J P Viard

Université René Descartes - Paris 5, Lutetia Parisorum, Île-de-France, France

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Publications (94)534.16 Total impact

  • The International Journal of Tuberculosis and Lung Disease 01/2013; 17(1):141-2. · 2.76 Impact Factor
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    ABSTRACT: Mycobacterium genavense, a nontuberculous mycobacterium, led to devastating infections in patients with acquired immunodeficiency syndrome (AIDS) before highly active antiretroviral therapy (HAART) was available, as well as in other immunocompromised patients. We conducted the current study to describe the features of this infection in patients infected with human immunodeficiency virus (HIV) in the HAART era and in non HIV-infected patients.We conducted a retrospective cohort survey in France. All patients with M. genavense infection diagnosed from 1996 to 2007 at the National Reference Center, Institut Pasteur, Paris, were identified and their clinical, laboratory, and microbiologic data were centralized in a single database. Twenty-five cases of M. genavense infection originating from 19 centers were identified. Twenty patients had AIDS, 3 had solid organ transplantation, and 2 had sarcoidosis. Sixty-four percent (n = 16) were male, mean age was 42 years, and median CD4 count was 13/mm (range, 0-148/mm) in patients with AIDS. Twenty-four patients had disseminated infection with fever (75%, n = 18), weight loss (79%, n = 19), abdominal pain (71%, n = 17), diarrhea (62.5%, n = 15), splenomegaly (71%, n = 17), hepatomegaly (62.5%, n = 15), or abdominal adenopathy (62.5%, n = 15). M. genavense was isolated from the lymph node (n = 13), intestinal biopsy (n = 9), blood (n = 6), sputum (n = 3), stool (n = 3), and bone marrow (n = 5). Eleven patients (44%) died, 8 (32%) were considered cured with no residual symptoms, and 6 (24%) had chronic symptoms. The 1-year survival rate was 72%.The prognosis of M. genavense infection in HIV-infected patients has dramatically improved with HAART. Clinical presentations in HIV and non-HIV immunocompromised patients were similar.
    Medicine 06/2011; 90(4):223-30. · 4.35 Impact Factor
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    ABSTRACT: Optimal staging and evaluation of residual lesions of invasive fungal infections (IFIs) are major challenges in the immunocompromised host. Preliminary data have suggested that [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) uptake may be observed in the course of active invasive fungal infections. The aim of this study was to assess the role of positron emission tomography with [¹⁸F]FDG ([¹⁸F]FDG-PET) in the diagnosis and staging of IFI. A prospective monocentric study evaluating [¹⁸F]FDG-PET in 30 consecutive adults and children with European Organization for Research and Treatment of Cancer/Mycoses Study Group probable or proven IFI was performed. Twenty males and ten females (median age, 45 years (range 6-7 years)) were enrolled. Twenty-six were immunocompromised, as follows: haematological malignancy (18) with allogeneic stem cell transplantation (16/18), solid tumour (three), solid organ transplantation (two), diabetes mellitus (two) and cystic fibrosis (one). IFIs were acute invasive aspergillosis (ten), chronic disseminated candidiasis (ten), zygomycosis (two), black grains eumycetoma (two), pulmonary Histoplasma capsulatum var. capsulatum histoplasmosis (two), and Phomopsis sp. osteoarthritis, Scedosporium apiospermum and Candida krusei spondylodiscitis, and acute pulmonary coccidioidomycosis in one case each. An increased uptake of [¹⁸F]FDG was observed in all areas previously identified by computed tomography and/or magnetic resonance imaging to be involved by IFI. In 4/10 chronic disseminated candidiasis cases, [¹⁸F]FDG-PET revealed small splenic abscesses that were unapparent on the corresponding computed tomography scan. [¹⁸F]FDG uptake disappeared after 6 months of antifungal therapy in three patients with chronic disseminated candidiasis for whom the [¹⁸F]FDG-PET was performed to assess the evolution of the disease. [¹⁸F]FDG-PET could potentially be useful for the initial diagnosis and staging of IFI. Whether or not [¹⁸F]FDG-PET might be useful for assessing the optimal duration of IFI therapy should now be assessed in a specific prospective study.
    Clinical Microbiology and Infection 03/2011; 17(3):409-17. · 4.58 Impact Factor
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    Journal of the International AIDS Society 11/2010; 13(Suppl 4). · 3.94 Impact Factor
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    ABSTRACT: Kidney transplantation is now considered as a reasonable option for HIV-infected patients with end-stage renal disease. We describe here a retrospective study conducted in five transplantation centers in Paris. Twenty-seven patients were included. Immunosuppressive protocol associated an induction therapy and a long-term treatment combining mycophenolate mofetil, steroids and either tacrolimus or cyclosporine. All the patients had protocol biopsies at 3 months and 1 year. Patient's survival was 100% at 1 year and 98% at 2 years. Graft survival at 1 and 2 years is 98% and 96% at 1 and 2 years, respectively. The mean glomerular filteration rate values at 12 and 24 months were 60.6 mL/min/1.73 m² (range 23-98) and 65.4 mL/min/1.73 m² (range 24-110), respectively. Acute cellular rejection was diagnosed in four cases (15%). Because of high trough levels of calcineurin inhibitor, protease-inhibitor therapies were withdrawn in 11 cases. HIV disease progression was not observed. One patient developed B-cell lymphoma. In conclusion, our study confirms the safety of renal transplantation in HIV-infected patients with few adverse events and a low incidence of acute rejection.
    American Journal of Transplantation 10/2010; 10(10):2263-9. · 6.19 Impact Factor
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    ABSTRACT: Darunavir (DRV) is the latest protease inhibitor (PI) to be approved for antiretroviral-naive and -experienced HIV-infected patients. We examined virologic and immunologic outcomes of highly antiretroviral-experienced patients with triple-class drug resistance receiving DRV/r-based regimens, and attempted to identify factors predictive of virologic success. We studied patients beginning a ritonavir-boosted DRV (DRV/r 600/100mg twice daily)-containing regimen. Virologic success was defined as plasma viral load (pVL)<50copies/ml at week 36. We studied 62 patients with very severe immunodeficiency (CDC stage C in 69% of cases; median CD4 cell nadir 12/mm(3)). They had previously received a median of four PI and had extensive PI resistance, with a median of three major PI and two DRV resistance mutations. The baseline median pVL and CD4 cell count values were 4.6log(10) and 150/mm(3). At week 36, pVL had fallen by 2.6log(10) and the CD4 cell count had risen by 123cells/mm(3). The virologic success rate was 55% overall, and was improved by concomitant first use of enfuvirtide (67%), raltegravir (69%) or etravirine (75%). Virologic success was independently associated with fewer major PI mutations, previous tipranavir exposure, and concomitant first use of enfuvirtide or raltegravir. In these highly antiretroviral-experienced patients with triple-class drug resistance, virologic success of DRV-containing regimens was mainly associated with the use of new drug classes and/or fully active drugs. Interestingly, previous tipranavir failure did not undermine the efficacy of DRV, confirming the low level of cross-resistance and, probably, distinct resistance profiles between DRV and tipranavir.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 03/2010; 47(3):248-52. · 3.12 Impact Factor
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    ABSTRACT: BACKGROUND: Used in combination with antiretroviral therapy, subcutaneous recombinant interleukin-2 raises CD4+ cell counts more than does antiretroviral therapy alone. The clinical implication of these increases is not known. METHODS: We conducted two trials: the Subcutaneous Recombinant, Human Interleukin-2 in HIV-Infected Patients with Low CD4+ Counts under Active Antiretroviral Therapy (SILCAAT) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). In each, patients infected with the human immunodeficiency virus (HIV) who had CD4+ cell counts of either 50 to 299 per cubic millimeter (SILCAAT) or 300 or more per cubic millimeter (ESPRIT) were randomly assigned to receive interleukin-2 plus antiretroviral therapy or antiretroviral therapy alone. The interleukin-2 regimen consisted of cycles of 5 consecutive days each, administered at 8-week intervals. The SILCAAT study involved six cycles and a dose of 4.5 million IU of interleukin-2 twice daily; ESPRIT involved three cycles and a dose of 7.5 million IU twice daily. Additional cycles were recommended to maintain the CD4+ cell count above predefined target levels. The primary end point of both studies was opportunistic disease or death from any cause. RESULTS: In the SILCAAT study, 1695 patients (849 receiving interleukin-2 plus antiretroviral therapy and 846 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 202 cells per cubic millimeter were enrolled; in ESPRIT, 4111 patients (2071 receiving interleukin-2 plus antiretroviral therapy and 2040 receiving antiretroviral therapy alone) who had a median CD4+ cell count of 457 cells per cubic millimeter were enrolled. Over a median follow-up period of 7 to 8 years, the CD4+ cell count was higher in the interleukin-2 group than in the group receiving antiretroviral therapy alone--by 53 and 159 cells per cubic millimeter, on average, in the SILCAAT study and ESPRIT, respectively. Hazard ratios for opportunistic disease or death from any cause with interleukin-2 plus antiretroviral therapy (vs. antiretroviral therapy alone) were 0.91 (95% confidence interval [CI], 0.70 to 1.18; P=0.47) in the SILCAAT study and 0.94 (95% CI, 0.75 to 1.16; P=0.55) in ESPRIT. The hazard ratios for death from any cause and for grade 4 clinical events were 1.06 (P=0.73) and 1.10 (P=0.35), respectively, in the SILCAAT study and 0.90 (P=0.42) and 1.23 (P=0.003), respectively, in ESPRIT. CONCLUSIONS: Despite a substantial and sustained increase in the CD4+ cell count, as compared with antiretroviral therapy alone, interleukin-2 plus antiretroviral therapy yielded no clinical benefit in either study. (ClinicalTrials.gov numbers, NCT00004978 [ESPRIT] and NCT00013611 [SILCAAT study].)
    New England Journal of Medicine 10/2009; 361:1548-59. · 54.42 Impact Factor
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    Clinical Microbiology and Infection 09/2009; 15 Suppl 2:230-1. · 4.58 Impact Factor
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    ABSTRACT: There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts' opinion and level of agreement were evaluated. The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3-6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was "very good" for eleven, and "good" for the remaining three. Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.
    Vaccine 02/2009; 27(10):1523-9. · 3.49 Impact Factor
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    ABSTRACT: African tick bite fever is caused by Rickettsia africae. The number of reported cases in international travelers has significantly increased recently. The gold standard treatment is doxycycline. Here, we present a case of R africae infection associated with quick complete resolution following the initiation of pristinamycin therapy.
    Journal of Travel Medicine 01/2009; 16(2):136-7. · 1.68 Impact Factor
  • Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2009; 39.
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    ABSTRACT: Microsporidiosis first came to prominence as an opportunistic infection in patients with acquired immunodeficiency syndrome. Microsporidia are now emerging pathogens responsible for severe diarrhea during solid organ transplantation. Two main clinical entities can be identified: infection by Enterocytozoon bieneusi, causing diarrhea with limited treatment options; and infection by Encephalitozoon intestinalis, which may disseminate and usually responds to albendazole treatment. We describe here 2 cases of microsporidiosis caused by E. bieneusi in a renal and a liver transplant recipient, respectively, in whom complete clinical efficacy of a short course of fumagillin therapy was obtained. Long-term microbiological eradication was assessed using classical methods and monitored using a real-time quantitative polymerase chain reaction-based method. Both patients experienced drug-induced thrombocytopenia, which resolved after withdrawal of the treatment. We also review the 18 other previously reported cases of microsporidiosis in transplant recipients. In case of persistent diarrhea in solid organ transplant patients, microsporidiosis should be considered. Based on the present experience, treating E. bieneusi infection with 7 days of fumagillin therapy is adequate to eradicate E. bieneusi in this context.
    Transplant Infectious Disease 10/2008; 11(1):83-8. · 1.98 Impact Factor
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    ABSTRACT: Pasteurella are commensal gram-negative bacteria isolated from the oral cavity of many domesticated animals. Most human infections occur post animal bite or scratch injury resulting in local cutaneous infection; however, case reports suggest that transmission may occur via animal secretions. Pasteurella species can be associated with serious systemic infections particularly in those with underlying disease and in the immunocompromised. We present a case of invasive Pasteurella multocida sinusitis in an immunocompromised renal transplant patient most likely acquired from a pet dog through direct mucosal inoculation via licking.
    Transplant Infectious Disease 07/2008; 10(3):206-8. · 1.98 Impact Factor
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    ABSTRACT: This study investigated the incidence of pancreatitis and its association with antiretroviral therapy (ART), focussing on stavudine and didanosine. EuroSIDA has collected information on pancreatitis since Summer 2001. All identified cases have been verified by the coordinating centre. Individuals were followed from June 2001 or the date of entry into EuroSIDA (whichever occurred later) until a diagnosis of pancreatitis or the last study visit. Factors associated with pancreatitis were investigated using Poisson regression. Cumulative lengths of exposure to didanosine without stavudine, stavudine without didanosine, stavudine with didanosine, and other ART were time-updated variables. Treatment variables were fitted with a 6-month time lag. There were 43 (nine presumptive) pancreatic events in 9678 individuals during 33 742 person-years (incidence 1.27/1000 person-years). The incidence among those with no, 2 or less and over 2 years' exposure to ART including stavudine and didanosine was 1.24, 1.73 and 0.78/1000 person-years, respectively. In multivariable analysis, higher baseline CD4 cell counts were associated with a decreased risk of pancreatitis. There was no evidence of an association of pancreatitis with cumulative exposure to didanosine and stavudine, didanosine without stavudine, stavudine without didanosine, or other ART. We observed a low overall rate of pancreatitis in the years 2001-2006, and did not find an association of an increased incidence of pancreatitis with cumulative exposure to antiretroviral agents generally, and to didanosine and stavudine in particular.
    AIDS (London, England) 02/2008; 22(1):47-56. · 4.91 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/2008; 29.
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    ABSTRACT: Introduction On compte 500 000 patients aspléniques en France ce qui représente une population importante que le médecin généraliste doit savoir prendre en charge. L’asplénie confère à ces patients une susceptibilité aux infections par les germes encapsulés et les agents intra-érythrocytaires. Ces infections sont souvent des septicémies ou méningites d’évolution fulminante et sont appelées OPSI (overwhelming post splenectomy infections). Les recommandations en termes de prévention de ces infections sont codifiées depuis longtemps, mais l’incidence des OPSI reste élevée avec une mortalité importante. Objectif Étudier les pratiques de prévention des infections en médecine hospitalière et libérale pour savoir si elles sont en adéquation avec les recommandations. Patients et méthodes Les dossiers de patients splénectomisés entre 2000 et 2005 ont été analysés, avec un recueil dans les dossiers hospitaliers et par questionnaire téléphonique auprès des médecins traitants. Les données récoltées étaient les caractéristiques démographiques, les vaccinations et antibioprophylaxie administrées, et la survenue éventuelle d’un événement infectieux. Résultats 154 dossiers ont été analysés à l’hôpital et 46 en ville. La couverture vaccinale anti- pneumococcique est bonne avec des résultats de 70,6 % à l’hôpital et 82,3 % en ville. La vaccination contre le méningocoque et l’haemophilus est médiocre avec respectivement 24 % et 44 % de couverture vaccinale à l’hôpital. Concernant l’antibioprophylaxie, les résultats sont similaires à ceux de la littérature, autour de 70 % de prescription. L’incidence des infections graves de 8,4 % est importante et liée à la grande représentation de patients d’hématologie dans notre population. Conclusion Les pratiques de prévention des infections chez les splénectomisés sont partiellement connues des médecins hospitaliers et des médecins traitants, avec notamment des lacunes dans la vaccination contre le méningocoque et l’haemophilus
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2008; 38.
  • Journal of Infection - J INFECTION. 01/2008; 56(4):308-309.
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    ABSTRACT: Coccidioidomycosis is an endemic mycosis in the southwest of United States resulting from the inhalation of arthrospores present in desert soil. The authors present a case of uncomplicated pulmonary coccidioidomycosis in a healthy woman, acquired during a recent trip to California. The initial clinical presentation first suggested a diagnosis of community-acquired pneumonia, then of tuberculosis. The diagnosis was finally reached with blood tests and mycological culture of broncho-alveolar lavage fluid. The final identification of Coccidioides immitis was made by molecular analysis. Clinical resolution of the infection was obtained after three months of posaconazole treatment. Coccidioidomycosis is a major cause of pneumonia. Its diagnosis requires specific investigation such as mycological culture, histology, blood tests and molecular biology helps to identify the species. The progression of the disease as well as the associated immunocellular deficit are strictly correlated with the onset of complications and late relapses despite an adequate initial treatment using antifungal molecules and/or surgery.
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2008; 38(6):336-342.
  • Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2008; 38(6):291-292.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2006; 27.

Publication Stats

2k Citations
534.16 Total Impact Points

Institutions

  • 2008–2011
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
  • 2004
    • University College London
      Londinium, England, United Kingdom
  • 2001
    • University of Copenhagen
      • Department of International Health, Immunology and Microbiology
      Copenhagen, Capital Region, Denmark
  • 1999
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1994–1998
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1988–1998
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Département de Pathologie
      Créteil, Ile-de-France, France