P. Troude

No evidence of a change in HIV-1 virulence since 1996 in France

Objective:We investigated temporal trends in the CD4 cell count and in plasma HIV RNA and total HIV DNA levels measured at the time of primary HIV infection, as proxies for HIV-1 virulence, taking changes in patient characteristics into account. Design:We studied 903 patients enrolled during primary HIV infection in the French multicenter ANRS PRIMO cohort from 1996 to 2007. Methods:Associations between the year of primary HIV infection and the values of the three markers were tested with regression models. The year of primary HIV infection was first introduced as a restricted cubic splines function in a regression model in order to explore the shape of the associations, and then as a continuous/categorical variable. The following confounders were considered in multiple regression analysis: time since infection and age (introduced as restricted cubic spline functions), sex, place of birth (Africa vs. others), symptomatic primary HIV infection, smoking, and virus-related factors (subtype B vs. non-B, and drug resistance mutations). Results:Multivariate analysis showed no temporal trends in the CD4 cell count (square-root) or in HIV-1 RNA and DNA levels (log10) measured at the time of primary HIV infection. We observed the well described associations between the prognostic markers and the time since infection, sex, symptomatic primary HIV infection, and smoking. Conclusion:The CD4 cell count and HIV RNA and DNA levels measured at the time of primary HIV-1 infection remained stable across 12 consecutive years (1996–2007) in the ANRS PRIMO cohort, suggesting no major change in virulence, after taking into account changes in patient characteristics.

Who does not participate in a follow-up postal study? a survey of infertile couples treated by in vitro fertilization

BackgroundA good response rate has been considered as a proof of a study’s quality. Decreasing participation and its potential impact on the internal validity of the study are of growing interest. Our objective was to assess factors associated with contact and response to a postal survey in a epidemiological study of the long-term outcome of IVF couples.MethodsThe DAIFI study is a retrospective cohort including 6,507 couples who began an IVF program in 2000-2002 in one of the eight participating French IVF centers. Medical data on all 6,507 couples were obtained from IVF center databases, and information on long-term outcome was available only for participants in the postal survey (n = 2,321). Logistic regressions were used to assess firstly factors associated with contact and secondly factors associated with response to the postal questionnaire among contacted couples.ResultsSixty-two percent of the 6,507 couples were contacted and 58% of these responded to the postal questionnaire. Contacted couples were more likely to have had a child during IVF treatment than non-contactable couples, and the same was true of respondents compared with non-respondents. Demographic and medical characteristics were both associated with probability of contact and probability of response. After adjustment, having a live birth during IVF treatment remained associated with both probabilities, and more strongly with probability of response. Having a child during IVF treatment was a major factor impacting on participation rate.ConclusionsNon-response as well as non-contact were linked to the outcome of interest, i.e. long-term parenthood success of infertile couples. Our study illustrates that an a priori hypothesis may be too simplistic and may underestimate potential bias. In the context of growing use of analytical methods that take attrition into account (such as multiple imputation), we need to better understand the mechanisms that underlie attrition in order to choose the most appropriate method.

Factors associated with failure to return for HIV test results in a free and anonymous screening centre.

Free and anonymous screening centres (CDAG: Centres de Depistage Anononyme et Gratuit) are public facilities set up for HIV infection diagnosis in France. Some people visiting CDAG fail to return for test results and are not informed of their serology. This study aimed to assess factors associated with failure to return for HIV test results. Patients visiting the Fernand-Widal CDAG (Paris) for an HIV test in January–February 2011 were eligible to take part in the study. Data were collected with an anonymous self-administered questionnaire. Factors associated with failure to return were assessed using logistic regression models. Of the 710 participants (participation rate 88%), 46 patients failed to return. Not specifying birthplace and not living in the region of Paris were associated with failure to return. Those who perceived no risk of HIV infection and those who felt they were more at risk than other people were both statistically associated with failure to return. Self-perceived risk seemed to be of chief concern for failure to return for HIV test results and should be considered during pre-test counselling.

Emergency department of a university hospital: who is admitted and who is transferred?

Objectives Our main aim was to describe the path of patients seen in our emergency department (ED) and either admitted or transferred and to compare the characteristics of patients hospitalized in our hospital with those of transferred patients. Our secondary aim was to compare the receipts linked to patient hospital stays. Population and methods All patients seen in the ED of our hospital and ill enough to be either admitted or transferred were prospectively enrolled during 2 consecutive weeks. Information was obtained from the hospital discharge report and from local medical databases. The characteristics of the patients and receipts were compared according to their path. Results Among the 251 patients included in the study, 9% were transferred directly from the ED to another hospital. Among admitted patients, two-thirds were admitted to the short-stay unit (SSU). Schematically, patients transferred from the ED are more likely to be men around 50 years of age with few comorbidities, requiring surgery with relatively short hospital stays. Patients transferred from the SSU were more likely to be women around 67 years of age with severe comorbidities requiring medical care and longer stays. The mean receipt per day was two to three times greater for patients transferred from the ED as compared with patients hospitalized in our hospital. The mean receipt per day for patients transferred from the SSU also tended to be higher. Conclusion Our results show that patients requiring shorter care are transferred, whereas more severe patients are hospitalized on site. Hospitals will need solutions to optimize their receipts while fulfilling their public missions such as continuity of care.

O6-5.6 Spontaneous live birth after in vitro fertilisation treatment: frequency and associated factors

Introduction Spontaneous live births (SLB) after in vitro fertilisation (IVF) treatment are not unusual, but reported SLB rates vary widely and little is known of their associated factors. Our objective was to examine the frequency of SLB and their associated factors among couples who had had IVF, successfully or unsuccessfully. Methods A retrospective cohort of couples was recruited in eight French IVF centers. The couples had begun IVF treatment in the participating centers between 2000 and 2002, and were followed-up by postal questionnaire between 2008 and 2010. Analysis was carried out on 2134 couples who were still together at the time of the postal survey. Separate analyses were conducted according to the outcome of medical treatment: live birth (n=1320) or no (n=814). Multivariate analysis that included socio-demographic and medical characteristics was conducted using logistic regression. Results The SLB rate was 17% among couples who had had a first live birth through medical treatment and 24% among couples who had unsuccessful treatment. In both groups, SLB was associated with younger age of the women, fewer IVF attempts and the origin of infertility. In couples who had not been successful with IVF, SLB was also associated with a shorter duration of infertility. Conclusion Even in a population which had had IVF because of a very low monthly probability of conception, SLB is still possible, especially among couples who did not succeed in having a child through fertility treatment. Occurrence of SLB was mainly related to a better initial fertility prognosis.