Dominique Baratin

Clinical features of acute retroviral syndrome differ by route of infection but not by gender and age

The rate of HIV disease progression is associated with the severity of the acute retroviral syndrome (ARS). We explored the clinical features of ARS by gender, age and route of infection among 378 individuals with documented ARS enrolled in 5 prospective cohort studies with similar enrollment criteria. No major differences were detected by gender or by age. Several symptoms were reported less frequently in the injecting drug users as compared with infection acquired through sexual contacts (either heterosexual or homosexual). This was observed in particular for fever (50% vs. 77%, p=.001), skin rash (21% vs. 51%, p=.001), pharyngitis (18% vs. 43%, p=.004), and myalgia (29% vs. 52%, p=.01). Genital ulcerations were present only in cases of sexual exposure to HIV. Injecting drug users had or reported symptoms associated with the ARS less frequently than persons acquiring HIV via sexual transmission.

Pneumococcal pneumonia in HIV-infected patients by antiretroviral therapy periods

To ascertain the relationship between periods of various antiretroviral therapies and the incidence of first community‐acquired pneumococcal pneumonia (CAPP) among HIV‐1 infected patients.

Characteristics of patients diagnosed with AIDS shortly after first detection of HIV antibodies in Lyon University hospitals from 1985 to 2001

A diagnosis of AIDS shortly after the detection of HIV antibodies suggests a long‐lasting course of the disease without care. The factors associated with a short delay between the initial HIV‐1‐positive test and the first AIDS‐defining event were identified in 1901 patients from 1985 to 2001 in Lyon University hospitals. A total of 576 individuals (30.3%) had an interval of ≤3 months between the detection of HIV infection and AIDS. The factors independently associated with a delay of ≤3 months were: age from 30 to 44 years [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.9–3.2]; age from 45 to 59 years (OR 5.6; 95% CI 3.9–7.8); age ≥60 years (OR 4.5; 95% CI 2.5–8.1), compared to those<30 years old; heterosexuality (OR 2.4; 95% CI 1.6–3.4); injection drug use (OR 2.1; 95% CI 1.5–2.7); and other exposures (OR 2.4; 95% CI 1.6–3.4), compared to homosexual exposure; two opportunistic infections at AIDS (OR 1.8; 95% CI 1.4–2.4) compared to one; and Pneumocystis carinii pneumonia as initial AIDS event (OR 2.6; 95% CI 1.8–3.7), compared to Kaposis sarcoma. These results provide opportunities to refocus local public health interventions to reduce delayed access to care.

Evaluation of adult dTPaP vaccination coverage in France: experience in Lyon city, 2010–2011

BackgroundCompliance with official recommendations can be assessed by evaluating vaccination coverage (VC) in populations. The main objective of our study was to assess VC of adults against diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) according to age. The second objective was to explore if vaccination status could be confirmed by documentation.MethodsA cross-sectional study was conducted in 680 adults consulting for biological examination in private laboratories in Lyon (France) to evaluate VC for diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) and enabled reported vaccinations to be compared with documented, confirmed vaccinations.ResultsVerification of documented, confirmed vaccinations disclosed VC of 78.7% for tetanus, 63.6% for poliomyelitis, 57.8% for diphtheria and 10.7% for pertussis. Comparison of confirmed and self-reported vaccinations revealed that a large percentage of people who thought that they were vaccinated were not. VC significantly decreased with age for diphtheria and poliomyelitis and did not vary by gender. The VC rate for pertussis has increased since the 2008 recommendations were made.ConclusionsThe main thrust of this study was to compare reported and confirmed data. A significant percentage of people wrongly believed that they were up to date with their vaccination.

Incidence of methicillin-resistant Staphylococcus aureus nosocomial infections in intensive care units in Lyon University hospitals, France, 2003-2006.

We describe the trends in the incidence of methicillin-resistant Staphylococcus aureus nosocomial infection in intensive care units in Lyon hospitals from January 1, 2003, through December 31, 2006. The incidence rate decreased from 1.77 cases per 100 ICU patients in 2003 to 1.16 cases per 100 ICU patients in 2006, a reduction of 38.0% (P = .05).

Effect of early initiation of highly active antiretroviral therapy on CD4 cell count and HIV-RNA viral load trends within 24 months of the onset of acute retroviral syndrome*

The effect of starting highly active antiretroviral therapy (HAART) early after the onset of acute retroviral syndrome (ARS) on CD4 and HIV‐RNA trends was studied over a 2‐year follow‐up period.

Reduction of urinary tract infections acquired in an intensive care unit during a 10-year surveillance program

Purpose To describe trends of urinary catheter-related infections (UCRIs) acquired by patients hospitalized in intensive care units (ICU) in relation with an infection control program. Materials and methods Prospective surveillance in one ICU of a university hospital in Lyon (France) between 1995 and 2004. Results A 66% reduction of urinary catheter-related infections (UCRIs) acquired by patients hospitalized was observed between 1995 and 2004 after adjustement on age, gender, antibiotic use at admission, and duration of exposure to urinary catheter. Conclusions These results, obtained by continuous epidemiological monitoring of nosocomial infections, are encouraging with regard to the improvement of infection control measures and the evolution of medical practices. Further studies in ICUs are needed to confirm this trend.

The AIDS epidemic in Lyon: patient characteristics and defining illnesses between 1985 and 2000

To define the characteristics of 1899 patients diagnosed with AIDS at Lyon University Hospitals (LUH) across four time periods corresponding to different antiretroviral eras, and to analyse the evolution of specific AIDS‐defining illnesses (ADIs) with time.

First presentation for care of HIV-infected patients with low CD4 cell count in Lyon, France: risk factors and consequences for survival.

Abstract To identify the risk factors associated with presentation for care with CD4 cell count ≤200 cells/mm3 and death in HIV-infected patients in Lyon, France. Data were analyzed on participants from mid-1992 to December 2006 in the Lyon section of the French Hospital Database on HIV Infection. Patients were stratified into two categories according to CD4 cell count at first presentation for care in University of Lyon hospitals: Group 1 (Gr1) patients with CD4 ≤200 cells/mm3 and Group 2 (Gr2) patients with CD4 >200 cells/mm3. Multivariate logistic regression assessed the risk factors associated with first presentation for care with CD4 ≤200 cells/mm3. Survival was analyzed according to the Cox regression model. Among 3569 eligible patients (838 females and 2731 males, mean age: 36.3±10.3 years), 1139 (31.9%) were categorized as Gr1. The factors associated with first presentation for care with CD4 ≤200 cells/mm3 were: older age, male gender, route of HIV transmission, migrant populations, geographical areas other than Rhône-Alpes, and access to care in 1992–1997. Overall mortality was higher in Gr1 than in Gr2 (24.4% [278/1139] vs. 4.1% [101/2430]; p<0.001). The risk of death was 5.81 [4.61–7.32] in Gr1 compared to Gr2. In addition to CD4 cell count, age and enrollment periods for care were factors independently related to death. Despite public health efforts in Lyon, one-third of HIV-infected patients reach the health care system with CD4 cell count ≤200 cells/mm3, which was linked with higher mortality.

A recent increase in AIDS at Lyon University Hospitals: patient characteristics and comparisons with previous years

A 36% increase in the incidence of AIDS was observed in 2002/2003 compared with 2000/2001 at Lyon University Hospitals.