Catherine Quantin

Does hepatitis C virus co-infection accelerate clinical and immunological evolution of Hiv-infected patients?

Objective:To study the influence of hepatitis C virus (HCV) co-infection on clinical and immunological evolution of HIV-infected patients. Design:A longitudinal study of HIV-infected individuals with or without HCV infection, identified at the Infectious Diseases Department of Dijon University Hospital and enrolled in a historical cohort, was performed. Methods:One hundred and nineteen HIV-infected people co-infected with HCV and 119 matched individuals infected with HIV alone were included in the cohort (median participation time 3 years; range, 2 months to 11.5 years). Clinical progression was defined as one or more of the following: a 30% decrease in the Karnofsky index; a 20% loss of body weight; an AIDS-defining illness (for non-AIDS patients); death (except by accident, suicide or overdose). Immunological progression was defined as a 50% decrease in the initial CD4 T-cell count (for patients with an initial count > 100 × 106 cells/l). Effects of HCV co-infection were evaluated using Kaplan-Meier survival analysis and significance was tested using univariate (log-rank and Petos tests) and multivariate methods (Coxs model). Results:In univariate analysis, immunological progression was not statistically different between the HCV-positive group and the HCV-negative group, whereas clinical progression was significantly faster in HCV-positive patients (P < 0.005, log–rank test). In a multivariate Cox model, clinical progression remained significantly associated with infection by HCV [hazard ratio (HR), 1.64; 95% confidence interval (CI), 1.06–2.55; P < 0.05]. Stratified multivariable analysis retained HCV as a significant prognostic factor of clinical progression (HR, 10.9; 95% CI, 1.09–109.3; P < 0.05) and immunological progression (HR, 2.31; 95% CI, 1.16–4.62; P < 0.02) for patients with an initial CD4 count above 600 × 106 cells/l. Conclusions:Clinical progression is more rapid in HIV–HCV co-infected patients than in HIV-seropositive patients are not infected by HCV. The prognostic value of HCV infection for both clinical and immunological progression is significant at early stages of HIV infection. These findings may argue for active management of hepatitis C infection in co-infected individuals, especially for asymptomatic patients whose CD4 count is above 600 × 106 cells/l, to predict and prevent accelerated progression of HCV and HIV diseases.

How to ensure data security of an epidemiological follow-up: quality assessment of an anonymous record linkage procedure.

A computerised record hash coding and linkage procedure is proposed to allow the chaining of medical information within the framework of epidemiological follow-up. Before their extraction, files are rendered anonymous using a one-way hash coding based on the standard hash algorithm (SHA) function, in order to respect the legislation on data privacy and security. To avoid dictionary attacks. two keys have been added to SHA coding. Once rendered anonymous, the linkage of patient information can be accomplished by means of a statistical model, taking into account several identification variables. Quality assessment of this anonymous record linkage procedure shows a specificity of 100% and a sensitivity of 95%.

Neonatal outcome associated with singleton birth at 34–41 weeks of gestation

BACKGROUND Approximately 75% of preterm births are late-preterm (34(0/7) to 36(6/7) weeks gestation). This group has usually been considered as a whole in studies assessing the outcome of these preterm infants by comparison with term infants. However, the respective contribution to prognosis of each week of gestation has not been fully clarified. METHODS A population-based study of 150 426 live-born singleton neonates with gestational ages ranging from 34 to 41 weeks of gestation. RESULTS The rate of severe respiratory disorders (treated by mechanical ventilation and/or nasal continuous positive airway pressure) markedly declined with gestational age from 19.8% at 34 weeks to 0.28% at 39-41 weeks. Between 34 and 38 weeks, each additional week diminished the relative risk (crude or adjusted) of severe respiratory disorders by a factor varying from 2 to 3. The rate of poor prognosis (death and/or severe neurological condition) significantly declined between 34 and 38 weeks and remained stable thereafter. A multivariate analysis showed that antepartum haemorrhage and hypertensive disorders during pregnancy were significantly associated with severe respiratory disorders and poor outcome. Diabetes was an additional factor associated with severe respiratory disorders. CONCLUSIONS Future studies should delineate more precisely the respective contribution of gestational age, maternal complication and induced delivery in the prognosis of infants born between 33 and 39 weeks gestation.

Prognostic factors for the long-term development of ocular lesions in 327 children with congenital toxoplasmosis.

The aim of this study was to identify the high-risk factors associated with the development of ocular lesions in a large cohort of children with congenital toxoplasmosis (CT), irrespective of their gestational age at the time of maternal infection. Children were managed according to a standardized protocol and monitored for up to 14 years at the Croix-Rousse Hospital, Lyon, France. Cox model and a flexible regression, spline-based method were used for the analysis. During a median follow-up time of 6 years, 79 of the 327 children (24%) had at least one retinochoroidal lesion. No bilateral impairment of visual acuity was observed. The risk of a child developing ocular disease was higher not only when mothers were infected early during pregnancy, which was expected, but also when CT was diagnosed prior to or at the time of birth, when non-ocular manifestations were present at baseline and when birth was premature.

Outcomes After Acute Myocardial Infarction in HIV-Infected Patients Analysis of Data From a French Nationwide Hospital Medical Information Database

Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systemes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.1% [ P <0.001] and 1.4% versus 5.5% [ P <0.001], respectively). From the database, we then analyzed a cohort derived from a matching procedure, with 1 HIV patient matched with 2 patients without HIV, based on age and sex (n=1824). Ischemic cardiomyopathy was more frequent in the HIV group (7.6% versus 4.2%, P =0.003). Hospitalization and 1-year mortality rates were similar in the 2 groups (3.1% versus 2.1% [ P =0.168] and 1.4% versus 1.7% [ P =0.642], respectively). However, at 12 months, hospitalizations for episodes of heart failure were significantly more frequent in HIV-infected than in uninfected patients (3.3% versus 1.4%, respectively; P =0.020). HIV infection, diabetes mellitus, history of ischemic cardiomyopathy, and undergoing percutaneous coronary intervention were associated in univariate analysis with occurrence of heart failure. By multivariable analysis, HIV infection (odds ratio 2.82, 95% confidence interval 1.32–6.01), diabetes mellitus, and undergoing percutaneous coronary intervention remained independent predictors of heart failure. Conclusions— The present study demonstrates that after acute myocardial infarction, HIV status influences long-term risk, although the short-term risk in HIV patients is comparable to that in uninfected patients. # Clinical Perspective {#article-title-41}Background— We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction. Methods and Results— From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.1% [P<0.001] and 1.4% versus 5.5% [P<0.001], respectively). From the database, we then analyzed a cohort derived from a matching procedure, with 1 HIV patient matched with 2 patients without HIV, based on age and sex (n=1824). Ischemic cardiomyopathy was more frequent in the HIV group (7.6% versus 4.2%, P=0.003). Hospitalization and 1-year mortality rates were similar in the 2 groups (3.1% versus 2.1% [P=0.168] and 1.4% versus 1.7% [P=0.642], respectively). However, at 12 months, hospitalizations for episodes of heart failure were significantly more frequent in HIV-infected than in uninfected patients (3.3% versus 1.4%, respectively; P=0.020). HIV infection, diabetes mellitus, history of ischemic cardiomyopathy, and undergoing percutaneous coronary intervention were associated in univariate analysis with occurrence of heart failure. By multivariable analysis, HIV infection (odds ratio 2.82, 95% confidence interval 1.32–6.01), diabetes mellitus, and undergoing percutaneous coronary intervention remained independent predictors of heart failure. Conclusions— The present study demonstrates that after acute myocardial infarction, HIV status influences long-term risk, although the short-term risk in HIV patients is comparable to that in uninfected patients.

Severe respiratory disorders in term neonates

Few prospective population-based studies of respiratory diseases have been conducted in term neonates. We aimed to describe mechanically ventilated respiratory disorders in term neonates and associated risk factors in a regional-based study of livebirths between 37 and 41 weeks. The study was prospective for epidemiological data recording, and retrospective for collecting additional data from charts of neonates with severe (mechanically ventilated) respiratory disorders. A total of 14,813 neonates with gestational age (GA) 37-38 weeks and 50,187 neonates with GA 39-41 weeks were included. The overall incidences (per thousand livebirths) of mechanically ventilated transient tachypnoea of the newborn (TTN) respiratory distress syndrome (RDS) and meconium aspiration syndrome (MAS) were 0.72 per thousand[95% CI 0.53 per thousand, 0.96 per thousand], 0.38 per thousand[95% CI 0.25 per thousand, 0.57 per thousand] and 0.61 per thousand[95% CI 0.44 per thousand, 0.84 per thousand], respectively. Increasing GA from 37 to 41 weeks was associated with a significant decrease in incidence of RDS and TTN without any significant change for MAS. Multivariable analysis was used to identify independent factors associated with severe respiratory disorders: in the 37-38 weeks group - Apgar score < or =3 at 1 min, elective caesarean section (CS), emergency CS and placental abruption; in the 39-41 weeks group - Apgar score < or =3 at 1 min, elective CS, emergency CS, meconium-stained amniotic fluid and abnormal cardiotocography. Comparing the population attributable risks, the main risk factor of severe respiratory disorders was elective CS in the 37-38 weeks group and meconium-stained amniotic fluid in the 39-41 weeks group.

Incidence of Acute Postoperative Endophthalmitis after Cataract Surgery: A Nationwide Study in France from 2005 to 2014.

PURPOSE To report the incidence of acute postoperative endophthalmitis (POE) after cataract surgery from 2005 to 2014 in France. DESIGN Cohort study. PARTICIPANTS Patients undergoing operation for cataract surgery by phacoemulsification and presenting acute POE. METHODS We identified acute POE occurring within 6 weeks after phacoemulsification cataract surgery and the use of intracameral antibiotic injection during the surgical procedure by means of billing codes from a national database. MAIN OUTCOME MEASURES Incidence of acute POE. RESULTS From January 2005 to December 2014, 6 371 242 eyes in 3 983 525 patients underwent phacoemulsification cataract surgery. The incidence of acute POE after phacoemulsification decreased from 0.145% to 0.053% during this 10-year period; the unadjusted incidence rate ratio (IRR) (95% confidence interval) was 0.37 (0.32-0.42; P < 0.001). In multivariate analysis, intracameral antibiotic injection was associated with a lower risk of acute POE 0.53 (0.50-0.57; P < 0.001), whereas intraoperative posterior capsule rupture, combined surgery, and gender (male) were associated with a higher risk of acute POE: 5.24 (4.11-6.68), 1.77 (1.53-2.05), and 1.48 (1.40-1.56) (P < 0.001), respectively. CONCLUSIONS Access to a national database allowed us to observe a decrease in acute POE after phacoemulsification cataract surgery from 2005 to 2014. Within the same period, the use of intracameral antibiotics during the surgical procedures increased.

Modelling time-dependent hazard ratios in relative survival: application to colon cancer.

The Cox model is widely used in the evaluation of prognostic factors in clinical research. In population-based studies, however, which assess long-term survival of unselected populations, relative survival models are often considered more appropriate. In both approaches, the validity of proportional hazard hypothesis should be evaluated. To explore the validity of the proportional hazard assumption in a population-based study of colon cancer, to propose non-proportional hazard relative survival models and to evaluate their utility. The use of a piecewise proportional hazard relative survival model in colon cancer has shown that the effects of most clinical prognostic factors such as age, period of diagnosis and stage are non-proportional. The non-proportional hazard relative survival models developed in this article have been found to be efficient tools for better understanding the time-dependent aspect of prognostic factors.

Can Birth Weight Standards Based on Healthy Populations Improve the Identification of Small-for-Gestational-Age Newborns at Risk of Adverse Neonatal Outcomes?

OBJECTIVES. To develop neonatal growth standards based on (1) the entire population of live births and (2) a healthy subpopulation and compare them in identifying infants as small for gestational age and at risk of adverse neonatal outcomes. PATIENTS AND METHODS. We included all births, between 28 and 41 weeks of gestation, reported in Burgundy (France) from 2000 to 2006. Fetal deaths, multiple births, and chromosomal aberrations were excluded. We first estimated separate birth weight distributions at each week of gestation for (1) all neonates and (2) only infants born from women without maternal diseases. Small for gestational age was defined as a birth weight below the 10th percentile of the corresponding standard. We assessed the associations of small for gestational age on the basis of the alternative definitions, with mortality and major neonatal outcomes. RESULTS. We included 127 584 live births. For term newborns, small for gestational age was significantly associated with an increased risk of death with both standards. In contrast, for preterm newborns (32–36 weeks), small for gestational age was not significantly associated with mortality and morbidity. Very preterm infants (28–31 weeks) identified as small for gestational age according to the healthy-population standard were at higher risk of chronic lung disease and intraventricular hemorrhage. When using the entire-population standard, small for gestational age was associated with chronic lung disease but not intraventricular hemorrhage. The area under the receiver operating characteristic for predicting an intraventricular hemorrhage was significantly greater for small for gestational age defined with the healthy-population standard compared with small for gestational age classified with the entire-population standard. CONCLUSIONS. Neonatal growth standards based on healthy populations could improve the identification of very preterm neonates as small for gestational age and at risk of intraventricular hemorrhage.

A Hospital-Based and a Population-Based Stroke Registry Yield Different Results: The Experience in Dijon, France

BACKGROUND AND PURPOSE The aim of this study was to demonstrate the different results obtained from a population-based and a hospital-based stroke study in the same city. METHODS Between January 1 and December 31, 1993, we collected information on all of the first strokes in the population of the city of Dijon, in conjunction with the Dijon Stroke Registry, collecting the first-ever strokes from patients living in Dijon as well as on all the first strokes in residents and nonresidents of Dijon who were treated at Dijon University Hospital. Demographic details, medical history, vascular risk factors, stroke subtype, as diagnosed by CT scan, and mortality rates were compared between the strokes observed in the population of the city of Dijon among residents as well as nonresidents in Dijon who were treated at Dijon University Hospital. RESULTS We collected information on 210 strokes observed in the population of Dijon city, 171 Dijon residents and 395 non-Dijon city residents hospitalized at the University Hospital of Dijon. These three groups were quite different. The residents of Dijon treated for stroke at the University Hospital were younger and their incidence of cerebral hemorrhage, cardiac arrhythmia, ischemic heart disease and case fatality rate were higher than those from the Dijon Stroke Registry. CONCLUSIONS Type of stroke data bank is very important in order to describe cerebrovascular disease. Hospital-based studies tend to include more severe strokes, those occurring in a younger population, and those having a higher mortality. Population-based studies, on the other hand, give a somewhat different picture of stroke.