Biomedical subjects
Publications and source records attributed to J B Brunet.
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SETTING: Western Europe: 8 countries and the city of Amsterdam. OBJECTIVE: To identify factors associated with extrapulmonary tuberculosis (EPTB) at AIDS diagnosis among adult AIDS patients. DESIGN: The proportion of AIDS case diagnosed between January 1988 and June 1992 with EPTB was analysed by age, gender, year of diagnosis, country and HIV transmission category. Multiple logistic regression was performed separately for patients infected through heterosexual contact who were likely to originate from Africa or the Caribbean (heterosexual subgroup 1), and for other patients. RESULTS: The overall proportion with EPTB was 4.6% and remained stable between 1988 and 1992. It differed significantly by country (from 2.4% in the United Kingdom to 24.7% in Portugal) and by transmission category (2.7% among homo/bisexuals, 5.8% among injecting drug users, 13.6% among heterosexual subgroup 1). In multivariate analysis, the risk of EPTB was independently associated with younger age and male gender. Among patients other than from heterosexual subgroup 1, country and transmission category were also independent predictors of EPTB at AIDS diagnosis. CONCLUSION: The risk of presenting EPTB as an AIDS-defining disease is not homogeneous within Europe. Results suggest an increased risk of tuberculosis in specific groups of HIV-infected persons (persons originating from sub-Saharan Africa, injecting drug users) and a potential role of recent Mycobacterium tuberculosis infection among younger patients.
Two complementary surveys were carried out in the 89 hospital units of South-Eastern France which deal with pregnant women. Firstly, in November 1991, medical chiefs of these units were interviewed face-to-face about their current HIV screening policy. Secondly, between Jan 27 and March 22, 1992, all women at the end of their pregnancy attending these units were included in an anonymous unlinked seroprevalence survey, irrespective of pregnancy outcome (n = 11,056). The goal of the research was to compare HIV prenatal screening policies and seroprevalences by pregnancy outcomes in order to contribute to the public debate initiated on that issue by the French health authorities. The seroprevalence survey showed a global prevalence rate of 0.43% (CI 95% = 0.32-0.54) with the prevalence among women who had an elective abortion (0.56%) being more than twice that among women who delivered (0.22%). However, routine HIV screening was more frequent toward women coming for regular prenatal care than for women seeking abortion. A systematic procedure for obtaining women's consent for HIV testing only existed in a minority of units. Only 23 out of the 62 units offering both antenatal and termination services to women had the same screening policy for women attending the different services. The research confirmed that a mandatory requirement would not improve HIV screening policy during prenatal care. However, less emphasis on women who have opted for termination of pregnancy, an absence of appropriate counselling and information procedures, and pressures on HIV-infected women to terminate current pregnancies and discourage future ones strongly suggest that HIV prenatal screening in French hospitals remains mainly focussed on fetal concerns, without sufficient attention towards the needs of women at risk of HIV infection.
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OBJECTIVE: To evaluate the serological and epidemiological characteristics of HTLV-I/II-positive blood donors in continental France during the first 6 months of universal screening of blood donations (n = 1,816,927). METHOD: A collaborative investigation of all confirmed anti-HTLV-I/II-positive samples reported by blood transfusion centres was performed. Seventy-three out of 77 reported samples were retested at two reference laboratories. Epidemiological data on risk factors were compiled. RESULTS: Of the 73 retested samples, 66 were confirmed to be HTLV-I-positive and one to be HTLV-II-positive; six samples were designated false-positive, mainly because of non-specific reactivity to recombinant gp21 in Western blot. The overall prevalence of HTLV-I/II in continental France is 0.039 per thousand. The main risk factor identified for HTLV-I infection was directly (origin) or indirectly (heterosexual contact) linked to endemicity in the Caribbean. The cost per case of avoided contamination in the 6-month period of this study was 1.36 million French francs. CONCLUSIONS: Sixty-two per cent of HTLV-I/II-infected blood donations would not have been discarded through the previous targeted HTLV screening or through other mandatory tests, including anti-hepatitis B core. To avoid false-positive results, we propose a new algorithm of diagnosis.
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The prevalence of HIV infection in women at end of pregnancy, irrespective of outcome, was determined in a comprehensive survey of both women and medical centres during successive 4-week periods in four areas of the Paris region, France. Blood samples were tested anonymously for antibodies to human immunodeficiency virus (HIV)-1 and HIV-2. Of the 11,593 blood samples 0.40% (95% confidence interval [CI] 0.28-0.51) were positive for HIV-1 and 0.02% (95% binomial interval [BI] 0.002-0.065) for HIV-2. Seroprevalence was higher among women with ectopic pregnancy (2%) (95% BI 0.24-7.04); the rate in women having an elective or therapeutic abortion was more than twice that in those delivering babies (0.70% vs 0.28%, p less than 0.05, relative risk 2.54, 95% CI 1.36-4.75). Studies with neonatal HIV seroprevalence as a surrogate for HIV prevalence in pregnant women would underestimate prevalence in these women.
This paper describes the epidemiology of AIDS-associated non-Hodgkin's lymphoma (NHL) in the World Health Organization (WHO) European Region. Data, collected by the WHO Collaborating Centre on AIDS in Paris, France, were derived from the national AIDS surveillance systems of 21 countries. Among 53,042 cases reported as of the end of June 1991, 1,617 (3.0%) had NHL as the presenting clinical manifestation of AIDS. The proportion of cases presenting with NHL ranged from 1.1% in children infected perinatally to 3.9% among haemophiliacs. In comparison with intravenous drug users (IVDUs) (2.6% of whom had NHL), a moderate excess was found among homosexual or bisexual men (odds ratio - OR -:1.2, 95% confidence interval - CI -:1.0-1.3). Over time, the proportion of NHL was constant, but whereas among homosexual or bisexual men the frequency of NHL as AIDS-indicator disease significantly increased (9.7% per year), among IVDUs a significant downward trend emerged (17.1% per year). In respect to age, two peaks of NHL were seen at the age groups 10-19 (3.8%) and 50-59 (4.3%). The proportion of AIDS-associated NHL significantly increased with increasing age among homosexual and bisexual men and heterosexuals whereas it decreased among IVDUs. All these differences, however, have to be interpreted cautiously on account of the limitations of the reporting systems.
European data on transfusion-associated (TA) AIDS cases reported by December 31, 1989 have been analyzed using both parametric and nonparametric methods. Parametric estimates of the median incubation period of TA AIDS in adults vary from 6.5 to 11 years according to the type of distribution assumed (Weibull or gamma) and the latest year of diagnosis included (1987 or 1988). The latter finding may reflect a lengthening of the incubation period due to increasing treatment of HIV-infected patients prior to the development of AIDS. It is predicted that, by the end of 1991, between 2,000 and 3,000 cases of AIDS will have been diagnosed in Europe among adults infected by transfusion between 1978 and 1985 (when systematic screening of donated blood was introduced in most western countries). It is not possible, however, to predict how many further cases may arise among those transfused more recently in countries in which screening was introduced at a later date.
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Statistical modelling is applied to routine AIDS surveillance data to assess recent trends and to provide a range of short-term predictions. Several alternative functions have been fitted to half-yearly incidence data reported by the countries of the European Community by 31 December 1989 and adjusted for reporting delays. Among homosexual/bisexual men, recent trends in AIDS incidence are more nearly linear than exponential. Higher though less than exponential rates of growth are observed among intravenous drug users and among those presumed infected by heterosexual contact. Extrapolations to the end of 1991 using each of five functions provide a range of forecasts. Projections of total cumulated cases to the end of 1991 lie in the range 60,000-78,000, with 24,000-30,000 projected cases among homosexual/bisexual men, 23,000-33,000 among intravenous drug users, and 6000-8000 in the heterosexual transmission group. With the possible exception of the latter group, the lower parts of these ranges appear more probable.
AIDS-related Kaposi's sarcoma (KS) has a better prognosis than other presentations of AIDS. It is more frequent among homo-bisexual men than in other risk groups. This has raised the possibility of specific etiological agent(s) or co-factor(s) which induce its development. However, this suggestion is confusing since it implies that exposure to such agent(s) or co-factor(s) would result in an improved prognosis. Recent virological studies indicate that the HIV itself could be responsible for the induction or growth of KS. Since HIV antigenemia and the immunosuppression are lower among KS cases than among those with opportunistic infections (OI), we could expect a lower level of exposure to AIDS-related factors in KS cases as compared to OI cases. To investigate this possibility, we compared 25 cases with Kaposi's sarcoma alone (KS) with 25 cases having OI without KS, among homo-bisexual men. The KS cases were more likely than OI cases to have a higher educational level. They were less likely to have inhaled nitrites, to have had repeated syphilis and repeated gonorrhoea, and to be promiscuous. In the multivariate analysis, the factors which best discriminated the groups were nitrite inhalations, history of repeated syphilis, and anonymous promiscuity ("one-night stands"). Our study does not support the hypothesized association between nitrite inhalations and Kaposi's sarcoma. We found that cases with opportunistic infections - that is, with a poor prognosis - had been exposed to AIDS-related risk factors (e.g. history of venereal diseases, nitrite inhalations, promiscuity) at higher levels than cases with Kaposi's sarcoma alone.(ABSTRACT TRUNCATED AT 250 WORDS)
A survey of the social perception of AIDS and its prevention was carried out in December 1987 in a representative sample of the adult population of the Paris region (France). A significant part of the general public still holds misconceptions about transmission by casual contact and blood donation. Misbeliefs about modes of transmission clearly encourage individuals' willingness to stigmatize AIDS patients and to support the most coercive measures of prevention (such as quarantine). Advertizing efforts to promote use of condoms, sexual education in schools, and systematic HIV screening for pregnant women are the only measures which create a broad consensus independently of sociocultural differences. Socioeconomic status and even religious or political beliefs strongly influence public opinions toward other preventive measures.
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A study was conducted by the French Communicable Diseases Network to evaluate the use of HIV-antibody testing by general practitioners. The study was aimed at determining the type of patient being tested and why. Data from two periods, Nov-Dec 86 and March-April 87, were compared. The percentages of subjects spontaneously asking for the test were about 50% in both studied periods. During the first period, tested patients were mainly male subjects (82%) and belonged to high risk groups (66%), whereas during the second period male subjects represented 47% and subjects belonging to high risk groups 27% of those tested. During the four months between the 2 study periods, an information campaign on AIDS was begun. During the second study period, in fact, the number of women being tested had increased, the number of patients with clinical symptoms had decreased and more patients were tested because of past or present STDs. In addition, fewer seropositive subjects were found during the second period. Only one subject with no known risk factor was found to be seropositive but she did have clinical symptoms of HIV infection.
To identify risk factors for A.I.D.S. among homosexual men in France, a high-risk group in a moderate-incidence area, we undertook a case-control study in Paris and its suburbs. Fifty-three cases were compared to 99 controls from a venereal disease clinic and 79 controls from the staff of an amateur gay broadcasting station. In our univariate analysis, cases were more likely than controls to belong to upper socio-economical classes, to have used local corticosteroids, to have regularly inhaled nitrites, to report history of syphilis and of herpes infections, to have higher level of promiscuity with occasional partners ("one night stands"), and to have had sexual encounters in the U.S.A. In the multivariate analysis, history of syphilis and promiscuity with occasional partners appeared to be the main risk factors, as well as the use of local corticosteroids, especially during the prodrome period. The correlation between promiscuity and disease risk was weak in our study when we did not discriminate between occasional and regular sex partners, contrary to that found in epidemiological studies of A.I.D.S. and H.I.V.-seropositivity in high-incidence areas. In association with the history of syphilis, the development of the syndrome in our moderate-incidence country is more correlated to the contact with "one-night-stand" partners rather than to the total number of the sex partners. The public health policies in our area should be adapted to these findings. Otherwise they may be less efficient than hoped.