Number, type and cost of microbiological tests during HIV Pre-Exposure Prophylaxis: The experience of a French hospital.

BACKGROUND: Microbiological tests are required for individuals on HIV Pre-Exposure Prophylaxis (PrEP), but their real-life numbers, types and cost are poorly described. METHODS: Number, type, and results of microbiological tests performed in a Besançon Hospital-associated laboratory, France, from 2016 to 2019, in the setting of PrEP consultations were retrospectively collected. Costs were estimated by the current reimbursement rate set by the French national protection system. RESULTS: 756 consultations for PrEP initiation or follow-up of 135 persons were performed over 4 years. Among 3434 tests performed in the institution-associated laboratory, 1083 and 2351 were virological and bacteriological tests, respectively. Serology was predominant in virology (98% of virological tests), with HIV, HCV, and HBV screening as the 3 more frequent assays, whereas molecular biology was predominant in bacteriology (63.1% of bacteriological tests) with N. gonorrhoeae and C. trachomatis screening as leader assays. Agar-based culture accounted for 1% of bacterial tests. The global cost of microbiological tests was 45,983.20 euros, corresponding to a mean cost of 60.80 euros per consultation. Virological and bacteriological tests accounted for 37.7% and 62.3% of this budget, respectively. No seroconversion was observed for HIV or HCV. N. gonorrhoeae and C. trachomatis were detected at least once in 39.3% and 22.4% of individuals, respectively, with 15% of symptomatic episodes in both cases. Active syphilis infection was detected in 15.4% of individuals. CONCLUSIONS: Since numerous microbiological tests are required during PrEP, the availability of specific technical platforms should not be neglected by centers wishing to set up PrEP consultations.

Kaposi sarcoma among people living with HIV in the French DAT'AIDS cohort between 2010 and 2015.

BACKGROUND: Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV-infected people. OBJECTIVE: To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. METHODS: Retrospective study using longitudinal data from 44 642 patients in the French Dat'AIDS multicenter cohort. Patients' characteristics were described at KS diagnosis according to ART exposure and to HIV-plasma viral load (HIV-pVL) (≤50 or >50) copies/mL. RESULTS: Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART-experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV-pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted-PI-based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. LIMITATIONS: Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. CONCLUSION: Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV-pVL ≤50 cp/mL remain to be explored.

Missed opportunities of HIV pre-exposure prophylaxis in France: a retrospective analysis in the French DAT'AIDS cohort.

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016. METHODS: Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. RESULTS: Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). CONCLUSION: With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.

[Ocular syphilis: 9 cases]. / Syphilis oculaire : à propos de 9 cas.

Syphilis is a disease with ocular involvement may be opening and cover all ocular structures. The objective of the study was to retrospectively identify and describe all cases of ocular syphilis diagnosed in the ophthalmology department of Besançon University Hospital from March 2004 to April 2014. Between March 2004 and April 2014, we diagnosed and monitored 9 male patients (13 eyes) with ocular syphilis (1 interstitial keratitis, chorioretinitis associated with a 1 hyalite, 3 panuvéites, 1 chorioretinitis after placoid, 3 bilateral papillary edema). Patients had a mean age of 52.6 years (32-77 years) at diagnosis and the inaugural symptoms were in 100% of cases decreased visual acuity. The follow-up period ranged from 1 month to 5 years. The curative treatment included intravenous antibiotics penicillin G for 3 weeks. All patients had an improvement in their AV (AV initial range "counting fingers" and 0.6 versus AV final between 0.5 and 1 in decimal scale). Syphilis is a disease currently on the rise. It must be systematically sought before any inflammatory disease of the eye or papilledema.

Compliance to recommendations for the management of curative treatment of Plasmodium vivax/ovale infections.

OBJECTIVES: We assessed the compliance to recommendations for the routine management of Plasmodium vivax/ovale malaria, and analyzed the impact of discrepancies on the quality of care. PATIENTS AND METHODS: We reviewed the cases of P. ovale and P. vivax malaria treated at the Besançon University Hospital, France (2008-2013). RESULTS: Chloroquine was prescribed in 44% of the 18 cases (4 due to P. ovale, 14 to P. vivax). Radical cure with primaquine was prescribed after the first bout of malaria for 6 patients. The primaquine dose prescribed was inferior to the recommended one for 4 patients. The mean delay between schizonticide treatment and primaquine cure was 43 days. CONCLUSIONS: The delay before access to primaquine radical cure was the only parameter, likely to alter treatment effectiveness, but also difficult to shorten. Future national guidelines should take into account that not all patients have access to primaquine treatment immediately after schizonticide treatment.

[Study of new HIV infection between 2000 and 2007 in the north and east of France]. / Étude des infections à VIH nouvellement découvertes entre 2000 et 2007 dans le Nord et l'Est de la France.

UNLABELLED: In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data. OBJECTIVE: The authors' aim was to study the epidemiologic evolution of new HIV cases between January 1, 2000 and December 31, 2007 in North and East of France, to compare them with national and local data, to complete them, and to identify local specificities. METHOD: A retrospective observational study was made, with a standardized questionnaire completed by any volunteer HIV care center in the North and the East of France. RESULTS: Three thousand and thirty questionnaires were analyzed. The main trends over these eight years were similar to those observed in the rest of France: a decreasing number of women and patients of foreign origin, a decreasing number of patients with a late diagnosis, an increasing number of primary infections, and a higher CD4 count on initiation of antiretroviral treatment. However, local specificities appeared, such as: increasing proportion of men having sex with men and a less important proportion of co-infected patients with hepatitis B and/or C than on the national level. The therapeutic regimen is adequate according to expert recommendations, with, however, a marked "center effect" concerning prescription habits. DISCUSSION: Such a local epidemiological study, even if it confirms observed trends in the rest of France, allows detailing them and suggesting prevention measures more specifically adapted to local settings.

[Risk factors for Abacavir-induced hypersensibility syndrome in the "real world"]. / Facteurs de risque de syndrome d'hypersensibilité à l'Abacavir en pratique clinique de routine.

UNLABELLED: Abacavir (ABC) is a generally well-tolerated NRTI. However, up to 5% of patients may develop hypersensitivity syndrome (HSS) within the first weeks of treatment. The objectives of this study were to describe the side effects of ABC, to evaluate the incidence of the ABC-HSS, and to identify the risk factors of HSS after first exposure to ABC in a cohort of patients followed up in a university HIV clinic. METHODS: The charts of all HIV-infected patients who started ABC between February 1998 and May 2002 were reviewed. HSS was defined as the onset, within 8 weeks of ABC initiation, of either a skin rash associated with at least one of the following symptoms (fever, gastrointestinal symptoms, respiratory symptoms, myalgia, malaise) or at least three of the above symptoms in the absence of rash. A multivariate logistic regression analysis was performed to identify risk factors of HSS. RESULTS: Of the 191 patients studied (134 M, 57 F, mean age 39 years), 53 (27.8%) presented with manifestations that were regarded as potential side-effects of ABC. Ten (5.2%) developed HSS, none of whom died. Two factors were independently associated with an increased risk of HSS: history of allergy to nevirapine (OR 8.1, 95% CI 1.6-40.5, p = 0.02), and being naïve to ART (OR 5.8, 95% CI 1.2-28.5, p = 0.04). CONCLUSION: This study "in the real world" confirms that the incidence of ABC-induced HSS is of about 5%. It also confirms that HSS occurs more frequently in patients with a history of allergy to nevirapine and in ART-naïve patients.

[Severe acute respiratory syndrome (SARS). The questions raised by the management of a patient in Besançon and Strasbourg]. / Syndrome respiratoire aigu sévère (Sras) Les questions posées par la prise en charge d'un patient à Besançon et Strasbourg.

INTRODUCTION: In mid-June 2003, 8500 probable cases of Severe Acute respiratory Syndrome (SARS) responsible for 800 deaths in 29 countries were reported by the World Health Organization (WHO). In France, 5 probable cases of SARS were diagnosed until May 2003. We report the case of one of the 5 French cases, hospitalized successively in Besançon then in Strasbourg. OBSERVATION: This 54 year-old man was infected during the Air France flight from Hanoi to Paris via Bangkok by the index case, who himself had been contaminated at the French hospital in Hanoi and who was hospitalized in a critical state in the Tourcoing hospital shortly after his arrival in France. The first clinical signs (fever and dry cough) appeared 4 days after contact with the index case. The chest X-ray showed a pulmonary consolidation 6 days after the first clinical symptoms. Blood test revealed deep lymphopenia and elevated LDH. The patient finally recovered with a treatment combining ribavirin and steroids. CONCLUSION: The clinical symptoms of SARS are unspecific and its evolution may be misleading. The epidemiological context (contact with the index case) is a key point for the diagnosis. The management of such a patient requires the careful protection of contacts, the adequation between medical and paramedical staff and excess work and communication to the general public.

[Infectious osteoarthritis due to Propionibacterium acnes. Two new cases]. / Infections ostéoarticulaires à Propionibacterium acnes. Deux nouveaux cas.

INTRODUCTION: Propionibacterium acnes is an anaerobic germ, usually found as a saprophyte of the skin and the mucosa. It may be responsible for iatrogenic or spontaneous osteoarhritis. EXEGESIS: We report two new cases of septic arthritis induced by P. acnes: a case of iatrogenic spondylodiscitis and a case of spontaneous septic arthritis of the lumbar facet joints. The two patients were immunocompetent, without acne. CONCLUSION: Except for patients with criteria of the SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteomyelitis), osteoarthritis caused by P. acnes is increasingly described. The number of these infections is probably underestimated because of the technical problems involved in isolating P. acnes in the laboratory.