OBJECTIVES:To characterize real-world treatment switching in France to bictegravir (BIC or B) or dolutegravir (DTG)-based regimens with a focus on treatment persistence, effectiveness (HIV-1 RNA ≤50 copies/ml) and particular attention to the prevalence and incidence of comorbidities. METHODS:People living with HIV from the prospective ANRS-CO3-AquiVIH-NA cohort, who switched from effective antiretroviral treatment (ART) to a BIC- or DTG-based regimen between 2018 and 2021, were eligible for analysis. RESULTS:A total of 2275 people living with HIV were included (52% receiving B/F/TAF, 8% DTG/3TC/ABC, 18% DTG/RPV, 22% DTG/3TC) with a median age of 53-56 years and a comorbidity prevalence of 71%-75% across treatment groups (chronic kidney disease (CKD) 15%-25%, diabetes mellitus 15%-19%, hypertension 57%-64%). Viral suppression rates at month 18 (LOCF, last observation carried forward) using a missing-equals-excluded (M = E) approach were 97% on B/F/TAF, 95% on DTG/3TC/ABC, 97% on DTG/RPV and 96% on DTG/3TC. Discontinuation rates were 16.5% for B/F/TAF, 37.5% for DTG/3TC/ABC, 16.7% for DTG/RPV and 17.3% for DTG/3TC, driven by adverse events in 5.6%, 12.5%, 5.6% and 6.1%, respectively. Comorbidity incidence rates/1000 person years in those free of the respective disease were 39 for hypertension, 22 for diabetes mellitus, 13 for cardiovascular events and 5 for CKD. CONCLUSIONS:In this real-world cohort, treatment persistence 18 months after therapy switch was similar for B/F/TAF, DTG/RPV and DTG/3TC, but significantly lower for DTG/3TC/ABC. All regimens maintained high levels of viral suppression. Furthermore, the cohort illustrates the disease burden experienced by middle-aged and elderly people living with HIV and highlights the importance of adapting ART to the specific needs of this population.
Background The benefit of percutaneous coronary intervention (PCI) for chronic total coronary occlusions (CTOs) to improve clinical symptoms and quality of life (QoL) as compared with optimal medical therapy (OMT) is still under debate because of the scarcity of available randomized trials (RCTs). Objectives We evaluated the effect of PCI vs OMT in patients with a CTO and no concomitant coronary lesions in a post-hoc pooled analysis of 2 RCTs. Methods A total of 518 patients with a single CTO and no other significant coronary lesion were extracted from 2 RCTs, EUROCTO and DECISION-CTO, which had compared PCI vs OMT. Randomization to PCI or OMT was 1:1 in DECISION and 2:1 in EUROCTO. The clinical status was assessed by the Seattle Angina Questionnaire (SAQ) at baseline and after 12 months, and clinical events were monitored for 3 years. Results PCI was successful in 92.2%. On an intention-to-treat analysis, PCI appeared to be superior to OMT for the change of angina frequency scores between baseline and follow-up (12.2 vs 8.6; P = 0.009), QoL (19.5 vs 11.3; P < 0.001), and the SAQ summary score (13.8 vs 8.5; P < 0.001). For physical limitation, the difference was just at the level of the Bonferroni correction for multiple tests (P = 0.01). There was a wide variability of changes in SAQ scores. For QoL, the major determinant for a significant improvement was a low baseline score and the assignment to PCI, whereas gender, diabetes, or lesion complexity had no influence. During a mean follow-up of 3.1 years, the clinical endpoints of cardiac death or nonfatal myocardial infarction were similar in both groups (OMT vs PCI: 2.7% vs 5.1%; P = 0.17). The rates of stroke or hospitalization for bleeding were similar, and only target lesion revascularizations were more frequent with OMT (18.8% vs 10.6%; P = 0.005). Conclusions In this post-hoc analysis from 2 RCTs of patients with a single CTO and no significant concomitant lesion, PCI achieved better improvement in QoL, angina frequency, and the SAQ summary score than OMT with no signal of excess harm regarding clinical endpoints. (EUROCTO [Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions; NCT01760083] and DECISION-CTO [Drug-Eluting Stent Implantation Versus Optimal Medical Treatment in Patients With Chronic Total Occlusion; NCT01078051])
Millions of households have cats or dogs as pets, and infections due to bites or scratches are increasing, with the most common pathogens being Pasteurella spp., Bartonella spp., Capnocytophaga spp, and Francisella tularensis. The objective of this study was to describe patients admitted to the intensive care unit (ICU) for infection transmitted by cats or dogs, as well as their outcomes. The retrospective multicentre observational cohort study PETSEPSIS included consecutive adults admitted to 46 ICUs in France between 2009 and 2019 for sepsis due to cat or dog bites and/or caused by any of the four above-listed bacteria. We described their features and outcomes and performed univariate and multivariate analyses to identify factors associated with death. We included 174 patients with a median age of 64 [50–74] years; 58.1
Le cancer représente la première cause de mortalité en France. Malgré l’existence de traitements anti-cancéreux, la guérison n’est pas toujours garantie et certaines personnes entrent dans une phase dite « palliative ». Durant cette phase visant à améliorer l’espérance et surtout la qualité de vie, le souhait du retour à domicile (RAD) peut être formulé par le patient. L’équipe hospitalière se doit de respecter la volonté du patient. Pourtant, certaines demandes de RAD ne sont pas satisfaites. Nous pouvons ainsi nous interroger sur la manière dont l’équipe pluriprofessionnelle évalue la faisabilité du RAD pour les patients en phase palliative d’un cancer. Méthode : L’objectif de l’étude est de réaliser une analyse de pratique professionnelle afin de déterminer les outils d’évaluation utilisés par l’équipe ainsi que le rôle de l’ergothérapeute dans cette organisation. Cinq ergothérapeutes correspondants aux critères d’inclusion ont répondu à des entretiens semi-structurés. Un questionnaire a aussi été diffusé auprès d’équipes hospitalières intervenant dans le RAD de patients en phase palliative de cancer. Résultats : Sur les 26 outils proposés par la littérature, seules les échelles d’auto-évaluation de la douleur sont utilisées par la majorité des répondants. L’évaluation en équipe est principalement basée sur des échanges oraux avec une certaine subjectivité. Conclusion : L’utilisation des outils recommandés pour évaluer la faisabilité d’un RAD en phase palliative ne se reflète pas dans les pratiques. L’évaluation pluriprofessionnelle de ces situations est propre à chaque structure et dépend de la dynamique d’équipe dont l’ergothérapeute fait parfois partie.
Critical-illness survivors may experience post-traumatic stress disorder (PTSD) and quality-of-life impairments. Resilience may protect against psychological trauma but has not been adequately studied after critical illness. We assessed resilience and its associations with PTSD and quality of life, and also identified factors associated with greater resilience. This prospective, multicentre, study in patients recruited at 41 French ICUs was done in parallel with the NUTRIREA-3 trial in patients given mechanical ventilation and vasoactive amines for shock. Three months to one year after intensive-care-unit admission, survivors completed the Connor-Davidson Resilience Scale (CD-RISC-25), Impact of Event-Revised scale for PTSD symptoms (IES-R), SF-36 quality-of-life scale, Multidimensional Scale of Perceived Social Support (MSPSS), and Brief Illness Perception Questionnaire (B-IPQ). Of the 382 included patients, 203 (53.1
