Chapitre 2. La loi de bioéthique : un enjeu de démocratie sanitaire.

The law of bioethics defines the judicial framework for governing medical practices and research involving the human body and the embryo. Does any scientific or technologic innovation warrant a modification of the law? To respond to this question, a preliminary reflection is necessary so as to define new equilibria which respect ethical principles, the promotion of solidarity with respect for the autonomy of each person.The CCNE is charged with organizing public debate, in the form of a general assembly of bioethics, with the support of regional spaces of ethical reflection. This extensive experience took place from January to June 2018 and lead to several lessons, notably the strong expression of a need for information and a critical vision of the notion of medical progress.Then, the parliamentary instruction and hearings that accompanied it, from 24 July 2019 to 2 August 2021, contributed developments to the initial bill. Thus, the periodic review of the law of bioethics is now based on citizen participation in the construction of legislative arbitration, demonstrating the French way of social participation.

Chapitre 2. La loi de bioéthique : un enjeu de démocratie sanitaire.

The law of bioethics defines the judicial framework for governing medical practices and research involving the human body and the embryo. Does any scientific or technologic innovation warrant a modification of the law? To respond to this question, a preliminary reflection is necessary so as to define new equilibria which respect ethical principles, the promotion of solidarity with respect for the autonomy of each person.The CCNE is charged with organizing public debate, in the form of a general assembly of bioethics, with the support of regional spaces of ethical reflection. This extensive experience took place from January to June 2018 and lead to several lessons, notably the strong expression of a need for information and a critical vision of the notion of medical progress.Then, the parliamentary instruction and hearings that accompanied it, from 24 July 2019 to 2 August 2021, contributed developments to the initial bill. Thus, the periodic review of the law of bioethics is now based on citizen participation in the construction of legislative arbitration, demonstrating the French way of social participation.

[National Consultative Ethics Committee: forty years of bioethics in France!] / Comité consultatif national d'éthique : quarante ans de bioéthique en France.

NATIONAL ADVISORY COMMITTEE ON ETHICS: FORTY YEARS OF BIOETHICS IN France. The history of the National Advisory Committee on Ethics for Life Sciences and Health (CCNE) shows its specificity, the evolution of its competences and its role in the institutional landscape of ethics in France, between independence and openness to the City. While constantly reaffirming its adherence to fundamental ethical principles, the CCNE has been marked by forty years of movements, crises and upheavals in the fields of health, science and society. What about tomorrow?

COMITÉ CONSULTATIF NATIONAL D'ÉTHIQUE : QUARANTE ANS DE BIOÉTHIQUE EN France. La spécificité du Comité consultatif national d'éthique pour les sciences de la vie et de la santé (CCNE) apparaît à travers son histoire, qui est celle de l'évolution de ses compétences et de son rôle dans le paysage institutionnel de l'éthique en France, entre indépendance et ouverture sur la Cité. Tout en réaffirmant sans cesse son adhésion à des principes éthiques fondamentaux, le CCNE a été marqué par quarante ans de mouvements, de crises et de bouleversement dans le champ de la santé, des sciences et de la société. Et demain ?

[Ethical issues of vaccination against Sars-CoV-2]. / Enjeux éthiques de la vaccination contre le Sars-CoV-2.

As a tool for public health, the vaccination policy is based on the analysis of benefits and risks. Thus, the National Consultative Ethics Committee has been at the heart of the orientations taken in terms of the deployment of the vaccination against severe acute respiratory syndrome coronavirus 2, by contributing its reflections on the associated ethical issues.

CD4+ cell count recovery after combined antiretroviral therapy in the modern combined antiretroviral therapy era.

OBJECTIVE: To assess CD4 recovery after combined antiretroviral therapy (cART) initiation with sustained virologic control. DESIGN: Cohort study based on the French Hospital Database on HIV (FHDH-ANRS CO4). METHODS: We selected naive HIV-1-infected individuals initiating cART between 2006 and 2014 with CD4 cell counts less than 500 cells/µl who achieved virologic control, defined as two consecutive viral loads less than 50 copies/ml. We estimated the cumulative incidence of CD4 recovery at least 500 cells/µl and identified associated factors, considering 'virologic failure,' 'loss to follow-up' and 'death' as competing events. RESULTS: We analyzed 6050 individuals with a median follow-up of 14.2 months since virologic control. The cumulative incidence for CD4 recovery after 6 years of virologic control reached 69.7%. The main factor associated with CD4 recovery was the CD4 count at treatment initiation [subdistribution hazard ratio (sHR) 9.64, 95% confidence interval (95% CI) 8.12-11.43 for CD4 cell counts between 350 and 500 cells/µl compared with CD4 cell counts <100 cells/µl). A higher CD4/CD8 ratio at initiation was also independently associated with a higher probability of CD4 recovery [sHR 1.67; 95% CI 1.34-2.09] for a CD4/CD8 ratio ≥1.00 vs. < 0.30). Higher viral load at initiation was also associated with a higher probability of CD4 recovery, whereas time to viral suppression was not. CONCLUSION: After 6 years of sustained virologic control, a large majority of the population achieved CD4 recovery. A higher CD4 cell count at initiation was a strong predictor of CD4 recovery and, to a lesser extent, a higher CD4/CD8 ratio at initiation. These results confirm the necessity of early treatment.

HIV-AIDS and noncommunicable diseases: a shared vision.

Although different in nature, HIV/AIDS and the noncommunicable diseases have many issues in common: the importance of rapid screening, the high cost of treatment, patients' treatment adherence, and the challenge of integrating services in basic health facilities, especially in the South. Several lessons can be drawn today from the fight against AIDS (about community involvement, the organization of research, free treatment, and the mobilization of funding) that can nourish strategic thinking for the fight against noncommunicable diseases.

Recurrent obstructive acute pyelonephritis: A rare form of Actinotignum (Actinobaculum) schaalii infection in a HIV-1 infected patient.

Actinobaculum schaalii is a rarely reported, anaerobic, Gram-positive bacterium which role as uropathogen is emerging. We report here the case of a 47 year old HIV-1 infected woman presented with five recurrent episodes of obstructive pyelonephritis in the context of multiple renal stones. No bacteria was found until the fifth episode, during which prolonged urinary cultures as well as 16S rDNA sequencing allowed the diagnosis of A. schaalii infection. She had developed a life-threatening condition with severe renal failure. A right nephrectomy was performed and found that the intrarenal stones were attributed to the antiretroviral therapy. The renal parenchyma corresponded to an end-stage renal disease with chronic pyelonephritis without abcesses or granules. The situation improved after six months of amoxicillin therapy.