Drastic Reduction in Time to Controlled Viral Load in People With Human Immunodeficiency Virus in France, 2009-2019: A Longitudinal Cohort Study.

BACKGROUND: Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019. METHODS: We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan-Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021. RESULTS: Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127-745] to 73 [48-132] days in 2009-2011 and 2018-2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009-2011 to 13 [5; 26] days in 2018-2019, and from ART to controlled VL from 83 [35; 130] in 2009-2011 to 38 [28; 90] days in 2018-2019. Differences were observed depending on patients' characteristics. CONCLUSIONS: We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade.

Real-life challenges using personalized prognostic scoring systems in acute myeloid leukemia.

Personalized medicine is a challenge for patients with acute myeloid leukemia (AML). The identification of several genetic mutations in several AML trials led to the creation of a personalized prognostic scoring algorithm known as the Knowledge Bank (KB). In this study, we assessed the prognostic value of this algorithm on a cohort of 167 real life AML patients. We compared KB predicted outcomes to real-life outcomes. For patients younger than 60-year-old, OS was similar in favorable and intermediate ELN risk category. However, KB algorithm failed to predict OS for younger patients in the adverse ELN risk category and for patients older than 60 years old in the favorable ELN risk category. These discrepancies may be explained by the emergence of several new therapeutic options as well as the improvement of allogeneic stem cell transplantation (aHSCT) outcomes and supportive cares. Personalized medicine is a major challenge and predictions models are powerful tools to predict patient's outcome. However, the addition of new therapeutic options in the field of AML requires a prospective validation of these scoring systems to include recent therapeutic innovations.

The Prognosis of ART Is Not Altered in Cystic Fibrosis Women: A Case-Report Study.

Research Question: Unlike in men, a very limited number of studies were focused on the specificity of ART management of cystic fibrosis (CF) in women. The purpose of this study was to determine the causes of infertility in patients, the appropriate ART treatment, and their prognosis in terms of pregnancy. Design: We conducted a multicentre analytical case-control study including CF women who were age-matched to non-CF women. We reported the causes of infertility, the ART management type and pregnancy outcomes. Results: 17 cases were compared to 34 controls. There was no significant difference between the groups concerning cause infertility. There was a non-statistically significant trend with a lower antral follicle count in CF compared to controls (19.5 versus 26.8, p=0.08). IUI seemed to be as successful as IVF/ICSI in CF as opposed to controls where the IVF/ICSI was the most effective (in CF group for HCG >100 UI/L: 38.8% vs. 36.8%, p=0.4175). There were more embryos obtained in CF than in controls (3.1 versus 1.6, p=0.02). The number of oocytes and embryos obtained and pregnancy outcomes remained similar between DF508 homozygous group and others CFTR mutations group. The results of ART procedures and pregnancy evolution were not influenced by FEV1. Conclusion: In absence of any other pathology, IUI may be first option for CF women. If insemination fails, IVF with a low dose of gonadotropins may be more appropriate to prevent the risk of hyperstimulation syndrome. FEV1 and genetic do not seem to be contributing factors in the prognosis of ART.

Preventive effect of bariatric surgery on type 2 diabetes onset in morbidly obese inpatients: a national French survey between 2008 and 2016 on 328,509 morbidly obese patients.

BACKGROUND: The association between bariatric surgery (BS) and the prevention of type 2 diabetes (T2D) and its complications in patients with obesity has been rarely addressed in large, nationwide database studies. OBJECTIVE: To estimate the preventive effect of BS against T2D and its vascular complications in patients with obesity without co-morbidity at baseline. SETTING: All French public and private hospitals. METHODS: Data were extracted from the French National Health Service database between 2008 and 2016. All patients with obesity aged 18- to 60-years old, free of T2D and major co-morbidities, and with at least 1 year of follow-up were analyzed. Patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) were included in the BS group, and patients with obesity with no history of BS were considered as controls. RESULTS: Of 328,509 patients with obesity, 102,627 had BS. Between 2009 and 2016, 9.7% (31,946/328,509) of patients had a diagnosis of T2D associated with morbid obesity, 13.2% of the control group versus 2.0% of the BS group (P < .001). BS was associated with favorable 8-year T2D event-free survival estimates of 92.3% in the BS group against 58.2% in the control group. The hazard ratio for the diagnosis of T2D was .18 (95% confidence interval, .17-.19) for the BS group versus controls, after adjustment on age, sex, body mass index, and baseline differences. A significant difference was found between the type of bariatric procedure (P < .001) with more T2D after AGB (4.5%) than after GB (1.2%) or SG (0.9%). T2D complications were more common in controls (P < .001) with multiple T2D complications occurring in 1% of patients in the control group and .1% in the BS group (P < 0.001). GB and SG were more effective than AGB. CONCLUSIONS: This nationwide study shows that BS reduces the new onset of T2D in patients with obesity by 82%. SG and GB give comparable results and both are more effective than AGB.

Revisional But Not Conversional Gastric Bypass Surgery Increases the Risk of Leaks: Review of 176 Redo out of 932 Consecutive Cases.

INTRODUCTION: Nowadays, surgeons are dealing more and more with patients experiencing failure of a previous bariatric procedure after the worldwide exponential increase of bariatric surgery. Only a few and contradictory studies investigated both outcomes and complications risk factors in this subset population of bariatric patients. We aimed to study a homogeneous population of patients undergoing redo bariatric surgery (REDO-BS) resulting in bypass anatomy to evaluate early postoperative outcomes and identify risk factors of postoperative complications and mortality. MATERIAL AND METHODS: In this study, we compared the outcomes of patients undergoing REDO-BS from another former bariatric procedure into Roux-en-Y gastric bypass (RYGP) to those undergoing primary RYGP. Data were extracted from a prospectively maintained database. RESULTS: One hundred thirty-eight conversional bariatric surgery (CBS) cases resulting in RYGP anatomy and 38 RBS cases of pouch resizing (PR) were compared with 756 primary RYGP. There were no statistical significant difference in outcomes between the primary and CBS groups but patients undergoing PR had a significant higher risk of developing a leak than others. CBS complication risk factors were age (OR = 1.05; p = 0.04), operative time, and T2DM (OR = 4.11; p = 0.03). CONCLUSIONS: CBS is safe and leads to similar early postoperative outcomes as primary RYGP whereas the indication for revisional surgery such as PR should be carefully evaluated as it is associated with an increased risk of leak.

Prostate cancer: net survival and cause-specific survival rates after multiple imputation.

BACKGROUND: Estimations of survival rates are diverse and the choice of the appropriate method depends on the context. Given the increasing interest in multiple imputation methods, we explored the interest of a multiple imputation approach in the estimation of cause-specific survival, when a subset of causes of death was observed. METHODS: By using European Randomized Study of Screening for Prostate Cancer (ERSPC), 20 multiply imputed datasets were created and analyzed with a Multivariate Imputation by Chained Equation (MICE) algorithm. Then, cause-specific survival was estimated on each dataset with two methods: Kaplan-Meier and competing risks. The two pooled cause-specific survival and confidence intervals were obtained using Rubin's rules after complementary log-log transformation. Net survival was estimated using Pohar-Perme's estimator and was compared to pooled cause-specific survival. Finally, a sensitivity analysis was performed to test the robustness of our constructed multiple imputation model. RESULTS: Cause-specific survival performed better than net survival, since this latter exceeded 100 % for almost the first 2 years of follow-up and after 9 years whereas the cause-specific survival decreased slowly and than stabilized at around 94 % at 9 years. Sensibility study results were satisfactory. CONCLUSIONS: On our basis of prostate cancer data, the results obtained by cause-specific survival after multiple imputation appeared to be better and more realistic than those obtained using net survival.