More winners than losers over 12 years of monitoring tiger moths (Erebidae: Arctiinae) on Barro Colorado Island, Panama.

Understanding the causes and consequences of insect declines has become an important goal in ecology, particularly in the tropics, where most terrestrial diversity exists. Over the past 12 years, the ForestGEO Arthropod Initiative has systematically monitored multiple insect groups on Barro Colorado Island (BCI), Panama, providing baseline data for assessing long-term population trends. Here, we estimate the rates of change in abundance among 96 tiger moth species on BCI. Population trends of most species were stable (n = 20) or increasing (n = 62), with few (n = 14) declining species. Our analysis of morphological and climatic sensitivity traits associated with population trends shows that species-specific responses to climate were most strongly linked with trends. Specifically, tiger moth species that are more abundant in warmer and wetter years are more likely to show population increases. Our study contrasts with recent findings indicating insect decline in tropical and temperate regions. These results highlight the significant role of biotic responses to climate in determining long-term population trends and suggest that future climate changes are likely to impact tropical insect communities.

A Comparison of Outcomes After Endoscopic Repair of Partial- Versus Full-Thickness Tears of the Gluteus Medius Tendon.

PURPOSE: The purpose of this study was to evaluate and compare the functional outcomes after endoscopic repair of partial or full-thickness gluteus medius tears at a minimum 2 years' follow-up. METHODS: Patients with isolated tears of the gluteus medius tendon repaired endoscopically between 2012 and 2017 were evaluated at a minimum 2 years of follow-up. Patients with large, retracted and/or irreducible tears, advanced atrophy, or fatty degeneration or with concomitant other hip pathology were excluded. Functional outcomes were assessed using the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain preoperatively and at the last follow-up RESULTS: Forty-six patients, 3 men and 43 women with a mean (SD) age of 63 (9; range, 43-82) years, were included. Thirty-three patients (72%) had partial-thickness tears and 13 (28%) had full-thickness tears. Pain was reduced significantly from a median of 8 (IQR: 6-8) at the preoperative visit to a median of 2 (IQR: 15) at the most recent follow-up (P < .0001). The mHHS and NAHS improved significantly from a median of 44 (IQR: 35-52) to 80 (IQR: 64-87) (P < .0001) and 52 (IQR: 43-56) to 75 (IQR: 66-94) (P < .0001), respectively. These improvements were clinically relevant and surpass the reported minimal clinically important difference. Patients with partial tears had significant functional gains in the mHHS in comparison with patients with full-thickness tears (P = .02). No other statistically significant difference between groups of tear grade was observed. CONCLUSIONS: Endoscopic repair of gluteus medius tendon tears yields excellent functional outcomes at a minimum follow-up of 2 years. A lower functional improvement for full-thickness tears was observed; this difference was statistically significant for 1 of the 2 scores evaluated. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort.

Spinopelvic parameters in greater trochanteric pain syndrome: a retrospective case-control study.

PURPOSE: Greater trochanteric pain syndrome (GTPS) is a condition resulting in lateral hip pain, most commonly caused by tendinosis or tear of the gluteus medius and minimus tendons, and greater trochanteric bursitis. Our aim was to assess pelvic parameters and proximal femoral anatomy in patients suffering from surgical-stage GTPS compared with a control group. METHODS: This retrospective, case-control study assessed 43 patients suffering from GTPS, matched according to age, gender, body mass index and level of sport and physical activity to 43 control patients, between 2013 and 2018. Pelvic parameters, including pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), and proximal femoral anatomy, including femoral offset (FO) and neck-shaft angle (NSA), were measured using the EOS Imaging™ system. RESULTS: GTPS patients had a significantly lower mean (± SD) SS than control patients (33.1 ± 10.4 vs. 39.6 ± 9.7°, respectively; p < 0.05). There was no significant difference in PT (21.3 ± 7.1 vs. 19.0 ± 7.2°), PI (53.5 ± 11.6 vs. 57.7 ± 10.5°), FO (40.4 ± 8 vs. 42.2 ± 6.8°) or NSA (125.1 ± 5.8 vs. 124.4 ± 4.7°). There was no difference in lower back pain symptoms in a subgroup analysis of GTPS patients. CONCLUSIONS: Sacral slope was lower in patients with surgical-stage GTPS than in asymptomatic hip patients, using the EOS Imaging™ system.

The biology and ecology of Necrodes littoralis, a species of forensic interest in Europe.

Necrodes littoralis (Linnaeus, 1758) (Coleoptera: Silphidae), also known as the "shore sexton beetle," is a common silphid beetle that visits and breeds on large vertebrate cadavers. This study describes, for the first time, the involvement of N. littoralis on human corpses based on a large dataset of 154 French forensic cases. Various parameters regarding corpse location, decomposition stages, and entomofauna were extracted from each file. Compared to all of the forensic entomology cases analyzed between 1990 and 2013 (1028), N. littoralis was observed, on average, in one case out of eight; most of these cases occurred during spring and summer (73.5%). More than 90% of the cases were located outdoors, especially in woodlands, bushes, and fields. The decomposition stage of the corpse varied among cases, with more than 50% in the advanced decomposition stage, 36% in the early decomposition stage, and less than 10% in the fresh, mummified, or skeletonized stages. Regarding other necrophagous species sampled with N. littoralis, Calliphorid flies were found in 94% of the cases and Fanniidae/Muscidae in 65% of the cases. Chrysomya albiceps, a heliophilic species mostly located in the Mediterranean area, was present in 34% of the cases (only 20% in the whole dataset). The most common coleopteran species were Necrobia spp. (Coleoptera: Cleridae) and Creophilus maxillosus (Coleoptera: Staphylinidae); these beetles were observed in 27% of the cases. The over-representation of these species is likely due to similar requirements regarding the climate and decomposition stage. As N. littoralis is frequently observed and tends to become more common, we conclude that the developmental data for this species would be a precious tool for forensic entomologists in Europe.

Involvement of larder beetles (Coleoptera: Dermestidae) on human cadavers: a review of 81 forensic cases.

From 1994 to 2013, French forensic entomology laboratories investigated 1,093 cases. Larder beetles (Coleoptera: Dermestidae) were observed in 81 (7.5%) of these cases. To describe and analyze these 81 cases, eight parameters were used: city, location (indoor or outdoor), decay stage (fresh, decay, or dry), dermestid species and instar (adults and/or larvae), presence of living calliphorid larvae, presence of calliphorid pupae or adults, and presence of other necrophagous species. Eight Dermestidae species were observed: Dermestes frischii (42% of cases), Dermestes undulatus (35.8%), Dermestes peruvianus (12.3%), Dermestes lardarius (9.9%), Dermestes haemorrhoidalis (8.6%), Dermestes maculatus (7.4%), Dermestes bicolor (3.7%), and Dermestes ater (1.2%). Larder beetles primarily developed on human cadavers in outdoor locations in areas with a dry climate and were never reported in oceanic areas (which are characterized by frequent rainfall and high ambient humidity). The number of dermestid species on a single corpse never exceeded three. Typically, one species was found per corpse. Species differed between indoor and outdoor cases, with D. frischii and D. undulatus dominant in outdoor cases, while D. peruvianus dominant in indoor cases. Calliphoridae was found in 88% of the cases, while Hydrotaea and Piophilidae were observed 40% of the time. Regarding Coleoptera, Necrobia spp. (Coleoptera: Cleridae) was observed in 46% of the cases. Lastly, we observed a typical decomposition pattern, with preferential feeding areas on the face, hands, and feet (i.e., the extremities). Pupation chambers on or inside the bones were not observed.

A striking new genus and species of tiger-moth (Lepidoptera: Erebidae, Arctiinae, Arctiini) from the Caribbean, with molecular and morphological analysis of its systematic placement.

Westindia Vincent, a new genus, is proposed for W. haxairei Vincent, a new species of Neotropical tiger-moth described from Dominican Republic. Habitus, male and female genitalia are described and figured. The systematic position of the new genus within Arctiinae is discussed in light of a comparative morphology and a molecular phylogeny derived from the DNA barcode fragment of the mitochondrial COI gene and of the D2 region of the 28S rDNA gene.

Influence of knot strength on the mechanical performance of a biodegradable gillnet.

Ghost fishing is a global issue that can be addressed using fishing gear materials that do not persist in the marine environment. However, for these alternatives to be widely adopted, they must meet the same mechanical specifications as current commercial materials while degrading without any negative impact. The objective of this study was to compare a conventional gillnet made of polyamide 6 (PA6) with an alternative made of poly(butylene succinate-co-adipate-co-terephthalate) (PBSAT) at three different scales: monofilament, knot, and net. While the PBSAT monofilament's strength was half that of the conventional PA6 net, knot and net losses were even more significant. This indicates a greater sensitivity of the material to the knot. Since the results between the knot and net scales were coherent, testing whole net panels is not necessary. Studying the curvature and the behaviour of the knot revealed its complex geometry and mechanical behaviour. Testing the weaver's knot is a good indicator for studying the relevance of an alternative to conventional fishing gear materials. This should be considered when developing biodegradable nets in order to reduce ghost fishing at sea.

A quantitative and qualitative method to control chemotherapeutic preparations by Fourier transform infrared-ultraviolet spectrophotometry.

Chemotherapy products in hospitals include a reconstitution step of manufactured drugs providing an adapted dosage to each patient. The administration of highly iatrogenic drugs raises the question of patients' safety and treatment efficiency. In order to reduce administration errors due to faulty preparations, we introduced a new qualitative and quantitative routine control based on Fourier Transform Infrared (FTIR) and UV-Visible spectrophotometry. This automated method enabled fast and specific control for 14 anticancer drugs. A 1.2 mL sample was used to assay and identify each preparation in less than 90 sec. Over a two-year period, 9370 controlled infusion bags showed a 1.49% nonconformity rate, under 15% tolerance from the theoretical concentration and 96% minimum identification matching factor. This study evaluated the reliability of the control process, as well as its accordance to chemotherapy deliverance requirements. Thus, corrective measures were defined to improve the control process.

Mitigating plastic pollution at sea: Natural seawater degradation of a sustainable PBS/PBAT marine rope.

This paper evaluates the use of a PBS/PBAT biodegradable rope to reduce the environmental impact of fishing gear lost at sea. The study aims to better understand the degradation mechanisms that the rope and its monofilaments may encounter due to the long term exposure to seawater. The monofilaments were immersed in natural seawater for up to 18 months, and rope samples were also immersed to study aging at a larger scale and evaluate the ability of a modelling tool to predict initial and aged states of the rope. At low temperatures, no loss of properties was observed for the monofilament and rope. However, at higher temperatures, biodegradation and hydrolysis processes were observed, leading to a faster loss of properties in the monofilament compared to the rope. The modelling tool provided conservative predictions due to severe mechanical test conditions of aged monofilament and a degradation gradient within the rope structure.

Arthroscopic treatment of type I and II greater trochanteric pain syndrome.

The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44±11 [26-65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at≥3 on VAS. The satisfaction rate was 7/10±2 [3-10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure. LEVEL OF EVIDENCE: IV; retrospective, case series.

Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years' follow-up in a case-control study.

BACKGROUND: Tibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HYPOTHESIS: Postoperative lift-off is a rare event that is predictive of laxity. METHODS: We carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. RESULTS: The frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12-49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DISCUSSION: Immediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years' follow-up; however, a long-term assessment is required to verify this finding. LEVEL OF EVIDENCE: III - case-control study.

Does the alpha-defensin lateral flow test conserve its diagnostic properties in a larger population of chronic complex periprosthetic infections? Enlargement to 112 tests, from 42 tests in a preliminary study, in a reference center.

BACKGROUND: Diagnosis of periprosthetic infection (PPI) is crucial for management of bone and joint infection. The preoperative gold-standard is joint aspiration, providing results after 2-14 days' culture, with non-negligible false negative rates due to the fragility of certain micro-organisms and/or prior antibiotic treatment. The Synovasure™ alpha-defensin lateral flow test (Zimmer, Warsaw, IN, USA) contributes within minutes to joint fluid diagnosis of almost all infectious agents, including in case of concomitant antibiotic therapy. Validity remains controversial, notably in complex microbiological situations: multi-operated patients, diagnostic doubt despite iterative sterile culture, long-course antibiotic therapy. We extended a prospective study reported in 2018, to determine whether the test maintained diagnostic value in a larger population, assessing 1) negative (NPV) and positive (PPV) predictive value, and 2) sensitivity and specificity. HYPOTHESIS: Synovasure™ maintains NPV above 95% in a broader population of microbiologically complex suspected PPI. MATERIAL AND METHODS: Synovasure™'s performance was assessed between October 2015 and October 2019 in 106 patients (112 tests) in complex diagnostic situations: 37 discordant cultures (discordant findings between 2 samples), 65 cases with clinically or biologically suspected infection but iterative sterile culture, 10 emergencies (requiring surgery, precluding antibiotic window, or mechanical failure in suspected infection), including 5 with ongoing antibiotic therapy for infection in another organ. Six tests were repeated in the same patient and same joint at >6 months' interval for strong clinical suspicion of infection. The main endpoint was the MSIS score (MusculoSkeletal Infection Society, 2018). RESULTS: NPV was 98.8%, PPV 72.4%, sensitivity 95.5% and specificity 91%. Prevalence of infection was 19.6%. Only 1 of the 22 infected patients had negative Synovasure™ tests, compared to 81 of the 84 non-infected patients. CONCLUSION: Synovasure™ is a reliable novel diagnostic test, contributing mainly to ruling out infection thanks to its strong NPV. The cost imposes sparing use, but medico-economic assessment would be worthwhile. LEVEL OF EVIDENCE: III; prospective of diagnostic performance.

Description of five new Lophocampa Harris from the Dominican Republic (Lepidoptera, Erebidae, Arctiinae).

Five new species of Lophocampa are described from the Dominican Republic. Lophocampa occidentalis n. sp. is described from two males, Lophocampa perezgelaberti n. sp. from three males and two females, Lophocampa desotoi n. sp. from seven males and two females, Lophocampa sharki n. sp. from three males and Lophocampa flavoabdominalis n. sp. from five males and one female. The habitus and genitalia are illustrated. A comparison with closest species is proposed on morphological and molecular characters.

The low impact of fish traps on the seabed makes it an eco-friendly fishing technique.

Besides understanding the effects of fishing on harvested fish stocks, effects on non-target species, habitats and seafloor integrity also need to be considered. Static fishing gears have often been mentioned as a lower impact fishing alternative to towed gears, although studies examining their actual impact on the seafloor are scarce. In this study, we aimed to describe fish trap movements on the seafloor related to soaking time and trap retrieval. Impacts on the seafloor of lightweight rectangular traps and heavier circular traps were compared. We used 3D video cameras to estimate sweeping motion on the seabed and penetration into the sediment during soaking time. The area and distance swept by each type of trap during retrieval was determined by a camera set up facing the sea bottom. The potential rotation of the traps around the mainline was assessed using an Acoustic Doppler Current Profiler. Results showed that no penetration and almost no movements could be detected during soaking time for either lightweight or heavy commercial traps, even for high tidal coefficient (maximum 6 cm). No rotation could be observed when the tide turned. The swept area covered by a trap during retrieval was low (maximum 2.04 m2) compared to towed fishing gear and other static gear.

A profile on the Synovasure alpha defensin test for the detection of periprosthetic infections.

INTRODUCTION: Clinicians have waited a long time for a 'universal' marker that may help them distinguish infected from non-infected total joint arthroplasties when doubts persist after using classical clinical and biological signs of infection. In recent years, synovial fluid biomarkers including leukocyte esterase, alpha-defensins, and CRP have shown promising results for the diagnosis of periprosthetic joint infections (PJIs). AREAS COVERED: This review provides an overview of the rational and the use of the Synovasure® alpha-defensin tests in patients with a suspicion of PJI. Using a systematic investigation by keywords, we looked for all citations (and the citations to these citations) of the selected papers. EXPERT OPINION: The Synovasure® alpha-defensin tests demonstrate high potential for the diagnosis of PJIs. However, the data currently available also show that the universal marker of infection in the settings of PJIs is still to be discovered.

A methodological framework for characterizing fish swimming and escapement behaviors in trawls.

Knowledge about fish behavior is crucial to be able to influence the capture process and catch species composition. The rapid expansion of the use of underwater cameras has facilitated unprecedented opportunities for studying the behavior of species interacting with fishing gears in their natural environment. This technological advance would greatly benefit from the parallel development of dedicated methodologies accounting for right-censored observations and variable observation periods between individuals related to instrumental, environmental and behavioral events. In this paper we proposed a methodological framework, based on a parametric Weibull mixture model, to describe the process of escapement attempts through time, test effects of covariates and estimate the probability that a fish will attempt to escape. We additionally proposed to better examine the escapement process at the individual level with regard to the temporal dynamics of escapement over time. Our approach was used to analyze gadoids swimming and escapement behaviors collected using a video set up in front of a selective device known to improve selectivity on gadoids in the extension of a bottom trawl. Comparison of the fit of models indicates that i) the instantaneous rate of escape attempts is constant over time and that the escapement process can be modelled using an exponential law; ii) the mean time before attempting to escape increases with the increasing number of attempts; iii) more than 80% of the gadoids attempted to escape through the selective device; and iv) the estimated probability of success was around 15%. Effects of covariates on the probability of success were investigated using binomial regression but none of them were significant. The data set collected is insufficient to make general statements, and further observations are required to properly investigate the effect of intrinsic and extrinsic factors governing gadoids behavior in trawls. This methodology could be used to better characterize the underlying behavioral process of fish in other parts of a bottom trawl or in relation to other fishing gears.

Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study).

Between 1 and 2% of people aged 50 years and over living at home in France are likely to experience a fragility fracture each year. Three-quarters of these individuals are not diagnosed with osteoporosis and lose the opportunity for appropriate care. PURPOSE: To estimate the incidence of fragility fractures in France and to describe the characteristics of individuals with such fractures and of their fractures. METHODS: In April-May 2018, a postal survey was performed in France targeting a representative panel of 15,000 individuals aged ≥ 50 years, who were invited to complete a questionnaire. If they reported experiencing a fracture in the previous 3 years, they were asked to provide information on demographics, fracture type, risk factors for fractures and osteoporosis diagnosis. Only fragility fractures were considered, and these were classified as major (associated with increased mortality) or minor, based on the fracture site. RESULTS: Around 13,914 panellists returned an exploitable questionnaire (92.8%). About 425 participants reported ≥ 1 fragility fracture (453 fractures), corresponding to a 12-month incidence rate of 1.4% [95%CI: 1.2, 1.6]. Incidence was higher in women (1.99% [1.87, 2.05]) than in men (0.69% [0.38, 0.86]) and increased with age. Around 157 fractures (34.6%) were classified as major. Participants reporting major fractures were older than those reporting minor fractures (mean age: 72.6 ± 11.3 vs 67.1 ± 10.6) and more likely to report previous corticosteroid use (odds ratio: 1.90 [95%CI: 1.13, 3.18]). No other patient characteristic was associated with fracture severity. About 117 participants with fractures (27.5%) had undergone bone densitometry, and 97 (22.8%) declared having received a diagnosis of osteoporosis. CONCLUSIONS: Around 340,000 people aged ≥ 50 years living at home in France are estimated to experience osteoporotic fractures each year. However, > 75% of panellists reporting fractures were never diagnosed with osteoporosis and thus did not have the opportunity to receive appropriate care.

Two new species of the Neotropical Lophocampahyalinipuncta (Rothschild) group (Lepidoptera, Erebidae, Arctiinae).

Two new species of Lophocampa Harris are described and illustrated, Lophocampaazuayensis sp. n., and Lophocampacarpishensis sp. n. Both new species were confused with Lophocampahyalinipuncta (Rothschild, 1909), and a comparative diagnosis is provided.

RésuméDeux nouvelles espèces de Lophocampa Harris sont décrites et illustrées, Lophocampaazuayensis sp. n., et Lophocampacarpishensis sp. n. Une comparaison avec Lophocampahyalinipuncta (Rothschild, 1909), l'espèce avec laquelle ces taxa étaient confondus, est proposée.

Effect of low temperature in the development cycle of Lucilia sericata (Meigen) (Diptera, Calliphoridae): implications for the minimum postmortem interval estimation.

Knowledge of necrophagous insects' developmental data is necessary for the forensic entomologist to estimate a reliable minimum postmortem interval (PMImin). Among the most represented necrophagous species, Lucilia sericata (Diptera, Calliphoridae) is particularly interesting. It is regularly identified in samples, with a predominance in summer, and is commonly used by analysts of our entomology department (Institut de Recherche Criminelle de la Gendarmerie Nationale) to estimate the PMImin with the accumulated degree days (ADD) method. This method requires the mathematical lower thermal threshold to be known. This value dictates the quality of the applied ADD method but cannot be considered as fixed, especially when insect development occurs at temperatures close to the biological threshold. In such conditions, it is necessary to study the influence of such temperatures on development rate, as well as the consequences of estimating the period of first oviposition on cadavers, when using the ADD method. Seven replicate rearings were conducted at six different temperatures: 30 °C, 24 °C, 18 °C, 15 °C, 12 °C and 10 °C. Time of development and time of emergence were recorded. The effect of low temperature on the development cycle and the reliability of the ADD method under this entire temperature spectrum were studied using different linear regression models. Calculated durations of total insect time development and experimental rearing duration were then compared. A global linear model cannot be used on the whole temperature spectrum experienced by L. sericata without resulting in an overestimation at some temperatures. We found a combination of two linear regression models to be suitable for the estimation of the total development time, depending on the temperature experienced by L. sericata. This approach allowed us to obtain a variation lower than 2% at 12 °C and 10 °C between the calculated duration and experimental duration of development. In comparison, the results obtained with a global model show a variation higher than 3% at 12 °C and 10% at 10 °C.

Characteristics and outcomes of HIV-infected patients in the ICU: impact of the highly active antiretroviral treatment era.

OBJECTIVE: To examine whether the introduction of highly active antiretroviral therapy (HAART) has changed the rate of admission, the clinical spectrum, and the mortality of HIV-infected ICU patients. DESIGN: Observational study. SETTING: Infectious diseases ICU in a teaching hospital, Paris, France. PATIENTS: All HIV-infected patients admitted during a pre-HAART era (1995-1996; n=189) and a HAART era (1998-2000; n=236). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: At the HAART era, 79% of patients had derived no or little benefit from the availability of HAART at ICU admission: 44% had no history of antiretroviral (ARV) medications and 35% had failed to respond to ARV. As compared with the pre-HAART era, the rate of hospitalized HIV-infected patients requiring the ICU stay increased (HAART, 5.9% vs pre-HAART, 4.4%; p=0.004). The admission was more likely to occur through the emergency room (45 vs 29%, p=0.0004), and the patients to be foreigners (38.1 vs 28.6%; p=0.04). After adjustment for significant prognostic covariates (AIDS-related tumors at admission, CD4 count <50/mm(3), poor functional status (Knaus score C or D), SAPSII, and need for mechanical ventilation), ICU survival was unchanged (adjusted OR=0.613, 95% CI=0.312-1.206), but 3-month survival was significantly improved (adjusted OR=0.57; 95% CI=0.32-0.99; p=0.045). CONCLUSION: The number of HIV-infected patients admitted to the ICU remained high in the HAART era. Underutilization of HAART and limited access to health care are possible explanations. The ICU mortality has remained unchanged, but 3-month mortality has decreased.