The aim of the paper is to describe the characteristics of postmenopausal HIV-infected women and to investigate the factors associated with an earlier onset of menopause in a hospital-based cohort. ...Information was collected using a self-administered questionnaire. A Cox model was used to determine factors associated with menopause. Among the 404 women who completed the questionnaire, 69 were naturally postmenopausal at the time of the study (median age at onset: 49 years, premature menopause <40 years: 12%). The onset of menopause was studied among the 41 women still menstruating at the enrollment in the cohort, and who experienced menopause during follow-up. African origin (hazard ratio HR = 8.16; 95% confidence interval CI = 2.23-29.89) and history of injecting drug use (IDU) (HR = 2.46; 95% CI = 1.03-5.85) were associated with an increased risk of earlier menopause. Women with a CD4 cell count <200 cells/mm(3) tended to reach menopause earlier (HR = 2.25; 95% CI = 0.94-5.39). Earlier occurrence of menopause seems to be associated with factors already reported in HIV-negative women (IDU, ethnicity) and with HIV-related immunodeficiency.
Background. High grade non-Hodgkin lymphoma (NHL) remains the most common Acquired Immune Deficiency Syndrome (AIDS)—associated neoplasia and an important cause of mortality in people living with ...human immunodeficiency virus (HIV) infection in industrialized countries in the era of highly active antiretroviral therapy (HAART). Method. A case-control study was implemented in a large cohort of HIV-infected patients. Case patients had newly diagnosed NHL, and control subjects were matched for CD4+ cell count, calendar period, sex, and length of follow-up. Results. Variables associated with a decreased risk of NHL were the use of HAART during follow-up for at least 6 months (odds ratio OR, 0.46; 95% confidence interval CI, 0.21–0.98), receipt of a diagnosis of AIDS before the censoring date (OR, 0.37; 95% CI, 0.18–0.76), and undetectable level of HIV RNA during follow-up (OR, 0.34; 95% CI, 0.15–0.77). The use of antiherpetic drug for at least 6 months was associated with a nonsignificant decreased risk of NHL (OR, 0.40; 95% CI, 0.11–1.44; P = .16). In multivariate analysis, variables significantly associated with a decreased risk of NHL were the use of HAART for at least 6 months during follow-up (OR, 0.37; 95% CI, 0.16–0.87) and receipt of an AIDS-related diagnosis before the censoring date (OR, 0.44; 95% CI, 0.21–0.93). Age, transmission group, hepatitis B and C coinfections, CD4+ and CD8+ cell count nadir, and previous history of herpes virus infection were not associated with an increased risk for NHL. Conclusion. The use of HAART for at least 6 months was associated with a decreased risk of NHL, whereas uncontrolled HIV RNA load may be associated with an increased risk. The role of antiherpetic drugs needs further investigation.
Highlights • SVR12 was 63% in a real-life setting in HIV/HCV patients treated with TVR or BOC. • Low HCV VL and virological response at W4 were the 2 factors associated with SVR12. • The SVR12 was ...83% (TVR) and 73% (BOC) in patients with low HCV VL (<800,000 UI/mL). • BOC/TVR may provide a good alternative in settings where access to new DAA is limited
Objectives
The objective of this nested study was to assess the prevalence of psychiatric disorders in a sample of HIV/hepatitis C virus (HCV)‐coinfected patients according to their HCV status.
...Methods
The nested cross‐sectional study, untitled HEPAVIH‐Psy survey, was performed in a subset of HIV/HCV‐coinfected patients enrolled in the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) CO13 HEPAVIH cohort. Psychiatric disorders were screened for using the Mini International Neuropsychiatric Interview (MINI 5.0.0).
Results
Among the 286 patients enrolled in the study, 68 (24%) had never received HCV treatment, 87 (30%) were treatment nonresponders, 44 (15%) were currently being treated and 87 (30%) had a sustained virological response (SVR). Of the 286 patients enrolled, 121 patients (42%) screened positive for a psychiatric disorder other than suicidality and alcohol/drug abuse/dependence, 40 (14%) screened positive for alcohol abuse/dependence, 50 (18%) screened positive for drug abuse/dependence, 50 (17.5%) were receiving an antidepressant treatment and 69 (24%) were receiving an anxiolytic. Patients with an SVR did not significantly differ from the other groups in terms of psychiatric disorders. Patients receiving HCV treatment screened positive less often for an anxiety disorder. The highest rate of drug dependence/abuse was among HCV treatment‐naïve patients.
Conclusions
Psychiatric disorders were frequent in HIV/HCV‐coinfected patients and their rates were comparable between groups, even for patients achieving an SVR. Our results emphasize the need for continuous assessment and care of coinfected patients, even after HCV clearance. Drug addiction remains an obstacle to access to HCV treatment. Despite the recent advent and continued development of directly acting antiviral agents (DAAs), it is still crucial to offer screening and comprehensive care for psychiatric and addictive disorders.
The impact of antiretroviral drug exposure and associated lipodystrophy and/or insulin resistance (IR) on advanced liver fibrosis in HIV/HCV‐coinfected patients is not fully documented. We determined ...the prevalence of advanced liver fibrosis (defined by hepatic stiffness ≥9.5 kPa) and associated factors, focusing on the impact of highly active antiretroviral therapy and its major adverse effects (lipodystrophy and IR), in 671 HIV/HCV‐coinfected patients included in the ANRS CO13 HEPAVIH cohort. One hundred ninety patients (28.3%) had advanced liver fibrosis. In univariate analysis, advanced liver fibrosis was significantly associated with male sex, higher body mass index, HCV infection through intravenous drug use, a lower absolute CD4 cell count, a longer history of antiretroviral treatment, longer durations of protease inhibitors, non‐nucleoside reverse transcriptase inhibitors and NRTI exposure, lipodystrophy, diabetes, and a high homeostasis model assessment method (HOMA) value. The only antiretroviral drugs associated with advanced liver fibrosis were efavirenz, stavudine and didanosine. In multivariate analysis, male sex (OR 2.0, 95% CI 1.1–3.5; P = 0.018), HCV infection through intravenous drug use (OR 2.0, 95% CI 1.1–3.6; P = 0.018), lipodystrophy (OR 2.0, 95% CI 1.2–3.3; P = 0.01), median didanosine exposure longer than 5 months (OR 1.7, 95% CI 1.0–2.8; P = 0.04) and a high HOMA value (OR 1.1, 95% CI 1.0–1.2; P = 0.005) remained significantly associated with advanced liver fibrosis. Mitochondrial toxicity and IR thus appear to play a key role in liver damage associated with HIV/HCV‐coinfection, and this should be taken into account when selecting and optimizing antiretroviral therapy. Antiretroviral drugs with strong mitochondrial toxicity (e.g. didanosine) or a major effect on glucose metabolism should be avoided.
Hyperammonemia attributed to multiple myeloma has been rarely reported.
We report a 63-year-old man who was admitted to an intensive care unit for confusion and altered mental status progressing to ...coma that was related to a relapsing multiple myeloma. Chemotherapy allowed the reduction of serum ammonia and the return to a normal state of consciousness.
Hyperammonemic encephalopathy is a rare complication of multiple myeloma and is associated with high in-patient mortality. To our knowledge, this is the first case of hyperammonemic encephalopathy due to a relapsing myeloma diagnosed and treated in intensive care unit.
Interstitial lung disease, cutaneous rash and elevated serum angiotensin converting enzyme (ACE) may suggest diagnoses other than sarcoidosis.
A 58-year-old man had presented dyspnoea for 2 years ...with increased angiotensin-converting enzyme, as well as an interstitial syndrome and micronodules. The possibility of sarcoidosis was raised. Systemic corticosteroids resulted in improvement of the dyspnoea although it recurred on dose reduction. We noted fluctuating eczematous macules of the limbs with a histology of aspecific folliculitis. The identification of Mycobacterium avium complex (MAC) in the bronchoalveolar wash prompted us to initiate antimycobacterial therapy, but this was to no avail. Review of the CT-scan and questioning of the patient (daily use of a Jacuzzi for 7 years) resulted in diagnosis of hypersensitivity pneumonitis due to MAC. The cutaneous lesions were taken to indicate "hot tub folliculitis". Discontinuation of hot-tub use and a short course of oral corticosteroids resulted in healing within 4 months, with no recurrence at 2 years.
HTL is a form of hypersensitivity pneumonitis due to the presence of MAC in the water of Jacuzzis. This condition regresses spontaneously without treatment on discontinuation of Jacuzzi use. Hot-tub folliculitis due to Pseudomonas aeruginosa (PA) presents as macules and papules on covered skin areas (swimsuit) within 48hours of bathing and often declines within 2 weeks.
Our case is original as regards the concomitant lung and cutaneous involvement associated with Jacuzzi use, with an immunoallergic mechanism for the MAC and probably an infectious mechanism for the PA.
Objectives
The aims of the present study were to estimate the prevalence of renal impairment (RI) among HIV‐infected adult patients and to investigate the associated factors.
Methods
A ...cross‐sectional survey was conducted in a French hospital‐based cohort. Clearance of creatinine (CC) was calculated using the Cockcroft–Gault formula. Four stages of RI were defined: mild (60–90 mL/min), moderate (30–60), severe (15–30) and end stage (<15). Logistic regression models were used to investigate factors associated with RI.
Results
The male/female ratio of the 2588 patients enrolled was 3:1 and the median age was 42 years. At the time of assessment of CC, the median CD4 count was 430 cells/μL and HIV plasma viral load (VL) was<50 copies/mL in 60%. The overall prevalence of RI was 39.0%: 34.2% mild, 4.4% moderate, 0.3% severe and 0.2% end‐stage. Mild RI was associated with female gender odds ratio (OR)=3.3: 95% CI 2.6–4.3), age >50 years (OR=9.8: 7.4–13.0) and 40–50 years (OR=1.9: 1.5–2.4), body mass index (BMI) <22 kg/m2 (OR=3.3: 2.7–4.3) and tenofovir exposure (OR=1.4: 1.0–1.9 for <1 year and OR=1.5: 1.2–2.0 for >1 year). Advanced RI (CC <60 mL/min) was associated with age >50 years (OR=5.6: 2.9–10.9) and 40–50 years (OR=2.2: 1.1–1.4), BMI <22 kg/m2 (OR=1.5: 1.0–2.4), hypertension (OR=2.5: 1.4–2.5) and indinavir (IDV) exposure >1 year (OR=2.3: 1.5–3.6).
Conclusion
This survey confirms the high prevalence of RI in HIV‐infected patients and indicates the importance of the investigation of renal function especially in women, older patients, those with a low BMI or treated with tenofovir or IDV.
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