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Background Nearly half of HIV-infected children worldwide are born in West and Central African countries where access to prevention of mother-to-child transmission of HIV (PMTCT) programmes is still limited. WHO recommends reinforced antiretroviral prophylaxis for infants at high risk of mother-to-child transmission of HIV (MTCT) but its implementation needs further investigation in the field. Methods The prospective ANRS 12344-DIAVINA study evaluated the feasibility of a strategy combining early infant diagnosis (EID) and reinforced antiretroviral prophylaxis in high-risk infants as identified by interviews with mothers at Ignace Deen Hospital, Conakry, Guinea. Results 6493 women were admitted for delivery, 6141 (94.6%) accepted HIV testing and 114 (1.9%) were HIV positive. Among these, 51 high-risk women and their 56 infants were included. At birth, a blood sample was collected for infant EID and reinforced antiretroviral prophylaxis was initiated in 48/56 infants (86%, 95% CI 77%–95%). Iron supplementation was given to 35% of infants for non-severe anaemia. Retrospective measurement of maternal plasma viral load (pVL) at delivery revealed that 52% of women had pVL Conclusions Reinforced antiretroviral prophylaxis and EID at birth are widely feasible. However, mothers’ self-disclosure of HIV status and antiretroviral intake do not allow adequate evaluation of MTCT risk, which argues for maternal pVL measurement near delivery. Furthermore, actions against stigmatization are crucial to improve PMTCT.

Myalgia or muscle weakness is frequently observed during HIV infection (1), and 15% of HIV patients may have an increased serum creatine kinase (CK) level.1 Case reports or case series have suggested that HIV-associated myopathies represent a large spectrum of disease.2 To date, data on muscle involvement during HIV infection remain sparse and we aimed to describe the clinical characteristics and evolution of biopsy-proven HIV-associated myopathies. All HIV-positive patients who had a muscle biopsy performed at the Pitie-Salpetriere University Hospital between 2001 and 2012 were identified. Medical records were retrospectively reviewed to assess muscle disease features and HIV infection characteristics. Patients were classified histologically as polymyositis (PM), non-specific myositis (NSM), immune-mediated necrotizing myopathy (IMNM), or inclusion body myositis (IBM) according to the European Neuromuscular Center (ENMC) criteria.3 4 Isolated mitochondrial abnormality (IMA) was defined as presence of cytochrome c oxidase negative fibres and/or succinate dehydrogenase positive staining without inflammatory cell infiltrate or rimmed vacuoles. PM or NSM evolution towards IBM was evaluated at follow-up. Uncontrolled viral load was defined as >40 copies/mL. Categorical variables are reported herein as numbers and/or percentages and were compared using a χ2 or Fisher’s exact test. Quantitative variables are reported as median (IQR1–IQR3) and compared using non-parametric one-way one-way analysis of variance (ANOVA). For all statistical analyses, p

In response to the alarming decline of biodiversity worldwide, international governmental organizations are promoting a market-based approach to biodiversity through the economic valuation and pric...

The effects of a 10-year control of HIV replication without viral blips with antiretroviral therapy were examined in progressors. CD4 cell counts did not plateau but showed a continuous increase until the 10th year. Ultrasensitive techniques showed very low plasma HIV RNA and cell-associated DNA levels. Robust memory T cell responses to HIV-p24 were higher than in 3-year treated patients and comparable to those of Elite controllers, whereas interferon-gamma-producing HIV-specific T cells were infrequent. Long-term and efficient antiretroviral therapy provides continuous benefits both on the immune system and on the HIV reservoirs.

International audience; Background: HIV-infected patients with TB need simplified, effective and well-tolerated antiretroviral regimens. Methods: The French ANRS 129 BKVIR open trial evaluated the once-daily tenofovir DF/emtricitabine and efavirenz combination, started within 12 weeks after TB treatment initiation, in antiretroviral-naive HIV-1-infected patients. Success was defined as an HIV-1 RNA

Background The world-wide AIDS epidemic is reflected in Western Europe in an increasing number of HIV-infected persons who originate from Africa. We describe the characteristics and response to antiretroviral therapy (ART) of HIV-infected patients born in Africa and living in France. Methods Analysis of data from the (Anti PROtease COhorte APROCO) cohort study of HIV-infected patients initiating ART was carried out. Included in the study were 90 patients born in sub-Saharan Africa, 53 in North Africa and 771 in metropolitan France. Results At baseline, there was a higher proportion of women and of the heterosexual transmission route of infection among patients born in sub-Saharan Africa, a higher proportion of injecting drug users among patients born in North Africa and a higher frequency of unemployment and of unstable housing conditions among patients born in both sub-Saharan and North Africa as compared with patients born in France. The median CD4 cell count was lower in patients born in both sub-Saharan and North Africa (sub-Saharan Africa: 197 cells/μL; North Africa: 222 cells/μL) than in patients born in France (307 cells/μL). Median HIV-1 viral loads were similar. After a median follow-up time of 36 months (2506 patient-years), the Kaplan–Meier estimations of probability of survival without new AIDS-defining events were not different. After 36 months of ART, in multivariate analysis, median CD4 cell count, CD4/CD8 ratio and viral load were not statistically different according to birthplace, but the median CD4 percentage was lower in patients born in both sub-Saharan and North Africa. The adherence profiles were similar. Conclusions Although clinical response and adherence to ART did not appear to differ in patients according to their birthplace, the reasons for the more advanced HIV infection observed at ART initiation among patients born in Africa should be further investigated.

Resume Objectif La schizophrenie pourrait apparaitre comme un obstacle a la mise en route et a l’observance d’un traitement antiretroviral chez des patients infectes par le VIH. L’objectif de ce travail est de decrire l’evolution clinique et biologique de 7 patients schizo-phrenes (diagnostic pose selon les criteres du DSM-IV-R) infectes par le VIH, chez lesquels une multitherapie antiretrovirale a ete instauree. Observations Une prise en charge multidisciplinaire associant infectiologue, psychiatre, assistante sociale, alcoologue, structures d’observance, de soins aux usagers de drogues et de soins a domicile, et associations a ete realisee, avec suivi medico-psychiatrique au moins mensuel et coordonne. Il s’agissait de 6 hommes et 1 femme, âges de 26 a 48 ans. Pour 5 patients, la schizophrenie etait connue depuis 6 mois a 20 ans avant le diagnostic d’infection par le VIH. Pour les 2 autres patients, le diagnostic semblait proche de la decouverte de l’infection. Tous recevaient un traitement neuroleptique au long cours. Deux d’entre eux etaient toxicomanes actifs, puis substitues. Avant le debut du traitement antiretroviral, 6 patients avaient une infection avancee, stade C, nadir des CD4 de 6 a 70/mm3, tandis qu’un patient avait une primo-infection VIH. Un traitement avec inhibiteurs de protease (IP) avait ete debute chez 6 patients entre mai 1996 et aout 1997, et en juillet 1998 pour le dernier, pris en charge a cette date. La reponse au traitement antiretroviral par IP a ete lente chez tous les patients, la charge virale (CV) devenant indetectable apres 5 mois a 4 ans chez 6/7 patients, avec, pour 3 d’entre eux, la survenue d’infections opportunistes. Chez 5 patients, elle est restee indetectable jusqu’en janvier 2002 (arret de l’etude) avec des CD4 entre 45 et 1 000/mm3 ; 1 patient est decede de cirrhose terminale mixte (ethylisme et hepatite C), 1 autre avait une CV partiellement controlee a 10 000 copies/mL, en rapport avec une observance incomplete. Conclusion Les patients schizophrenes infectes par le VIH peuvent avoir une reponse favorable aux traitements antiretroviraux, meme si elle apparait lente, et une bonne observance de ceux-ci, meme complexes, a condition d’une prise en charge soutenue, multidisciplinaire, coordonnee et perseverante.

Resume Introduction La tuberculose peut etre responsable d’atteinte myocardique dont la frequence est vraisemblablement sous-evaluee en raison de la difficulte du diagnostic. Nous avons etudie l’apport de l’imagerie par resonance magnetique (IRM) cardiaque chez trois patients. Observations Trois patients ont ete traites pour une tuberculose disseminee. Ils avaient des anomalies cardiaques moderees (tachycardie, dyspnee d’effort). L’electrocardiogramme etait normal chez 2 patients, l’echographie cardiaque montrait une hypokinesie localisee. L’IRM cardiaque trouvait des prises de contraste nodulaires intramyocardiques et une hypokinesie en cine-IRM. Le traitement antituberculeux a entraine une evolution clinique favorable chez les 3 patients, dont un a recu egalement une corticotherapie. Discussion L’IRM cardiaque est un examen non invasif. Il a permis d’apporter des arguments importants pour le diagnostic de myocardite tuberculeuse dans les 3 cas.

Immune reconstitution inflammatory syndrome (IRIS) occurred in 16 of 37 antiretroviral-naive patients who were treated subsequently for tuberculosis and human immunodeficiency virus (HIV) type 1 infection. IRIS was related to increases in the CD4 cell percentage and in the ratio of CD4 cells to CD8 cells after 1 month of antiretroviral therapy and to dissemination of tuberculosis. These results have implications for the diagnosis of IRIS and the understanding of its pathogenesis.

We report a case of endocarditis due to the rod-shaped Neisseria species Neisseria bacilliformis . The phenotypic characterization of this recently characterized bacteria is difficult, and the identification requires the sequencing of the 16S rRNA gene. The resolution of the disease was complete after appropriate antibiotic therapy, and surgery was not required.

Q fever may lead to serious complications in chronically infected patients. We report two cases of psoas abscess due to Coxiella burnetii associated with lumbar osteomyelitis secondary to an aortic aneurysmal infection. Diagnosis was based on serology, and PCR detected C. burnetii DNA in an abscess sample.

Four HIV-1-infected patients presented with unusual clinical manifestations in the course of disseminated histoplasmosis, including liver abscesses, compressive lymphadenitis, intestinal obstruction, uveitis and arthritis within a median of 45 days after initiation of highly active antiretroviral therapy (HAART). They had a median increase of 106 CD4 cells/mul and granulomas with caseation in three. Partial immune reconstitution induced by HAART during disseminated histoplasmosis either related to the variety capsulatum or duboisii may be associated with immune reconstitution inflammatory syndrome.

The immune reconstitution inflammatory syndrome (IRIS), occurring in chronically HIV-infected patients, is a set of heterogeneous pathological manifestations attributed to an excessive and deregulated immune response to various pathogens and non infectious stimuli shortly after initiation of antiretroviral therapy. Mycobacteria and fungi are the main causes of IRIS, but many other pathogens and autoimmune/inflammatory disorders have also been incriminated Diagnosis is difficult and the optimal therapeutic strategy remains to be determined. Steroids have been recommended for tuberculosis-associated IRIS. Outcome is generally favorable, with the exception of central nervous system involvement.

The immune reconstitution inflammatory syndrome is a heterogeneous collection of pathological manifestations attributed to an excessive and deregulated immune response to various infectious and non-infectious pathogens consecutive to the modification of immune status. Mycobacteria and mycoses in the context of an HIV infection are the main causes of IRIS but this syndrome is also observed with many infectious pathogens in the context of auto-immune or inflammatory diseases. An excessive specific CD4 Th1 response leading to delayed hypersensitivity with imbalanced effector and regulatory cellular immune responses is suggested. The role played by host polymorphisms remains to be investigated. The emergence of a unique syndrome gathering multiple immune-depression/reconstitution such as HIV infection and antiretroviral therapy, decrease of immune depression in transplant, recovery from neutropenia after chemotherapy for cancer, and even post-partum period, could link various specialties and help to better understand physiopathology which is crucial to elaborate preventive therapies.

The immune reconstitution inflammatory syndrome (IRIS), occurring in chronically HIV-infected patients, is a set of heterogeneous pathological manifestations attributed to an excessive and deregulated immune response to various pathogens and non infectious stimuli shortly after initiation of antiretroviral therapy. Mycobacteria and fungi are the main causes of IRIS, but many other pathogens and autoimmune/inflammatory disorders have also been incriminated Diagnosis is difficult and the optimal therapeutic strategy remains to be determined. Steroids have been recommended for tuberculosis-associated IRIS. Outcome is generally favorable, with the exception of central nervous system involvement.

Large intra-individual variability in plasma levels may limit the interest of therapeutic drug monitoring based on a single determination. Indinavir concentrations were determined both in plasma and hair samples, and correlated with concomitant plasma HIV-RNA in 43 HIV-infected patients. In multivariate analysis, significant association was found between HIV-RNA below 50 copies/ml and indinavir concentrations in hair but not in plasma, suggesting that hair concentrations gave more extensive information on drug exposure than a single plasma sample.

Background Environmentally driven immune activation was suggested to contribute to high rates of HIV-1 infection in Africa. We report here a study of immune activation markers and susceptibility to HIV-1 infection in vitro of forty-five highly exposed uninfected partners (EUs) of HIV-1 infected individuals in Central African Republic, in comparison with forty-four low-risk blood donors (UCs). Results Analysis of T lymphocyte subsets and activation markers in whole blood showed that the absolute values and the percentage of HLA-DR+CD4 T cells and of CCR5+CD4 T cells were lower in the EUs than in the UCs (p = 0.0001). Mutations in the CCR5 coding region were not found in either group. Susceptibility to in vitro infection of unstimulated peripheral blood mononuclear cells, prior of PHA activation, was decreased in EUs compared to UCs, either using a CXCR4-tropic or a CCR5-tropic HIV-1 strain (p = 0.02 and p = 0.05, respectively). Levels of MIP-1β, but not of MIP-1α or RANTES, in the supernatants of PHA-activated PBMC, were higher in the EUs than in the UCs (p = 0.007). Conclusion We found low levels of CD4 T cell activation and reduced PBMC susceptibility to HIV-1 infection in Central African EUs, indicating that both may contribute to the resistance to HIV-1 infection.

Schizophrenia might appear to be an obstacle to the initiation of and especially compliance with antiretroviral therapy for HIV-infected patients. The aims of this study were to describe the clinical, immunologic and virologic course after initiation of antiretroviral therapy in 7 HIV patients with schizophrenia (according to DSM-IV-R criteria), and to analyse the possibilities of an adequate antiretroviral therapy for those patients.Multidisciplinary management by specialists in infectious diseases, addiction-related disorders, treatment adherence and compliance, and psychiatrists, as well as social workers, home care agencies, and patient advocacy and assistance groups, was organized with coordinated medical-psychiatric follow-up at least once a month. The patients, 6 men and 1 woman, were aged from 26 to 48 years; schizophrenia had been diagnosed in 5 patients 6 months to 20 years before the HIV infection was discovered; diagnoses of both diseases were essentially simultaneous for the other 2. All patients took long-term neuroleptics for their schizophrenia. Two were active drug addicts who received drug substitution treatment. Before antiretroviral treatment began, 6 patients had advanced infection: stage C with peak CD4 cell counts ranging from 6 to 70/mm3; they began treatment with protease inhibitors between May 1996 and August 1997. The seventh patient was first seen during primary HIV infection in July 1998, and treatment began then. Response to antiretroviral treatment with protease inhibitors was slow for all patients, but viral load became undetectable for 6 of the 7, after 5 months to 4 years; 3 had opportunistic infections. Follow-up ended in January 2002: 5 patients still had undetectable viral loads,, with CD4 cell counts ranging from 45 to 1 000/mm3. One patient died from mixed terminal cirrhosis (alcohol abuse and hepatitis C); the viral load in another was only partially controlled (10 000 copies/ml), because of poor treatment adherence.Individuals with schizophrenia can respond well to antiretroviral treatment, although response may appear slow; they can adhere to complex treatment regimens as long as they receive well coordinated and sustained multidisciplinary support.

Tuberculosis can be responsible for myocardial damage, the frequency of which is probably underestimated because of the difficulty in its diagnosis. We studied the contribution of cardiac magnetic resonance imaging (MRI) in three patients.Three patients were treated for disseminated tuberculosis. They had moderate cardiac abnormalities (tachycardia, dyspnoea on effort). The electrocardiogram was normal in 2 patients and the echocardiography showed localized hyperkinesias. Cardiac MRI revealed intra-myocardial nodular gadolinium enhancement and hyperkinesias. The clinical outcome in the 3 patients was favourable following anti-tuberculosis therapy; one patient was also administered corticosteroids.Cardiac MRI is a non-invasive examination that brought important arguments for the diagnosis of tubercular myocarditis in the 3 patients.

Diffuse infiltrative lymphocytosis syndrome (DILS) in patients with human immunodeficiency virus (HIV) infection is characterized by persistent CD8+ lymphocytosis with visceral lymphocytic infiltration. DILS induces a large spectrum of clinical features. We describe 2 HIV-infected patients with upper respiratory tract involvement that occurred during the course of DILS. (authors)

Tenofovir disopril fumarate, a new nucleotide analogue against human immunodeficiency virus-1 (HIV-1), can induce hypophosphataemia, the mechanism of which is unclear. Moreover, a renal tubulopathy can occur in long-term treated patients, as observed in 2 HIV-1-infected patients after 12 months of tenofovir therapy, with polyuria-polydipsia, proteinuria, glycosuria and amino-aciduria, which resolved after discontinuation of tenofovir. The risk of renal tubulopathy symptoms in patients on long-term tenofovir therapy should be noted.

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

We studied the clinical resistance to acyclovir of infections with varicella-zoster viruses (VZV) in patients with acquired immunodeficiency syndrome, and we correlated it to virologic analyses. Eleven patients with VZV infections (treated with acyclovir, 30 mg/kg/day, given intravenously, or 4 g/day, given orally) were included in the study because of the failure of 10 days of acyclovir therapy. Susceptibility of VZV isolates to acyclovir was tested using a plaque reduction assay to determine the 50% inhibitory concentration (IC(50)) of acyclovir and the SI(50) (IC(50) of the patient isolate/IC(50) of the reference strain) to acyclovir. The thymidine kinase (TK) gene, which supports the resistance, was sequenced on amplified products. Only 3 patients had a significant increase in the IC(50), as compared with the IC(50) of the reference strain (SI(50) of > or =4), and a mutation in the TK gene. For the other 8 patients, the clinical resistance was not confirmed by the virologic results: the SI(50) was < 4, and no mutation was detected in the TK gene. Because no acyclovir-resistant strain appeared during a shorter period of time, we suggest an increase in the duration of the treatment to 21 days before acyclovir resistance is suspected.

We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.

Introduction et objectifs Evaluer le traitement des IRIS des pts co-infectes VIH/TB. Materiels et methodes Etude retrospective des IRIS-TB diagnostiques dans des hopitaux de la region parisienne depuis 1996. Resultats Les traitements de 49 premiers episodes ( n = 34) ou rechutes d’IRIS ( n = 15) chez 34 pts (mediane CD4 = 35/mm 3 ) ont ete etudies : pas de traitement specifique ( n = 13), interruption de ART ( n = 17) parfois associee a une corticotherapie (CT) ( n = 5), CT ( n = 17), AINS ( n = 2). L’evolution finale a ete favorable pour 33/34 pts (mediane 8,5 jours, 1-60), quel que soit le traitement initial ou les traitements successifs, sauf une rupture de rate necessitant splenectomie. L’evolution a ete favorable sans traitement specifique dans 12/13 cas (13 e cas : splenectomie) (mediane 17 jours, 13-60). L’interruption de ART dans 17 cas, associee a CT dans 5 cas, a permis une evolution favorable (mediane 8 jours, 2-25), mais s’est accompagnee d’une rechute lors de la reintroduction de ART dans 5/8 cas (63 %), plus rares si realisee sous CT (1/9). La CT a permis une evolution plus rapide (mediane 2 jours, 1-30), mais des rechutes d’IRIS ont ete observees apres arret ou decroissance de CT dans 7/22 cas (32 %). Parmi les 25 pts avec un ARN-VIH n = 16, CD4 = +146/mm 3 ) vs sans CT ( n = 9 ; CD4 = +236/mm 3 ) ( p = 0,10) independamment des eventuels arrets de ART. Conclusion L’evolution des IRIS-TB est souvent favorable sans traitement specifique. L’interruption des ART doit etre evitee en raison des frequentes rechutes lors de la re-introduction d’ART. Bien que la CT soit rapidement efficace, les rechutes d’IRIS ne sont pas rares et l’impact sur la reconstitution immune merite d’etre plus precisement etudie.

Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal. During 2019–2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d’Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). Methods ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users.Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing.Coupons survey WP: an anonymous telephone survey of HIVST users.Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST.Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. Discussion ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO’s Ethical Research Committee. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10212-1.