Satisfaction with sexual life in people living with HIV/AIDS: the persistent weight of the fear of transmission.

Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.

[Use of HIV rapid tests in free and anonymous screening consultations in the French West Indies]. / Tests de dépistage rapides du VIH dans des consultations de dépistage anonyme et gratuit aux Antilles.

OBJECTIVE: Late screening for HIV is frequent in people living in the French West Indies. Rapid tests (RT) create new opportunities to improve screening for HIV. We evaluated the feasibility and acceptability of RT among users of free and anonymous screening consultations in Fort-de-France and Saint-Martin. METHODS: After confirming its reliability on more than 20,000 samples, a RT (Determine HIV-1+2 was offered on site to all testers in addition to the classic tests. RESULTS: From October 2007 to May 2008, 373 RT were performed, four were confirmed positive. Results of RT were returned to 99.4% of testers versus 89.4% of persons who underwent additional classic tests. The rate for unclaimed classic tests results was higher for the latter than for persons who had only RT: 22.2% versus 10.6%. CONCLUSIONS: Results show that RT improves the proportion of people who are informed of their results. Nevertheless, efforts must be made to persuade patients to come back for results of the standard tests to be informed of a potential sexually transmitted infection or an acute HIV infection.

Acquired protein S deficiency: correlation with advanced disease in HIV-1-infected patients.

A plasma free protein S deficiency was detected in 41 of 63 patients infected with the human immunodeficiency virus type I (HIV-1). This study consisted in a prospective analysis of blood samples from 26 patients with confirmed diagnosis of AIDS, two with AIDS-related complex, 10 with polyadenopathy, and 25 who were asymptomatic. Protein S levels were compared to a matched control group of 24 healthy subjects. A deep venous thrombosis occurred in three AIDS patients with free protein S deficiency. A significant decrease in plasma free protein S levels was observed in HIV-1-seropositive patients (mean +/- SD, 56.5 +/- 23.3%) as compared with control subjects (105.3 +/- 18%, p = 0.0001). Free protein S levels were significantly lower in patients with full-blown AIDS (37.6 +/- 12.3%) than in patients without AIDS (69.8 +/- 19.9%, p = 0.0001). Low plasma free protein S levels correlated with high beta 2-microglobulin values (p = 0.0001), low CD4+ T-cell counts (p = 0.0002) and elevated urinary neopterin concentrations (p = 0.005). According to a multiple regression analysis, the progression to stages IVB, IVC1 or IVD of the Centers for Disease Control (CDC) appeared to be the main explanatory variable in free protein S-deficient patients. Such results suggest that free protein S deficiency may coincide with the development of AIDS. This could contribute to hypercoagulability and, in some instances, thromboembolic complications in AIDS patients.

Genetic diversity and phylogenetic analysis of human immunodeficiency virus type 1 subtypes circulating in French Guiana.

We investigated the characterization of different HIV-1 subtypes present in French Guiana by use of three different methods. Serological methods were used for the initial screening, which were then confirmed by the heteroduplex mobility assay (HMA). The V3 env region was subsequently sequenced for phylogenetic analysis, to confirm the subtype of the samples, and to assign a subtype to samples that gave results that were difficult to interpret or discordant by serology or HMA. A total of 221 HIV-1 seropositive samples were typed; 110 of them were confirmed by HMA and 16 were sequenced. Of the 221 samples tested 210 patients (95%) were found to be infected with subtype B, 10 (4.5%) were infected with subtype A, and one patient was infected with subtype F. Phylogenetic analysis demonstrated that the strains from French Guiana were closely related to the subtype A and B subtypes, and that one strain was closely related to an F subtype (100% bootstrap value). Four strains from French Guiana clustered in the subtype A (99% bootstrap value) and the other strains were associated with subtype B (100% bootstrap value). The geographic position of French Guiana suggested that HIV-1 was probably introduced into the country via several routes, and thus the pattern of the HIV-1 epidemic might evolve in the near future.

[The HIV infection in pregnant women in French Guiana]. / L'infection par le VIH chez la femme enceinte en Guyane française.

OBJECTIVE: The aim of this study is to analyse the characteristics of HIV pregnant women in French Guiana then to evaluate the HIV mother to child transmission rate (MTCT) and determine the pronostic factors associated with MTCT. PATIENTS AND METHOD: An epidemiological study has been led including all deliveries in French Guiana from January 1998 to December 2000. For each case a standardized questionnaire has been gathered including epidemiological, clinical and biological data and an univariate analysis has been realized. A hundred and forty-eight women have been included in the study among 135 women came for delivery. RESULTS: The factors associated with increased MTCT in our study were no antiretroviral therapy before delivery, the lack of follow-up during pregnancy and no antiretroviral therapy in children. The HIV mother to child transmission rate was 6,5% despite the availability of antiretroviral therapies. DISCUSSION AND CONCLUSION: This rate may be explained by the difficulties of follow-up in HIV infected women. Much more needs to be done to improve access to care for women coming from foreign countries. This may be indispensable to reduce the HIV mother to child transmission rate in French Guiana.

[Spinal tuberculosis in children: contribution of imaging to diagnostic and therapeutic management]. / Tuberculose vertébrale de l'enfant: place de l'imagerie dans la démarche diagnostique et thérapeutique.

BACKGROUND: Spinal tuberculosis is an increasingly common condition, particularly in children. CASE REPORT: A 2-year-old boy presented with spinal tuberculosis with psoas abscesses. Radiological imaging played a major role in the diagnostic process. DISCUSSION: In children, spinal tuberculosis is a serious condition due to its rapid spread. Clinical symptoms are often insidious and histological and bacteriological studies may fail to disclose the diagnosis. Radiological investigations are essential in the diagnostic approach.

[Causes of death among HIV infected adults in French Guyana and the French West Indies in the era of highly active antiretroviral therapy (HAART)]. / Causes de décès des adultes infectés par le VIH dans les départements français d'Amérique à l'ère des traitements antirétroviraux hautement actifs.

OBJECTIVE: The survey "Mortality 2000" had for aim to describe the distribution of causes of death in HIV-infected adults in France. METHOD: Hospital wards involved in the management of HIV infection prospectively reported deaths occurring in 2000. The causes of death were documented using a standardized questionnaire. RESULTS: In French Guyana and the French West Indies the five referent wards reported 81 deaths. The main underlying causes of death were AIDS-related (67%), non-AIDS and non-hepatitis related cancer (9%), cardiovascular disease (7%), bacterial infections (5%), and end stage liver disease (4%). Among AIDS-related deaths, the more frequent diseases were histoplasmosis and toxoplasmosis in Guyana and atypical mycobacterial infection, tuberculosis, and cytomegalovirus disease in the West Indies. Median age was 43 years, transmission of HIV infection was heterosexual in 79%; 56% lived in poor socio-economic conditions, and 30% were born abroad. One out of five had been recently diagnosed with HIV infection and one out of three had never received antiretroviral treatment. CONCLUSION: In 2000, two in three death cases in HIV-infected adults were AIDS-related in French Guyana and the French West Indies. Improved strategies for screening HIV infection before the occurrence of AIDS are still needed taking into consideration poor socio-economic and migrant conditions.

Impact of rapid HIV testing on the return rate for routine test results in sexually transmitted infection testing centres.

To strengthen HIV screening in the French West Indies (FWI), we evaluated the feasibility of rapid tests in sexually transmitted infection (STI) testing centres. Rapid testing was offered to each user ahead of the standard screening tests. Between October 2007 and December 2008, 847 users had HIV rapid testing, and 1724 users did not have rapid testing. The results of rapid testing were returned to 99.1% of testers. However, clients who underwent rapid testing were significantly more likely than others to have not returned to get the results of their standard screening tests (for HIV and other STIs): 27.4% versus 14.0% with a relative risk of 1.96 (95% confidence interval [CI] 1.67-2.30, P < 0.0001). Rapid HIV testing has the capacity to reduce the return rates for confirmatory results of HIV testing and other STIs.

Paromomycin: an effective treatment for cryptosporidial diarrhea in patients with AIDS.

Cryptosporidiosis is a common cause of diarrhea in patients with AIDS but remains one of the most challenging AIDS-related conditions to treat. We therefore carried out an open, uncontrolled, prospective study to evaluate the efficacy of oral paromomycin for the treatment of chronic diarrhea due to Cryptosporidium in 24 successive patients infected with human immunodeficiency virus. Twenty-two of the 24 patients responded clinically, with complete remission occurring in 18 cases and marked reduction of the diarrhea occurring in four. Clearance of cryptosporidia from stools and/or intestinal biopsy specimens occurred within 2-4 weeks. Furthermore, all 18 patients who achieved complete remission gained weight. Ten patients relapsed either during administration of maintenance therapy or after discontinuation of treatment, but diarrhea resolved again after increasing or restarting paromomycin therapy in all but two. Paromomycin appeared to be an active and well-tolerated treatment for cryptosporidiosis in patients with AIDS. Efficacy is dose-related, and continuous maintenance therapy is required to prevent relapses. These data suggest that paromomycin might be given as first-line therapy in AIDS-related cryptosporidiosis, but this should be confirmed by the findings of a controlled, randomized trial.

Diagnostic value of amplification of human cytomegalovirus DNA from gastrointestinal biopsies from human immunodeficiency virus-infected patients.

In order to assess the value of human cytomegalovirus (HCMV) DNA amplification of gastrointestinal biopsies, we studied 57 human immunodeficiency virus-infected patients with and without gastrointestinal HCMV diseases. After DNA extraction, a 406-bp fragment from the unique short region of the HCMV genome was amplified by 35 cycles of polymerase chain reaction (PCR) and semiquantified from 80 to 80,000 HCMV genomic copies. Among 12 non-AIDS patients, the PCR assay was negative for 11 of 12 duodenal and 8 of 8 colorectal samples. It was also negative for 28 of 31 duodenal and 12 of 15 colorectal samples from 31 AIDS patients without gastrointestinal HCMV diseases. Among 14 AIDS patients with gastrointestinal HCMV diseases, the PCR assay was positive for 12 of 12 patients with HCMV duodenitis and for 13 of 13 patients with HCMV colitis. Results were dichotomized between high and low HCMV-DNA copy numbers. For duodenitis, sensitivity was 92% and specificity was 100%. For colitis, sensitivity was 92% and specificity was 93%. Specificity and sensitivity were not influenced by shedding status for HCMV or by other gastrointestinal infections. HCMV DNA amplification of gastrointestinal biopsies is a sensitive and specific tool for the diagnosis of gastrointestinal HCMV diseases in AIDS patients.

Fever of unknown origin in HIV-infected patients: a critical analysis of a retrospective series of 57 cases.

OBJECTIVES: The aim of the study was to assess the incidence and aetiology of fever of unknown origin in human immunodeficiency virus (HIV)-infected patients, and to evaluate the usefulness of the main diagnostic procedures. DESIGN: A retrospective study. SETTING AND SUBJECTS: We reviewed the records of 270 HIV-infected patients who were hospitalized for the first time in a department of infectious and tropical diseases during the 27 month study period. MAIN OUTCOME MEASURES: Fifty-seven patients (21%) had a history of fever of unknown origin. RESULTS: The aetiology was found in 49 cases (86%). The major cause of the fever was mycobacteriosis: atypical mycobacteria in 10 cases, Mycobacterium tuberculosis in 10, mycobacteria of unspecified type in two, and BCG strain in one. A liver biopsy and a thoracic CT scan greatly contributed to the diagnosis of mycobacterial infection. Seventeen patients were given empiric antimycobacterial therapy as a therapeutic test, of whom seven had a favourable response. The other main causes of fever were cytomegalovirus infection in five patients, leishmaniasis in four, and lymphoma in four. CONCLUSIONS: Fever of unknown origin is a frequent occurrence in the course of HIV infection, and mycobacterial infection should be considered as a first-line diagnosis in such cases. The place of empiric antimycobacterial therapy in the diagnostic strategy requires further evaluation, but appears to be an alternative to multiple investigative procedures.

Pulmonary hemorrhage and glomerulonephritis in primary biliary cirrhosis.

We observed life-threatening intrapulmonary hemorrhages and focal proliferative glomerulonephritis in a 41-yr-old woman with primary biliary cirrhosis. The severity of the symptoms necessitated blood transfusions and mechanical ventilation; the patient improved with the help of corticosteroid therapy. No formal evidence of either Goodpasture's syndrome or any other well-defined systemic vasculitis could be found. Neutrophil cytoplasmic antibodies were initially positive and became undetectable after 3 mo of immunosuppressive treatment without relapse. This association has not been described previously and may be added to the list of extrahepatic immune-mediated conditions associated with primary biliary cirrhosis.

Correlation between antiretroviral resistance mutations, biological parameters, and clinical evolution in zidovudine-treated patients infected with human immunodeficiency virus type 1.

To evaluate the correlation between zidovudine (ZDV) resistance mutations of human immunodeficiency virus type 1 (HIV-1), biological parameters, and clinical evolution, 111 HIV-1-infected patients treated with ZDV were studied. Specific mutations at codons 70, 215, and 41 in the HIV-1 reverse transcriptase coding region conferring resistance to ZDV were detected using a selective polymerase chain reaction. The appearance of ZDV resistance mutations was significantly correlated with baseline clinical stage, CD4+ cell count, and viral load, but not with duration of ZDV therapy or p24 antigen level. In univariate analysis, results showed a prognostic role of mutations at codons 215 and 41 for clinical progression to the acquired immune deficiency syndrome (AIDS) or death. In multivariate analysis after controlling for viral load, CD4+ cell count, and clinical stage, the presence of the mutation at codon 215 (but not at codon 41) remained an independent predictor of subsequent clinical evolution.

Comparative study of cutaneous leishmaniasis in human immunodeficiency virus (HIV)-infected patients and non-HIV-infected patients in French Guiana.

BACKGROUND: Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES: To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS: A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS: Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS: In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.

Waterborne outbreak of intestinal microsporidiosis in persons with and without human immunodeficiency virus infection.

Among 1454 persons whose stool samples (n=5692) were submitted to a reference laboratory for microsporidia assessment from 1993 to 1996, microsporidia were identified in 338 persons: 261 persons infected with human immunodeficiency virus (HIV), 16 transplant patients, and 61 others. Intestinal microsporidiosis appears to be an endemic disease in HIV-positive persons (prevalence, 0.1%) and a sporadic disease in HIV-negative persons (prevalence, <1/1 million). A waterborne outbreak in 200 persons (attack rate, 1% in HIV-positive patients/month) occurred in the 1995 summer, without evidence of fecal contamination of water. No explanation was found before the outbreak ended, several months before the antiprotease era. Factors associated with microsporidiosis diagnosis were HIV infection, male homosexuality, low CD4 cell counts, and diarrhea. The major factor associated with a diagnosis of microsporidiosis during the outbreak was living in an area corresponding to one of the three water distribution subsystems of the town. Lake contamination was suspected.