[Evaluation of an outpatient multidisciplinary Neuro-HIV clinic by the patients and referring doctors]. / Evaluation de la plateforme Neuro-VIH d'un hôpital universitaire par les patients et les médecins traitants.

The neurocognitive complaints among HIV infected patients remain frequent, and to establish their etiology can be challenging. We created in 2011 an outpatient Neuro-HIV clinical platform that takes advantage of a multidisciplinary approach with 5 specialists (neuropsychologist, neurologist, psychiatrist, infectiologist and neuroradiologist). In order to estimate its utility, we conducted two questionnaire-based interviews by phone calls with the patients and their referring physicians. Three quarters of both the patients and the physicians interviewed consider the platform useful or essential. Even though there is often no immediate treatment for cognitive disorders, the patients receive from this multidisciplinary approach a better understanding of their disease, which may help them to better cope with their anxieties in daily life.

Les plaintes neurocognitives chez les patients infectés par le VIH sont fréquentes, et diagnostiquer leur étiologie est complexe. En 2011, nous avons créé une plateforme ambulatoire Neuro-VIH permettant une évaluation multidisciplinaire (neuropsychologues, neurologues, psychiatres, infectiologues, neuroradiologues) de ces patients. Afin d'évaluer l'utilité de cette plateforme, une enquête téléphonique auprès des patients ainsi que de leurs médecins traitants a été effectuée. Trois quarts des patients et médecins interrogés la considèrent utile, voire indispensable. Malgré l'absence de traitement immédiat des troubles cognitifs, les patients disent que bénéficier de cette approche multidisciplinaire leur a permis de clarifier la nature de leurs troubles et de mieux faire face à leurs angoisses sur les plans privé et professionnel.

Humoral response to the influenza A H1N1/09 monovalent AS03-adjuvanted vaccine in immunocompromised patients.

BACKGROUND: Few data are available regarding the immunogenicity and safety of the pandemic influenza vaccine in immunocompromised patients. We evaluated the humoral response to the influenza A H1N1/09 vaccine in solid-organ transplant (SOT) recipients, in patients with human immunodeficiency virus (HIV) infection, and in healthy individuals. METHODS: Patients scheduled to receive the pandemic influenza vaccine were invited to participate. All participants received the influenza A H1N1/09 AS03-adjuvanted vaccine containing 3.75 µg of hemagglutinin. SOT recipients and HIV-infected patients received 2 doses at 3-week intervals, whereas control subjects received 1 dose. Blood samples were taken at day 0, day 21, and day 49 after vaccination. Antibody responses were measured with the hemagglutination inhibition assay (HIA) and a microneutralization assay. RESULTS: Twenty-nine SOT recipients, 30 HIV-infected patients, and 30 healthy individuals were included in the study. Seroconversion measured by HIA was observed in 15 (52%) of 29 SOT recipients both at day 21 and day 49; in 23 (77%) of 30 at day 21 and 26 (87%) of 30 at day 49 in HIV-infected patients, and in 20 (67%) of 30 at day 21 and in 23 (77%) of 30 at day 49 in control subjects (P = .12 at day 21 and P = .009 at day 49, between groups). Geometric means of antibody titers were not significantly different between groups at day 21 or at day 49. CONCLUSIONS: Influenza A H1N1/09 vaccine elicited a similar antibody response in HIV-infected individuals and in control subjects, whereas SOT recipients had an overall lower response. A second dose of the vaccine only moderately improved vaccine immunogenicity in HIV-infected patients.