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Widespread use of the measles vaccine should lead to the elimination of this disease. Here, we study the seroprevalence of measles in a cohort of adults living with HIV born after the introduction of measles vaccine in France and attempt to identify risk factors for the absence of serum measles antibody.In this multi-centre cross-sectional study, adult outpatients born after 1980 were screened for the presence of measles IgG antibody. Demographic and clinical data were obtained from the standardized electronic medical record system. Univariate and multivariate logistic regressions were performed to identify factors associated with the absence of measles antibodies.Between April 2019 and April 2020, 648 participants were enrolled. The median age was 33 years, 53.6% were born outside of France, and 74% were considered as socially deprived. Plasma HIV RNA was undetectable in 86% of patients. Among 603 evaluable patients, measles serology was positive in 87.2%. Only 81.8% of the patients with documented vaccination tested positive for measles IgG. Younger age was significantly associated with the absence of measles serum antibodies ( P = 0.004 for each 10-year lower), as was birth in France ( P 0.001) and absence of social vulnerability ( P = 0.04).The current study revealed a low seroprevalence of measles compared with that previously reported in France 6 years earlier and to the expected rate to achieve herd immunity. Checking vaccination record should be systematically carried out in patients living with HIV to fill the immunity gaps.

Early gestational diabetes mellitus (eGDM) is diagnosed when fasting plasma glucose before 24 weeks of gestation (WG) is ≥ 5.1 mmol/L, whilst standard GDM is diagnosed between 24 and 28 WG by oral glucose tolerance test (OGTT). eGDM seems to have worse obstetric outcomes than standard GDM. We compared the rates of postpartum glucose metabolism disorders between women with early versus standard GDM in this prospective study on women with GDM from three university hospitals between 2014 and 2016. Patients were included if they were Trial registration: NCT01839448, ClinicalTrials.gov on 22/04/2013.

International audience; Background: Pregnant women with type 1 diabetes (T1D) have high risk of complications despite improved care based on technology advancements.Objective: To assess the effects of pregnancy planning on fetal and maternal outcomes in T1D women treated with continuous subcutaneous insulin infusion (CSII).Study design: We retrospectively assessed maternal and neonatal outcomes in T1D women using CSII who had planned or unplanned pregnancies between 2002 and 2018. The study was done in two European countries with similar sustained programs for pregnancy planning over the study period.Results: Data from 107 pregnancies and newborn babies were collected. Seventy-nine pregnancies (73.8%) had been planned. HbA1c was lower in planned versus unplanned pregnancy before and during all three trimesters of pregnancy (p < 0.0001). Pregnancy planning was associated with a reduction in the occurrence of iatrogenic preterm delivery (RR 0.44, 95% CI 0.23-0.95; p = 0.01). Risk reduction persisted after adjustments for mother's age above 40 years and preeclampsia. High HbA1c before or during pregnancy was associated with an increased risk of iatrogenic preterm delivery (RR 3.05, 95% CI 1.78-5.22, p < 0.0001). Premature newborns needed intensive care more often than those at term (RR 3.10, 95% CI 1.53-4.31; p = 0.002).Conclusions: Pregnancy planning in T1D women using CSII was associated with better glucose control and decreased risk of iatrogenic preterm delivery. Hence preconception care also improves pregnancy outcome in patients using an advanced mode of insulin delivery. Planned pregnancies could further benefit from the use of new metrics of glucose control.

BackgroundSafety 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.ObjectivesTo 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.MethodsIn 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 (ResultsAmong 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 ConclusionsIn 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.

Background: 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. Methods: A standardized letter was sent to the 133 women who delivered in Nantes hospital from 01/01/2003 to 31/12/2012 (167 births). Results: 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. Conclusions: 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.

Access to in vitro fertilization (IVF) for obese women varies across centers, and the impact of obesity on IVF outcomes is widely discussed. We assessed the impact of obesity and its severity on live birth rate (LBR) after IVF. We included women treated for IVF in our center. Data were prospectively collected in the BabySentryTM software. LBR per cycle and cumulative LBR including all attempts of the couple were calculated, considering transfer of both fresh and frozen embryos. Of 1588 included women (2379 controlled ovarian stimulations), 70.2%, 19.5%, 7.9%, and 2.4% were normal-weight, overweight, class I obesity, and class II/III obesity, respectively. For each cycle, LBR did not differ according to BMI category. Adjusted odds ratios (95% confidence intervals) for obtaining a live birth at the first cycle were 1.11 (0.78&ndash, 1.58) for overweight, 1.17 (0.70&ndash, 1.95) for class I obese, and 1.05 (0.48&ndash, 2.31) for class II/III obese women, as compared with normal-weight women. Similarly, no significant associations were found at cycles 2, 3, and 4. Cumulative LBR increased with the number of cycles, independently of the BMI class (p log-rank = 0.91). After adjustment, obesity status did not impact significantly the miscarriage rate, regardless of the cycle. In conclusion, neither women obesity nor its severity impacted the cumulative LBR after IVF.

International audience; OBJECTIVE:To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes.METHODS: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

Objective: To determine whether changing antiretroviral therapy (ART) during pregnancy in order to follow guidelines because of concern about fetal risks led to poorer virological outcomes. Methods: All pregnancies in women with HIV1 infection enrolled in the national multicenter prospective French Perinatal cohort were included between 01/2005 and 12/2015, at 14 gestational weeks or more and 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 pregnancy-related 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. Results: Of 10553 pregnancies in the cohort, 1797 were taking ART at conception and had a viral load

Immunological failure is identified from the estimation of certain parameters of a mathematical model of HIV infection dynamics. This identification is supported by clinical research results from an original clinical trial. Standard clinical data were collected from infected patients starting highly active antiretroviral therapy (HAART) after just 1 month of therapy initiation and were used to carry out the model identification. The early diagnosis is shown to be consistent with patient monitoring after 6 months. Fil: Rivadeneira Paz, Pablo Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Santa Fe. Instituto de Desarrollo Tecnológico Para la Industria Química (i); Argentina Fil: Moog, Claude. Centre National de la Recherche Scientifique; Francia Fil: Stan, Guy Bart. Imperial College London; Reino Unido Fil: Costanza, Vicente. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Santa Fe. Instituto de Desarrollo Tecnológico Para la Industria Química (i); Argentina Fil: Brunet, Cecile. Universite de Nantes; Francia Fil: Raffi, Francois. Universite de Nantes; Francia Fil: Ferré, Virginie. Universite de Nantes; Francia Fil: Mhawej, Marie José. Centre National de la Recherche Scientifique; Francia Fil: Biafore, Federico Leonardo. Universidad Nacional de San Martin. Escuela de Ciencia y Tecnologia. Centro de Matematica Aplicada; Argentina Fil: Ouattara, Djomangan. Universite de Nantes; Francia Fil: Ernst, Damien. Universite de Liege; Bélgica Fil: Fonteneau, Raphael. Universite de Liege; Bélgica Fil: Xia, Xiaohua. University of Pretoria; Sudáfrica

BACKGROUND: Intrapartum intravenous zidovudine (ZDV) prophylaxis is a long-standing component of prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in high-resource countries. In some recent guidelines, intravenous ZDV is no longer systematically recommended for mothers receiving combination antiretroviral therapy (cART) with low viral load. We evaluated the impact of intravenous ZDV according to viral load and obstetrical conditions. METHODS: All HIV-1-infected women delivering between 1 January 1997 and 31 December 2010 in the French Perinatal Cohort (ANRS-EPF) were analyzed if they received ART during pregnancy and did not breastfeed. We identified maternal and obstetrical characteristics related to lack of intravenous ZDV and compared its association with MTCT rate and other infant parameters, according to various risk factors. RESULTS: Intravenous ZDV was used in 95.2% of the 11 538 deliveries. Older age, multiparity, and preterm and vaginal delivery were associated with lack of intravenous ZDV (n = 554). In women who delivered with viral load ≥1000 copies/mL, the overall MTCT rate was higher without than with intravenous ZDV (7.5% vs 2.9%; P = .01); however, there was no such difference when the neonate received postnatal intensification therapy. Among them, 77% of women who had viral load

Introduction : Le VIH fait partie des maladies chroniques pour lesquelles il serait interessant de connaitre les besoins et attentes des patients dans le domaine biomedical mais aussi dans leurs dimensions psychosociale, affective et professionnelle, afin de pouvoir mettre en place des programmes d’education therapeutique. Materiel et methode : Apres une premiere etape qualitative par entretien semi-directif permettant d’identifier des besoins educatifs, une deuxieme etape quantitative sous forme d’auto questionnaire a ete menee chez l’ensemble des patients venant en consultation aux CHU de Nantes et Angers. Resultats : Notre echantillon comportait 351 patients avec 73 % d’hommes et 27 % de femmes âges en moyenne de 45,7 ans (ecart-type = 11). Soixante-treize pour cent des patients declaraient parler avec leur medecin hospitalier et seulement 29 % avec les infirmieres. Les patients etaient a 83 % satisfaits de la disponibilite des professionnels de sante. Quatre-vingt-huit pour cent estimaient qu’on leur expliquait les decisions prises les concernant et 80 % qu’on leur demandait leur avis. Trente-et-un pour cent preferaient laisser les medecins decider. Parmi les 301 patients traites, 97 % estimaient etre capables de prendre correctement leur traitement, 56 % n’avaient jamais ressenti le besoin de faire une pause therapeutique et 48 % declaraient ne pas connaitre les complications du VIH. Soixante-huit pour cent des patients avaient peur du risque d’infection et en particulier les jeunes (p < 0,001). Les patients estimaient en majorite (63 % ; n = 190) avoir ete suffisamment informes sur l’existence d’une fatigue. Pour les autres effets indesirables (lipodystrophie, douleur, insomnie, modification de l’image corporelle), seule la moitie des patients estimait avoir ete suffisamment informe. Sur le plan affectif, 79 % des patients avaient quelqu’un a qui parler en cas de probleme et estimaient pouvoir trouver du soutien aupres de leurs proches. La moitie des patients se sentait isolee et 19 % discrimines (74 % des discriminations concernait les demandes de credits). Trois quarts des patients ne souhaitaient pas s’exprimer au sujet de leurs difficultes financieres, de leurs problemes professionnels et de la mort de proches due au VIH. Enfin, les patients traites depuis plus de dix ans ressentaient un besoin plus fort de s’investir dans une association (p = 0,001). Conclusion : Cette enquete quantitative est riche d’enseignements en matiere de besoins et d’attentes en education therapeutique. Il est fondamental que parallelement a la mise en œuvre de programme d’ETP, un travail de promotion sociale de ces personnes soit realise.

Objectives: The aims of this study was to analyze the immuno-virologic response after optimised background antiretroviral therapy (OBT) associated to new active antiretroviral treatment (ART) in HIV-1 infected patients with chronic virologic failure. Methods: We conducted a descriptive analysis of the immuno-virologic responses in HIV-1 adult infected patients: 1) harbouring multiple therapeutic failures with ART; 2) with no virologic response obtained over 10 years (1997-2008); and 3) treated with OBT combined with new drugs including at least 1 of the 3 active ART among darunavir/ritonavir, etravirine and raltegravir; 4) observed between month 0 (M0), before new ART to month 12 (M12) after new ART initialisation. Results: Twenty three patients were included in the study. After OBT, the proportion of patients with undetectable viral load was significantly higher at M6 and M12 than M0 (86% and 73% versus 0%, p = 0.03, respectively). At the same period, the median HIV viral load decreased significantly in 19/23 (83%) patients from 4.3 to 1.69log10 HIV-1 RNA copies/ml (p 3 [0 - 604] to 449/mm3 [130 - 964] between M0 and M12 (p 3 decreased from 57% to 23% (p = 0.02). Tolerability was good and no death was recorded during the 12-month' follow-up. Conclusions: These results show that the combination of OBT with the new ART can offer a salvage therapy in patients presenting a long-term history of virologic failures.

Summary Background and objectives The main aim of this study was determining the risk factors of chronic kidney disease (CKD) in HIV-1-infected patients. Design, setting, participants, & measurements Patients were followed from seven large HIV reference centers in France that maintain prospective databases on HIV-1-infected patients. The main outcome was the time to CKD defined as two consecutive measures of estimated GFR ≤60 ml/min per 1.73 m2 over ≥3 months. A Cox9s model with delayed entry was used to search predictive factors of time to CKD. Results From 1993 to 2006, 349 out of 7378 patients were found to have CKD. Of these, 166 had hypertension, 33 had diabetes, and 26 were antiretroviral therapy–naive. Occurrence of acute kidney injury (hazard ratio [HR] = 2.40) and hypertension (HR = 2.39) were strongly associated with an increased risk of CKD. Patients with a durable level of CD4 count >200 cells/mm3 had a lower risk of CKD (HR = 0.63). Recent exposure to indinavir (HR = 2.03), totenofovir (HR = 1.55), and abacavir (HR = 1.37) were associated with an increased risk of CKD. Past exposure to tenofovir was also associated with an increased risk of CKD (HR = 2.23), and a trend toward significance was observed for past exposure to indinavir (HR = 1.28). Conclusions CKD was not rare in HIV-infected patients and occurs preferentially in HIV-infected patients exposed to certain ARVs, specifically abacavir, indinavir and tenofovir. This requires closer monitoring of renal function in patients exposed to one of these drugs.

International audience; This paper studies the influence of apoptosis in the dynamics of the HIV infection. A new modeling of the healthy CD4+ T-cells activation-induced apoptosis is used. The parameters of this model are identified by using clinical data generated by monitoring patients starting Highly Active Anti-Retroviral Therapy (HAART). The sampling of blood tests is performed to satisfy the constraints of dynamical system parameter identification. The apoptosis parameter, which is inferred from clinical data, is then shown to play a key role in the early diagnosis of immunological failure.

The aim was to study the mechanisms involved in the dyslipidemia associated with lipodystrophy in HIV infected patients on antiretroviral therapy (ART). We investigated the in vivo kinetics of apolipoprotein B100 (apoB) containing lipoproteins using a 14 h primed constant infusion of [5,5,5, (2)H(3)] leucine and compartmental modelling in normolipidemic without lipodystrophy (7 patients, NLD) or dyslipidemic with lipodystrophy (7 patients, LD) treated with ART. Subjects in group LD showed higher plasma triglycerides (5.73+/-3.58 vs 1.29+/-0.54 g/L, p

Epidemiological evidence clearly shows that obesity contributes to menstrual disorders, infertility and poor pregnancy outcome. Clinicians face two problems: obesity-related infertility and, consequently, obesity in women using assisted reproductive technologies. Whereas weight loss constitutes the first-line therapy for the former, the same does not always apply for the latter. Much debate surrounds the relationship between overweight patients and the outcome of IVF treatment. Adjusting the dose of gonadotropins is the most characteristic feature of IVF treatment in such patients. Nevertheless, considering the poorer outcome of pregnancies in obese patients, all efforts (changes in lifestyle habits, psychological counseling, antiobesity medical therapy and, possibly, bariatric surgery) should be made to encourage weight loss before fertility treatment is begun.

BACKGROUND Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF). METHODS All neonates, born alive, to HIV-1-infected women enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events. RESULTS Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count

The purpose of this study was to identify and quantify needs and expectations among HIV patients with a view to developing and implementing a therapeutic patient education program.A qualitative study using semi-structured interviews was conducted to identify patient education needs. A quantitative study based on a personal questionnaire was subsequently conducted at the teaching hospitals of Nantes and Angers (France).The study was based on a sample of 351 patients (73% of the sample were men and 27% were women). The mean age of the participants was 45.7 years. 73% of the patients stated that they had spoken to a hospital practitioner, while just 29% claimed to have spoken to nurses. 83% stated that they were satisfied with the availability of nursing staff. 88% considered that practitioners explained their treatment decisions, while 80% stated that they had been asked for their opinion. Of the 301 patients treated, 97% felt that they were able to correctly take their medication, while 48% felt that they had no knowledge of HIV-related complications. 68% of the patients expressed concerns about infection risks, particularly young patients (p0.001). Concerning the side effects of treatment (lipodystrophy, pain, insomnia, physical changes), half of the patients felt that they had been adequately informed. In terms of emotional support, 79% of the patients stated that they had someone to talk to in the event of a problem. Half of the patients felt isolated and 19% felt discriminated against. Three quarters of the patients did not wish to discuss their financial difficulties, their work problems or the death of a close relative due to HIV infection. Finally, patients treated for more than ten years felt a stronger need to join an association (p = 0.001).The results suggest the need to improve patients' ability to express their needs, particularly those who are not members of an association. In addition to the implementation of a therapeutic education program, a social support program is also needed.

International audience; An increasing number of sophisticated control algorithms become available in the current literature to optimize the HIV therapy. Unfortunately, the pharmacokinetics and pharmacodynamics of antiretroviral drugs are ignored and these algorithms remain purely theoretic. This issue is investigated explicitly in this paper. An elementary pharmacodynamics model is combined with a non linear feedback control computed from standard engineering methods. It is shown that it results in the design of a realistic dosage regimenwhich drives the immunological system close to the healthy equilibrium state. Although the problem is dealt as a single input system, it is argued that the procedure can be extended to a multitherapy design or to any available control law.

International audience; Ce travail a pour objectif de présenter différents indicateurs relatifs à la santé mentale des femmes infectées par le VIH suivies en France. Dans un premier temps, nous utiliserons les données de l'enquête Vespa, afin de présenter une analyse des facteurs associés aux tentatives de suicide. Dans un second temps, nous présentons des résultats obtenus à partir des données de la cohorte Aproco de patients infectés par le VIH et sous thérapies antirétrovirales. Nous proposons une analyse des facteurs associés à une meilleure qualité de vie physique et mentale trois années après la mise sous traitementLes différents résultats mettent en évidence un impact important des symptômes lipodystrophiques, ainsi que des caractéristiques socio démographiques et psychosociales telles que les comportements de discrimination quant à la santé mentale des femmes infectées par le VIH.L'ensemble de ces résultats est discuté au regard de l'évolution de la prise en charge des femmes infectées par le VIH, dans une logique d'optimisation des pratiques des divers acteurs concernés par cette prise en charge.

Recommended antiretroviral regimens include a nucleoside reverse transcriptase inhibitor (NRTI) component. Class cross-resistance and mitochondrial toxicity are recognized as problems with this class of antiretrovirals.In a pilot open-label study, 65 antiretroviral-naive and 21 experienced but nonnucleoside reverse transcriptase inhibitor-naive HIV-1-infected adults were given a combination of lopinavir/ritonavir (533.3/133.3 mg twice daily) and efavirenz (600 mg once daily) for 48 weeks.At baseline, the mean viral load was 4.84 log10 copies/mL and the mean CD4 count was 311 cells/mm. At week 24, the proportions of patients with a viral load400 copies/mL were 78% and 93% using an intent-to-treat and on-treatment analysis, respectively. At week 48, proportions were 73% and 97%, respectively. Treatment discontinuation occurred in 21 patients during the 48-week period, with 33% of those attributable to drug-related adverse effects. A viral load400 copies/mL at week 24 or 48 was associated with nonadherence in 3 patients and virologic failure in 1 patient. After an increase during the first 8 weeks, fasting lipid levels remained stable up to 48 weeks.The lopinavir/ritonavir-efavirenz combination is associated with a high rate of virologic response and should be compared with more classic NRTI-containing regimens in randomized and controlled clinical trials.

Introduction : With the implementation of combined antiretroviral therapy (cART) and prevention of mother-to-child transmission (MTCT) we observed dramatic decreases in rates of perinatal MTCT of HIV, 0.3% in France in women with plasma viral load (pVL)