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1.
J Eur Acad Dermatol Venereol ; 38(1): 191-196, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37611258

RESUMO

BACKGROUND: Dengue is an arbovirosis affecting nearly 4 billion people worldwide. Since 2018, dengue has been re-emerging in Reunion Island. The incidence of mucocutaneous manifestations varies according to the studies and is generally called 'rash'. OBJECTIVES: To assess the prevalence of different mucocutaneous symptoms and describe the characteristics of patients developing these symptoms and the clinical signs associated with severe dengue. METHODS: A prospective study was conducted in 2019 at the University Hospital of La Réunion, in patients presenting a positive PCR for dengue. Descriptive analyses were performed. All cases in the prospective study were examined by a dermatologist. RESULTS: A total of 163 cases were included. The prevalence of mucocutaneous signs was 80.4%. A pruritus was reported in 33.7% cases, an erythematous rash in 29.4% and a mouth involvement including lip, tongue, cheek, angular cheilitis, pharyngitis, mouth ulcer and gingivitis in 31.3%. Most of symptoms appeared in the first days, but some of them could disappear only after the 3rd week. Mucocutaneous signs were not associated with a severe dengue fever (p = 0.54), but ecchymotic purpura was (p = 0.037). In multivariate analysis, skin involvement was associated with flu-like syndrome (headache, pharyngitis, rachis pain) and patient required rehydration but not invasive reanimation. CONCLUSION: This work confirms the high prevalence of skin symptoms in dengue disease, but also their wide diversity. The mucocutaneous involvement of dengue fever appears to be accompanied by a pronounced flu-like syndrome in people without severity, but careful examination to identify ecchymotic purpura or sign of dehydration in the mucous membranes would better identify cases that may worsen.


Assuntos
Dengue , Exantema , Faringite , Púrpura , Dengue Grave , Humanos , Dengue Grave/complicações , Dengue Grave/epidemiologia , Dengue/complicações , Dengue/epidemiologia , Dengue/diagnóstico , Estudos Prospectivos , Púrpura/complicações , Exantema/complicações , Equimose , Boca , Faringite/complicações
2.
Public Health ; 225: 147-150, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37925839

RESUMO

BACKGROUND: Martinique is the second French Region with the lowest physician-to-population ratio, which may affect waiting times for access to care. OBJECTIVES: To assess (i) factors influencing waiting times from diagnosis to cancer-related treatments in breast cancer women in Martinique, and (ii) the impact of waiting times on patients' survival. STUDY DESIGN: Retrospective observational study. METHODS: Data on women diagnosed with invasive breast cancer between 1st January 2013 and 31st December 2017 and initially treated by surgery were extracted from the Martinique population-based registry. A cox model was performed to find predictive factors for waiting times. A log-rank test was used to compare time-to-treatment between groups. RESULTS: In total, 713 patients were included (mean age: 58 ± 13). Median time from diagnosis to surgery was 40 [25-60] days. Age at diagnosis was found to predict variations in waiting times. Patients > 75 had longer waiting time to surgery than those < 40 or [40-50] (P = 0.016 and P < 0.001, respectively). Women with a time-to-treatment ≥ 4 months had a significant lower survival (P < 0.01). CONCLUSIONS: Specific interventions are needed to improve waiting time from diagnosis to initial treatment, as they are longer than recommended and affect survival time.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/terapia , Neoplasias da Mama/diagnóstico , Tempo para o Tratamento , Martinica/epidemiologia , Estudos Retrospectivos , Modelos de Riscos Proporcionais
3.
Public Health ; 196: 129-134, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192605

RESUMO

OBJECTIVES: As trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. STUDY DESIGN: We performed a retrospective cohort study using data from the mainland French Dat'AIDS cohort. METHODS: Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. RESULTS: Between 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat'AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (-38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (-43.6%), P < 0.01, than in those born abroad (-23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was -46.7% among men who have sex with men (MSM), -43.5% for heterosexual women and -33.3% for heterosexual men. CONCLUSION: Our findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Estudos de Coortes , Feminino , França/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos
4.
HIV Med ; 21(7): 463-469, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32558205

RESUMO

OBJECTIVES: Post-exposure prophylaxis (PEP) care remains a challenge for individuals with potential sexual exposure to HIV in terms of PEP completion and ongoing risk behaviours. METHODS: A retrospective analysis was carried out on data from the French Dat'AIDS prevention cohort (NCT03795376) for individuals evaluated for PEP between 2004 and 2017. A multivariable analysis was performed of predictors of both PEP completion and condom use [odds ratios (ORs)] and their associated probabilities (P, with P > 95% being clinically relevant). RESULTS: Overall, 29 060 sexual exposures to HIV were evaluated for PEP [36% in men who have sex with men (MSM) and 64% in heterosexuals]. Overall, 12 different PEP regimens were offered in 19 240 cases (46%). Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) was the preferred backbone (n = 14 304; 74%). We observed a shift from boosted protease inhibitor-based regimens to nonnucleoside reverse transcriptase inhibitor- or integrase inhibitor-based regimens in recent years. Overall, 20% of PEP prescriptions were prematurely discontinued. Older age, MSM, intercourse with a sex worker, rape and intercourse with a known HIV-infected source patient were factors associated with increased rates of PEP completion (OR > 1; P > 98%). None of the 12 PEP regimens was associated with premature discontinuation. We also found 12 774 cases of unprotected sexual intercourse (48%). Condom use decreased (OR < 1; P > 99%) with the year of exposure, and was lower in MSM and rape victims. Condom use increased (OR > 1, P > 99%) with age, and was higher in those who had intercourse with a sex worker or with a female partner and in those with knowledge of the partner's HIV status. CONCLUSIONS: We provide new insights into how rates of condom use and PEP completion might be improved in those receiving PEP by targeting certain groups of individuals for interventions. In particular, youth and MSM at risk should be linked in a prevention-to-care continuum.


Assuntos
Emtricitabina/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pós-Exposição/métodos , Tenofovir/uso terapêutico , Sexo sem Proteção/estatística & dados numéricos , Adulto , Preservativos , Feminino , França , Infecções por HIV/transmissão , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Análise Multivariada , Estudos Retrospectivos , Parceiros Sexuais/classificação
5.
J Eur Acad Dermatol Venereol ; 34(5): 1065-1073, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31953902

RESUMO

BACKGROUND: Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV-infected people. OBJECTIVE: To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. METHODS: Retrospective study using longitudinal data from 44 642 patients in the French Dat'AIDS multicenter cohort. Patients' characteristics were described at KS diagnosis according to ART exposure and to HIV-plasma viral load (HIV-pVL) (≤50 or >50) copies/mL. RESULTS: Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART-experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV-pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted-PI-based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. LIMITATIONS: Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. CONCLUSION: Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV-pVL ≤50 cp/mL remain to be explored.


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Herpesvirus Humano 8 , Sarcoma de Kaposi , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia
6.
BMC Infect Dis ; 19(1): 278, 2019 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-30909885

RESUMO

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) was implemented in France in November 2015 based on individual-level risk factors for HIV infection. We evaluated the proportion of missed opportunities for PrEP among newly HIV-diagnosed people entering the Dat'AIDS cohort in 2016. METHODS: Multicenter retrospective analysis in 15 French HIV clinical centers of patients with a new diagnosis of HIV infection. Among them we differentiated patients according to the estimated date of infection: those occurring in the PrEP area (a previous negative HIV test in the last 12 months or those with an incomplete HIV-1 western blot (WB) with no HIV-1 anti-Pol-antibody at time of HIV diagnosis) and those in the pre-PrEP area (older infections). Epidemiological, biological and clinical data at HIV diagnosis were collected. Clinicians retrospectively identified potential eligibility for PrEP based on individual-level risk factors for HIV infection among those infected in the PrEP area. RESULTS: Among 966 patients with a new HIV diagnosis, 225 (23.3%) were infected in the PrEP area and 121 (53.8%) had complete data allowing evaluation of PrEP eligibility. Among them, 110 (91%) would have been eligible for PrEP, median age 31 years, with 68 (75.6%) born in France and 10 (11.1%) in Central/West Africa, with more than one previous STI in 19 (15.7%). The main eligibility criteria for PrEP were being a man who had sex with men or transgender 91 (82.7%) with at least one of the following criteria: unprotected anal sex with ≥2 partners in the last 6 months: 67 (60.9%); bacterial sexually transmitted infection in the last 12 months: 33 (30%); Use of psychoactive substances in a sexual context (chemsex): 16 (14.5%). PrEP was indicated for other HIV risk factors in 25 (22.7%). CONCLUSION: With 91% (110/121) of patients infected in the PrEP area eligible for PrEP, this study highlights the high potential of PrEP in avoiding new infection in France but also shows a persistent delay in HIV testing. Thus, an important limit on PrEP implementation in France could be insufficient screening and care access.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Sorodiagnóstico da AIDS , Adulto , África Ocidental , Estudos de Coortes , Diagnóstico Tardio , Feminino , França , HIV-1 , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Comportamento Sexual , Parceiros Sexuais , Pessoas Transgênero , Sexo sem Proteção
7.
HIV Med ; 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29856132

RESUMO

OBJECTIVES: People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of this study was thus to study demographic, socio-economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013. METHODS: This was a nested case-control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5-year periods) and clinical centre. RESULTS: Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV-related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide. CONCLUSIONS: In the cART era, HIV-related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort.

8.
HIV Med ; 18(6): 395-401, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28858437

RESUMO

OBJECTIVES: The aim of the study was to describe the ageing HIV-infected population (> 50 years old) and their current antiretroviral therapy (ART), comorbidities and coprescriptions in France in 2013 and to compare them to the younger population. METHODS: A retrospective analysis of a prospectively collected database was performed. The characteristics of patients receiving ART as well as their current ART and their numbers of comorbidities and comedications at the censoring date (1 July 2013) were compared between patients ageing with HIV infection, patients who seroconverted while ageing, and younger patients. RESULTS: We compared 10 318 ageing patients [median age 56 years; 25% interquartile range (IQR) 53-62 years] with 13 302 younger patients (median age 42 years; 25% IQR 36-47 years). The ageing patients were more frequently male than the younger patients (77 vs. 65%). Among the ageing patients, 7025 were diagnosed with HIV infection before 2000 and represented a distinct group, the 'experienced ageing' group, by comparison with the 'recently diagnosed ageing' group. Triple therapy containing a boosted protease inhibitor was used in 28.2% of the patients (vs. 39% and 36% of the younger and "recently diagnosed ageing" groups, respectively); a nonnucleoside reverse transcriptase inhibitor in 27% (vs. 33% and 38%, respectively), an integrase strand transfer inhibitor (INSTI) in 9% (vs. 7% and 9%, respectively), and another regimen (fewer or more than three drugs) in 35.8% (vs. 21% and 16.5%, respectively). "Experienced ageing" patients typically had one or more comorbidities (62.1%) and were receiving at least one comedication (71%). Central nervous system (CNS) agents (prescribed in 44.6% of the "experienced ageing" patients) and antilipidaemics (in 44.2%) were the most frequently prescribed comedications. INSTIs were used in 23% of the population and were used significantly more often in patients with comorbidities and coprescriptions. For all comparisons, P < 0.0001. CONCLUSIONS: In ageing HIV-infected patients, especially those with a long history of HIV infection, comorbidities and coprescriptions are highly prevalent.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Comorbidade/tendências , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/tratamento farmacológico , Adulto , Fatores Etários , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Caracteres Sexuais
9.
HIV Med ; 17(5): 380-4, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27093565

RESUMO

OBJECTIVES: To compare the efficacy, in current clinical practice, of first regimens containing abacavir with lamivudine (ABC/3TC) or tenofovir with emtricitabine (TDF/FTC) in patients with baseline viral load ≥100,000 HIV-1 RNA copies/mL. METHODS: Using a prospective cohort, we selected all patients starting a first HIV regimen based either on ABC/3TC or on TDF/FTC. The propensity score (PS) method was used to limit the indication bias due to the observational nature of the data. Adjusting and weighting methods via PS were used to compare the effectiveness of a first regimen containing ABC/3TC or TDF/FTC. The primary outcome was treatment failure by month 12 (M12). RESULTS: Overall, 2781 patients started an antiretroviral (ARV) regimen with ABC/3TC or TDF/FTC each in combination with efavirenz, boosted atazanavir or boosted darunavir. Among the 2472 uncensored patients before M12, 962 (39%) had a baseline viral load ≥100,000 copies/mL of whom 294 were in treatment failure at or before M12. Our analyses showed no difference between ABC/3TC and TDF/FTC in the risk of treatment failure at M12 in patients starting an ARV regimen with a high viral load (≥100,000 copies/mL). CONCLUSIONS: Using a large prospectively collected cohort of patients seeking care in France, we found no evidence that ABC/3TC based regimens led to more failures than TDF/FTC based ones in patients with high baseline viral loads.


Assuntos
Didesoxinucleosídeos/uso terapêutico , Emtricitabina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Lamivudina/uso terapêutico , Tenofovir/uso terapêutico , Carga Viral/efeitos dos fármacos , Didesoxinucleosídeos/farmacologia , Quimioterapia Combinada , Emtricitabina/farmacologia , Feminino , França , Humanos , Lamivudina/farmacologia , Masculino , Pontuação de Propensão , Estudos Prospectivos , Medição de Risco , Falha de Tratamento
10.
HIV Med ; 17(6): 471-8, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26611175

RESUMO

OBJECTIVES: Deficits in cognitive function remain prevalent in HIV-infected individuals. The aim of this European multicentre study was to assess factors associated with cognitive function in antiretroviral therapy (ART)-naïve HIV-infected subjects at the time of enrolment in the NEAT 001/Agence Nationale de Recherche sur le SIDA (ANRS) 143 study. METHODS: Prior to starting ART, seven cognitive tests exploring domains including episodic memory, verbal fluency, executive function and psychomotor speed were administered with scores standardized to z-score using the study population sample mean and standard deviation. The primary measure was overall z-score average (NPZ). We assessed associations between baseline factors and test results using multivariable regression models. RESULTS: Of 283 subjects with baseline cognitive assessments, 90% were male and 12% of black ethnicity. Median (interquartile range) age, years of education, years of known HIV infection, baseline CD4 count and baseline HIV RNA were 39 (31, 47) years, 13 (11, 17) years, 1 (0, 4) years, 344 (279, 410) cells/µL and 4.74 (4.28, 5.14) log10 HIV-1 RNA copies/mL, respectively. Forty per cent were current smokers. Factors significantly associated with poorer overall cognitive performance in multivariable models included older age, shorter duration of education, black ethnicity, lower height, and lower plasma HIV RNA. CONCLUSIONS: In this large, European-wide, ART-naïve population with relatively preserved immunity and early HIV infection, cognitive function scores at the time of ART initiation were associated with demographic and HIV-disease factors.


Assuntos
Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Infecções por HIV/complicações , Infecções por HIV/patologia , Adulto , Antirretrovirais/administração & dosagem , Europa (Continente) , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Testes Psicológicos
11.
Epidemiol Infect ; 144(11): 2363-70, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27033595

RESUMO

To describe the consequences of medical care interruptions (MCIs) we selected patients with at least two medical encounters between January 2006 and June 2013 in the Dat'AIDS cohort. Patients with any time interval >15 months between two visits were defined as having a MCI, as opposed to uninterrupted follow-up (UFU). Patients' characteristics at the time of HIV diagnosis and at the censoring date were compared between groups. Cox proportional hazards models were built to assess the role of interruptions on survival (total and AIDS-free). Of 11 116 patients, 824 had at least one MCI. These patients were younger at the time of HIV diagnosis (30 vs. 33 years, P < 0·0001). MCI was less frequent in men having sex with men vs. heterosexual patients [odds ratio (OR) 0·81, 95% confidence interval (CI) 0·69-0·96)], and a centre effect was described. MCI was independently associated with AIDS (OR 2·54, 95% CI 2·10-3·09) and death (OR 2·65, 95% CI 1·94-3·61). At the censoring date, 52·2% of patients with at least one MCI had viral load below detection vs. 85·3% of the UFU group (P < 0·0001). In conclusion, MCIs were associated with patients' survival and with the proportion of viral loads below detection in our cohort, compromising individual and collective treatment benefits.


Assuntos
Infecções por HIV/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Modelos de Riscos Proporcionais , Fatores de Risco , Carga Viral , Adulto Jovem
12.
Euro Surveill ; 18(18): 20472, 2013 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-23725775

RESUMO

Two gendarmes who participated in canyoning activities on 27 June 2011 on the Caribbean island of Martinique were diagnosed with leptospirosis using quantitative real-time polymerase chain reaction (qPCR), 9 and 12 days after the event. Among the 45 participants who were contacted, 41 returned a completed questionnaire, of whom eight met the outbreak case definition. The eight cases sought medical attention and were given antibiotics within the first week after fever onset. No severe manifestations of leptospirosis were reported. In seven of the eight cases, the infection was confirmed by qPCR. Three pathogenic Leptospira species, including L. kmetyi, were identified in four of the cases. None of the evaluated risk factors were statistically associated with having developed leptospirosis. Rapid diagnostic assays, such as qPCR, are particularly appropriate in this setting ­ sporting events with prolonged fresh-water exposure ­ for early diagnosis and to help formulate public health recommendations. Participants in such events should be made specifically aware of the risk of leptospirosis, particularly during periods of heavy rainfall and flooding.


Assuntos
Surtos de Doenças , Leptospira/isolamento & purificação , Leptospirose/epidemiologia , Montanhismo , Adulto , Feminino , Humanos , Leptospirose/diagnóstico , Leptospirose/prevenção & controle , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Sensibilidade e Especificidade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
13.
Infect Dis Now ; 53(2): 104634, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36436804

RESUMO

OBJECTIVES: To assess the level of knowledge about HPV in a population attending a sexual health clinic in the University Hospital of Martinique. METHODS: Cross sectional observational study based on a validated questionnaire among 500 young adults between June 2020 and March 2021. First question was "Have you ever heard of HPV?". If the answer was "Yes", the person was invited to answer the next 28 questions. RESULTS: Overall, 68% of participants had never heard of HPV, rising to 74.6% of women. Out of 28 questions, the median of correct answers by participants was 15 (IQR 8-19). We did not find any difference related to age. Women had more correct answers than men on most of the items related to screening and vaccine. CONCLUSION: In Martinique, knowledge about HPV is poor. New communication methods are required to reach young boys and girls.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Saúde Sexual , Masculino , Adulto Jovem , Humanos , Feminino , Papillomavirus Humano , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Martinica/epidemiologia , Estudos Transversais , Índias Ocidentais
14.
J Antimicrob Chemother ; 67(3): 691-5, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22160145

RESUMO

OBJECTIVES: Long-term results at week 96 are needed to evaluate the capacity of the darunavir/ritonavir monotherapy strategy to maintain a sustained control of the HIV-1 viral load. METHODS: MONOI is a prospective, open-label, non-inferiority, randomized, 96 week trial comparing darunavir/ritonavir monotherapy versus a darunavir/ritonavir triple-therapy strategy to maintain HIV-1 viral load suppression in HIV-1-infected patients. CLINICAL TRIAL REGISTRATION: NCT00412551. RESULTS: From 225 randomized patients, 219 patients reached the 48 week follow-up and 211 reached the 96 week follow-up (106 patients in the darunavir monotherapy arm and 105 in the darunavir triple-therapy arm). Baseline characteristics were well balanced between the two treatment groups. At week 96, in intent-to-treat analysis, 91/103 patients (88%, 95% CI 81-94) allocated to the darunavir/ritonavir monotherapy arm and 87/104 patients (84%, 95% CI 75-90) allocated to the darunavir triple-therapy arm achieved an HIV-1 viral load <50 copies/mL, with no statistical difference between the two groups. Throughout the 96 week follow-up, 66/112 patients (59%, 95% CI 49-68) and 79/113 patients (70%, 95% CI 61-78) consistently had HIV-1 RNA <50 copies/mL with darunavir/ritonavir monotherapy and darunavir/ritonavir triple therapy, respectively. CONCLUSIONS: The MONOI study establishes darunavir/ritonavir monotherapy as durable and efficacious for maintaining virological suppression in HIV-1 patients. Darunavir/ritonavir monotherapy should be considered as a (tailored) treatment option for standard triple-therapy patients who have had a substantial period of viral suppression.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Ritonavir/administração & dosagem , Sulfonamidas/administração & dosagem , Carga Viral , Darunavir , Humanos , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
16.
Med Trop (Mars) ; 71(2): 205, 2011 Apr.
Artigo em Francês | MEDLINE | ID: mdl-21695890

RESUMO

The purpose of this report is to describe the first case of occupational exposure to syphilis. This accident occurred during curettage of a venous ulcer in a 68-year-old woman in Martinique Island. The patient presented primary syphilis without HIV. This case points out the need for enhanced syphilis screening in epidemic areas.


Assuntos
Curetagem , Enfermeiras e Enfermeiros , Exposição Ocupacional/prevenção & controle , Úlcera Varicosa/cirurgia , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Martinica , Salas Cirúrgicas , Penicilina G Benzatina/uso terapêutico , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Resultado do Tratamento , Úlcera Varicosa/complicações
17.
Med Mal Infect ; 39(6): 370-4, 2009 Jun.
Artigo em Francês | MEDLINE | ID: mdl-19346089

RESUMO

OBJECTIVE: Late screening for HIV is frequent in people living in the French West Indies. Rapid tests (RT) create new opportunities to improve screening for HIV. We evaluated the feasibility and acceptability of RT among users of free and anonymous screening consultations in Fort-de-France and Saint-Martin. METHODS: After confirming its reliability on more than 20,000 samples, a RT (Determine HIV-1+2 was offered on site to all testers in addition to the classic tests. RESULTS: From October 2007 to May 2008, 373 RT were performed, four were confirmed positive. Results of RT were returned to 99.4% of testers versus 89.4% of persons who underwent additional classic tests. The rate for unclaimed classic tests results was higher for the latter than for persons who had only RT: 22.2% versus 10.6%. CONCLUSIONS: Results show that RT improves the proportion of people who are informed of their results. Nevertheless, efforts must be made to persuade patients to come back for results of the standard tests to be informed of a potential sexually transmitted infection or an acute HIV infection.


Assuntos
Testes Anônimos/métodos , Infecções por HIV/diagnóstico , Reações Falso-Negativas , Reações Falso-Positivas , Infecções por HIV/prevenção & controle , HIV-1/isolamento & purificação , HIV-2/isolamento & purificação , Hospitais Universitários , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Martinica , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa , Fatores de Tempo
18.
PLoS One ; 14(9): e0222067, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490985

RESUMO

BACKGROUND: Rapid antiretroviral therapy (ART) initiation has been proven beneficial for patients and the community. We aimed to analyze recent changes in timing of ART initiation in France and consequences of early start. METHODS: We selected from a prospective nationwide cohort, on 12/31/2017, patients with HIV-1 infection diagnosed between 01/01/2010 and 12/31/2015. We described time from (1) diagnosis to first specialized medical encounter, (2) from this encounter to ART initiation, (3) from diagnosis to first undetectable HIV viral load (VL). We analyzed the determinants of measured temporal trends. A multivariate logistic regression was performed to assess characteristics related with 1-year retention in care. RESULTS: In the 7 245 included patients, median time (1) from HIV diagnosis to first medical encounter was 13 (IQR: 6-32) days, (2) to ART initiation was 27 (IQR: 9-91) days, decreasing from 42 (IQR: 13-272) days in 2010 to 18 (IQR: 7-42) in 2015 (p<0.0001), (3) to first undetectable VL was 257 (IQR: 151-496) days, decreasing from 378 (IQR: 201-810) days in 2010 to 169 (IQR: 97-281) in 2015. After one year, proportion of patients alive and still in care was significantly lower in those in the lower quartile of time from first encounter to ART (<9 days) than those in the higher quartile (>90 days), 79.9% and 85.2%, respectively (p<0.0001). CONCLUSIONS: In a country with unrestricted rapid access to ART, keeping recently diagnosed HIV infected patients in care remains challenging. Starting ART rapidly did not seem to be profitable for all and every patient.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Retenção nos Cuidados/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/farmacologia , Estudos de Coortes , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Carga Viral/efeitos dos fármacos
19.
Med Mal Infect ; 38(6): 299-308, 2008 Jun.
Artigo em Francês | MEDLINE | ID: mdl-18395383

RESUMO

OBJECTIVES: The authors had for aim to describe demographic, immunovirilogical and therapeutic characteristics of HIV infected patients enrolled in a French clinical cohort. STUDY DESIGN: A cross-sectional analysis was performed on 30 September 2006, among patients followed in seven French University Medical Centers using the Nadis computerized medical file. RESULTS: Among 8714 patients enrolled (median age 43 years: 15-86, sex ratio 2.37), sexual transmission was the most frequent route of infection (heterosexual: 39.3%, homosexual: 34.8%). HIV and hepatitis C (HCV) or B (HBV) co-infection rates were at 19.2 and 5.8%, respectively. The number of patients who had a triple infection with HIV-HBV-HCV were 1.7%. CDC aids classification was A: 56.7%, B: 19.6%, C: 23.7%. We observed a higher proportion of female patients and an increase of the median age. The number of patients receiving antiretroviral therapy (ARV) at the study date were 81.7%, 11.7% were ARV-naive and 6,6% on a treatment interruption. Under ARV, the median CD4 count was 478cells per millimetre cube (1 to 2166) and 84.8% of patients had an undetectable viral load (VL). Among these patients, 10% had a CD4 cell count inferior or equal to 200 per millimetre cube. Patients followed in centers that participated in this study were different regarding sex, transmission routes, and HBV or HCV co-infection rates, but not regarding the proportion of patients with undetectable VL. ARV combination included more frequently protease inhibitors than nonnucleosidic reverse transcriptase (50% versus 26.2%). CONCLUSION: Among the 8714 HIV-infected patients on ARV, 85% had a VL inferior or equal to 400 per millilitre, 10% of whom had CD4 cell counts inferior or equal to 200 per millimetre cube. The proportion of patients on ARV with undetectable VL was comparable in centers who participated in this study.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , França/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Heterossexualidade , Homossexualidade , Humanos , Masculino , Pessoa de Meia-Idade
20.
Eur J Obstet Gynecol Reprod Biol ; 222: 70-74, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29353134

RESUMO

INTRODUCTION: The WHO and the HCSP recognize the Zika virus as a public health problem of international concern primarily because of the foetal risks. During the epidemic in Martinique, several modifications to the normal obstetrical follow-up were set up and information had to be delivered to pregnant women about these modifications, the attitudes to prevent infection and the signs motivating additional visits. The objective of our work was to evaluate the knowledge, attitudes and practices of pregnant women in Martinique about the risks associated with Zika infection during pregnancy in the immediate aftermath of the epidemic. MATERIALS AND METHODS: A descriptive cross-sectional survey was conducted from February to May 2017. It took place through an anonymous and standardized face-to-face questionnaire. The questions dealt with the pregnant women general knowledge about the virus, information disseminated by media on this subject, the potential risks, the protective measures taken and the monitoring throughout the pregnancy in case of infection. RESULTS: The total sample consisted of 297 pregnant women. Despite a weak adherence to individual and domestic protection recommendations, we found a good level of knowledge about Zika virus from pregnant women in Martinique. The fetal risk in case of maternal infection was known for 96.6% of those surveyed, individual protective measures were followed by 64.6% of women, 77.0% knew where to go in case of suspected infection, and 79.4% reported that the modifications in follow-up mainly concerned ultrasound monitoring. CONCLUSION: The awareness campaign on zika virus had a significant impact on population's knowledge and main practical information was correctly captured. The information did not spill excessive fear. Nevertheless, modification of individual behavior appeared harder to obtain.


Assuntos
Anormalidades Congênitas/prevenção & controle , Surtos de Doenças , Doenças Fetais/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Complicações Infecciosas na Gravidez/prevenção & controle , Infecção por Zika virus/prevenção & controle , Zika virus/patogenicidade , Adolescente , Adulto , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/virologia , Estudos Transversais , Feminino , Doenças Fetais/epidemiologia , Doenças Fetais/fisiopatologia , Doenças Fetais/virologia , Seguimentos , Sistemas de Informação em Saúde , Inquéritos Epidemiológicos , Humanos , Martinica/epidemiologia , Meios de Comunicação de Massa , Ambulatório Hospitalar , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Risco , Ultrassonografia Pré-Natal , Adulto Jovem , Zika virus/isolamento & purificação , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia
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