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L Cuzin

Publications and source records attributed to L Cuzin.

12 recordsLinked to original sources
PubMed2006

[Medical care for HIV infection in France in 2005, the NADIS cohort study on 7416 patients].

OBJECTIVE: This study had for aim to evaluate the immuno-virological and therapeutic profile of a cohort of 7416 HIV-1 infected patients followed in six French hospital with the Nadis software. METHOD: This cross sectional and retrospective study was performed between June 1, 2004 and June 1, 2005. We analyzed the demographic (sex, age, HIV infection route), immunovirological, and therapeutic characteristics (last treatment prescribed) of the 7416 cohort patients. RESULTS: The mean age was 43 years, 29% were women and 29% HCV/HBV co infected. The viral load was 1.9 log(10)copies/ml (IQR: 1.5-3.3) and the CD4 cells count was 452/mm(3) [IQR: 306-630]. Among the 5,913 antiretroviral treated patients, VL was less than 200 copies/ml for 74.7% of patients and 50% of them had a CD4 cell count superior to 500/mm(3); the drug regimen was 2 or 3 nucleosides reverse transcriptase inhibitors (NRTI) combined with one protease inhibitor (88% Ritonavir boosted) in 42% of the patients, 26% of them were treated with 2 NRTI and 1 non-NRTI, and 14% with 3NRTI. Patients with undetectable VL were followed 5.1/year versus 7.2 for non- VL controlled patients (P<10(-3)). The heterosexual route predominated among the new 531 HIV-diagnosed patients among whom 25% had a median CD4 cell count of 242/ m(3). CONCLUSION: Close to 75% of antiretroviral treated patients had a VL<200 copies/ml but 15% kept a low CD4 cell count. The characteristics of recently diagnosed HIV positive patients stresses the need for more information on prevention and an early diagnosis.

Adult↗
PubMed2006

Predictive factors of treatment interruption duration in a cohort of HIV-1 infected patients with CD4 count greater than 350 cells per mm3.

OBJECTIVE: To determine predictive factors of treatment interruption (TI) duration within a cohort of HIV-1 infected patients having stopped their treatment with CD4 above 350 cells per mm(3). DESIGN: Data were collected from computerized medical records. Patients were selected if they were HIV-1 positive, 18 years of age or older, and had stopped their treatment between January 1st, 1999 and July 1st, 2003, with CD4 count above 350 cells per mm(3). The study period was censored on October 1st, 2003. Patients were assessed every 3 months from inclusion to censure. A survival analysis using the Cox proportional hazard model was performed. RESULTS: One hundred eighty-five patients were included. The median duration of TI was 43 weeks. Sixty-three patients remained off-treatment at censure. In the multivariate analysis, TI duration was shorter if CD4 nadir was below 250 cells per mm(3) before TI (relative hazard, 2.10), age superior to 40 (relative hazard, 1.72), viral load higher than 2.3 log.copies per ml (relative hazard, 1.52), and CDC class C (relative hazard, 1.78) at TI. Neither CD4 cell count at TI, numbers of treatments, nor duration of treatment and infection before TI were independent predictive factors of early treatment resumption (TR). CONCLUSION: Some clinical and biological data may be used as predictive factors of early TR. Our results can have implications on future therapeutic strategies, in which the goal of therapy is to maintain CD4 cell count above a predetermined threshold using cycles of therapy followed by prolonged interruption according to CD4 count.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Incidence and risk factors of bacterial pneumonia requiring hospitalization in HIV-infected patients started on a protease inhibitor-containing regimen.

OBJECTIVE: To describe the incidence and risk factors of bacterial pneumonia occurring in patients treated with antiretrovirals. METHODS: In the ongoing APROCO (Anti-proteases) cohort, 1281 patients at the initiation of a protease inhibitor (PI)-containing antiretroviral regimen were enrolled from 1997-1999. All events requiring hospitalization during follow up are recorded. Of these, bacterial pneumonia was defined as the occurrence of a new pulmonary infiltrate with fever and either evidence of a bacteriological cause (definite cases) or favourable outcome with antimicrobial therapy (presumptive cases). Risk factors of bacterial pneumonia were studied using survival analyses. RESULTS: During a median follow up of 43 months, 29 patients had at least one episode of bacterial pneumonia, giving an incidence of 0.8/100 patient years. The 11 definite cases were attributable to Streptococcus pneumoniae (n=9), Legionella pneumophila (n=1) and Haemophilus influenzae (n=1). In multivariate analysis, bacterial pneumonia was significantly more frequent in older patients, injecting drug users, patients having a CD4 cell count>500 cells/microL at baseline and patients who initiated PI therapy with nonboosted saquinavir. It was significantly less frequent in nonsmokers. The occurrence of bacterial pneumonia was also associated with lower self-reported adherence to antiretroviral therapy and to higher plasma HIV-1 RNA levels during follow-up. CONCLUSIONS: Bacterial pneumonia occurs rarely in patients treated with a PI-containing regimen and may be associated with virological failure.

AIDS-Related Opportunistic Infections↗
PubMed2005

Triple nucleoside reverse transcriptase inhibitor- vs. nonnucleoside reverse transcriptase inhibitor-containing regimens as first-line therapy: efficacy and durability in a prospective cohort of French HIV-infected patients.

OBJECTIVE: Based on the short-term results of the AIDS Clinical Trials Group (ACTG) A5095 trial, zidovudine (ZDV)/lamivudine (3TC)/abacavir (ABC) is no longer recommended as a first-line antiretroviral regimen. Data on the efficacy of this triple nucleoside reverse transcriptase inhibitor (NRTI) combination compared with the gold-standard nonnucleoside reverse transcriptase inhibitor (NNRTI) regimen could provide important information. METHODS: Patients were selected from three prospective cohorts of patients who received first-line therapy with ZDV/3TC plus an NNRTI or ABC, started after January 1998. Immunovirological changes and the proportion of treatment discontinuations were compared between groups. RESULTS: Of the 380 patients, 190 started on ABC [the triple-NRTI group (3N)] and 190 on NNRTI. At baseline, there was no statistical difference between the NNRTI and 3N groups for age (mean=38 years), sex (66% male) or CD4 cell count (mean=305 cells/muL). Mean baseline plasma HIV-1 viral load (pVL) was higher in the 3N group (4.6 vs. 4.3 log10 HIV-1 RNA copies/mL: P<0.01). Lower and higher estimates of median pVL decrease at month 24 were 2.05 and 4.76 log10 copies/mL in the 3N group, and 1.73 and 4.31 log10 copies/mL in the NNRTI group (not significant). CD4 cell count evolution did not differ between groups. Treatment discontinuation occurred in 45% vs. 44% of patients in the NNRTI and 3N groups, respectively, after median durations of 9 and 4 months, respectively (P=0.02). CONCLUSIONS: In this prospective cohort, 3N and NNRTI regimens as first-line therapy produced similar immunovirological responses.

Adult↗
PubMed2004

[Management of occupational and sexual exposure to HIV in the Toulouse teaching hospital].

OBJECTIVE: This study had aim to describe the management of occupational and sexual HIV exposure in the Toulouse teaching hospital. DESIGN: A prospective descriptive study was made of patients reporting with potential HIV exposure in Toulouse between 01/01/2000 and 12/31/2002. RESULTS: Six hundred and ninety three cases were reported, 236 after occupational and, 457 after sexual exposure. The frequency of sexual exposures increased with time. 61.2% of patients received post-exposure treatment and no seroconversion was diagnosed during their follow-up. Eighty-four percent of treated patients received three anti-retroviral drugs, with a protease inhibitor in 57%. Treatment was more frequently prescribed in sexual exposures than in occupational ones. For occupational exposures, the median time between exposure and consultation was 4 h and was decreased by spontaneous bleeding but not affected by source patient serostatus or injury deepness. Treatment was more frequent when injury was deep, when there was spontaneously bleeding, and when the source patient serostatus was positive or unknown. For sexual exposures, the median time between exposure and consultation was significantly superior to 4 h. That was diminished by positive source person serostatus but not affected by the partner's gender, nature of intercourse, or rape. Treatment was more frequently prescribed in case of positive or unknown source person serostatus, rape and homosexual intercourse. CONCLUSIONS: Given the delay before consultation for sexual exposures and out of delay treatment in occupational exposures, discussion with health professionals on implementing procedures and means seems mandatory.

Adolescent↗
PubMed2003

[NADIS 2000, development of an electronic medical record for patients infected by HIV, HBV and HCV].

OBJECTIVE: to develop an electronic medical record for patients living with HIV, HBV or HCV in order to improve their management, facilitate communication between all the caregivers, and to create a useful medical database for research and assessments. This project (NADIS 2000) involved 6 centres of Infectious Diseases in France in partnership with Fédialis Médica (subsidiary of the GSK group in France). METHODS: A specifications sheets was drawn-up by a piloting Committee regrouping the various correspondents in each centre and a computer expert representing Fédialis Médica. A Scientific and Development committee regrouped the heads of departments of each centre and the representatives from Fédialis Médica and GSK and was charged with defining the general concept of the project and guaranteeing the scientific and clinical aspects. RESULTS: NADIS 2000 version 1.0 was activated in the departments of infectious diseases in Nice and Toulouse in November 2000 and in others Units at the end of 2001. NADIS 2000 permitted real-time use by the physicians in the Outpatients and Day-care Units and was easily handled by all the practitioners. Its use was eased by the principles clearly defined before its application (department project, progressive but exhaustive use), an intuitive interface simulating a consultation, and functions proposing direct benefits for the physicians (graphical visualization of the biological variables, printing of prescriptions and letters). CONCLUSION: The activation and input methods of NADIS 2000 are user friendly and the physicians find it rapidly easy to use. New functional aspects are being developed as well as its use in other hospital departments.

Computer Communication Networks↗
PubMed2003

[Anti-retroviral treatment interruptions in HIV-infected adults: causes, clinical, immunological and virological consequences].

INTRODUCTION: This retrospective study analyses causes as well as clinical, immunological and virological consequences of antiretroviral treatment interruptions (Ti) of more than 30 days in HIV-1 infected adults. METHODS: This causes were classified as related to drug toxicity, therapeutic or adherence failure. We studied therapeutic regimens before Ti and after treatment reinitiation (TR), clinical events related to Ti, CD4 cells and viral loads before Ti and at months 3, 6, 9, and 12 after TR. RESULTS: Out of 188 Ti analysed, 42.6% were related to therapeutic failure, 33.5% to drug toxicity, and 23.9% to adherence failure. Eight Aids defining clinical events were reported during Ti, in patients with low CD4 cells and high viral load (P < 0.05). Viral loads evolution after TR was better if Ti was related to treatment failure (P < 0.05), was prolonged (P < 0.05), and if CD4 cells were high before Ti and at TR (P < 0.05). Median CD4 cells was of 296/mm(3) at month 12 after TR vs 382 before Ti. CONCLUSIONS: Ti consequences are strongly related to CD4 cells, which decrease sharply during Ti, increasing Aids defining events probability. Prospective randomised clinical studies are needed to define usefulness of Ti.

Adult↗
PubMed2003

[Experience of an adherence support for HIV-1 seropositive patients with failure under treatment].

CONTEXT: To be successful highly active antiretroviral therapies need very high levels of adherence to be successful. In need to help patients in dealing with adverse effects, complexity and multiple constraints of these drugs, adherence support programs have been developed. Therefore, the efficacy on viral load of these interventions has not been established in the HIV-1 positive population. The aim of our study was to assess the virological efficacy of this type of program in our institution. METHODS: Non randomized intervention study with a control group. The intervention group was constituted of patients presenting with virological failure who where admitted in the adherence program. The control group (2:1) has been selected in our data base. Factors known to influence viral load have been analyzed by multiple logistic regression. RESULTS: The probability of obtaining a significant decrease of viral load was better at 6 months for patients using the adherence program (OR: 4,48 [2,72-11,8]). This benefit was not sustained at 12 months. The program efficacy varied with the kind of treatment (with or without protease inhibitors), the therapeutic history and the initial viral load. The absence of protease inhibitor, a high initial viral load, small number of previous drugs were linked to viral load decrease. CONCLUSION: The good virological results observed at 6 months in the intervention group are incentive. Long term virological gain and the profile of patients who could make the best of an adherence support program have to be determined.

Adult↗
PubMed2000

Hepatitis C virus co-infection is a negative prognostic factor for clinical evolution in human immunodeficiency virus-positive patients.

A longitudinal study of human immunodeficiency virus (HIV)-infected individuals followed-up in 13 centres was performed to assess the influence of hepatitis C virus (HCV) on the clinical and immunological evolution of HIV-infected patients. Eight-hundred and twelve HIV-infected patients with known HIV acquisition date, 89 co-infected with HCV, were included in the cohort. Clinical progression was defined as: 30% decrease of Karnofsky's index; and/or 20% body weight loss; and/or acquired immune deficiency syndrome (AIDS)-defining illness; and/or death (except by accident, suicide, or overdose). Immunological progression was defined as a decrease of initial CD4 count to below 200 mm(-3). If immunological progression was not statistically different between groups (P=0.25), clinical progression was significantly faster in HCV-HIV co-infected patients in univariate (P=0.02) and multivariable survival analysis (hazard ratio=1.63, P=0.03). This argues for active management of hepatitis C chronic infection among HCV-HIV co-infected patients.

Adult↗
PubMedDate not supplied

[The Nadis cohort: 6236 HIV-infected patients followed up in French university hospitals].

OBJECTIVE: The Nadis electronic medical patient record allows real time constitution of a database including the clinical, therapeutic, biological, and epidemiological features of HIV-positive patients. METHODS: Data concerning HIV-infected patients followed-up in 6 French University Hospitals was collected. Data quality was assessed on a regular basis in each center. RESULTS: The 6 first University hospitals using Nadis agreed to group their data on March 15, 2004, concerning 6236 patients having consulted at least once in the previous year. Among these, 29% were female patients, 80% were under treatment on March 15, 2004, 9% were off treatment, 29% were co-infected by hepatitis B or C virus, 57% had an undetectable viral load, 15% of the treated patients were in a worrying immunovirological situation, 358 were diagnosed HIV-positive in 2003. 35% of these "new patients" were women, the mode of infection was sexual in 80%, 45% were under treatment on March 15, 04. This recent data allowed us to have an accurate assessment of this population's management in 2004.

Adult↗