Viral rebound on antiretroviral therapy in France according to region of origin, sex, and HIV acquisition group. Results from the French Hospital Database on HIV (ANRS CO4-FHDH).

BACKGROUND: Assessing the potential increased risk of viral rebound (VR) in migrants requires adequate control for sex and acquisition risk groups. METHODS: People living with HIV1, enrolled in the ANRS CO4-French Hospital Database on HIV, who achieved virological suppression with antiretroviral therapy (ART) initiated between 2006 and 2016 were included. We first compared the risk of VR, with loss to follow-up and death considered as competing events, across origin among the HIV acquisition groups, then across acquisition groups among the different origins, and finally across modality of a variable combining sex, acquisition group, and origin. Models were adjusted for clinical and biological confounding factors. RESULTS: We included 21 571 French natives (FRA), 10 148 migrants from sub-Saharan Africa (SSA), 1137 migrants from the non-French West Indies (NFWI), and 4205 other migrants (OTHER). The 5-year probability of VR was 19% (95% confidence interval [CI] 19-20) overall, 15% in FRA, 21% in OTHER, 26% in SSA, and 34% in NFWI (p < 0.0001). It was 14% in men who have sex with men (MSM), 23% in heterosexual men, and 23% in women (p < 0.0001). After adjustment, all acquisition groups had a higher risk of VR than MSM from FRA, with men and women from NFWI having the highest risk (adjusted hazard ratio [aHR] 2.46; 95% CI 2.12-2.86 and aHR 2.59; 95% CI 2.20-3.04, respectively). Within each acquisition group, all groups of origin had a higher risk of VR than FRA. Within each region of origin, except the NFWI, heterosexual men had a higher risk of VR than MSM. CONCLUSIONS: After accounting for sex and acquisition group, migration, especially from NFWI, remains prognostic of VR.

[Screening and prevention of toxic optic neuropathies due to anti-mycobacterium therapies: proposal of recommendations]. / Dépistage et prévention des neuropathies optiques toxiques aux anti-mycobactériens : proposition de recommandations.

While treatment of pulmonary infections by Mycobacterium tuberculosis is currently only rarely the cause of iatrogenic complications, treatment of atypical mycobacterial infections often requires prolonged treatment duration, which can lead to toxic optic neuropathies. This review summarizes the indications for such prolonged treatment and risk factors for toxic optic neuropathies when using ethambutol, isoniazid and/or linezolid and proposes customized screening recommendations.

[Multidisciplinary consultation for patients with HPV-related invasive carcinoma or precancerous lesions]. / Consultation multidisciplinaire pour les patients atteints d'une pathologie tumorale (carcinome infiltrant ou lésion précancéreuse) liée à HPV : la consultation multidisciplinaire papillomavirus.

Given the recent increase in the number of human papillomavirus (HPV)-induced cancers in other locations than gynaecological, the number of patients with two cancers at distinct sites, and because of the lack of exhaustive data, we decided to create a multidisciplinary network around an HPV consultation at the Georges-Pompidou European Hospital (HEGP). This network aims to set up the best tools for detecting HPV-associated "multisite" precancerous lesions in order to determine the possible impact of dedicated care for this at-risk population. This monthly consultation was created at the HEGP in June 2014. It is currently organized around five consultations: gynaecological, ENT, urological, digestive and immunological. Every patient who has been diagnosed with HPV-related cancer and whose care is provided at the HEGP is offered this particular follow-up: systematically, once the initial lesion has been treated, the patient is convened annually for a day during which it benefits from the consultations mentioned above. A consultation with a psychologist is systematically proposed. Local samples are taken at each site: a cytological examination, the analysis of known predictive and prognostic virological markers are carried out. This study fits more broadly in a theme of clinical and fundamental research around cancers related to HPV.

[Pneumocystis jiroveci pneumonia in patients with cancer: is it unavoidable?]. / Pneumocystose chez les patients d'onco-hématologie: est-ce inévitable?

INTRODUCTION: Although the use of prophylactic medication has reduced the incidence of Pneumocystis jiroveci pneumonia (PCP), it still occurs in cancer patients and is associated with a high morbidity and mortality. STATE OF THE ART: Patients with haematological malignancies are at high risk for PCP because of chemotherapy and steroid-induced immunosuppression. Despite highly active prophylactic regimens, most cases occur in patients who are not receiving any prophylactic treatment even though the risk factors are well described. PCR techniques have been used for PCP diagnosis but these highly sensitive methods may not be able to discriminate between airway colonisation and infection. PERSPECTIVES: Prophylaxis should be widely recommended for patients receiving prolonged steroid therapy or other immunosuppressive drugs. A low CD4+-T cell count (less than 200/microl) may be a useful marker to identify high risk patients who should not discontinue prophylaxis. CONCLUSION: Because PCP is very severe in cancer patients, higher risk patients must be identified and long-term prophylaxis should be maintained as long as immunosuppression persists.

[HPV (Human Papilloma Virus) implication in other cancers than gynaecological]. / Impact de l'HPV (Human Papilloma Virus) dans les carcinomes autres que gynécologiques.

Worldwide, approximately 5 to 10% of the population is infected by a Human Papilloma Virus (HPV). Some of these viruses, with a high oncogenic risk (HPV HR), are responsible for about 5% of cancer. It is now accepted that almost all carcinomas of the cervix and the vulva are due to an HPV HR (HPV16 and 18) infection. However, these viruses are known to be involved in the carcinogenesis of many other cancers (head and neck [SCCHN], penis, anus). For head and neck cancer, HPV infection is considered as a good prognostic factor. The role of HPV HR in anal cancer is also extensively studied in high-risk patient's population. The role of HPV infection in the carcinogenesis of esophageal, bladder, lung, breast or skin cancers is still debated. Given the multiple possible locations of HPV HR infection, the question of optimizing the management of patients with a HPV+ cancer arises in the implementation of a comprehensive clinical and biological monitoring. It is the same in therapeutics with the existence of a preventive vaccination, for example.

Prevalence and clinical predictors of pulmonary tuberculosis among isolated inpatients: a prospective study.

Guidelines help to prevent the transmission of Mycobacterium tuberculosis in healthcare settings, but may also result in the unnecessary isolation of many patients. We performed a prospective study to assess the prevalence and identify clinical predictors of culture-proven tuberculosis among inpatients isolated for suspected pulmonary tuberculosis (PTB) at our hospital. We also wished to validate a pre-existing clinical decision rule to improve our isolation policy. From August 2005 to January 2007, 134 patients isolated on admission to the ward for suspicion of PTB were prospectively enrolled. The admitting team made the decision to isolate patients on the basis of clinical and radiological findings, without the use of the clinical decision rule, and graded the overall suspicion of PTB. Twenty-six of the 134 isolated patients had PTB (prevalence: 19.4%), as well as one patient not isolated at admission. Univariate analysis revealed that PTB was significantly associated with young age, lack of human immunodeficiency virus (HIV) infection, weight loss, night sweats, fever, upper lobe disease and, especially, cavitary lesions on chest X-ray (adjusted OR 25.4, p <0.0001). Low suspicion of PTB by the admitting team and low clinical decision rule score had negative predictive values of 98.5% and 95.8% for PTB, respectively. Use of the clinical decision rule in addition to the team assessment would have led to the isolation of the patient with PTB not isolated on admission, and avoided 16 (14.8%) unnecessary isolations. In conclusion, the prevalence of PTB among isolated inpatients was high, and the use of a clinical decision rule in addition to clinical impression might improve isolation decisions.

Pneumocystis jirovecii pneumonia in renal transplant recipients occurring after discontinuation of prophylaxis: a case­control study.

A case-control study was conducted to identify risk factors for Pneumocystis jirovecii pneumonia (PCP) in renal transplant recipients. Eleven cases of PCP were matched with 22 controls. Cases occurred a median of 18 months after transplantation, and none of the recipients was receiving prophylaxis. Univariate analysis showed that graft rejection, duration of steroid use, use of mammalian target of rapamycin (mTOR) inhibitors and lymphocytopenia at the time of prophylaxis discontinuation were risk factors for PCP. In the multivariate model, only graft rejection (OR 8.66, p 0.017) remained significantly associated with PCP. In patients with a history of graft rejection, PCP prophylaxis should be maintained, especially among those with lymphocytopenia.

Tratamiento de tabaquismo en funcionarios de la salud en 11 centros de Atención Primaria / Treatment of smoking habit in public health officials in 11 Primary Care Centers

Es importante implementar tratamiento de tabaquismo en la Atención Primaria de la Salud (APS). Por esta razón, en el año 2010 iniciamos en 11 consultorios de Servicios de Salud Metropolitano Suroriente (SSMSO) y Viña-Quillota (SSVQ), en Chile, un programa de tratamiento antitabáquico dirigido a funcionarios en esta etapa. La intervención estuvo basada en profesionales de programas de enfermedades respiratorias, capacitados mediante un curso internet-presencial de 106 h. Se encuestaron a los integrantes del centro de salud, se analizó tabaquismo mediante talleres, especialmente las contradicciones entre fumar y trabajar en la salud y se les ofreció tratamiento psicosocial y farmacológico. Un total de 796 funcionarios fueron encuestados. Varones, 229 (28,8%). Fumadores, 332 (41,7%). Fumadores diarios, 223 (28,0). Alto grado de adicción, 25 (7,5%). Ingresaron a tratamiento 81 funcionarios, reciben fármacos 76. El número de sesiones de terapia fue 6,6, promedio. Los fármacos se emplearon en 3 esquemas: bupropión 150 mg c/12, chicle de nicotina (2 mg) según demanda y vareniclina 1 mg c/12. Cada centro utilizó un solo tipo de esquema (al azar) por 3 meses. Efectos secundarios de fármacos fueron leves 5,6% y no determinaron suspensión de tratamiento. A los 6 meses, 29 funcionarios (34,1%) se mantenían sin fumar. La cesación fue comprobada por cooximetría e información de testigos. El costo del tratamiento promedio por persona fue US$92. Conclusión. Es posible realizar tratamiento de tabaquismo a los funcionarios de la salud, basado en profesionales de los centros APS con costo y rendimiento aceptable. El proyecto fue financiado por Laboratorios GlaxoSmithkline, PfizerChile, Johnson y Johnson y los Servicios de Salud (AU)

It is important to implement smoking cessation treatment in Primary Health Care (PHC). Thus, in the year 2010, we initiated a smoking cessation treatment program aimed at health care staff workers in this stage in 11 South-Eastern Metropolitan Health Services (SSMSO) and Viña-Quillota Health Services (SSVQ) out-patient clinics, in Chile. The intervention was based on professionals of respiratory disease programs, trained by a 106 hour internet and on-site course. The members of the health care site were interviewed. Smoking habit was analyzed by workshops, especially the contradictions between smoking and working in health care and psychosocial and pharmacological treatment was offered. A total of 796 health care workers were surveyed: Males-229 (28.8%). Smokers-332 (41.7%). Daily smokers-223 (28.0). High grade of addiction-25 (7.5%). A total of 81 staff workers received treatment, 76 receiving drugs. There was an average of 6.6 therapy sessions. The drugs were used in 3 regimens: bupropion 150 mg c/12, nicotine gum (2 mg) on demand and varenicline 1 mg c/12. Each center used only one regimen (at random) for 3 months. Secondary effects of the drugs were mild, 5.6%, and did not lead to treatment cessation. At 6 months, 29 staff workers (34.1%) continued without smoking. The cessation was verified by co-oximetry and witness information. Average treatment cost per person was $92 (USA). Conclusions. Treatment for smoking cessation in health care workers is possible, based on the staff workers of the PHC sites and with acceptable cost and performance. The project was funded by GlaxoSmithkline, PfizerChile, Johnson and Johnson Laboratories and the Health Care Services (AU)