Objectives
People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of ...this study was thus to study demographic, socio‐economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013.
Methods
This was a nested case–control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5‐year periods) and clinical centre.
Results
Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV‐related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide.
Conclusions
In the cART era, HIV‐related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort.
Background & Aims
HCV incidence still appears on the rise in HIV‐infected MSM in France. We assessed the incidence of HCV infection in HIV‐positive and in preexposure prophylaxis (PrEP)‐using MSM.
...Methods
HIV‐infected, HCV‐negative MSM with serological follow‐up in 2016 and HIV‐negative, HCV‐negative PrEP‐using MSM enrolled from January 2016 to May 2017 in the French Dat’AIDS cohort were analysed to assess the incidence of a primary HCV infection. The incidence of HCV reinfection was also determined in patients having cured a previous infection.
Results
Among 10 049 HIV‐infected MSM followed in 2016, 681 patients were already HCV‐infected when entering the study (prevalence 6.8%). Serological follow‐up was available in 2016 for 4151 HCV‐negative patients. Virological follow‐up was available for 478 patients who had cured a previous infection. Fifty‐seven HCV infections occurred in 2016 (42 primary infections, 15 reinfections). Incidence of primary HCV infection, reinfection and overall HCV infection was, respectively, 1.0, 3.1 and 1.2/100 person‐years (PY). From January 2016 to May 2017, 930 HIV‐negative subjects were enrolled for PrEP. Seventeen patients were already HCV‐infected (prevalence 1.8%). Twelve HCV infections occurred during follow‐up (10 primary infections, 2 reinfections) giving an incidence of primary infection of 1.0/100 PY and an overall incidence of 1.2/100 PY.
Conclusions
The overall incidence of HCV infection and of a primary HCV infection in HIV‐positive and in PrEP‐using MSM appeared similar in France in 2016 to early 2017. HIV‐positive and PrEP‐using MSM probably share similar at‐risk practices and both should be targeted for preventative interventions.
See Article on Page 1733
The ANTARES high-energy neutrino telescope is a three-dimensional array of about 900 photomultipliers distributed over 12 mooring lines installed in the Mediterranean Sea. Between February and ...November 2007 it acquired data in a 5-line configuration. The zenith angular distribution of the atmospheric muon flux and the associated depth–intensity relation are measured and compared with previous measurements and Monte Carlo expectations. An evaluation of the systematic effects due to uncertainties on environmental and detector parameters is presented.
Background
More than 10 years after the introduction of combination antiretroviral therapy (cART), we examined the trend in the proportion of deaths caused by end‐stage liver disease (ESLD) in ...HIV‐infected adults in France between 1995 and 2005.
Design and methods
In 2005, 34 departments prospectively recorded all deaths in HIV‐infected patients who were followed in those departments (around 24 000). Results were compared with those of four previous cross‐sectional surveys conducted since 1995 using the same methodology.
Results
Among 287 reported deaths in 2005, 100 (35%) were related to AIDS, and 48 (17%) to ESLD. Three out of four patients who died from ESLD‐related causes had chronic hepatitis C. Excessive alcohol consumption was reported in approximately half of the patients (48%). At death, 62% of patients had undetectable HIV viral load and the median CD4 count was 237 cells/μL. From 1995 to 2005, the proportion of deaths caused by ESLD increased from 2 to 17% (P<0.001). The proportion of deaths caused by hepatocellular carcinoma increased from 5% in 1995 to 25% in 2005 (P=0.0337).
Conclusions
Over the 10 years from 1995 to 2005, the proportion of deaths caused by hepatitis C virus‐related ESLD has increased in HIV‐infected patients. ESLD is currently a leading cause of death in this population, with hepatocellular carcinoma representing a quarter of liver‐related deaths. Recommendations for the detection of hepatocellular carcinoma should be strictly applied in these patients.
A new method for the measurement of the muon flux in the deep-sea ANTARES neutrino telescope and its dependence on the depth is presented. The method is based on the observation of coincidence ...signals in adjacent storeys of the detector. This yields an energy threshold of about 4
GeV. The main sources of optical background are the decay of
40K and the bioluminescence in the sea water. The
40K background is used to calibrate the efficiency of the photo-multiplier tubes.
Some of the 12 criminal trials and sentences in France for HIV transmission in 1998–2011 attracted substantial public attention, with a possible negative impact on people living with HIV (PLWH) ...through reinforced stigma and discrimination. This analysis aimed to characterize PLWH enrolled in the representative ANRS-VESPA2 survey, aware of and concerned about convictions for HIV transmission. Being a migrant from Sub-Saharan Africa, having difficult socio-economic conditions, having unprotected sex with one’s main partner and concealing one’s HIV status were all factors statistically associated with concern about the sentences. Participants tempted to press charges against someone for infecting them were more likely to be younger, women, not living in a couple, unemployed, and to report a major depressive disorder. Concern about HIV-related criminal proceedings among the most vulnerable PLWH do not reflect the actual risk of prosecution they are exposed to.
Objectives
To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) ...regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir.
Methods
From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models.
Results
The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79).
Conclusions
Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.
Objectives
Five to eight per cent of HIV‐positive individuals initiating abacavir (ABC) experience potentially fatal hypersensitivity reactions (HSRs). We sought to describe the proportion of ...individuals initiating ABC and to describe the incidence and factors associated with HSR among those prescribed ABC.
Methods
We calculated the proportion of EuroSIDA individuals receiving ABC‐based combination antiretroviral therapy (cART) among those receiving cART after 1 January 2009. Poisson regression was used to identify demographic, and current clinical and laboratory factors associated with ABC utilization and discontinuation.
Results
Between 2009 and 2016, of 10 076 individuals receiving cART, 3472 (34%) had ever received ABC‐based cART. Temporal trends of ABC utilization were also heterogeneous, with 28% using ABC in 2009, dropping to 26% in 2010 and increasing to 31% in 2016, and varied across regions and over time. Poisson models showed lower ABC utilization in older individuals, and in those with higher CD4 cell counts, higher cART lines, and prior AIDS. Higher ABC utilization was associated with higher HIV RNA and poor renal function, and was more common in Central‐East and Eastern Europe and lowest during 2014. During 779 person‐years of follow‐up (PYFU) in 2139 individuals starting ABC after 1 January 2009, 113 discontinued ABC within 6 weeks of initiation for any reason incidence rate (IR) 14.5 (95% confidence interval (CI) 12.1, 17.5) per 100 PYFU, 13 because of reported HSR IR 0.3 (95% CI 0.1, 1.0) per 100 PYFU and 35 because of reported HSR/any toxicity IR 4.5 (95% CI 3.2, 6.3) per 100 PYFU. There were no factors significantly associated with ABC discontinuation because of reported HSR/any toxicity.
Conclusions
ABC remains commonly used across Europe and the incidence of discontinuation because of reported HSR was low in our study population.
Objectives
There are currently few data on the long‐term risk of cancer and death in individuals taking raltegravir (RAL). The aim of this analysis was to evaluate whether there is evidence for an ...association.
Methods
The EuroSIDA cohort was divided into three groups: those starting RAL‐based combination antiretroviral therapy (cART) on or after 21 December 2007 (RAL); a historical cohort (HIST) of individuals adding a new antiretroviral (ARV) drug (not RAL) to their cART between 1 January 2005 and 20 December 2007, and a concurrent cohort (CONC) of individuals adding a new ARV drug (not RAL) to their cART on or after 21 December 2007. Baseline characteristics were compared using logistic regression. The incidences of newly diagnosed malignancies and death were compared using Poisson regression.
Results
The RAL cohort included 1470 individuals with 4058 person‐years of follow‐up (PYFU) compared with 3787 (4472 PYFU) and 4467 (10 691 PYFU) in the HIST and CONC cohorts, respectively. The prevalence of non‐AIDS‐related malignancies prior to baseline tended to be higher in the RAL cohort vs. the HIST cohort adjusted odds ratio (aOR) 1.31; 95% confidence interval (CI) 0.95–1.80 and vs. the CONC cohort (aOR 1.89; 95% CI 1.37–2.61). In intention‐to‐treat (ITT) analysis (events: RAL, 50; HIST, 45; CONC, 127), the incidence of all new malignancies was 1.11 (95% CI 0.84–1.46) per 100 PYFU in the RAL cohort vs. 1.20 (95% CI 0.90–1.61) and 0.83 (95% CI 0.70–0.99) in the HIST and CONC cohorts, respectively. After adjustment, there was no evidence for a difference in the risk of malignancies adjusted rate ratio (RR) 0.73; 95% CI 0.47–1.14 for RALvs. HIST; RR 0.95; 95% CI 0.65–1.39 for RALvs. CONC or mortality (adjusted RR 0.87; 95% CI 0.53–1.43 for RALvs. HIST; RR 1.14; 95% CI 0.76–1.72 for RALvs. CONC).
Conclusions
We found no evidence for an oncogenic risk or poorer survival associated with using RAL compared with control groups.
Objectives
The aim of this study was to assess the impact of hepatitis B virus (HBV) infection on non‐liver malignancies in people living with HIV (PLWH).
Methods
All persons aged ≥ 18 years with ...known hepatitis B virus (HBV) surface antigen (HBsAg) status after the latest of 1 January 2001 and enrolment in the EuroSIDA cohort (baseline) were included in the study; persons were categorized as HBV positive or negative using the latest HBsAg test and followed to their first diagnosis of nonliver malignancy or their last visit.
Results
Of 17 485 PLWH included in the study, 1269 (7.2%) were HBV positive at baseline. During 151 766 person‐years of follow‐up (PYFU), there were 1298 nonliver malignancies, 1199 in those currently HBV negative incidence rate (IR) 8.42/1000 PYFU; 95% confidence interval (CI) 7.94–8.90/1000 PYFU and 99 in those HBV positive (IR 10.54/1000 PYFU; 95% CI 8.47–12.62/1000 PYFU). After adjustment for baseline confounders, there was a significantly increased incidence of nonliver malignancies in HBV‐positive versus HBV‐negative individuals adjusted incidence rate ratio (aIRR) 1.23; 95% CI 1.00–1.51. Compared to HBV‐negative individuals, HBsAg‐positive/HBV‐DNA‐positive individuals had significantly increased incidences of nonliver malignancies (aIRR 1.37; 95% CI 1.00–1.89) and NHL (aIRR 2.57; 95% CI 1.16–5.68). There was no significant association between HBV and lung or anal cancer.
Conclusions
We found increased rates of nonliver malignancies in HBsAg‐positive participants, the increases being most pronounced in those who were HBV DNA positive and for NHL. If confirmed, these results may have implications for increased cancer screening in HIV‐positive subjects with chronic HBV infection.
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