Environmental SARS-CoV-2 contamination in hospital rooms of patients with acute COVID-19.

OBJECTIVE: Data on the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) remain conflicting. Airborne transmission is still debated. However, hospital risk control requires better understanding of the different modes of transmission. This study aimed to evaluate the frequency of, and factors associated with, environmental air and surface contamination in the rooms of patients with coronavirus disease 2019 in the acute phase of the disease. METHODS: Sixty-five consecutive patients were included in this study. For each patient, seven room surfaces, air 1 m and 3 m from the patient's head, the inner surface of the patient's mask, and the outer surface of healthcare workers' (HCW) masks were sampled. Environmental contamination was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) for SARS-CoV-2 RNA on surfaces, air and masks. A viral isolation test was performed on Vero cells for samples with an RT-qPCR cycle threshold (Ct) ≤37. RESULTS: SARS-CoV-2 RNA was detected by RT-qPCR in 34%, 12%, 50% and 10% of surface, air, patient mask and HCW mask samples, respectively. Infectious virus was isolated in culture from two samples among the 85 positive samples with Ct ≤37. On multi-variate analysis, only a positive result for SARS-CoV-2 RT-qPCR for patients' face masks was found to be significantly associated with surface contamination (odds ratio 5.79, 95% confidence interval 1.31-25.67; P=0.025). CONCLUSION: This study found that surface contamination by SARS-CoV-2 was more common than air and mask contamination. However, viable virus was rare. The inner surface of a patient's mask could be used as a marker to identify those at higher risk of contamination.

Prevalence of HIV-1 drug resistance in treated patients with viral load >50 copies/mL: a 2014 French nationwide study.

Background: Surveillance of HIV-1 resistance in treated patients with a detectable viral load (VL) is important to monitor, in order to assess the risk of spread of resistant viruses and to determine the proportion of patients who need new antiretroviral drugs with minimal cross-resistance. Methods: The HIV-1 protease and reverse transcriptase (RT) and integrase genes were sequenced in plasma samples from 782 consecutive patients on failing antiretroviral regimens, seen in 37 specialized centres in 2014. The genotyping results were interpreted using the ANRS v24 algorithm. Prevalence rates were compared with those obtained during a similar survey conducted in 2009. Results: The protease and RT sequences were obtained in 566 patients, and the integrase sequence in 382 patients. Sequencing was successful in 60%, 78%, 78% and 87% of patients with VLs of 51-200, 201-500, 501-1000 and >1000 copies/mL, respectively. Resistance to at least one antiretroviral drug was detected in 56.3% of samples. Respectively, 3.9%, 8.7%, 1.5% and 3.4% of patients harboured viruses that were resistant to any NRTI, NNRTI, PI and integrase inhibitor (INI). Resistance rates were lower in 2014 than in 2009. Resistance was detected in 48.5% of samples from patients with a VL between 51 and 200 copies/mL. Conclusion: In France in 2014, 90.0% of patients in AIDS care centres were receiving antiretroviral drugs and 12.0% of them had VLs >50 copies/mL. Therefore, this study suggests that 6.7% of treated patients in France might transmit resistant strains. Resistance testing may be warranted in all treated patients with VL > 50 copies/mL.

[Use of enfurvitide in pregnancy in HIV positive women in seven cases]. / Utilisation de l'enfuvirtide chez la femme enceinte séropositive VIH, à propos de sept cas.

OBJECTIVE: With a panel of more than 22 drugs, the treatment of HIV subjects is nowadays quite easier. But due to the number of multiparus women often harbouring a multidrug resistant virus, or seen late in pregnancy or inobservant, taking care of these pregnancies remains difficult. The use of enfuvirtide seems quite interesting for these situations. PATIENTS AND METHODS: In a retrospective study, we have focused our work on the consequences of enfuvirtide used in seven pregnancies, paying particular attention to efficacy, pharmacokinetics and tolerance. RESULTS: The use of enfuvirtide during 30 days in average seems safe and the tolerance was satisfactory in all seven cases. All infants are seronegative without abnormalities. The dosages in umbilical cord were negative. Five women experienced an elective caesarean, one had caesarean section in emergency, and one had a vaginal delivery. DISCUSSION AND CONCLUSION: The 23 cases published in the English literature indicate the interest of enfuvirtide use in these difficult situations. Indeed, enfuvirtide is injectable, favouring the adherence; it has a good tolerance, a quick efficacy and no placental transfer. Evidently, enfuvirtide is always prescribed in association.