J P Viard

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

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Publications (97)672.27 Total impact

  • F Mechaï · N Veziris · O Aoun · E Bille · M Lecuit · F Brossier · J P Viard · O Lortholary ·

    The International Journal of Tuberculosis and Lung Disease 01/2013; 17(1):141-2. DOI:10.5588/ijtld.12.0778 · 2.32 Impact Factor
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    ABSTRACT: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. To identify the optimal CD4 cell count at which cART should be initiated. Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. HIV clinics in Europe and the Veterans Health Administration system in the United States. 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.
    Annals of internal medicine 04/2011; 154(8):509-15. DOI:10.1059/0003-4819-154-8-201104190-00001 · 17.81 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVES: Bacterial pneumonia still contributes to morbidity/mortality in HIV infection despite effective combination antiretroviral therapy (cART). Evaluation of Subcutaneous Interleukin-2 in a Randomized International Trial (ESPRIT), a trial of intermittent recombinant interleukin-2 (rIL-2) with cART vs. cART alone (control arm) in HIV-infected adults with CD4 counts ≥300cells/μL, offered the opportunity to explore associations between bacterial pneumonia and rIL-2, a cytokine that increases the risk of some bacterial infections. METHODS: Baseline and time-updated factors associated with first-episode pneumonia on study were analysed using multivariate proportional hazards regression models. Information on smoking/pneumococcal vaccination history was not collected. RESULTS: IL-2 cycling was most intense in years 1-2. Over ≈7 years, 93 IL-2 [rate 0.67/100 person-years (PY)] and 86 control (rate 0.63/100 PY) patients experienced a pneumonia event [hazard ratio (HR) 1.06; 95% confidence interval (CI) 0.79, 1.42; P=0.68]. Median CD4 counts prior to pneumonia were 570cells/μL (IL-2 arm) and 463cells/μL (control arm). Baseline risks for bacterial pneumonia included older age, injecting drug use, detectable HIV viral load (VL) and previous recurrent pneumonia; Asian ethnicity was associated with decreased risk. Higher proximal VL (HR for 1 log(10) higher VL 1.28; 95% CI 1.11, 1.47; P<0.001) was associated with increased risk; higher CD4 count prior to the event (HR per 100 cells/μL higher 0.94; 95% CI 0.89, 1.0; P=0.04) decreased risk. Compared with controls, the hazard for a pneumonia event was higher if rIL-2 was received <180 days previously (HR 1.66; 95% CI 1.07, 2.60; P=0.02) vs.≥180 days previously (HR 0.98; 95% CI 0.70, 1.37; P=0.9). Compared with the control group, pneumonia risk in the IL-2 arm decreased over time, with HRs of 1.41, 1.71, 1.16, 0.62 and 0.84 in years 1, 2, 3-4, 5-6 and 7, respectively. CONCLUSIONS: Bacterial pneumonia rates in cART-treated adults with moderate immunodeficiency are high. The mechanism of the association between bacterial pneumonia and recent IL-2 receipt and/or detectable HIV viraemia warrants further exploration.
    HIV Medicine 04/2011; 12(4):219-227. · 3.99 Impact Factor
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    ABSTRACT: Clin Microbiol Infect 2011; 17: 409–417 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 6–75 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. DOI:10.1111/j.1469-0691.2010.03301.x · 5.77 Impact Factor
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    Journal of the International AIDS Society 11/2010; 13(Suppl 4). DOI:10.1186/1758-2652-13-S4-O43 · 5.09 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/1.73m2 (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. DOI:10.1111/j.1600-6143.2010.03258.x · 5.68 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. DOI:10.1016/j.jcv.2009.12.022 · 3.02 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. · 55.87 Impact Factor
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    Clinical Microbiology and Infection 09/2009; 15 Suppl 2(s2):230-1. DOI:10.1111/j.1469-0691.2008.02149.x · 5.77 Impact Factor

  • Médecine et Maladies Infectieuses 06/2009; 39. DOI:10.1016/S0399-077X(09)74403-8 · 1.24 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. DOI:10.1016/j.vaccine.2009.01.003 · 3.62 Impact Factor
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    ABSTRACT: Background: Aspergillus malignant external otitis (MEO) are rare potentially life-threatening invasive fungal infections affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with cranial nerve palsies and can result in irreversible hearing and neurological impairments. Methods: We report the first two cases of Aspergillus MEO treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus invasive external otitis. Results: A total of 22 patients, including the two present reports, were analyzed. One of the patients did not receive antifungal therapy, as the diagnosis was only made post-mortem. Seventeen patients were initially treated with amphotericin B and nine of them received itraconazole as an additional agent. Two patients received initial therapy with itraconazole and the two present patients were treated with voriconazole alone. Fifteen patients underwent an initial extensive surgical debridement. Most of the patients had a favorable outcome, fifteen patients experienced a complete recovery and five exhibited a partial improvement. Two patients died of invasive aspergillosis and four patients with initial improvement died of complications of their underlying conditions . The two present patients had a favorable outcome under long-term oral voriconazole therapy. Conclusions: Although voriconazole has been shown effective for the treatment of invasive aspergillosis, its precise role for the management of MEO had not been documented. These observations demonstrate that voriconazole is now an effective therapeutic option for the management of Aspergillus MEO.
    Infectious Diseases Society of America 2008 Annual Meeting; 10/2008
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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. DOI:10.1111/j.1399-3062.2008.00347.x · 2.06 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. DOI:10.1111/j.1399-3062.2007.00270.x · 2.06 Impact Factor
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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.
    Médecine et Maladies Infectieuses 06/2008; 38(6):336-342. DOI:10.1016/j.medmal.2007.08.004 · 1.24 Impact Factor

  • Médecine et Maladies Infectieuses 06/2008; 38(6):291-292. DOI:10.1016/j.medmal.2007.08.005 · 1.24 Impact Factor

  • La Revue de Médecine Interne 06/2008; 29. DOI:10.1016/j.revmed.2008.03.202 · 1.07 Impact Factor
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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
    Médecine et Maladies Infectieuses 06/2008; 38. DOI:10.1016/S0399-077X(08)73029-4 · 1.24 Impact Factor

  • Journal of Infection 04/2008; 56(4):308-309. DOI:10.1016/j.jinf.2008.01.039 · 4.44 Impact Factor
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    ABSTRACT: Virus-associated hemophagocytic syndrome (VAHS) is a rare complication in early cytomegalovirus (CMV) infection. There is no standard therapy for VAHS and the clinical course is variable. Data on the use of intravenous immunoglobulin (IVIG) in the treatment of CMV-associated VAHS are limited. We report a previously healthy, 32-year-old woman who presented with general malaise, fever, chills, and splenomegaly. Laboratory examination showed marked elevation of aminotransferase, leucopoenia, and thrombocytopenia. Acute CMV-infection was documented by the presence of immunoglobulin M anti-CMV and positive viremia in blood sample. Bone marrow examination revealed extensive hemophagocytosis. IVIG was administered after the diagnosis of CMV-associated VAHS. Her symptoms and laboratory abnormalities improved dramatically after the onset of the treatment and she did not require antiviral agent.
    American Journal of Hematology 02/2008; 83(2):159-62. DOI:10.1002/ajh.21008 · 3.80 Impact Factor

Publication Stats

2k Citations
672.27 Total Impact Points


  • 2008-2010
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
    • Sikkim Manipal Institute of Technology
      Rungpo, Sikkim, India
  • 1995-2010
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • Hôpital Saint Joseph
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1988
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1987
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France