To describe integrase strand transfer inhibitor (INSTI) resistance profiles and factors associated with resistance in antiretroviral-naive and -experienced patients failing an INSTI-based regimen in ...clinical practice.
Data were collected from patients failing an INSTI-containing regimen in a multicentre French study between 2014 and 2017. Failure was defined as two consecutive plasma viral loads (VL) >50 copies/mL. Reverse transcriptase, protease and integrase coding regions were sequenced at baseline and failure. INSTI resistance-associated mutations (RAMs) included in the Agence Nationale de Recherches sur le SIDA genotypic algorithm were investigated.
Among the 674 patients, 359 were failing on raltegravir, 154 on elvitegravir and 161 on dolutegravir therapy. Overall, 90% were experienced patients and 389 (58%) patients showed no INSTI RAMs at failure. The strongest factors associated with emergence of at least one INSTI mutation were high VL at failure (OR = 1.2 per 1 log10 copies/mL increase) and low genotypic sensitivity score (GSS) (OR = 0.08 for GSS ≥3 versus GSS = 0-0.5). Patients failing dolutegravir also had significantly fewer INSTI RAMs at failure than patients failing raltegravir (OR = 0.57, P = 0.02) or elvitegravir (OR = 0.45, P = 0.005). Among the 68 patients failing a first-line regimen, 11/41 (27%) patients on raltegravir, 7/18 (39%) on elvitegravir and 0/9 on dolutegravir had viruses with emergent INSTI RAMs at failure.
These results confirmed the robustness of dolutegravir regarding resistance selection in integrase in the case of virological failure in routine clinical care.
Diffuse and abundant sweating in a middle age patient evolving for several weeks should raise suspicion of malignant lymphoma and infectious or neuroendocrine disorders before considering a drug ...origin. We report a patient who presented with severe and invalidating excessive sweating related to hydromorphone therapy for vertebral pain. Amongst their many reported side-effects, excessive sweating disappearing with discontinuation of the drug have been reported with some opiates.
La maladie de Gaucher (MG) est une maladie génétique lysosomale, due à un déficit d’activité de la bêta-glucocérébrosidase, caractérisée par des atteintes hématologiques, viscérales et osseuses. ...L’objectif principal de notre étude était de décrire le parcours diagnostique de patients atteints de MG de type 1 et le rôle du médecin interniste.
Étude rétrospective multicentrique incluant des patients atteints de MG de type 1, menée au sein de 16 centres, entre 2009 et 2011.
Cinquante-cinq patients atteints d’une MG de type 1 ont été inclus, suivis par un interniste ou un hématologue. Ils étaient initialement hospitalisés dans 8 services de spécialité différents. Le diagnostic a été établi par un myélogramme chez 22 patients (40 %), par un dosage enzymatique de la glucocérébrosidase chez 15 patients (27 %), par une biopsie médullaire chez 9 patients (16 %). Le recours au dosage enzymatique était plus fréquent après 1990. Le délai entre la date de première hospitalisation pour symptômes en lien avec la MG et le diagnostic définitif était inférieur à 1 an pour 38 patients (81 %). Les suspicions de MG étaient majoritairement adressées à un médecin interniste.
La maladie semble mieux reconnue et diagnostiquée plus rapidement depuis 1990 malgré la multiplicité des parcours, dans lesquels le rôle du médecin interniste paraît important.
Gaucher disease (GD) is a rare genetic lysosomal storage disorder caused by a beta-glucocerebrosidase deficiency and responsible for a lysosomal storage disorder. GD is characterized by haematological, visceral and bone involvements. The aim of this study was to describe the diagnostic journey of type 1 GD patients as well as the role of the internist.
A retrospective multicentric study involving type 1 GD patients has been conducted in 16 centers, between 2009 and 2011.
Fifty-five type 1 GD patients were included, under the care of an internist or an haematologist. They were originally hospitalized in 8 different specialized units. Diagnosis was established by bone-marrow aspiration in 22 patients (40%), by enzymatic assay of glucocerebrosidase activity in 15 patients (27%), and by bone-marrow biopsy in 9 patients (16%). The use of enzymatic assay became more frequent after 1990. The delay between first hospitalization due to GD symptoms and definitive diagnosis was less than one year for 38 patients. Patients with suspected GD were mainly referred to an internist physician.
GD seems to be better recognized and quickly diagnosed since 1990 in spite of the multiplicity of journeys. The role of the internist seems important.
We aimed to assess the prevalence of interatrial electromechanical dyssynchrony in systemic sclerosis (SSc) patients, and to study the correlation between interatrial delay and standard follow-up ...parameters.
Forty consecutive patients with SSc were studied. Classical echocardiographic measurements were obtained, including indices of left ventricular (LV) systolic and diastolic function, right ventricular function, and pulmonary artery pressure (PAP). Left atrial (LA) function was studied using volume measurements. The interatrial mechanical (IAMD) delay was obtained by measuring the time delay between the peak atrial velocities at the lateral tricuspid and mitral annuli using tissue Doppler imaging. A cut-off value of 35 ms was chosen to define the presence of a significant interatrial delay. The IAMD was compared to NYHA class, six-minute walking test (6MWT), NT proBNP levels, and the carbon monoxide diffusion capacity over alveolar volume ratio (DLCO/VA), as well as to classical echocardiographic parameters.
Forty percent of patients were found to have significant interatrial dyssynchrony with an IAMD of 35 ms or more. Patients with interatrial dyssynchrony were more symptomatic, had a shorter 6MWT, higher NT proBNP levels, and a lower DLCO/VA compared with those without dyssynchrony. Regarding conventional echocardiographic parameters, increased IAMD was associated with more pronounced LV diastolic dysfunction, LA enlargement and dysfunction, altered RV function, and higher PAP.
IAMD correlated with all of the standard follow-up parameters in SSc, and is probably a sensitive marker of LA involvement. This easy to measure parameter should be added to the routine echocardiographic assessment of these patients.
Des sueurs profuses, généralisées, évoluant depuis plusieurs semaines chez un patient d’âge moyen doivent faire rechercher une étiologie lymphomateuse, infectieuse ou neuroendocrine avant d’envisager ...une origine médicamenteuse. Nous rapportons l’observation d’un patient souffrant d’un tableau d’hypersudation, particulièrement sévère et invalidante liée à la prise d’hydromorphone (Sophidone LP
®) pour des douleurs rachidiennes. Parmi les nombreux effets secondaires potentiels des opiacés, des épisodes d’hypersudation résolutifs à l’arrêt sont décrits lors de l’utilisation de certaines molécules.
Diffuse and abundant sweating in a middle age patient evolving for several weeks should raise suspicion of malignant lymphoma and infectious or neuroendocrine disorders before considering a drug origin. We report a patient who presented with severe and invalidating excessive sweating related to hydromorphone therapy for vertebral pain. Amongst their many reported side-effects, excessive sweating disappearing with discontinuation of the drug have been reported with some opiates.
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