RESUMEN
OBJECTIVES: The Saint-Antoine Orchestra Program aims at improving the clinical management of HIV-infected patients through access to care, prevention and early diagnosis of comorbidities. METHODS: The program was initiated in December 2004 on the whole database. The following topics were concerned: cardiovascular risk factors, gynecological follow-up, anti-HBV vaccinal coverage, sexuality and prevention of STIs, therapeutic adherence and counsels to travelers. The program included several actions: diffusion of information to patients, development of a computerized chart (alert pop-ups), individualized prescription advice and recommendations for specialist referral. RESULTS: The program was applied to 1959 patients whose initial characteristics were: mean age: 43+/-10 years; ratio M/W: 1466/493; European origin: 69%; sub-Saharan: 19%; mean duration of HIV infection: 9.3+/-6 years; naïve of antiretrovirals: 14%; mean CD4+count: 494+/-277/mm(3); HIV viral load inferior to 50 cp/ml: 62%. Among 1347 patients for whom cardiovascular risk factors were completely informed, 42% had two or more factors. In particular, 31% of them were smokers, 7% had an arterial pressure superior to 140/90 mmHg and 11% had LDL-cholesterolemia superior to 4.1 mmol/l. Among 1448 untreated patients, 70% were initially considered as adherent. Half of the concerned women had neither cervical smear nor mammography up to date. Among 67% patients with an informed complete HBV serology, 27% were seronegative among which 310 (86%) were eligible for the vaccine. Problems of sexual difficulties or prevention were initially discussed for 11% of patients. Among them, 14% had a problem of prevention and 148 (66%) recognized sexual difficulties. CONCLUSION: The initiation of the Saint-Antoine Orchestra program has provided a unique opportunity to assess and improve the prevention and management of comorbidities in HIV patients. Also, this program aimed to improve professional practices.
Asunto(s)
Infecciones por VIH/complicaciones , Adulto , Árboles de Decisión , Diagnóstico Precoz , Femenino , Humanos , Masculino , Medicina Preventiva , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVES: The authors had for aim to assess incident HIV+ patients in Saint-Antoine hospital, Paris in 2002-2003 (transfers excluded). METHODS: Sociodemographic, clinical, and virological data were collected to compare French and sub-Saharan patients. RESULTS: Three hundred new HIV+ patients were identified: mean age 36.2 year; ratio M/W 65/35; origin: Caucasian 43%, African 44%, Maghrebian 8%, Asian 3%; nationality: French 45%, sub-Saharan African 44%; illegal aliens 65%; employed 51%; transmission: heterosexual 54%, homosexual 39%, intravenous drug user (IVDU) 2%; circumstances for diagnosis: HIV exposure 34%, primary infection 9%, symptoms/AIDS 23%, pregnancy 6%, other 28%; CDC stage: A 77%, B 9%, C 14%; mean T-CD4+ 374/mm3, median HIV-RNA 30780 cp/mL; co-infection HBV 7.3% HCV 5%. OUTCOME: 88% still followed up in Saint-Antoine, 2% transferred, 9% lost to follow-up, 1% dead. A significant difference was shown: 1) between French (N = 123) and African (N = 46) men for heterosexual transmission (10 vs 91%), working status (85 vs 28%), T-CD4+ (354 vs 251/mm3), outcome (lost to follow-up 5 vs 24%) [P < 0.01]; 2) between French (N=13) and African (N = 85) women for age (41 vs 32 years), working status (38 vs 10%), stage A (54 vs 81%) [P < 0.05]; 3) between African patients according to sex (46M/85W) for age (39 vs 32 years), working status (28 vs 10%; P = 0.01), outcome (lost to follow-up 24 vs 6%) [P < 0.01]. CONCLUSION: This study highlights the persistence of HIV in native homosexual French men and the increasing prevalence in African migrant with precarious social status.
Asunto(s)
Infecciones por VIH/clasificación , Adolescente , Adulto , África del Sur del Sahara/epidemiología , Anciano , Demografía , Empleo , Femenino , Francia/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Paris/epidemiología , Grupos Raciales , Carga ViralRESUMEN
OBJECTIVES: To assess the prevalence of chronic hepatitis C virus (HCV) infection with persistently normal alanine aminotransferase (ALT) levels in HIV-1-infected patients, together with its clinical, biological and histological characteristics and predictive factors. METHODS: We retrospectively studied all HCV/HIV-coinfected patients treated in our Infectious Diseases Department, for whom data on both HIV and HCV infection were available. We compared the demographic characteristics and parameters of HIV and HCV infection between cases, defined by persistently normal ALT levels (<45 IU/L) and detectable serum HCV-RNA (determined by PCR), and controls with high ALT levels and HCV PCR positivity during the previous 3 years. RESULTS: Among the 815 HIV-infected patients assessed for this study, 179 (22%) were HCV-coinfected, of whom 155 were eligible for this analysis. Of these 155 HCV-coinfected patients, 137 (88%) were HCV-PCR-positive, of whom 39 (28.5%) had persistently normal ALT levels (cases) and 98 (71.5%) had high ALT levels (controls). Relative to controls, cases had a significantly lower fibrosis score and a lower fibrosis progression rate (2.2 vs. 1.3, P=0.004; 0.3 vs. 0.2, P=0.006, respectively). Three factors associated with persistently normal ALT levels were identified, namely: HBsAg negativity (P=0.003), HCV genotype 4 (P=0.01) and female sex (P=0.05). CONCLUSION: Persistently normal ALT levels may be considered as a marker of slow HCV disease progression in HIV-coinfected patients, with significantly less severe hepatic lesions.
Asunto(s)
Alanina Transaminasa/sangre , Infecciones por VIH/complicaciones , VIH-1 , Hepacivirus , Hepatitis C/complicaciones , Adulto , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Genotipo , Infecciones por VIH/enzimología , Infecciones por VIH/patología , Hepacivirus/genética , Hepatitis C/enzimología , Hepatitis C/patología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Estudios RetrospectivosRESUMEN
OBJECTIVE: 1. to assess the impact of highly active antiretroviral therapy (HAART) on the occurrence of bacteraemia in HIV-infected patients and their clinical and microbiological characteristics. 2. to identify risk factors for bacteraemia in this setting. METHODS: The files of all HIV-infected patients hospitalized for an episode of bacteraemia in a 28-bed infectious diseases unit between January 1995 and December 1998 were reviewed. Cases occurring during HAART were compared to cases occurring in patients not receiving HAART. Furthermore, in a case-control study, patients with bacteraemia occurring during HAART were compared with other patients receiving HAART. RESULTS: There were 74 episodes of bacteraemia in patients not receiving HAART and 31 episodes in patients receiving HAART. The occurrence of bacteraemia fell from 10.5/100 hospitalizations in 1995 to 5.5/100 in 1998 (P = 0.02 trend test). The occurence of P. aeruginosa bacteraemia fell sharply (9/398 vs 1/273, P = 0.05). A significant fall in catheter-related infections was observed between 1995 and 1998 (5.5% vs 1.8%). The two-thirds/one-third distribution of hospital-acquired and community-acquired infections remained stable throughout the period study. In patients receiving HAART, the case-control study showed by multivariate analysis, that a CD4 cell count of less than 100/ micro L [OR = 7.3 (1.9-49.7)], and the use of exogenous devices [OR = 13.3 (2.5-71)] were significantly associated with the risk of bacteraemia. CONCLUSION: The introduction of HAART has been associated with a significant fall in the occurrence of bacteraemia. However, patients with a low CD4 cell count remain at risk of bacteraemia with similar microbiological and epidemiological characteristics than in the pre-HAART era.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Bacteriemia/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/microbiología , VIH-1 , Adulto , Antibacterianos/uso terapéutico , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Infección Hospitalaria , Femenino , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
We conducted a descriptive study in 9 cases of acute hepatitis A diagnosed in patients with human immunodeficiency virus (HIV). Despite the small number of cases studied, the results indicate that moderate HIV infection does not impair the natural history of acute hepatitis A.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatitis A/etiología , Enfermedad Aguda , Adulto , Progresión de la Enfermedad , Hepatitis A/diagnóstico , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Use of powerful multiple-drug antiretroviral regimens can significantly raise CD4+ counts restoring immune function, but in certain cases, leading to inflammatory reactions. CASE REPORT: An HIV-infected patient developed a mycobacteriosis of the digestive tract when his CD4 count fell below 5/mm3. He was given antimycobacterial treatment in combination with an effective triple antiretroviral regimen. At two years, the clinical situation was controlled with persistent optimal response (CD4 = 338/mm3 HIV-RNA < 500 copies/ml); the antimycobacterial regimen was discontinued. One year later the patient still had a CD4+ count above 500/mm3 but developed a voluminous mesenteric mass invaded by a CD68+ histiocyte proliferation. No causal agent could be identified. The clinical course was favorable after reintroducing antimycobacterial treatment combined with short-term corticosteroid therapy. DISCUSSION: Reconstitution of the immune system after long-term use of the new antiretroviral therapies raises the question of whether anti-infectious prophylaxis should be maintained. However, possible reactions to earlier pathogens after restoration of specific immunity would warrant secondary prophylaxis even in patients responding to powerful antiretroviral combinations.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Granuloma/etiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Linfadenitis/etiología , Mesenterio , Mycobacterium avium , Enfermedades Peritoneales/etiología , Tuberculosis/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Corticoesteroides/uso terapéutico , Adulto , Antibacterianos/uso terapéutico , Antibióticos Antituberculosos/uso terapéutico , Antituberculosos/uso terapéutico , Biopsia , Recuento de Linfocito CD4 , Claritromicina/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Etambutol/uso terapéutico , Estudios de Seguimiento , Granuloma/diagnóstico por imagen , Granuloma/patología , Humanos , Linfadenitis/diagnóstico por imagen , Linfadenitis/patología , Masculino , Mesenterio/patología , Enfermedades Peritoneales/diagnóstico por imagen , Enfermedades Peritoneales/patología , Rifabutina/uso terapéutico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Tuberculosis/inmunologíaRESUMEN
The frequent association of sleep apnea syndrome and essential hypertension led to think of sleep apnea as an etiology of hypertension, especially as a good correlation has been found between the severity of both diseases. Moreover, treating the apnea syndrome results in a decrease of blood pressure. The aim of our study is to depict the outlines of a severe hypertensive individual with sleep apnea by comparing 9 men primarily referred to the hypertension clinic with refractory hypertension and finally found to have sleep apnea (study group) to 23 men whose diagnosis of sleep apnea was made in the pulmonary unit (controls). Fifteen of these were hypertensives. Mean age of the study group was 47 +/- 7 years vs 60 +/- 11. Controls were less overweighted: BMI = 33 +/- 6 kg/m3 vs 39 +/- 5. Mean blood pressure was 171 +/- 16/107 +/- 4 mmHg in the study group vs 157 +/- 19/92 +/- 12 mmHg in controls. Prevalence of glucose metabolism disorders was significantly greater in the study group: 6 patients with maturity onset diabetes and 3 with proven glucose intolerance, vs respectively 4 and 6 controls. Triglycerides were elevated in both groups whereas mean cholesterol was slightly above normal values. Six patients of the study group could have an echocardiogram which showed left ventricular hypertrophy (mean left ventricular mass index = 206 +/- 31 g/m2 after the Penn convention).(ABSTRACT TRUNCATED AT 250 WORDS)