Dominique Salmon

Hôpital Cochin (Hôpitaux Universitaires Paris Centre), Lutetia Parisorum, Île-de-France, France

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Publications (262)1104.26 Total impact

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    ABSTRACT: Objectives: The objective of this study was to address the dynamics of archived resistant quasispecies in cell-associated HIV-1 DNA over time in heavily ART-experienced patients with currently suppressed plasma HIV-1 RNA. Methods: Longitudinal ultra-deep sequencing (UDS) analysis of reverse transcriptase, protease and V3 Env regions was performed on blood-cell-associated HIV-1 DNA samples. Drug-resistance-associated mutations (DRAMs) and tropism were interpreted using the ANRS and Geno2Pheno algorithms. We analysed frozen blood cells from patients enrolled in the INNOVE and ANRS 123 ETOILE studies who achieved sustained viral suppression after salvage optimized ART (SOT). Results: Samples were available at baseline and 6 and ≥12 months after SOT initiation in 10 patients. V3 loop sequences displayed wide intra-individual dynamics over time. Viral variants harbouring DRAMs exhibited three non-exclusive scenarios. First, when SOT exerted the same selective pressure as previous failing regimens, some viral quasispecies still harboured the same DRAMs at the same level as at the time of virological failure. Thus, as DRAMs were mostly associated with the same viral variant, variants with a complete resistance pattern remained archived. Second, some viral variants harbouring DRAMs were no longer detected over time when SOT consisted of new antiretroviral classes or had resistance profiles distinct from those of previous failing regimens. Third, variants with new DRAMs associated with SOT emerged in blood cells during follow-up despite sustained virological control. Conclusions: Using longitudinal UDS analysis and focusing on DRAMs and tropism as markers, we demonstrated that, despite sustained virological control, archived HIV-1 DNA quasispecies continued to evolve.
    No preview · Article · Dec 2015 · Journal of Antimicrobial Chemotherapy
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    ABSTRACT: Objectives: Paradoxical tuberculosis (TB) worsening, an example of the immune reconstitution inflammatory syndrome (IRIS), is an increasing phenomenon now described in several settings, including anti-tumor necrosis factor (TNF) discontinuation during biotherapy-induced TB. To better recognize it, we analyzed the frequency and factors associated with anti-TNF-induced TB-IRIS. Methods: Case-control study on anti-TNF-associated TB patients. IRIS cases, defined with the following consensus criteria, were matched to two controls (anti-TNF-associated TB without IRIS). IRIS frequency was based on the French RATIO registry. Conditional logistic-regression identified IRIS risk factors. Results: Fourteen patients developed anti-TNF-associated TB-IRIS within medians of 45 [IQR 22-131] days after starting anti-TB therapy and 110 [IQR 63-164] days after the last anti-TNF infusion. Each case was matched to two controls by year of TB diagnosis. IRIS-associated factors were (odds ratio [95% CI]): disseminated TB (11.4 [1.4-92.2], P=0.03), history of Mycobacterium tuberculosis exposure (12.7 [1.6-103.0], P=0.02) and steroid use at the time of TB diagnosis (4.6 [1.2-17.2], P=0.02). The RATIO registry IRIS frequency was 7%. Conclusion: After stopping biotherapy, paradoxical anti-TNF-associated TB worsening occurred most often in patients with disseminated TB. Although diagnosis remains difficult, physicians must be aware of IRIS because prolonged anti-TB treatment is not needed but, paradoxically, immunosuppressant reintroduction may be.
    No preview · Article · Dec 2015 · Joint, bone, spine: revue du rhumatisme
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    ABSTRACT: Hepatitis C virus (HCV) causes persistent infection in 75% of cases and is a major public health problem worldwide. More than 92% of intravenous drug users (IDU) infected by human immunodeficiency virus type 1 (HIV-1) are seropositive for HCV, and it is conceivable that some HIV-1-infected IDU who remain uninfected by HCV may be genetically resistant.Here we conducted a case-control study to identify mutations in HCV entry coreceptors in HIV-infected IDU who remained uninfected by HCV. We recruited 138 patients, comprising 22 HIV+ HCV- case IDU and 116 HIV+ HCV+ control IDU. We focused on coreceptors in which point mutations are known to abolish HCV infectivity in vitro. Our previous study of the Claudin-1 gene revealed no specific variants in the same case population. Here we performed direct genomic sequencing of the Claudin-6, Claudin-9, Occludin and Scavenger receptor-B1 (SCARB1) gene coding regions. Most HIV+ HCV- IDU had no mutations in HCV coreceptors. However, two HIV+ HCV- patients harbored a total of four specific mutations/variants of HCV entry factors that were not found in the HIV+ HCV+ controls. One case patient harbored heterozygous variants of both Claudin-6 and Occludin, and the other case patient harbored two heterozygous variants of SCARB1. This suggests that HCV resistance might involve complex genetic events and factors other than coreceptors, a situation similar to that reported for HIV-1 resistance.
    Full-text · Article · Nov 2015 · PLoS ONE
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    ABSTRACT: Background: As first generation HCV-specific protease inhibitors, boceprevir (BOC) or telaprevir (TVR) can achieve 60% to 70% sustained virological response (SVR) for HCV infected patients with genotype 1 infections, they could remain temporary a therapeutic option in patients living in resources limited countries with limited access to the new anti-HCV direct acting antiviral (DAA) drugs, such as sofosbuvir. Objectives and study design: Here we evaluated in a routine practice setting, the treatment responses, tolerance and factors associated with SVR of a triple therapy with BOC or TVR, combined with pegylated interferon and ribavirin (PegIFN/RBV) in HIV/HCV co-infected patients, included in a large cohort of HIV/HCV coinfected patients (ANRS CO13-HEPAVIH). Results: Among the 89 HIV/HCV coinfected patients treated, 65% of whom were previous non-responders to PegIFN/RBV therapy, 65%, 55% and 41% had at baseline genotype 1a, a high baseline HCV-RNA (≥800,000IU/ml) and a cirrhosis, respectively. The SVR12 rate was 63% overall, 53% for BOC-based regimen and 66% for TVR-based regimen. In multivariate analysis, two factors were significantly associated with HCV SVR: HCV viral load <800,000IU/mL at treatment initiation versus ≥800,000IU/mL (OR 4.403, 95% CI 1.29-15.04; p=0.018) and virological response at W4 (HCV-RNA undetectable after 4 weeks of triple therapy) (OR 3.35, 95% CI 1.07-10.48; p=0.038). Conclusions: Overall SVR12 was 63% and our results suggest that HIV/HCV coinfected patients with low HCV viral load (<800,000IU/mL) and undetectable HCV-RNA after 4 weeks of triple therapy with TVR or BOC-based regimen have a higher probability of treatment success.
    No preview · Article · Nov 2015 · Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology
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    ABSTRACT: Objective: We assessed the impact of a sustained virological response (SVR) on liver stiffness among HIV/hepatitis C virus (HCV)-coinfected patients enrolled in the ANRS CO13 HEPAVIH cohort. Methods: We studied HIV/HCV-coinfected patients who received at least one dose of any anti-HCV treatment and who had documented SVR status, a pretreatment FibroScan value of at least 7.1kPa, and at least one posttreatment FibroScan value. The time required to achieve at least a 30% decrease in liver stiffness was analyzed by constructing Kaplan-Meier curves and using Cox proportional hazards models. Results: Among 98 patients treated for HCV infection with either pegylated interferon along with ribavirin (n=89) or protease inhibitor-based triple therapy (n=9), 53 patients (54%) had an SVR. Median follow-up was 44.6 (interquartile range: 28.8-58.9) months. The probability of achieving a 30% decrease in FibroScan values was 51% [95% confidence interval (CI): 39-66] in patients with an SVR and 21% in nonresponders (95% CI: 11-36) at 1 year, and 74% (61-86) and 28% (17-44) at 2 years, respectively. In the subgroup of 35 cirrhotic patients (pretreatment liver stiffness 12.5kPa), 14 of 18 patients with an SVR and three of 17 nonresponders had a fibrosis score below 12.5kPa at the last follow-up examination. Multivariable analysis showed that SVR was independently associated with a 30% reduction in liver stiffness, both in the overall study group (hazard ratio: 5.77; 95% CI: 2.00-16.62; P=0.0012) and in cirrhotic patients (hazard ratio: 8.21; 95% CI: 2.15-31.34; P=0.0021). Robustness analyses using FIB4 values showed similar results. Conclusion: SVR is significantly associated with improvement in liver stiffness in HIV/HCV-coinfected patients, including those with cirrhosis. Copyright
    No preview · Article · Sep 2015 · AIDS
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    ABSTRACT: Surgical resection of a malignant bone tumor (BT) or soft tissue tumor (STT), with or without prosthetic replacement, carries a high risk of developing postoperative infections. There is limited knowledge on the bacteriological spectrum of these postsurgical infections that necessitate empirical antibiotic therapy. The aim of this study was to analyze the incidence and microbiological features of site infections following BT or STT resection. In this retrospective mono-center study, we analyzed the surgical and bacteriological data of all consecutive patients who developed an infection after surgical resection of a BT or STT between January 2010 and April 2014. Seventy-two consecutive patients who developed an infection on the site of surgical treatment for a BT (n = 42) or SST (n = 30) were included. Polymicrobism was frequently observed, more often associated with STTs (93%) than BTs (71%; P = 0.03). Gram-negative bacteria were more frequently isolated in STTs (55%) than in BTs (26%; P = 0.01) and non-prosthesis-associated infections (54%) than prosthesis-associated infections (29%; P = 0.04), whereas staphylococci were more frequently found in BTs (76%) than in STTs (52%; P = 0.03). Overall, we found gram negatives in 82% of early acute infections, 11% of chronic infections and 7% of late acute infections (P < 0.01). Postoperative infections in patients after surgical resection of BTs or STTs were often polymicrobial, especially following STTs. Causative bacteria were often gram negatives in STTs and non-prosthesis-associated infections, whereas staphylococci were predominant in BTs. Based on these findings, we recommend antibiotic coverage of both gram-positive and -negative bacteria with a combination of broad-spectrum antibiotics in STTs and antistaphylococcal antibiotics as first-line therapy in infections following BT surgery.
    Full-text · Article · Sep 2015
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    ABSTRACT: Evidence over the past decades have shown that HIV/HCV coinfected patients did not respond as well to HCV therapy as HCV mono-infected patients. However, these paradigms are being recently reassessed with the improvements of care for HIV and HCV patients. This article reviews these original paradigms and how the new data is impacting upon them. Treatment efficacy now appears comparable for HIV/HCV coinfected and HCV mono-infected patients, while liver fibrosis progression is increasingly similar in optimally managed patients. Additional importance of therapy is directed to drug-drug interactions and the impact of HCV reinfection, as well as the possibility of transmitted drug resistance.
    Full-text · Article · Aug 2015 · Journal of Hepatology
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    ABSTRACT: The prevalence and management of chronic Hepatitis B Virus (HBV) infection differ among European countries. The availability and reimbursement of diagnostics and drugs may also vary, determining distinct treatment outcomes. Herein, we analyze differences in medical facilities in care of chronic HBV infection across Europe. A survey was sent to the members of the ESCMID Study Group for Viral Hepatitis (ESGVH), all experts in chronic HBV infection management. The comprehensive survey asked questions regarding HBsAg prevalence, availability of diagnostics and drugs marketed, as well as distinct clinical practice behaviors in the management of chronic HBV infection. World Bank data was used to assess the economic status of respective countries. With 16 expert physicians responding (69%), HBsAg prevalence was <1% in France, Hungary, Italy, the Netherlands, Portugal, Spain, and United Kingdom. It was intermediate (1-5%) in Turkey, Romania, and Serbia, and high (>5%) in Albania, and Iran. Considering availability and reimbursement of HBV diagnostics (HBV-DNA, liver stiffness measurement), HBV drugs (interferon, lamivudine, tenofovir and entecavir), HBV prophylaxis and duration of HBeAg(+) and HBeAg (-) HBV infection, the majority of high and middle-income countries had no restrictions; Albania, Iran, and Serbia had several restrictions in diagnostics and HBV drugs. The countries in high-income group were also the ones with no restrictions to medical facilities while the upper-middle income countries had some restrictions. The prevalence of chronic HBV infection is much higher in Southern-Eastern than in Western European countries. Despite availability of European guidelines, policies for diagnostics and treatment vary significantly across European countries. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Jul 2015 · Clinical Microbiology and Infection
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    ABSTRACT: The current study aimed at describing the distribution and characteristics of malignancy related deaths in human immunodeficiency virus (HIV) infected patients in 2010 and at comparing them to those obtained in 2000 and 2005. Data were obtained from three national surveys conducted in France in 2010, 2005 and 2000. The underlying cause of death was documented using a standardized questionnaire fulfilled in French hospital wards involved in the management of HIV infection. Among the 728 deaths reported in 2010, 262 were cancer-related (36%). After a significant increase from 28% in 2000 to 33% in 2005 and 36% in 2010, cancers represent the leading cause of mortality in HIV infected patients. The proportion of deaths attributed to non-AIDS/non-hepatitis-related cancers significantly increased from 2000 to 2010 (11% of the deaths in 2000, 17% in 2005 and 22% in 2010, p<0.001), while those attributed to AIDS-defining cancers decreased during the same period (16% in 2000, 13% in 2005 and 9% in 2010, p = 0.024). Particularly, the proportion of respiratory cancers significantly increased from 5% in 2000 to 6% in 2005 and 11% in 2010 (p = 0.004). Lung cancer was the most common cancer-related cause of death in 2010 (instead of non-Hodgkin lymphoma so far) and represented the leading cause of death in people living with HIV overall. Cancer prevention (especially smoking cessation), screening strategies and therapeutic management need to be optimized in HIV-infected patients in order to reduce mortality, particularly in the field of respiratory cancers.
    Full-text · Article · Jun 2015 · PLoS ONE

  • No preview · Article · Jun 2015 · La Revue de Médecine Interne
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    ABSTRACT: Although the decline in cancer mortality rates with the advent of combination antiretroviral therapy (cART) in HIV-infected individuals can be mostly explained by a decrease in cancers incidence, we looked here if improved survival after cancer diagnosis could also contribute to this decline. Survival trends were analyzed for most frequent cancers in the HIV-infected population followed in the French Hospital Database on HIV: 979 and 2760 cases of visceral and non-visceral Kaposi's sarcoma (KS), 2339 and 461 cases of non-Hodgkin lymphoma (NHL) and Hodgkin's lymphoma (HL), 446 lung, 312 liver and 257 anal cancers. Five-year Kaplan-Meier survival rates were estimated for four periods: 1992-1996, 1997-2000, 2001-2004 and 2005-2009. Cox proportional hazard models were used to compare survival across the periods, after adjustment for confounding factors. For 2001-2004, survival was compared to the general population after standardization on age and sex. Between the pre-cART (1992-1996) and early-cART (1997-2000) periods, survival improved after KS, NHL, HL and anal cancer and remained stable after lung and liver cancers. During the cART era, 5-year survival improved after visceral and non-visceral KS, NHL, HL and liver cancer, being 83%, 92%, 65%, 87% and 19% in 2005-2009 respectively, and remained stable after lung and anal cancers, being 16% and 65% respectively. Compared with the general population, survival in HIV-infected individuals in 2001-2004 was poorer for hematological malignancies and similar for solid tumors. For hematological malignancies, survival continues to improve after 2004, suggesting that the gap between the HIV-infected and general populations will close in the future. This article is protected by copyright. All rights reserved. © 2015 UICC.
    No preview · Article · May 2015 · International Journal of Cancer
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    ABSTRACT: Acute hepatitis C virus (AHCV) infections are frequently seen worldwide in certain risk groups with an annual incidence rate varying between 0.08% and 66%. Although this incidence is substantial, a delayed diagnosis during chronic infection is most often made in the absence of clinical symptoms in the acute phase of the infection. Current used methods to diagnose AHCV are IgG antibody seroconversion and repeated HCV RNA measurements though no definite diagnostic test is currently available. Progress in the field of adaptive and innate immune responses has aided to both advancements in the field of HCV vaccine development and a more basic understanding of viral persistence. The rapid changes in the treatment of chronic HCV will affect therapeutic regimens in AHCV in the coming years leading to shorter treatment courses and pegylated interferon-free modalities. This review gives an overview of the current knowledge and uncertainties together with some future perspectives on acute HCV epidemiology, virology, immunology and treatment. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Apr 2015 · Clinical Microbiology and Infection
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    ABSTRACT: Clindamycin, a lincosamide antibiotic with a good penetration into bone, is widely used for treating bone and joint infections by Gram-positive pathogens. To be active against Staphylococcus spp, its concentration at the infection site, C, must be higher than 2× the minimal inhibitory concentration (MIC). The aims of the work were to study the determinants of plasma clindamycin trough concentration, C min, especially the effect of co-treatment with rifampicin, and the consequences on clinical outcome. An observational study was performed, involving patients hospitalized for a bone and joint infection who received clindamycin as part of their antibiotic treatment. Target C min was 1.7 mg/L, to reach the desired bone concentration/MIC >2, assuming a 30 % diffusion into bone and MIC = 2.5 mg/L. Sixty one patients (mean age: 56.8 years, 57.4 % male) were included between 2007 and 2011. 72.1 % underwent a surgery on a foreign material, and 91.1 % were infected by at least a Gram-positive micro-organism. Median C min value was 1.39 mg/L, with 58 % of the values below the threshold value of 1.7 mg/L. Median C min was significantly lower for patients taking rifampicin (0.46 vs 1.52 mg/L, p = 0.034). No patient with rifampicin co-administration reached the target concentration (maximal C min: 0.85 mg/L). After a median follow-up of 17 months (1.5-38 months), 4 patients relapsed, 2 died and 47 (88.7 % of the patients with known outcome) were cured, independently of association with rifampicin. This study shows the high inter-variability of plasma clindamycin concentration and confirms that co-treatment with rifampicin significantly decreases clindamycin trough concentrations.
    No preview · Article · Apr 2015 · Infection

  • No preview · Article · Apr 2015 · Journal of Hepatology
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    ABSTRACT: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice.
    Full-text · Article · Mar 2015 · PLoS Medicine
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    ABSTRACT: Background & AimsThe efficacy and safety of triple therapy combining boceprevir (BOC) or telaprevir (TVR) with pegylated interferon-alfa and ribavirin (PegIFN/RBV) has rarely been investigated in HIV/HCV genotype 1-coinfected patients with cirrhosis.Methods We conducted a European (France, Italy, Germany, Netherlands) multicenter study of triple therapy in cirrhotic HIV/HCV GT1-coinfected patients.ResultsFifty-nine patients (47 TVR, 12 BOC) were studied. Median CD4 cell count was 457 [293-578] /mm3, and HIV viral load was <50 copies/ml in 93% of patients. The HCV genotype was GT1a (78%) or GT1b (13%). Previous PegIFN/RBV therapy had resulted in non-response (73%) or relapse (12%), and 15% of patients were treatment-naïve. The sustained virological response rate at week 12 (SVR12) was 53% overall (57% with TVR, 36% with BOC). A baseline HCV-RNA level <800 000 IU/ml tended to be associated with SVR12 (65% vs 42%, P=0.11). In multivariate analysis, a virological response at week 4 after BOC or TVR initiation was significantly associated with SVR12 (P=0.040). Early discontinuation of triple therapy was frequent (n=26, 44%), because of non-response/breakthrough (65%) or adverse events (AEs) (35%). Three patients died. Severe anemia (<9 g/dl) occurred in 14 patients (25%), leading to ribavirin dose reduction (22%), EPO use (56%) or blood transfusion (14%). In multivariate analysis, lack of ribavirin dose reduction was significantly associated with severe AEs (P=0.006).Conclusions More than half of HIV/HCV GT1-coinfected patients with cirrhosis achieved a SVR12. To avoid unnecessary adverse effects, therapy should be discontinued if no response is obtained at week 4.This article is protected by copyright. All rights reserved.
    No preview · Article · Feb 2015 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: Objective To compare the management of chronic hepatitis B (CHB) and its evolution over time in currently-followed HIV-positive and HIV-negative patients.Methods709 consecutive patients with past or present positive HBs antigenemia seen in October 2012 in 19 French participating centers were included. The data were retrospectively collected from the first visit onwards through standardized questionnaires.ResultsCHB was less often assessed in the 299 HIV-positive patients, who were older, more likely to be male, excessive alcohol drinkers and HBe antigen-, HCV- and HDV-positive. They were also followed for a longer time (11.3+/-8.8 vs. 8.6+/-6.9 years, p<10-3) and were more frequently treated for HBV (95.3% vs. 56.8%, p<10-3). HBV was undetectable at the last visit in 80.8% of HIV-positive vs. 55.1% of HIV-negative patients (p<10-3).In multivariate analyses, undetectable HBV was significantly associated with older age, lower baseline HBV DNA, longer HBV therapy and no previous lamivudine monotherapy, but not with HIV.Cirrhosis was associated with age, male gender, Asian origin, alcoholism, HCV, HDV but not with HIV infection. Hepatocellular carcinoma, less frequently observed in HIV-positive patients (0.7% vs 4.7%, p=0.002), was positively associated with age, male gender, cirrhosis, and negatively associated with HIV infection (OR 0.15, 95%CI 0.03-0.67, p=0.01).Conclusions Though the assessment of CHB still has to be improved in HIV-positive patients, the negative impact of HIV on the virological, histological and clinical evolution of CHB seems to be disappearing, probably because of the immunovirological impact of HAART and the more frequent and longer use of HBV therapy.This article is protected by copyright. All rights reserved.
    Full-text · Article · Jan 2015 · Liver international: official journal of the International Association for the Study of the Liver
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    ABSTRACT: A majority of HIV-1-infected patients present a severe deficit in vitamin D, which predicts short-term mortality. Vitamin D is a naturally synthesized hormone, with important immunomodulatory functions. In the general population, its deficit has been associated with increased markers of inflammation. Vitamin D deficit may therefore play a role in the establishment of elevated systemic immune activation, which persists despite suppressive antiretroviral therapy (ART) in HIV-infected patients, and is predictive of disease progression; and vitamin D supplementation may be beneficial in this context. We performed both a cross-sectional study (vitamin D deficit versus normal level) and a longitudinal study (upon vitamin D supplementation for 6 to 12 months) of HIV-1-infected patients receiving suppressive ART. The primary outcome measure was the percentage of activated memory CD8 T cells in blood, which is a robust marker associated with disease progression. Secondary outcomes included general T-lymphocyte and B-lymphocyte phenotype. Although vitamin D deficiency had no influence on T-cell and B-cell subset distribution, we found an association between vitamin D and immune activation levels in HIV-1-infected patients. Vitamin D supplementation in vitamin D-deficient patients resulted in reduced immune activation levels. The present data support the rationale of vitamin D supplementation in the routine clinical management of HIV-1-infected patients, in order to decrease immune activation levels and possibly improve long-term survival.
    No preview · Article · Nov 2014 · AIDS (London, England)
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    A Lesueur · D Salmon · P Blanche · N Dupin · D Sicard

    Full-text · Dataset · Oct 2014

  • No preview · Article · Aug 2014

Publication Stats

5k Citations
1,104.26 Total Impact Points

Institutions

  • 2004-2015
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      • Service de Médecine Interne
      Lutetia Parisorum, Île-de-France, France
    • University of Florida
      Gainesville, Florida, United States
  • 1998-2015
    • Université René Descartes - Paris 5
      • • Faculté de Médecine
      • • Faculty of medicine
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
    • Université de Reims Champagne-Ardenne
      Rheims, Champagne-Ardenne, France
  • 2003-2013
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • University Hospital Estaing of Clermont-Ferrand
      Clermont, Auvergne, France
  • 2008
    • Groupe Hospitalier Saint Vincent
      Strasburg, Alsace, France
    • Sikkim Manipal Institute of Technology
      Rungpo, Sikkim, India
  • 2007
    • Bordeaux School of Public Health
      Burdeos, Aquitaine, France
  • 2006
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 1986-1999
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1990-1991
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service des Maladies Infectieuses et Tropicales
      Lutetia Parisorum, Île-de-France, France