner Bio One® kit. Cytologic analyses were performed using the 2001Bethesda classification.Results – Overall, 643 women were included in the study. Age-standardized HPV prevalence was 35%. Theprevalence curve by age group showed a U-shaped pattern: women over 50 years had the highest risk of being infected by HPV, followed by women aged 20-29 years. In addition, 26.1% of women with a normal smear test had HPV infection. The most frequent genotypes were HPV52, HPV58, and HPV16. On interpretable smears 1.16% of women had high grade superficial intra-epithelial (HSIL) lesions.Conclusions – The standardized prevalence of HPV in French Guiana is among the highest in the world. HSILcytological lesions were nearly 4 times more frequent than in the Île-de-France region. Given the importance of the incidence of cervical cancer in French Guiana, these results suggest it may be preferable to use HPV testing than cytology. Vaccination against HPV, preferably with the new nonavalent vaccine seems an appropriate prevention measure. However, this intervention will be a challenge to implement in this region where a significant proportion of the population is not covered by health insurance.
Contexte – Le cancer du col de l’utérus est le deuxième cancer féminin le plus fréquent en Guyane française.Des études ont montré que les populations résidant dans les communes isolées de l’intérieur du départementdébutent leur vie sexuelle de façon précoce et que le multipartenariat sexuel y est fréquent. Dans ce contexte, l’objectif principal de cette étude était de déterminer la prévalence de l’infection à papillomavirus humains (HPV) dans ces zones.Méthodes – Cette étude transversale multicentrique a été conduite auprès des femmes âgées de 20 à 65 ansrésidant dans les communes isolées des fleuves Maroni et Oyapock. Les femmes étaient incluses sur la basedu volontariat après avoir été informées du passage de l’équipe de l’étude via la radio locale et par les leadersd’opinion. La recherche d’infection à HPV et les analyses cytologiques ont été réalisées sur chaque prélèvement. L’infection à HPV était définie par la détection d’ADN viral par le kit de dépistage Greiner Bio One®. Les analyses cytologiques ont été décrites selon la classification de Bethesda 2001.Résultats – Au total, 643 femmes ont été incluses. La prévalence de l’infection à HPV, standardisée sur l’âge,était de 35%. La courbe de prévalence par classe d’âge présentait une forme en U : les femmes de plus de50 ans avaient le plus haut risque d’être infectées par HPV, suivies par les femmes âgées de 20 à 29 ans.Par ailleurs, 26,1% des femmes ayant un frottis normal étaient infectées par le HPV. Les génotypes les plusfréquents étaient HPV52, HPV58 et HPV16. Sur les frottis interprétables, 1,16% des femmes avaient des lésions de haut grade (type HSIL).Conclusions – Le taux standardisé de prévalence de l’infection par le HPV en Guyane est parmi les plus élevésau monde. Les lésions cytologiques de type HSIL étaient près de 4 fois plus fréquentes qu’en Île-de-France.Étant donné l’importance de l’incidence du cancer du col de l’utérus en Guyane, ces résultats montrent qu’il est peut être préférable d’utiliser le test HPV plutôt que la cytologie. La vaccination anti-HPV, de préférence avec le nouveau vaccin nonavalent, semble être une mesure de prévention appropriée. Pour autant, cela reste un challenge de mettre en oeuvre ces interventions dans cette région où une part importante de la population n’a pas d’assurance maladie.
ISSN: 1953-8030

Droits : info:eu-repo/semantics/OpenAccess
inserm-01407222
http://www.hal.inserm.fr/inserm-01407222
http://www.hal.inserm.fr/inserm-01407222/document
http://www.hal.inserm.fr/inserm-01407222/file/2016%2C%20Dufit%20et%20al.pdf

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
French Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%.
After describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors.
Outside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements.
All HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model.
147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release.
Despite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.
ISSN: 1932-6203

inserm-01519987
http://www.hal.inserm.fr/inserm-01519987
http://www.hal.inserm.fr/inserm-01519987/document
http://www.hal.inserm.fr/inserm-01519987/file/2017%2C%20Huber%20-%20Mortality%20HIV%20prisoners%20after%20release.pdf
DOI : 10.1371/journal.pone.0175740.t002

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
ISSN: 0342-4642

inserm-01622988
http://www.hal.inserm.fr/inserm-01622988
http://www.hal.inserm.fr/inserm-01622988/document
http://www.hal.inserm.fr/inserm-01622988/file/2017%2C%20Mutricy%20-%20Predictors%20of%20complications%20of%20snake%20enven_omation%20in%20Cayenne%2C%20French%20Guiana%2C%202007%E2%80%932015.pdf
DOI : 10.1007/s00134-017-4929-3