Patients with Long COVID continue to experience significant symptoms at 12 months and factors associated with improvement: A prospective cohort study in France (PERSICOR).

OBJECTIVES: This study examines long COVID symptoms course over 12 months, their impact on daily life, and associated factors for symptom relief. METHODS: A prospective cohort study included 231 participants with long COVID at 12-month follow-up. Data on characteristics, symptom course, and remission were collected using a questionnaire and a remission scale. Poisson regression models were used to estimate the prevalence rate ratio (PRR) and 95% confidence intervals (CIs) for factors associated with symptom improvement. RESULTS: Of the 231 participants, 63.2% developed SARS-CoV-2 antibodies before COVID-19 vaccination. At 12 months, only 8.7% (95% CI: 5.4-13.1%) reported complete remission, while 28.6% noted significant improvement. Most symptoms remained prevalent: asthenia (83.1%), neurocognitive/neurological (93.9%), cardiothoracic (77.9%), Musculoskeletal (78.8%). During long COVID, 62.2% stopped working, and only 32.5% resumed full-time professional activities. Presence of SARS-CoV-2 antibodies before vaccination increased the probability of improvement (aPRR: 1.60, P = 0.028), while ageusia at initial long COVID phase decreased the probability (aPRR: 0.38, P = 0.007). CONCLUSIONS: Long-COVID symptoms persisted in the majority of participants after 12 months, with significant impacts on daily life and work. SARS-CoV-2 antibodies were associated with better prognosis, while persistent ageusia indicated a lower probability of improvement. These findings highlight the need for ongoing support and care for individuals with long COVID.

Injectable long acting antiretroviral for HIV treatment and prevention: perspectives of potential users.

BACKGROUND: The use of long acting injectable (LAA) antiretroviral drugs may be an alternative option for HIV treatment and prevention. Our study focused on patient perspectives to understand which individuals, among people with HIV (PWH) and pre-exposure prophylaxis (PrEP) users, would constitute the preferential target for such treatments in terms of expectations, tolerability, adherence and quality of life. METHODS: The study consisted in one self-administrated questionnaire. Data collected included lifestyle issues, medical history, perceived benefits and inconveniences of LAA. Groups were compared using Wilcoxon rank tests or Fisher's exact test. RESULTS: In 2018, 100 PWH and 100 PrEP users were enrolled. Overall, 74% of PWH and 89% of PrEP users expressed interest for LAA with a significantly higher rate for PrEP users (p = 0.001). No characteristics were associated with acceptance of LAA in both groups in term of demographics, lifestyle or comorbidities. CONCLUSION: PWH and PrEP users expressed a high level of interest in LAA, since a large majority seems to be in favor of this new approach. Further studies should be conducted to better characterize targeted individuals.

Initier la PrEP en médecine de ville et envisager la santé sexuelle des personnes en situation de migration.

In June 2020, 32,000 people began HIV Pre-exposure prohylaxis (PrEP) in France. The objective of this work is to propose PrEP for migrants in city medical offices in collaboration with hospitals. This is happening in the Goutte d’Or neighborhood of Paris where one-third of the inhabitants were born abroad [1]. The Goutte d’Or multidisciplinary and multi-site health center (MSP), composed of independent health professionals, hosted this study.The obstacles to overcome are multifold, notably talking about sexuality and presenting a prevention method that is little known to people in migratory situations. In addition, the first prescription of ARVs in this period had to be given by a hospital doctor (until June 1st 2021) [2].The working hypothesis is that general practitioners can overcome these obstacles within the framework of a protocol defining the discussions on sexuality and the organization of a PrEP consultation along with the GP and a hospital doctor within the city doctor’s office.The study took place between March 1st 2018 and October 31st 2020. 180 questionnaires concerning opportunities for PrEP were distributed by general practitioners (GP) and a midwife from the MSP. 43 people were identified as qualifying for the PrEP. 24 PrEP were prescribed, 23 continuously, and one on demand. A semi-directive interview on sexual health was proposed to the 43 people identified for PrEP consultations.The in-depth interviews confirmed that although sexual health may not be the primary interest of the consultants, there are nevertheless real needs that are not often taken into account.

[Fragility and precariousness of people living with HIV]. / Fragilité et précarité des personnes vivant avec le VIH.

Fragility and Precariousness of People living with hiv Living with hiv in 2021 means having a Chronic disease that is still not "like the Others". Stigma and discrimination persist. And the prognosis remains uncertain in the Countries of the south where access to care Can be problematic and the emergence of Resistance is a concern. Being treated during the covid-19 pandemic Represented a public health challenge, but Persons living with hiv (plwhiv), who were More precarious and psychologically fragile Than the general population, were more Affected by the difficulties in accessing Care. The population of plwhiv includes two main Groups in particular migrants and msm (men who have sex with men) as indicated By the figures for new infections in 2020. The migrant population affected is heterogeneous, With people who have been living in France for decades but also newcomers Whose migration path is often marked by Traumatic events. In addition to the weight Of the hiv infection itself, frequent aggressions And concerns for loved ones back Home, as well as the weight of exile, result In a high prevalence of psychological disorders. Even today, being homosexual is not always Self-evident, whether the stigma comes from Others or is integrated by the person himself (internalized stigma). Aging is globally depreciated In our society but particularly in The gay community. This community is also Affected by the practice of chemsex and Slam, use of psychoactive substances. All of these elements lead to a high prevalence Of psychological disorders and possible Social insecurity. The care of plwhiv Must be global, it requires taking into account All these aspects, medical, psychological And social, and associating the patients To the care.

Fragilité et Précarité des personnes. Vivant avec le vih Vivre avec le vih en 2021 signifie être Atteint d'une maladie chronique qui n'est Toujours pas « comme les autres ¼. La Stigmatisation et les discriminations persistent, Et le pronostic reste incertain dans Les pays du sud, où l'accès aux soins reste Aléatoire et l'apparition de résistances Préoccupante. Être soigné pendant la pandémie de Covid-19 a représenté un défi de santé Publique, mais les personnes vivant Avec le vih (pvvih), plus précaires et Fragiles psychologiquement que la population Générale, ont été davantage Affectées par les difficultés d'accès Aux soins. La population des pvvih comprend en Particulier deux groupes principaux : les Migrants et les hommes qui ont des rapports Sexuels avec des hommes (hsh), Comme l'indiquent, en 2020, les chiffres Des nouvelles contaminations. La population migrante atteinte est hétérogène, Avec des personnes résidant sur Le sol français depuis des décennies mais Aussi des primo-arrivants, au parcours de Migration souvent semé d'événements Traumatiques. Outre le poids de l'atteinte Par le vih lui-même, les agressions fréquentes Et les préoccupations pour les Proches restés au pays, tout comme le Poids de l'exil, aboutissent à une prévalence Elevée des troubles psychiques. Aujourd'hui encore, être homosexuel ne va Pas toujours de soi, que la stigmatisation Provienne des autres ou qu'elle soit intégrée Par la personne elle-même (autostigmatisation). Le vieillissement est globalement Déprécié dans notre société et Particulièrement dans la communauté gay. Celle-ci est également atteinte par la pratique Du chemsex et du slam, des usages De substances psychoactives préoccupants. De tous ces éléments découlent de fortes Prévalences des troubles psychiques et Une éventuelle précarité sociale. La prise En charge des pvvih doit être globale, elle Nécessite de prendre en compte tous ces Aspects, médicaux, psychiques, sociaux, Et d'y associer les patients.

Adoption and Attitudes of eHealth Among People Living With HIV and Their Physicians: Online Multicenter Questionnaire Study.

BACKGROUND: The development of electronic health (eHealth) has offered the opportunity for remote care provision. eHealth addresses issues for patients and professionals favoring autonomy and compliance, respectively, while fostering closer links both between patients and health care professionals and among health care professionals themselves. OBJECTIVE: The aim of this study was to analyze the patterns of use, benefits, and perceived obstacles in eHealth among people living with HIV (PLHIV) and their caring physicians at hospitals. METHODS: An online multicenter observational survey was conducted October 15-19, 2018 in 51 medical units across France by means of self-administered questionnaires to collect sociodemographic and medical data, and perceptions of eHealth. Multiple correspondence analysis followed by mixed unsupervised classification were performed to analyze data of the respondents. RESULTS: A total of 279 PLHIV and 219 physicians responded to all parts of the questionnaire. Three groups of PLHIV were identified based on multivariate analysis. Group 1 comprised "eHealth believers" (121/279, 43.4%), who were more frequently above 60 years old and more likely to be receiving treatments other than antiretrovirals. Group 2, the "technology skeptics" (86/279, 30.8%), comprised more women with at least one child. Group 3, the "internet adopters" (72/279, 25.8%), were more frequently under 49 years of age, men who have sex with men, and more likely to use mobile apps for obtaining wellness/health information and related subjects. Three groups of physicians also emerged. Group 1 comprised those "strongly confident in eHealth" (95/219, 43.4%), who more frequently used mobile apps for wellness/health information and were more likely to accept prescription assistance software. Group 2 comprised physicians "strongly opposed to eHealth" (80/219, 36.5%), frequently asserting that eHealth challenges confidentiality. Group 3 were "open to eHealth" (44/219, 20.1%), comprising a higher proportion of infectious disease specialists, and were more likely to believe that medical apps are useful for patient education and information. No link was found between the groups of PLHIV and physicians. CONCLUSIONS: The literature on eHealth mainly classifies people as enthusiasts and skeptics; however, we identified a third profile among both PLHIV and physicians, albeit without a direct link between them. For PLHIV, this third group is attentive to eHealth for improving their health condition, and for physicians, this group considers eHealth to offer benefits to patients and their own practice.

Perspectives of injectable long acting antiretroviral therapies for HIV treatment or prevention: understanding potential users' ambivalences.

Recent clinical trial data showed that injectable long-acting antiretroviral treatment (LA-ART) every four or eight weeks could become an alternative option for HIV treatment or prevention. The purpose of our study was to explore perceptions and potential users' points of views of this new mode of administration through individuals' therapeutic itinerary and their singular history with ART. Between 2018 and 2019, a qualitative study was conducted in two University Hospitals in Paris, France. In-depth interviews were conducted with 15 virologically controlled People Living with HIV (PLWH) and 13 men on pre-exposure prophylaxis (PrEP) for at least six months. Interviews, focused on the daily experience with ART, were recorded, transcribed, and analyzed using thematic content analysis. Collected discourses were organized around three emergent concerns: social, material and experimental. Each of these concerns was perceived as ambivalent, balanced by skepticism and hope. It revealed the complexity of each individual's relationship to their HIV treatment or PrEP, leading to balance the injectable LA-ART popularity reported within clinical trials. This new mode of administration may be a suitable alternative for some PLWH and PrEP users, a "simplification" compared to the oral route. It opens a window for "customizable" ART-treatment according to individuals' lives.

HIV Vaccine Trials: Ethical, Psychological, and Psychological-Social Aspects (1991-1996).

The authors, who took part in designing and conducting the first phase-1 clinical trials of the HIV vaccine between 1991 and 1996, discuss the history of this innovative program, in particular, the conditions under which volunteers were recruited. They recall its multidisciplinary aspects; the team included, along with clinicians who were used to performing such trials, epidemiologists, psychiatrists, psychoanalysts, social psychologists, and a philosopher specialized in ethics. When forming this team, officials at France's National Research Agency on AIDS (ANRS) were careful to identify the volunteers social characteristics and pay heed to their subjective motivations for participating, given the context, namely a rising incidence of HIV infection and the challenges that were undermining confidence in medicine. Important in this context was the application of the Huriet-Sérusclat Act (1988) with its provisions for protecting participants. These clinical trials led to reformulating several ethical questions, for instance, the tension between the need of such trials and the necessity to not expose volunteers to poorly known risks; the importance of precise scientific information for delivering free, informed consent; and the possibility for volunteers to take part on the basis of their autonomy and "risk choice." The network of volunteers, which operated on this basis for nearly 25 years, is a rare example of collaboration between basic research in biomedicine, medical doctors, psychologists, psychoanalysts, and ethicists.