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1.
IDCases ; 33: e01847, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37528867

RESUMEN

We report the case of an obese patient who experienced late failure on day28 of a well-conducted treatment with artesunate, followed by dihydroartemisinin-piperaquine (DHA-PPQ) for a severe P. falciparum malaria attack. The same P. falciparum strain was evidenced at day0 and day28. Genotypic and phenotypic resistance tests could not explain this treatment failure. The low plasma piperaquine concentration at failure may explain the poor elimination of residual parasites.

2.
Infect Dis Now ; 51(8): 667-672, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34464757

RESUMEN

BACKGROUND: Approximately 5000 cases of imported malaria are observed each year in metropolitan France. Guidelines for the prevention and management of imported malaria were published by the French infectious disease society (French acronym SPILF) in 2017. OBJECTIVE: Study objective was to describe in a retrospective analysis (2015-2016) imported malaria cases recorded in a Parisian hospital, to analyze the congruence to previous guidelines (2014), deviation in respect to post hoc published guidelines and potential areas for improvement. RESULTS: Two hundred and one cases were analyzed using medical charts. There was a majority of men (sex ratio 2/1), with a mean age of 43 years at diagnosis. The main area of infection acquisition was sub-Saharan Africa (97%). The average time since return from the endemic area was 20 days. Patients consulted the emergency department for flu-like syndrome (32%), fever or chills (28%), and gastrointestinal symptoms (22%). Blood smears mainly identified Plasmodium falciparum (n=180, 90%). There were 52 (26%) severe malaria episodes. CONCLUSION: The analysis of national guideline adequacy highlighted difficulties in obtaining a complete biological workup at baseline, managing patients with vomiting, and in the post-treatment follow-up.


Asunto(s)
Antimaláricos , Malaria , Adulto , Antimaláricos/uso terapéutico , Francia/epidemiología , Humanos , Malaria/diagnóstico , Masculino , Estudios Retrospectivos , Viaje
3.
Med Mal Infect ; 50(7): 537-544, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31722864

RESUMEN

HIV infection has evolved into a chronic disease with comorbidities since the combination antiretroviral therapy era. Complications still occur and patients may need to be admitted to an intensive care unit. Acute respiratory failure is the first cause of these admissions, questioning the administration of solid oral dosage formulations. This issue is also observed in geriatric units where the prevalence of dysphagia is high and underestimated. The problem of antiretroviral administration is critical: altered solid oral dosage formulations and/or administration via enteral feeding tubes are sometimes the only option. The aim is to help manage antiretroviral treatment in unconscious or intubated patients and those with swallowing disorders who are hospitalized in intensive care units or geriatric units. This review provides information on the main antiretroviral regimens and on practical and legal aspects of manipulating solid oral dosage formulations and administration via enteral feeding tubes. Alternatives to the solid formulation are available for most of the 27 oral antiretrovirals available, or manufacturers provide recommendations for patients who are unable to swallow. Manipulation of solid oral dosage formulations such as crushing tablets or opening capsules and administration via feeding tubes are frequently reported but should be the last option for safety and liability issues. Before any off-label administration of a drug, physicians should consider alternatives to the solid oral dosage formulation and check whether the drug can be altered. Therapeutic monitoring is important in this particular setting as the pharmacokinetic profile of drugs is difficult to predict.


Asunto(s)
Antirretrovirales/administración & dosificación , Trastornos de Deglución/complicaciones , Nutrición Enteral/instrumentación , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Administración Oral , Humanos
7.
J Gynecol Obstet Biol Reprod (Paris) ; 45(5): 415-23, 2016 May.
Artículo en Francés | MEDLINE | ID: mdl-27079865

RESUMEN

A Zika virus epidemic is currently ongoing in the Americas. This virus is linked to congenital infections with potential severe neurodevelopmental dysfunction. However, incidence of fetal infection and whether this virus is responsible of other fetal complications are still unknown. National and international public health authorities recommend caution and several prevention measures. Declaration of Zika virus infection is now mandatory in France. Given the available knowledge on Zika virus, we suggest here a review of the current recommendations for management of pregnancy in case of suspicious or infection by Zika virus in a pregnant woman.


Asunto(s)
Enfermedades Fetales/virología , Complicaciones Infecciosas del Embarazo/virología , Infección por el Virus Zika , Líquido Amniótico/virología , ADN Viral/análisis , Femenino , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/epidemiología , Francia/epidemiología , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Complicaciones Infecciosas del Embarazo/terapia , Salud Pública , Virus Zika/genética , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/prevención & control
8.
Gynecol Obstet Fertil ; 42(7-8): 543-50, 2014.
Artículo en Francés | MEDLINE | ID: mdl-24969954

RESUMEN

The desire for children is a legitimate aspiration that should be part of multidisciplinary care for all men, women or couples living with HIV. The use of effective antiretroviral therapy has revolutionized the prevention of sexual, as well as mother-to-child HIV transmission. When the HIV plasma viral load is undetectable on long-term antiretroviral therapy, the risk of mother-to-child transmission is <1% and the risk of heterosexual HIV transmission without condom use in a stable relationship is very low (estimated at less than 1/10,000) in the absence of inflammation of the genital tract. In a man with a long-term undetectable viral load, viral shedding in semen is uncommon, but may occur persistently or intermittently. The same appears true of viral shedding in the vaginal tract of women. Reproductive options are: natural conception, self-insemination when the woman is HIV-infected, assisted reproduction. Natural conception is now considered to be an acceptable option when the conditions are met, after exploring four aspects: (1) virological (viral load undetectable sustained for at least 6 months on therapy), (2) genital (absence of genital infections or lesions), (3) fertility (after appropriate evaluation) and (4) detecting the ovulation period to limit intercourse without condoms. Assisted reproduction has two objectives in the context of HIV, to allow the couple to conceive without abandoning condom use and/or to treat infertility.


Asunto(s)
Infecciones por VIH/transmisión , Reproducción , Antirretrovirales/uso terapéutico , Condones , Femenino , Fertilización , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Heterosexualidad , Humanos , Inseminación Artificial , Masculino , Técnicas Reproductivas Asistidas , Semen/virología , Vagina/virología , Esparcimiento de Virus
9.
J Gynecol Obstet Biol Reprod (Paris) ; 43(7): 534-48, 2014 Sep.
Artículo en Francés | MEDLINE | ID: mdl-24947850

RESUMEN

With effective antiretroviral therapy, the risk of mother to child transmission (MTCT) is now under 1%. The 2013 French guidelines emphasize early antiretroviral lifelong antiretroviral therapy. Thus, the current trend for women living with HIV is to take antiretroviral therapy before, during and after their pregnancies. A major issue today is the choice of antiretroviral drugs, to maximize the benefits and minimize the risks of fetal exposure. This requires interdisciplinary care. The use of effective therapies permits gradual but profound changes in obstetric practice. When maternal plasma viral load is controlled (<50 copies/ml), obstetrical care can be more similar to standards in HIV-negative women. Prophylactic cesarean section is recommended when the viral load in late pregnancy is above 400 copies/mL. Intravenous zidovudine during labor is recommended only if the last maternal viral load is>400 copies/mL or in case of complications such as preterm delivery, bleeding or chorio-amnionitis during labor. In case of premature rupture of membranes before 34 weeks, a multidisciplinary decision should be made, based on gestational age and control of maternal viral load; if the woman is under antiretroviral therapy and especially if her viral load is undetectable, steroids and antibiotics should be offered and pregnancy can be continued except in case of signs or symptoms of chorio-amnionitis. Breastfeeding is not recommended in women living with HIV in France, as in industrialized countries. Prophylaxis in the newborn is usually zidovudine for 1 month. In case of significant exposure to HIV perinatally, in particular when, maternal viral load is>1000 copies/mL, prophylactic combination therapy is recommended. Monitoring of the child is necessary to determine whether or not it is free of HIV infection and to monitor possible adverse effects of perinatal exposure to antiretroviral drugs.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Femenino , Infecciones por VIH/complicaciones , Humanos , Embarazo
10.
Euro Surveill ; 19(14)2014 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-24739981

RESUMEN

Healthy travellers to countries where carbapenemases-producing Enterobacteriaceae (CPE) are endemic might be at risk for their acquisition, even without contact with the local healthcare system. Here, we report the acquisition of CPE (two OXA-181, one New Delhi metallo-beta-lactamase 1 (NDM-1)) in three healthy travellers returning from India. The duration of CPE intestinal carriage was less than one month. The results indicate that healthy travellers recently returning from India might be considered as at risk for CPE carriage.


Asunto(s)
Proteínas Bacterianas/metabolismo , Infecciones por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/aislamiento & purificación , Viaje , beta-Lactamasas/metabolismo , Adulto , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Enterobacteriaceae/genética , Infecciones por Enterobacteriaceae/microbiología , Heces/microbiología , Femenino , Francia , Humanos , India , Persona de Mediana Edad , Factores de Riesgo
11.
Clin Infect Dis ; 51(7): 833-43, 2010 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-20804413

RESUMEN

BACKGROUND: Management of pregnant women with human immunodeficiency virus (HIV) type 2 infection remains unclear because of its low prevalence and important differences from HIV-1. METHODS: Pregnant women monoinfected with HIV-2 or HIV-1 and their infants enrolled in the prospective, national, multicenter French Perinatal Cohort between 1986 and 2007. RESULTS: Overall, 2.6% (223/8660) of mothers were infected with HIV-2, and they accounted for 3.1% (367/ 11841) of the total births. Most were born in sub-Saharan Africa. A higher proportion of HIV-2-infected mothers than HIV-1-infected mothers had no symptoms, had received no antiretroviral therapy at conception (85.9% vs 66.7%), and had received no antiretroviral therapy during pregnancy (42.8% vs 19.9%), particularly highly active antiretroviral therapy (HAART) (79.7% vs 46.1%), and they had higher CD4 cell counts near delivery (median, 574 vs 452 cells/mm3; P < .01). If antiretroviral therapy was used, it was started at a later gestational age for HIV- 2-infected mothers (median, 28 vs 25 weeks; P < .01). HIV-2-infected mothers were more likely to deliver vaginally (67.9% vs 49.3%) and to breastfeed (3.6% vs 0.6%; P < .01), and their infants less frequently received postexposure prophylaxis. In the period 2000-2007, the proportion with viral load <100 copies/mL at delivery was 90.5% of HIV-2-infected mothers, compared with 76.2% of HIV-1-infected mothers (P=.1). There were 2 cases of transmission: 1 case in 1993 occurred following maternal primary infection, and the other case occurred postnatally in 2002 and involved a mother with severe immune deficiency. The mother-to-child transmission rate for HIV-2 was 0.6% (95% confidence interval, 0.07%-2.2%). CONCLUSIONS: Care for HIV-2-infected pregnant women rests on expert opinion. The mother-to-child transmission residual rate (0.07%-2.2%) argues for systematic treatment: protease inhibitor-based HAART for women requiring antiretrov


Asunto(s)
Infecciones por VIH/transmisión , Infecciones por VIH/virología , VIH-2/aislamiento & purificación , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/virología , Adulto , Estudios de Cohortes , Femenino , Francia , Humanos , Embarazo
12.
J Antimicrob Chemother ; 62(5): 914-20, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18718922

RESUMEN

OBJECTIVES: We investigated the in vitro phenotypic susceptibility of HIV-2 isolates from integrase inhibitor (INI)-naive patients to INIs and its relation to HIV-2 integrase gene polymorphism. METHODS: We determined the phenotypic susceptibility to raltegravir and elvitegravir of co-cultured isolates obtained from the HIV-2 ROD reference strain and from 14 clinical isolates. IC(50) values were compared with those for HIV-1 reference strains. HIV-2 integrase gene polymorphism was assessed in isolates from 52 INI-naive patients enrolled in the French HIV-2 cohort. RESULTS: Median raltegravir and elvitegravir IC(50) values for the 14 clinical HIV-2 isolates were 2.4 and 0.7 nM, respectively, and were similar to those observed for HIV-2 ROD and HIV-1 reference strains. Overall, 38% of HIV-2 integrase amino acids were polymorphic. The catalytic triad DDE and the HHCC and RKK motifs were fully conserved, at the same genomic positions as described in HIV-1. In subtype B isolates, the total length of the integrase gene varied, owing to the presence of stop codons at positions 288, 294, 297 and 302. Fourteen of the positions associated with substitutions conferring INI resistance in HIV-1 were polymorphic in HIV-2. CONCLUSIONS: Despite 40% heterogeneity between the HIV-1 and HIV-2 integrase genes, the phenotypic susceptibility of clinical HIV-2 isolates to INIs was similar to that of HIV-1. This new class of antiretroviral drugs thus represents a novel therapeutic possibility for HIV-2-infected patients who otherwise have few treatment options.


Asunto(s)
Farmacorresistencia Viral , Integrasa de VIH/genética , VIH-2/efectos de los fármacos , Inhibidores de Integrasa/farmacología , Polimorfismo Genético , Pirrolidinonas/farmacología , Quinolonas/farmacología , Secuencia de Aminoácidos , Sustitución de Aminoácidos/genética , Dominio Catalítico , Codón sin Sentido , Estudios de Cohortes , Secuencia Conservada , Francia , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-2/aislamiento & purificación , Humanos , Concentración 50 Inhibidora , Pruebas de Sensibilidad Microbiana , Datos de Secuencia Molecular , Mutación Missense , Raltegravir Potásico
13.
Arch Pediatr ; 15(3): 245-52, 2008 Mar.
Artículo en Francés | MEDLINE | ID: mdl-18321692

RESUMEN

UNLABELLED: Only few drugs for uncomplicated Plasmodium falciparum malaria are available in children. Atovaquone-proguanil is a recent antimalarial drug licensed in France for the uncomplicated P. falciparum malaria in adults. Few paediatric studies have evaluated atovaquone-proguanil in children for uncomplicated malaria in endemic area, but no study have evaluated this treatment for imported malaria. OBJECTIVE: To evaluate treatment by atovaquone-proguanil for uncomplicated and imported P. falciparum malaria in children. METHODS: We retrospectively evaluated the tolerance and the efficacy of atovaquone-proguanil in the children admitted in Robert-Debré Hospital (Paris) for a P. falciparum malaria. From January 2004 to December 2005, 48 children with a median age of 7,5 years (IQR 4-11) were treated with atovaquone-proguanil for a uncomplicated P. falciparum malaria, except for 5 children who had an isolated hyperparasitemia greater or equal to 5%. RESULTS: Atovaquone-proguanil was stopped for 3/48 children because of vomiting. Fever resolved in all the children between Day 3 and 7, following the beginning of the treatment. One child, with a favourable outcome, had a positive parasitemia at Day 4 equal to the initial parasitemia (0,1%). No late therapeutic failure was observed among the 24 children evaluated up to one month after starting treatment. CONCLUSION: Atovaquone-proguanil is an efficient and well-tolerated antimalarial treatment for uncomplicated P. falciparum malaria in children. The risk of vomiting should lead to a systematic initial hospitalisation of children treated with atovaquone-proguanil.


Asunto(s)
Antimaláricos/uso terapéutico , Atovacuona/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Proguanil/uso terapéutico , Animales , Proteína C-Reactiva/metabolismo , Niño , Preescolar , Combinación de Medicamentos , Quimioterapia Combinada , Tolerancia a Medicamentos , Hospitales Universitarios , Humanos , Pruebas de Función Hepática , Paris , Plasmodium falciparum , Estudios Retrospectivos , Viaje
14.
AIDS Care ; 19(3): 346-54, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17453568

RESUMEN

This study examined factors related to medical appointment attendance after childbirth among HIV-infected women in the Paris region. We hypothesized that despite regular utilization of prenatal care, many women may not attend medical appointments after delivery for their own HIV infection. This was an observational cohort study of HIV-seropositive women delivering in four Paris hospitals in 2001. Follow-up attendance through 24 months after delivery was defined as 'regular' for women who had > or =4 HIV visits during the period, 'irregular' for <4 visits in the 24-months period and/or a gap between two visits >12 months, and 'no attendance' when < or =1 visit in the 2-year period. Of 169 women enrolled, 125 (75%) had regular attendance, 24 (14%) had irregular attendance, and 18 (11%) had no attendance. Multivariate analysis found the greater number of HIV visits during pregnancy and the prescription of combination therapy (versus zidovudine monotherapy) during pregnancy to be significantly related to regular attendance. Of the 18 women who had no attendance, 8 women (47%) continued to attend regular paediatric appointments with their infants during the 24-month period. Scheduling more frequent HIV visits during pregnancy may establish a pattern that will improve attendance during the post-partum period. In addition, increased communication between the health care providers of the mother and child may increase appointment attendance following delivery.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Atención Posnatal/estadística & datos numéricos , Adulto , Estudios de Cohortes , Femenino , Humanos , Paris/epidemiología , Cooperación del Paciente , Embarazo , Complicaciones Infecciosas del Embarazo , Estudios Retrospectivos
15.
Gynecol Obstet Fertil ; 34(4): 304-11, 2006 Apr.
Artículo en Francés | MEDLINE | ID: mdl-16574463

RESUMEN

OBJECTIVE: Evaluate the mode of delivery of HIV-infected women and the risk of mother-to-child transmission. PATIENTS AND METHODS: A retrospective study conducted on HIV-infected women who delivered at the maternity ward of Bichat Hospital in Paris between 1st January 2000 and 31(st) December 2004. Pregnancy care, antiretroviral therapy, decision of the mode of delivery and neonate treatment were conformable to the French recommendations. RESULTS: The analysis was performed on 332 cases out of 358 pregnancies followed during this period. 75% received a Highly Active Anti Retroviral Therapy (HAART), 24% an AZT monotherapy and 1% did not receive any antiretroviral treatment. Plasmatic HIV viral load was under the level of detectability (50 copies/ml) for 64,6% of women under HAART and 28,7% of women under AZT monotherapy. Only 31,7% of women under HAART delivered vaginally. 44,7% of women under HAART with undetectable viral load at the moment of delivery delivered vaginally. 59,5% of women who were allowed to deliver vaginally had finally a vaginal delivery. 332 women gave birth to 341 babies with 9 twin pregnancies and one still-birth at 22 WA. Out of these 340 babies, 3 babies whose mother received HAART were HIV infected (2 in utero and 1 per-partum). DISCUSSION AND CONCLUSION: The reasons why only one third of HIV-infected women could deliver vaginally in this study are primarily the persistence of a detectable HIV viral load under HAART. Women's choice of the mode of delivery comes next, which depends on the quality of the counselling about the benefits and risks of the cesarean section in the context of HIV infection. The third reason is obstetrical contra indications to vaginal delivery in the context of HIV infection. In the future, it is possible to reduce the incidence of cesarean section in HIV-infected women by elevating the level of HIV plasmatic viral load which allowed vaginal delivery (1000 copies/ml), by improving the observance to antiretroviral treatment, by adaptating antiretroviral medications posology using determination of serum protease inhibitors concentration and by modifying obstetrical management with less restrictive contra indications to vaginal delivery. However the impact of prophylactic cesarean section when plasmatic HIV viral load is undetectable must still be evaluated.


Asunto(s)
Parto Obstétrico/métodos , Infecciones por VIH/complicaciones , Complicaciones Infecciosas del Embarazo , Terapia Antirretroviral Altamente Activa , Cesárea , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Factores de Riesgo , Carga Viral , Zidovudina/uso terapéutico
16.
AIDS Patient Care STDS ; 19(1): 9-18, 2005 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-15665631

RESUMEN

The purpose of this study was to compare treatment satisfaction with triple nucleoside reverse transcriptase inhibitor (NRTI) highly active antiretroviral treatment (HAART) regimens including abacavir (ABC) to HAART regimens that include protease inhibitors (PIs) and to estimate the relationship between patient satisfaction and adherence to HAART. Three open-label clinical trials comparing ABC-including HAART regimens with PI-including HAART regimens were completed, two with patients previously untreated with antiretroviral therapy and one with patients successfully treated with PI-including HAART regimens. The HIV Treatment Satisfaction Questionnaire (HIVTSQ) was completed at several time points during each trial. Levels of patient satisfaction with the ABC and PI regimens were compared for all three trials. The correlation between adherence and patient satisfaction scores was measured using data from an adherence questionnaire in one of the studies. In all three clinical trials, patient satisfaction scores were significantly higher with an ABC-including triple NRTI HAART regimen than with a PI-including HAART regimen. The difference was apparent by week 4 of the trial and was maintained throughout the trial time period. Inspection of the item responses in the patient satisfaction questionnaire indicated that treatment convenience, flexibility, impact on lifestyle, and side effects were key factors in the difference in satisfaction between the treatment groups. In addition, patient satisfaction was shown to be significantly correlated with adherence defined as taking 95% or more of prescribed doses. Greater satisfaction was reported by patients given an ABC-including HAART regimen than those given a PI-including HAART regimen. Patient satisfaction may be an indicator for better treatment adherence.


Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Didesoxinucleósidos/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , Adulto , Ensayos Clínicos como Asunto , Femenino , Estudios de Seguimiento , Infecciones por VIH/diagnóstico , Infecciones por VIH/mortalidad , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Cooperación del Paciente , Satisfacción del Paciente , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del Tratamiento , Carga Viral
17.
J Clin Microbiol ; 43(1): 484-7, 2005 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-15635022

RESUMEN

We described the baseline polymorphism of the human immunodeficiency virus type 2 (HIV-2) protease gene from 94 treatment-naive patients and the longitudinal follow-up of 17 protease inhibitor-treated patients. Compared to the HIV-2 consensus sequences, baseline polymorphism involved 47 positions. Substitutions selected under treatment were observed at positions corresponding to HIV-1 resistance mutations as well as at positions of currently unknown impact on HIV-1.


Asunto(s)
Proteasa del VIH/genética , Mutación , Polimorfismo Genético , Adulto , Farmacorresistencia Viral/genética , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/farmacología , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-2/efectos de los fármacos , VIH-2/enzimología , VIH-2/genética , Humanos , Masculino
18.
Hepatology ; 34(6): 1193-9, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11732009

RESUMEN

In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P =.012), higher total Knodell score (P =.011), and poorer sustained response to interferon therapy (P =.009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P =.001). Necroinflamatory score was higher in HIV-positive patients (P =.023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P =.011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR = 4.06, P =.024) and in interferon-untreated patients (RR = 4.76, P =.001), independently of age at HCV infection (P =.001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR = 10.8, P =.001) and in HIV-positive patients with CD4 cell count less than 200/mm(3) (RR = 11.9, P =.007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-RNA level and liver damage and decreasing sustained response to interferon therapy. Age and alcohol were cofactors associated with cirrhosis and mortality. Interferon therapy had a protective effect against HCV-related cirrhosis no matter what the patient's HIV status was.


Asunto(s)
Infecciones por VIH/etiología , Hepatitis C Crónica/etiología , Hepatitis C Crónica/fisiopatología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Infecciones por VIH/fisiopatología , Seronegatividad para VIH , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/patología , Hepatitis C Crónica/virología , Humanos , Sistema Inmunológico/fisiopatología , Interferones/uso terapéutico , Hígado/patología , Cirrosis Hepática/etiología , Masculino , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Carga Viral
19.
J Clin Microbiol ; 39(12): 4264-8, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11724830

RESUMEN

We have developed and evaluated a new method to quantify human immunodeficiency virus type 2 (HIV-2) proviral DNA based on LightCycler real-time PCR. The assay has a detection limit of 5 copies/10(5) peripheral blood mononuclear cells (PBMC) and is insensitive to HIV-2 strain variability: HIV-2 subtypes A and B are both recognized and quantified. The intra- and interassay coefficients of variation range from 16 to 40% for high provirus concentrations (5 x 10(5) copies) and from 41 to 39% for low concentrations (5 copies). We used this method to compare the proviral DNA load and viral RNA load in plasma with clinical and immunological status for 29 patients infected by HIV-2 (subtype A in 17 and subtype B in 12). The proviral load (median, 201 copies/10(5) PBMC) was similar to that reported for HIV-1 infection. The median proviral loads did not correlate with the CD4(+) cell count categories and were as follows for CD4(+) cell counts of >400, 200 to 400, and <200 cells/mm(3), respectively: 121 copies/10(5) PBMC (n = 8; range, <5 to 712 copies/10(5) PBMC); 114 copies/10(5) PBMC (n = 9; range, <5 to 1,907 copies/10(5) PBMC); and 285 copies/10(5) PBMC (n = 12; range, 53 to 2,524 copies/10(5) PBMC). Proviral load did not correlate with plasma HIV-2 RNA positivity. As HIV-2 is considered to replicate less efficiently than HIV-1, these high proviral loads might be explained by the proliferation of infected cells.


Asunto(s)
ADN Viral/sangre , Infecciones por VIH/virología , VIH-2/aislamiento & purificación , Provirus , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/epidemiología , VIH-2/clasificación , VIH-2/fisiología , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Carga Viral
20.
J Neurovirol ; 7(4): 375-81, 2001 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-11517420

RESUMEN

A monocenter observational study was conducted to determine the clinical and virological effects of cidofovir added to highly active anti-retroviral therapy (HAART) in AIDS-associated progressive multifocal leukoencephalopathy (PML). Exposure to other anti-viral drugs or late initiation of cidofovir were exclusion criteria. Of the 53 consecutive patients with virologically proven PML admitted at the NeuroAIDS Unit of Bicêtre Hospital between May 1996 and July 2000 and having received HAART with or without cidofovir, 46 met the inclusion criteria. Cidofovir was initiated in most cases on compassionate grounds. The 22 patients treated with HAART only (HAART group) were compared to the 24 patients treated with HAART and cidofovir (CDV group). Survival, neurological outcome assessed by the expanded disability status scale (EDSS), and monitoring of the JC virus (JCV) load in CSF were investigated prospectively. At baseline (date of initiation or intensification of HAART), both groups were similar regarding CD4 cell count, plasma HIV load, CSF JCV load, EDSS, and demographic features. Both groups had similar response to HAART in terms of plasma HIV load and CD4 cell count. At month 6, CSF-JCV load was below the detection level in 8 out of 24 (33%) patients from the CDV group and 7 out of 18 (39%) patients from the HAART group (P = 0.71). One-year cumulative probability of being alive was 62% in the CDV group and 53% in the HAART group (P = 0.72). However, an additional benefit with respect to survival was observed in patients who were given cidofovir after adjustment to the following baseline variables (CSF-JCV load, CD4 cell count, and EDSS). Despite the addition of cidofovir to HAART, no significant benefit had been observed in neurological outcome, particularly in patients with an early worsening.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/administración & dosificación , Citosina/análogos & derivados , Citosina/administración & dosificación , Virus JC/aislamiento & purificación , Leucoencefalopatía Multifocal Progresiva/tratamiento farmacológico , Organofosfonatos , Compuestos Organofosforados/administración & dosificación , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/virología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Terapia Antirretroviral Altamente Activa , Antivirales/efectos adversos , Cidofovir , Citosina/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Leucoencefalopatía Multifocal Progresiva/mortalidad , Leucoencefalopatía Multifocal Progresiva/virología , Masculino , Persona de Mediana Edad , Compuestos Organofosforados/efectos adversos , Estudios Prospectivos , Análisis de Supervivencia , Carga Viral
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