Publications (3)11.12 Total impact

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    ABSTRACT: Background: Recent trials have shown the potential benefits of ritonavir-boosted protease inhibitor (PI/r) monotherapy. As this alternative strategy has recently been included in European HIV treatment guidelines, its effectiveness needs to be assessed in routine practice. Methods: From 1st January to 31 December 2011, we identified all patients receiving a current PI/r monotherapy at a university-based hospital setting using the Diamm database system. Antiretroviral-naïve patients who directly initiated PI/r monotherapy were excluded. Patients who continued PI/r monotherapy after ending participation in a clinical trial were also included. We performed a retrospective, descriptive analysis of demographic, clinical and therapeutic characteristics of these patients. For biological variables, the last available value in 2011 was retained. Results: In 2011, among 3140 antiretroviral-treated patients in our department, 107 (3.4%) received PI/r monotherapy (lopinavir/r n = 58, darunavir/r n= 49). Of them, 30 (28%) started during 2011 and 31 (29%) continued after a prior trial. Two patients switched to DRV/r due to intolerance. Eighty-eight percent were male and median age at initiation was 45 years. The median time from starting multitherapy and switching to monotherapy was 30 months (range 2-117). At PI/r monotherapy initiation, median CD4 count was 567 cells/mm(3) and HIV RNA was below 50 copies/mL in 90% of patients. The median duration under PI/r monotherapy was 25.4 months (range 0.5-93). At the end of follow-up, median CD4 count was 643 cells/mm(3) and HIV RNA was below 50 copies/mL in 89% of cases. During 2011, 11 patients discontinued PI/r monotherapy, of whom 8 presented viral rebound. Only one patient exhibited major protease mutations. All these 8 patients achieved an undetectable viral load 3 months after therapeutic intensification. Conclusion: This descriptive analysis shows that PI/r monotherapy in routine practice could be considered as an alternative and successful maintenance strategy, especially among patients who achieved an undetectable viral load while undergoing prior multitherapy.
    Journal of the International AIDS Society 11/2012; 15(6):18255. DOI:10.7448/IAS.15.6.18255 · 4.21 Impact Factor
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    ABSTRACT: To assess the prevalence of chronic hepatitis C virus (HCV) infection with persistently normal alanine aminotransferase (ALT) levels in HIV-1-infected patients, together with its clinical, biological and histological characteristics and predictive factors. We retrospectively studied all HCV/HIV-coinfected patients treated in our Infectious Diseases Department, for whom data on both HIV and HCV infection were available. We compared the demographic characteristics and parameters of HIV and HCV infection between cases, defined by persistently normal ALT levels (<45 IU/L) and detectable serum HCV-RNA (determined by PCR), and controls with high ALT levels and HCV PCR positivity during the previous 3 years. Among the 815 HIV-infected patients assessed for this study, 179 (22%) were HCV-coinfected, of whom 155 were eligible for this analysis. Of these 155 HCV-coinfected patients, 137 (88%) were HCV-PCR-positive, of whom 39 (28.5%) had persistently normal ALT levels (cases) and 98 (71.5%) had high ALT levels (controls). Relative to controls, cases had a significantly lower fibrosis score and a lower fibrosis progression rate (2.2 vs. 1.3, P=0.004; 0.3 vs. 0.2, P=0.006, respectively). Three factors associated with persistently normal ALT levels were identified, namely: HBsAg negativity (P=0.003), HCV genotype 4 (P=0.01) and female sex (P=0.05). Persistently normal ALT levels may be considered as a marker of slow HCV disease progression in HIV-coinfected patients, with significantly less severe hepatic lesions.
    HIV Medicine 09/2004; 5(5):385-90. DOI:10.1111/j.1468-1293.2004.00239.x · 3.45 Impact Factor
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    ABSTRACT: 1. to assess the impact of highly active antiretroviral therapy (HAART) on the occurrence of bacteraemia in HIV-infected patients and their clinical and microbiological characteristics. 2. to identify risk factors for bacteraemia in this setting. The files of all HIV-infected patients hospitalized for an episode of bacteraemia in a 28-bed infectious diseases unit between January 1995 and December 1998 were reviewed. Cases occurring during HAART were compared to cases occurring in patients not receiving HAART. Furthermore, in a case-control study, patients with bacteraemia occurring during HAART were compared with other patients receiving HAART. There were 74 episodes of bacteraemia in patients not receiving HAART and 31 episodes in patients receiving HAART. The occurrence of bacteraemia fell from 10.5/100 hospitalizations in 1995 to 5.5/100 in 1998 (P = 0.02 trend test). The occurence of P. aeruginosa bacteraemia fell sharply (9/398 vs 1/273, P = 0.05). A significant fall in catheter-related infections was observed between 1995 and 1998 (5.5% vs 1.8%). The two-thirds/one-third distribution of hospital-acquired and community-acquired infections remained stable throughout the period study. In patients receiving HAART, the case-control study showed by multivariate analysis, that a CD4 cell count of less than 100/ micro L [OR = 7.3 (1.9-49.7)], and the use of exogenous devices [OR = 13.3 (2.5-71)] were significantly associated with the risk of bacteraemia. The introduction of HAART has been associated with a significant fall in the occurrence of bacteraemia. However, patients with a low CD4 cell count remain at risk of bacteraemia with similar microbiological and epidemiological characteristics than in the pre-HAART era.
    HIV Medicine 05/2003; 4(2):127-32. DOI:10.1046/j.1468-1293.2003.00146.x · 3.45 Impact Factor