Antiretroviral therapy (ART) in HIV pregnant women has led to a dramatic decrease in the rate of HIV mother-to-child transmission but this benefit is counterbalanced with adverse effects related to ...in utero and neonatal exposure to ART. In 2013, some parents described neurodevelopmental disorders in their children.
A standardized letter was sent to the 133 women who delivered in Nantes hospital from 01/01/2003 to 31/12/2012 (167 births).
Response rate was 33%. Over a 10-year period, 7 children had behavioral disorders and/or cognitive/developmental delay, 1 child had developmental delay + growth retardation and 2 experienced cancer.
We found a significant association between neurodevelopmental disorders, preterm birth and exposure to 3 nucleoside reverse transcriptase inhibitors (NRTIs). Further studies are needed and long-term follow-up into adulthood should continue.
Abstract
Objectives
Because NRTIs can have fetal toxicities, we evaluated a perinatal NRTI-sparing strategy to prevent perinatal HIV transmission. Our primary objective was to determine the ...proportion maintaining a viral load (VL) of <50 copies/mL up to delivery on darunavir/ritonavir monotherapy, without requiring treatment intensification.
Methods
In a one-arm, multicentre Phase 2 clinical trial, eligible patients in the first trimester of pregnancy on ART with plasma VL < 50 copies/mL received maintenance monotherapy with darunavir/ritonavir, 600/100 mg twice daily. VL was monitored monthly. ART was intensified in the case of VL > 50 copies/mL. Neonates received nevirapine prophylaxis for 14 days.
Results
Of 89 patients switching to darunavir/ritonavir monotherapy, 4 miscarried before 22 weeks’ gestation, 2 changed treatment for elevated liver enzymes without virological failure, and 83 were evaluable for the main outcome. Six had virological failure confirmed on a repeat sample (median VL = 193 copies/mL; range 78–644), including two before switching to monotherapy. In these six cases, ART was intensified with tenofovir disoproxil fumarate/emtricitabine. The success rate was 75/83, 90.4% (95% CI, 81.9%–95.7%) considering two patients with VL missing at delivery as failures, and 77/83, 92.8% (95% CI, 84.9%–97.3%) when considering them as successes since both had undetectable VL on darunavir/ritonavir throughout pregnancy. In ITT, the last available VL before delivery was <50 copies/mL in all of the patients. There was no case of perinatal HIV transmission.
Conclusions
Darunavir/ritonavir maintenance monotherapy required intensification in nearly 10% of cases. This limits its widespread use, thus other regimens should be evaluated in order to limit exposure to antiretrovirals, particularly NRTIs, during pregnancy.
New plant macrofossil studies in northwestern France enable a better insight into agriculture through the Bronze and Iron Age. Most of the previous analyses, carried out in Calvados (Normandy) on ...Late Iron Age dwellings, suggested distinctive characteristics such as the increase of
Avena
(oat) and the abundance of pulses in storage pits. The collection of a new database with 25 sites was done in response to the previous lack of studies, which became an issue in Brittany, Normandy and the Loire region, which are known for their western location and trade links throughout Europe. This paper deals with farming practices and their changes during the Bronze and Iron Ages. The aim was to gather new evidence related to sowing times, tilling of fields and fertility management of soils in order to discuss extensive or intensive cultivation in northwestern France. The crop cultivation techniques were investigated by studying the weed flora composition according to the FIBS approach (Functional interpretation of botanical survey). The results reveal combinations of evidence and a pattern of intra-regional diversity.
Abstract
Background
Safety data about rilpivirine use during pregnancy remain scarce, and rilpivirine plasma concentrations are reduced during second/third trimesters, with a potential risk of viral ...breakthroughs. Thus, French guidelines recommend switching to rilpivirine-free combinations (RFCs) during pregnancy.
Objectives
To describe the characteristics of women initiating pregnancy while on rilpivirine and to compare the outcomes for virologically suppressed subjects continuing rilpivirine until delivery versus switching to an RFC.
Methods
In the ANRS-EPF French Perinatal cohort, we included women on rilpivirine at conception in 2010–18. Pregnancy outcomes were compared between patients continuing versus interrupting rilpivirine. In women with documented viral suppression (<50 copies/mL) before 14 weeks of gestation (WG) while on rilpivirine, we compared the probability of viral rebound (≥50 copies/mL) during pregnancy between subjects continuing rilpivirine versus those switching to RFC.
Results
Among 247 women included, 88.7% had viral suppression at the beginning of pregnancy. Overall, 184 women (74.5%) switched to an RFC (mostly PI/ritonavir-based regimens) at a median gestational age of 8.0 WG. Plasma HIV-1 RNA nearest delivery was <50 copies/mL in 95.6% of women. Among 69 women with documented viral suppression before 14 WG, the risk of viral rebound was higher when switching to RFCs than when continuing rilpivirine (20.0% versus 0.0%, P = 0.046). Delivery outcomes were similar between groups (overall birth defects, 3.8/100 live births; pregnancy losses, 2.0%; preterm deliveries, 10.6%). No HIV transmission occurred.
Conclusions
In virologically suppressed women initiating pregnancy, continuing rilpivirine was associated with better virological outcome than changing regimen. We did not observe a higher risk of adverse pregnancy outcomes.
Severe combined immunodeficiency screening by measuring T-receptor excision circles at birth allows evaluation of the impact of various maternal conditions on newborn immunity. The slight decrease ...observed in a French cohort of newborns to HIV-infected mothers can be explained by the confounding factors of prematurity and African descent.
To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes.
All pregnancies in women with HIV-1 infection ...enrolled in the national multicenter prospective French Perinatal cohort at 14 week gestation or more were included between January 2005 and December 2015, if the mother was on ART at conception with a plasma viral load <50 copies/mL. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy and defined as for safety concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics.
Of 7079 pregnancies in the overall cohort, 1797 had ART at conception with a viral load <50 copies/mL before 14 week gestation. Of these, 22 changed regimens in the first trimester for intolerance, and 411 of the remaining 1775 (23%) solely for safety concerns. The proportion of change was higher when the initial treatment was not recommended in the national guidelines (OR adjusted: 23.1 14.0-38.2), than when it was an alternative option (ORa: 2.2 1.3-3.7), as compared to recommended first-line regimens. Treatment changes for safety concerns did not lead to poorer virological control, compared with pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 0.7-1.4).
Changing ART early in pregnancy to regimens considered safer for pregnancy, and neonatal health did not have a destabilizing effect on viral suppression.
Antiretroviral treatment interruption (TI) is not recommended in HIV-infected children. We aimed to evaluate the context and consequences of TI in clinical practice.
We investigated the probability ...and risk factors of a first TI in the 483 children treated with combined ART (cART) in the ANRS French national pediatric cohort. Immunologic and virologic outcomes were compared between patients with TI (TI group) and those on continuous treatment (matched control group), from a baseline defined as the age at first interruption for the TI child and the corresponding age for the control child.
At least one TI ≥ 3 months occurred in 42.4% of patients, at a median age of 8.0 years, for a median duration of 12.1 months. After cART initiation, the risk of TI was 7.0% (5.0-9.6) at 1 year and 30.3% (26.1-35.0) at 5 years and was higher for children starting treatment before 2000 and for children starting cART before 6 months of age. AIDS-free survival was similar, but severe immunosuppression occurred earlier in the TI group than in the control group (adjusted HR = 3.1; 1.0-9.1; P = 0.04). Four years after baseline, the proportion of patients with CD4% ≥ 25% was lower in the TI group than in the control group (52.0% vs. 72.0%; P < 0.01), even among children restarting cART at least 6 months earlier (aRR = 0.5; 0.3-0.9; P = 0.03).
The risk of TI in clinical practice has decreased but remains high. In intent-to-treat analysis, TI was associated with a greater risk of subsequent immunosuppression, even after cART resumption.
Les actes du colloque « Antiquité tardive dans l'Est de la Gaule, 2 », qui s'est tenu à Châlons-en-Champagne en septembre 2010, rassemblent vingt-six contributions portant sur l'archéologie de ...l'Antiquité tardive du Nord et de l'Est de la Gaule. La première partie de l'ouvrage présente quatorze travaux sur les sépultures, nécropoles et pratiques funéraires dans les provinces de Lyonnaise I et IV, de Belgique I et II et de Séquanaise, tant en milieu urbain que dans les campagnes. Ils s'attachent, entre autres, à traiter les questions de topographie funéraire, d'organisation interne des nécropoles, d'architecture funéraire et des pratiques de déposition dans les sépultures et révèlent la transformation progressive de la topographie funéraire, particulièrement en milieu urbain, mais aussi des pratiques spécifiques propres à la période, tant dans l'aménagement de la sépulture que dans le mobilier déposé. La seconde partie de l'ouvrage regroupe douze contributions illustrant l'actualité de la recherche dans ces régions, qu'il s'agisse de découvertes récentes ou de travaux de synthèse portant sur des sites ou des mobiliers.
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