NPAideS: a drug-checking study among 3-methylmethcathinone (3-MMC) users.

BACKGROUND: 3-methylmethcathinone (3-MMC) has been available on the European drug market for several years, but an increase in its availability seems to have occurred around 2020, associated with reports of harm and death. We aimed to analyze the composition of the supposed 3-MMC samples purchased and its concordance with the assumed composition of the drug. METHODS: A prospective multicenter (n = 6) study was conducted between February 2021 and September 2021 in Auvergne-Rhone-Alpes, France. The inclusion criteria were: 3-MMC users over 18 years of age in contact with a community-based organization (CBO) called AIDES. Consumption was evaluated with an anonymized questionnaire and samples of 3-MMC powder were analyzed with a combination of qualitative (GC-MS) and quantitative methods (UPLC-MS/MS), to compare the assumed and real compositions of the products purchased. RESULTS: We studied 45 samples provided by 33 users. The study population was predominantly male (91%), with a median age of 40 years, most were university graduates and regular users of 3-MMC. Intravenous drug use was reported by 15.2% of the population. Most of the users bought their 3-MMC online via the Clear Web. Drug testing was requested by 86% of the users, highlighting the need for this type of harm reduction strategy. The purity of the 3-MMC powder samples tested ranged from 21 to 98%. Other NPS drugs, such as 4-CEC (4-chloroethcathinone), 4-MMC, and 2-fluorodeschloroketamine (2-FDCK), supplied as methoxphenidine (MXP), were also detected. CONCLUSION: This prospective study shows that 3-MMC purity and dose vary considerably. It also describes the characteristics of 3-MMC users and their expectations of a drug-checking program. Our data suggest that drug-checking services may be useful in this population. Health associations and laboratories should work together to help increase access to such programs.

Factors associated with fear of COVID-19 infection in people living with HIV / Facteurs associés à la crainte de l'infection par la COVID-19 chez des personnes vivant avec le VIH

INTRODUCTION: People living with HIV (PLHIV) who may have experienced biographical disruptions in their life trajectory may have a vulnerability to risk that differs from the general population, particularly in the context of an infectious health crisis. This study aimed to understand the factors associated with concerns about being infected with COVID-19 among PLHIV during the first period of the health crisis. METHODS: This was an online cross-sectional study using an online self-administered questionnaire in the context of the COVID-19 epidemic in France among a population of PLHIV. The recruitment was done via social networks and through various actors in the fight against HIV. The self-questionnaire was available from July 2020 to September 2020. RESULTS: The ACOVIH study collected 249 responses, 202 men and 47 women, with a mean age of 46.6 ± 12.9 years. The most represented socio-professional categories were employees (n=73.29%), followed by managers, professionals and artists (n=59.24%). The PLHIV most worried about being infected by COVID-19 had a level of education lower than or equal to the baccalaureate, family difficulties related to HIV and a deterioration in the relationship of trust with the HIV medical team. CONCLUSION: Feelings of anxiety can have a health and psychosocial impact on PLHIV. It is necessary to consider these negative factors by proposing adapted support and by carrying out preventive actions aiming in particular at improving the literacy of the PLHIV.

Introduction: Les personnes vivant avec le VIH (PVVIH) ayant déjà vécu des perturbations biographiques dans leur trajectoire de vie peuvent avoir une vulnérabilité accrue aux risques, particulièrement dans le cadre d'une crise sanitaire infectieuse. La présente étude (« Adaptations à la COVID-19 lorsque l'on vit avec le VIH ¼ [ACOVIH]) vise à appréhender les facteurs associés à l'inquiétude d'être infecté par la COVID-19 chez les PVVIH durant la première période de la crise sanitaire. Méthodes: Il s'agissait d'une étude transversale en ligne par questionnaire autoadministré conduite dans le contexte épidémique de la COVID-19 sur le territoire français auprès d'une population de PVVIH. Les participants ont été recrutés via les réseaux sociaux et par le biais de divers acteur·trice·s de la lutte contre le VIH. L'autoquestionnaire était disponible de juillet 2020 à septembre 2020. Résultats: L'étude ACOVIH a recueilli 249 réponses, 202 hommes et 47 femmes, d'un âge moyen de 46,6 ± 12,9 ans. Les catégories socioprofessionnelles les plus représentées étaient les employés (n = 73, 29 %), suivis des cadres et des professions intellectuelles et artistiques (n = 59, 24 %). Les PVVIH les plus inquiètes à l'idée d'être infectées par la COVID-19 ont un niveau d'études inférieur ou égal au baccalauréat, des difficultés familiales en lien avec le VIH et une dégradation de la relation de confiance vis-à-vis de l'équipe médicale VIH. Conclusion: Le sentiment d'inquiétude peut avoir un impact sanitaire et psychosocial chez les PVVIH. Il est nécessaire de considérer ces facteurs négatifs en proposant un accompagnement adapté et en menant des actions préventives visant notamment à améliorer la littératie des PVVIH.

Changer de focale pour agir sur une épidémie transfrontalière. Le VIH à la frontière franco-suisse.

INTRODUCTION: The urban planning between France and Geneva leads us to target the local HIV epidemic dynamics in its cross-border dimension. We aim to assess its importance while taking into account cross-border movements.Purpose of research: This study aims to describe the HIV epidemic on a cross-border scale by comparing data with two other areas known for their HIV incidence, Lyon and Zurich, using epidemiological data available in France and Switzerland. RESULTS: Available data demonstrate that the Geneva cross-border region HIV epidemics are similar in magnitude to those of the Lyon metropolitan area and Zurich canton. In addition, describing the target groups attending two NGO’s services allows us to understand the dynamics of cross–border mobility as well as target groups’ health needs. CONCLUSION: The study shows that policy makers and experts need to focus on the cross-border dimension of the HIV epidemic dynamics in order to provide adequate responses around Geneva. We advocate for a sustained cross-border dialogue: to re-think the fight against HIV in the region, to take into account real life experiences, to make public policies and programs evolve on a cross-border basis, and to base our policies on a common set of good practices.

An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock.

Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head-neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head-neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.

A Case of Acoustic Shock with Post-trauma Trigeminal-Autonomic Activation.

This study reports the case of an acoustic shock injury (ASI), which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum) and outside the ears (blocked nose, pain in the neck/temporal region). We suggest that these symptoms may result from a loop involving injury to middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks. The pathophysiology of this ASI is reminiscent of that observed in post-traumatic trigeminal-autonomic cephalalgia. This framework opens new and promising perspectives on the understanding and medical management of ASI.

[Barriers and levers to HIV post-exposure prophylaxis]. / Freins et leviers de la prise en charge du traitement post-exposition au VIH.

Two challenges were identified to improve the place of PEP in combined prevention: (1) improvement of healthcare professionals’ knowledge, practices and attitudes; and (2) revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support..