Objectives
The aim of this article is to describe the development of a dynamic French cohort of HIV‐infected patients, the methodological issues and decisions made, and the characteristics of the ...patients currently enrolled.
Methods
Data are collected during medical encounters. Data quality is ensured by automated checks during data capture, by regular controls, by annual assessments, and by ad hoc processes before any scientific analysis is performed.
Results
In September 2007, 10 458 patients representing 59 383 patient‐years of follow‐up were followed in our centres, including 446 with a first HIV diagnosis in the past year. Among these recently diagnosed patients, 25.6% presented with late diagnosis. Our cohort included 3017 women (28.8%). The women were less likely to be receiving highly active antiretroviral therapy (HAART) than men, and when treated were less likely to be receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based regimens. Our network includes medical centres in overseas territories (1105 patients living overseas). In this particular population, women represented 38.5% of the patients, and the probable route of infection was heterosexual in 75.7% of the patients. Despite epidemiological and social disparities, more patients had nondetectable viral loads when receiving HAART in overseas departments than in metropolitan France.
Conclusion
The Nadis Cohort represents a collaboration of major French HIV treatment centres. In September 2007, the cohort database contained up‐to‐date information on more than 10 000 patients, of whom a significant proportion were women. As a consequence of the choices made when building the cohort and the efforts made to ensure the quality of the database, scientific studies are regularly performed using this cohort.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Context: LHX4 is a LIM homeodomain transcription factor involved in pituitary ontogenesis. Only a few heterozygous LHX4 mutations have been reported to be responsible for congenital pituitary hormone ...deficiency.
Subjects and Methods: A total of 136 patients with congenital hypopituitarism associated with malformations of brain structures, pituitary stalk, or posterior pituitary gland was screened for LHX4 mutations.
Results: Three novel allelic variants that cause predicted changes in the protein sequence of LHX4 (2.3%) were found (p.Thr99fs, p.Thr90Met, and p.Gly370Ser). On the basis of functional studies, p.Thr99fs mutation was responsible for the patients’ phenotype, whereas p.Thr90Met and p.Gly370Ser were likely polymorphisms. Patients bearing the heterozygous p.Thr99fs mutation had variable phenotypes: two brothers presented somato-lactotroph and thyrotroph deficiencies, with pituitary hypoplasia and poorly developed sella turcica; the youngest brother (propositus) also had corpus callosum hypoplasia and ectopic neurohypophysis; their father only had somatotroph deficiency and delayed puberty with pituitary hyperplasia. Functional studies showed that the mutation induced a complete loss of transcriptional activity on POU1F1 promoter and a lack of DNA binding. Cotransfection of p.Thr99fs mutant and wild-type LHX4 failed to evidence any dominant negative effect, suggesting a mechanism of haploinsufficiency. We also identified prolactin and GH promoters as potential target genes of LHX4 and found that the p.Thr99fs mutant was also unable to transactivate these promoters.
Conclusions: The present report describes three new exonic LHX4 allelic variants with at least one being responsible for congenital hypopituitarism. It also extends the phenotypical heterogeneity associated with LHX4 mutations, which includes variable anterior pituitary hormone deficits, as well as pituitary and extrapituitary abnormalities.
Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is ...known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV‐infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell‐mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV‐infected man and discuss the potential interactions between T. solium and HIV infections.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
5.
Drôle d'aplasie EL GUEDJ, M; ZAMFIR, R. M; BRICE, P ...
La Revue de médecine interne (Paris),
06/2000, Volume:
21
Conference Proceeding
Peer reviewed
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Histoplasma capsulatum var. capsulatum infection is a major AIDS-defining illness in French Guiana. Although it affects South and Central American countries, the number of published cases is low. We ...present the largest series of AIDS-related histoplasmosis. The aim of this work is to describe clinical features and to help optimize investigations in settings where antigen detection methods are not available.
Two hundred cases of AIDS-related histoplasmosis, diagnosed in the hospitals of French Guiana, were included retrospectively between 1982 and 2007.
At the time of diagnosis, 92% of patients did not receive highly active antiretroviral therapy. CD4 cell count was less than 100 cells/microl for 80% of them. Most patients had fever, lymphadenopathies, and pulmonary and digestive symptoms. Neurological signs and skin/mucosal locations were less common. Other opportunistic infections were associated in 36.6% of cases (mostly tuberculosis). In most of the patients, lactic dehydrogenase was at least four times the normal value, and there was a moderate increase of aspartate aminotransaminase but not alanine aminotransaminase levels. Bone marrow aspirations were useful, but cultures of liver and lymphadenopathy specimens were the most contributive. Following treatment initiation, 17.5% died within a month. Presumptive treatment was started before diagnostic confirmation in 14.3% of the cases.
In high prevalence settings, histoplasmosis often revealed AIDS in severely immunodeficient and poorly followed patients. In the absence of a quick sensitive technique, skin smear and fungal tissue cultures are contributive. Nevertheless, given the diagnostic delays and the poor prognosis, presumptive treatment with amphotericin B-containing regimens should be recommended when clinical and epidemiological contexts are evocative.
We report the occurence of myiasis owing to Dermatobia hominis (Dh) in a HIV‐infected subject. HIV infection did not modify the pathogenicity of myiasis. However, the clinical presentation seemed ...unusual with voluminous inflammatory nodules. Use of topical ivermectin killed the larvae and facilitated their extraction.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Risk factors for death in an HIV‐infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates ...were measured at the time of consultation. There were 223 deaths. Addictions adjusted hazard ratio (HR)=13; 95% confidence interval (CI) 5.5–30.6; P< 0.001, age >60 years (HR=1.5; 95% CI 0.9–2.5; P=0.13), male gender (HR=1.5; 95% CI 1.03–2.5; P=0.03) and CD4 count <50 cells/μL (HR=9.1; 95% CI 5.1–16.3; P<0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow‐up of addicted patients would have a significant impact on mortality.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
La Guyane Française est le département français le plus touché par l’infection par le VIH avec un taux d’incidence 11 fois plus élevé qu’au niveau national. Plusieurs essais cliniques ont montré une ...efficacité de la PREP dans la réduction de l’incidence du VIH dans les populations les plus exposées. Cette étude a pour but d’analyser la mise en place d’une consultation PREP dans une zone de forte prévalence telle que la Guyane en partenariat avec l’association Entr’aides.
Étude descriptive prospective monocentrique, du 01/02/2017 au 31/01/2019 au centre hospitalier de Cayenne.
Les critères d’inclusions sont :≥16 ans et répondant aux critères de mise sous traitement par PREP (Homme ayant des relations sexuelles avec des hommes (HSH), travailleur(euse) du sexe (TDS), usager de drogues, toute personne en vulnérabilité vis-à-vis du VIH). Pour chacun, après signature d’un consentement, des questionnaires standardisés initiaux et de suivis étaient renseignés.
Parmi les 61 patients inclus : 72 % sont des femmes (n=44), 25 % des hommes (n=15) et 3 % de transgenres (n=2). L’âge moyen est de 34,4 ans (de 17 à 65 ans). Les patients sont nés : en République dominicaine pour 67 % (n=41), en France pour 20 % (n=12), au Brésil pour 5 % (n=3), au Guyana pour 5 % (n=3), et 3 % (n=2) dans un autre pays.
Au sein des patients inclus : 80 % sont des TDS (n=49), 21 % des HSH (n=13), 5 % des usagers de drogues (n=3).
À la première consultation, 57 % (n=35) n’ont pas de droits sociaux, 7 % (n=4) ont une AME et 36 % (n=22) sont couverts par la sécurité sociale.
Les patients déclarent à 93 %(n=57) un antécédent de prise de risque : 62 % rupture de préservatif (RP), 11 % rapport vaginal non protégé, 18 % fellation non protégée et 18 % rapport anal non protégé.
Au sein des TDS, 88 % (n=43) déclarent une prise de risque antérieure dont 86 % (n=37) sont des RP, 22 % (n=11) avoir eu plus de 6 risques au cours de l’année, 12 %(n=6) ont été victimes de viol.
Au cours du suivi, 43 %(n=21) signalent une nouvelle RP.
Enfin, 7 % des patients déclarent un antécédent d’infection sexuellement transmissible (IST) et 13 % (n=8) ont présenté une IST au cours du suivi (5 syphilis, 2 infections à chlamydiae et 1 à gonocoque).
Le profil de la population accédant à la consultation PREP à Cayenne est singulier : majoritairement des femmes migrantes TDS.
La mise en place de la PREP auprès de ces populations en état de vulnérabilité que ce soit de par les pratiques à risque ou par la précarité des populations migrantes est un enjeu de santé publique dans la lutte contre l’épidémie.
Bien que le nombre de personne sous PREP reste encore limité, cette expérience est encourageante et prouve qu’un partenariat associatif permet d’accompagner vers la PREP un public classiquement décrit comme difficile à atteindre et victime d’inégalité d’accès aux soins.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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