Does hepatitis C virus co-infection accelerate clinical and immunological evolution of HIV-infected patients?

OBJECTIVE: To study the influence of hepatitis C virus (HCV) co-infection on clinical and immunological evolution of HIV-infected patients. DESIGN: A longitudinal study of HIV-infected individuals with or without HCV infection, identified at the Infectious Diseases Department of Dijon University Hospital and enrolled in a historical cohort, was performed. METHODS: One hundred and nineteen HIV-infected people co-infected with HCV and 119 matched individuals infected with HIV alone were included in the cohort (median participation time 3 years; range, 2 months to 11.5 years). Clinical progression was defined as one or more of the following: a 30% decrease in the Karnofsky index; a 20% loss of body weight; an AIDS-defining illness (for non-AIDS patients); death (except by accident, suicide or overdose). Immunological progression was defined as a 50% decrease in the initial CD4 T-cell count (for patients with an initial count > 100 x 10(6) cells/l). Effects of HCV co-infection were evaluated using Kaplan-Meier survival analysis and significance was tested using univariate (log-rank and Peto's tests) and multivariate methods (Cox's model). RESULTS: In univariate analysis, immunological progression was not statistically different between the HCV-positive group and the HCV-negative group, whereas clinical progression was significantly faster in HCV-positive patients (P < 0.005, log-rank test). In a multivariate Cox model, clinical progression remained significantly associated with infection by HCV [hazard ratio (HR), 1.64; 95% confidence interval (CI), 1.06-2.55; P < 0.05]. Stratified multivariable analysis retained HCV as a significant prognostic factor of clinical progression (HR, 10.9; 95% CI, 1.09-109.3; P < 0.05) and immunological progression (HR, 2.31; 95% CI, 1.16-4.62; P < 0.02) for patients with an initial CD4 count above 600 x 10(6) cells/l. CONCLUSIONS: Clinical progression is more rapid in HIV-HCV co-infected patients than in HIV-seropositive patients are not infected by HCV. The prognostic value of HCV infection for both clinical and immunological progression is significant at early stages of HIV infection. These findings may argue for active management of hepatitis C infection in co-infected individuals, especially for asymptomatic patients whose CD4 count is above 600 x 10(6) cells/l, to predict and prevent accelerated progression of HCV and HIV diseases.

[Comparison of MRA and angiography in the follow-up of intracranial aneurysms treated with GDC]. / Comparaison de l'ARM et de l'artériographie dans le suivi des anévrismes intracrâniens traités par gdc.

OBJECTIVE: Evaluation of TOF 3D MRA compared to angiography in the follow-up of intracranial aneurysms treated by Guglielmi detachable coils (GDC). MATERIAL: and method: Prospective analysis of follow-up MRA and angiographies for 20 patients with 22 aneurysms. There were 2 MRAs for 3 aneurysms giving a total of 25 cases. RESULTS: A poor correlation between MRA and angiography was observed in 21 cases of 25. For 9 cases, stable exclusion (95-100%) visible on MRA was confirmed by angiography. For 12 other cases, a residual flow within the aneurysmal neck or a residual flow between coils was detected by MRA and confirmed by angiography. A poor correlation was found in 4 cases out of 25: 3 residual flows within the aneurysmal neck and 1 residual flow within the coil mass not visible on MRA. MRA has a sensibility of 75% for the detection of an anomaly, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 69.2%. MRA is able to detect a large residual flow within aneurysmal neck and a re-growth, which would need a second embolization. Anomalies not visible on MRA as observed in our study, residual flow within the coil mass and the aneurysmal neck, do not require complementary treatment. CONCLUSION: A normal TOF 3D MRA can avoid an angiography in the follow-up of an intracranial aneurysm treated by GDC.