Sophie Mahy

Severe hypovitaminosis D correlates with increased inflammatory markers in HIV infected patients

BackgroundEven though it has been suggested that antiretroviral therapy has an impact on severe hypovitaminosis D (SHD) in HIV infected patients, it could be speculated that the different levels of residual inflammation on HAART (Highly Active Anti Retroviral Therapy) could contribute to SHD and aggravate bone catabolism in these patients.MethodsA cross-sectional study was carried out in an unselected cohort of 263 HIV infected outpatients consulting during Spring 2010. Clinical examinations were performed and medical history, food habits, sun exposure and addictions were collected. Fasting blood samples were taken for immunological, virological, inflammation, endocrine and bone markers evaluations.ResultsNinety-five (36%) patients had SHD. In univariate analysis, a significant and positive association was found between SHD and IL6 (p = 0.001), hsCRP (p = 0.04), increased serum C-Telopeptides X (CTX) (p = 0.005) and Parathyroid Hormon (PTH) (p < 0.0001) levels. In multivariate analysis, SHD deficiency correlated significantly with increased IL-6, high serum CTX levels, lower mean daily exposure to the sun, current or past smoking, hepatitis C, and functional status (falls), but not with the time spent on the current HAART (by specific drug or overall).ConclusionsSHD is frequent and correlates with inflammation in HIV infected patients. Since SHD is also associated with falls and increased bone catabolism, it may be of interest to take into account not only the type of antiretroviral therapy but also the residual inflammation on HAART in order to assess functional and bone risks. This finding also suggests that vitamin D supplementation may be beneficial in these HIV-infected patients.

Ocular syphilis and HIV infection.

Syphilitic ocular involvement is thought to be rare in HIV infected patients. During a 5-year study in 509 HIV-positive patients, syphilis was diagnosed in 3.9%, and the eye was involved in one-fifth of these. The high risk for sequelae emphasizes the need for prevention and for early diagnosis.

Impact of immunodepression and moderate alcohol consumption on coronary and other arterial disease events in an 11-year cohort of HIV-infected patients on antiretroviral therapy.

Objective To investigate the relationship between response to antiretroviral therapy (ART), alcohol use and occurrence of a major coronary or other arterial disease event (CADE) in HIV-infected individuals. Design A cohort study. A Cox model was used to identify the correlates of a first occurrence of a major CADE. Setting The French ANRS CO8 APROCO-COPILOTE cohort was set up in 1997 to study clinical progression and patient-reported outcomes (PRO) after initiating a protease inhibitor-containing ART. Clinical data were retrieved from medical records. Self-administered questionnaires collected data on PRO and behaviours, including alcohol use. Participants Metabolic data were only available for a subgroup (n=675) of the study group (n=1154). Main outcome measures Major coronary or other arterial disease first event. Results Over the 11-year follow-up, 49 major CADE were observed, with an incidence rate (95% CI)=0.75(0.57 to 0.99) per 100 person-years. Immunodepression (CD4 cell count <200 cells/mm3) was associated with an increased risk of CADE (adjusted HR (95% CI)=2.52(1.15 to 5.48)) after adjustment for female gender (0.25(0.08 to 0.83)), age (1.07(1.04 to 1.10)) and smoking>20 cigarettes/day (4.19(2.17 to 8.11)). Moreover, individuals with moderate alcohol consumption (≤4(3) alcohol units (AU)/day for men(women)) had a lower risk of CADE (0.38(0.20 to 0.71)) than alcohol abstainers, although the risk for those drinking>4(3)  AU/day for men(women) was not significantly different from this latter group. These associations remained valid after adjustment for metabolic disorders. No significant association with exposure to any specific antiretroviral was detected. Conclusions In the long term, absence of immunodepression and moderate alcohol consumption remain associated with a lower risk of a major CADE. Combined interventions to reduce CADE-risk-related behaviours including adherence counselling for assuring long-term immunological response to ART in HIV-infected individuals are now a clinical and public health priority.

Couverture vaccinale des professionnels de santé dans un service d’infectiologie

OBJECTIVES The studys objective was to evaluate with a standardized questionnaire the knowledge of healthcare workers (HCWs) regarding occupational vaccinations and their vaccination coverage. POPULATION AND METHODS This cross-sectional survey was conducted in the department of infectious diseases of a 1796 bed-teaching hospital in Dijon, France. RESULTS Fifty-seven (93%) out of 61 HCPs completed the questionnaire. Vaccination against HVB was the most frequently mentioned vaccination (79%), followed by BCG (66%), and combine vaccine against diphtheria, tetanus, and polio (DTP) (66 %). Influenza was the most often quoted among recommended vaccinations (70%), followed by measles (61%), pertussis (39%), and varicella (14%). The number of correct answers was significantly correlated with age of participants, being a physician, and having had courses on vaccination. Almost all HCPs were up to date for mandatory vaccinations. In 2009 to 2010, vaccination rates against seasonal flu and H1N1 flu reached 88%. Only 52% of HCPs knew about their pertussis immunization and only a third of those born before 1980 had been tested for measles. CONCLUSIONS HCPs knowledge of mandatory vaccinations is adequate but more limited for recommended vaccinations. Information on influenza vaccination has significantly improved its perception among HCPs resulting in a better adhesion to vaccination.

Disseminated histoplasmosis with cutaneous lesions in an HIV patient

Auteur(s) : Sophie MAHY1 sophie.mahy@chu-dijon.fr, Blandine BEL1, Pascal CHAVANET1, Frederic DALLE2, Michel DUONG1, Adeline ERVAIS-WAKOSA1, Tony PETRELLA3, Lionel PIROTH1 1 Department of Infectious Diseases, CHU Dijon, Bd marechal de Lattre de Tassigny, 21000 Dijon, France 2 Parasitology, CHU Dijon, Bd marechal de Lattre de Tassigny, 21000 Dijon, France 3 Anatomopathology, CHU Dijon, Bd marechal de Lattre de Tassigny, 21000 Dijon, France Disseminated histoplasmosis remains rare in metropolitan [...]

Duration of first-line antiretroviral therapy in HIV-infected treatment-naive patients in routine practice.

BACKGROUND First-line antiretroviral therapy (1st ART) is an important step in a patients management and often considered a long-term therapy at treatment initiation. METHODS To describe the duration of 1st ART and the factors associated with treatment modification in a recent real-life setting, antiretroviral-naive patients who began their 1st ART in six French hospitals in 2009-2012 were included in a cohort. Clinical, immunological, virological and therapeutic data, as well as the reasons for therapeutic changes, if any, were retrospectively collected. RESULTS A total of 206 patients started 1st ART, mainly a protease inhibitor-based triple therapy (73%), with a tenofovir-including backbone (87%). Of these, 89 (43%) had their 1st ART modified after a median of 16.5 months (IQR 8.0-32.8). Having a CD4+ T-cell count <200 cells/mm3, being pregnant, or 1st ART including zidovudine + lamivudine or lopinavir/r were significantly associated with a higher risk for treatment modification in multivariate analysis. In 47 patients (53%), 1st ART was modified for safety reasons, with no significant association with a given antiretroviral drug or class. No significant difference in virological, immunological and clinical outcomes was observed between the patients who had their 1st ART modified and those who did not. CONCLUSIONS The proportion of modifications of the 1st ART during the first 2 years remains high. These modifications are frequently because of safety issues and the willingness to simplify treatment, and less often driven by virological failure, thus emphasizing that 1st ART is not - or is no longer - a lifelong treatment.