BACKGROUND:The association between liver stiffness measurements (LSM) and mortality has not been fully described. In particular the effect of LSM on all-cause mortality taking sustained virological response (SVR) into account needs further study. METHODS:HIV/HCV participants in the French nation-wide, prospective, multicenter ANRS CO13 HEPAVIH cohort, with ≥1 LSM by FibroScan (FS) and a detectable HCV RNA when the first valid FS was performed were included. Cox proportional hazards models with delayed entry were performed to determine factors associated with all-cause mortality. LSM and SVR were considered as time dependent covariates. RESULTS:1,062 patients were included from 2005 to 2015 (69.8% men, median age 45.7 years (IQR 42.4-49.1)). 21.7% had baseline LSM >12.5 kPa. Median follow-up was 4.9 years (IQR 3.2-6.1). 727 (68.5%) were ever treated for HCV: 189 of them (26.0%) achieved SVR. 76 deaths were observed (26 liver-related, 10 HIV-related, 29 non-liver-non-HIV-related, 11 of unknown cause). At the age of 50, the mortality rate was 4.5% for patients with LSM ≤12.5 kPa and 10.8% for patients with LSM >12.5 kPa. LSM >12.5 kPa (adjusted Hazard Ratio [aHR] = 3.35 [2.06; 5.45], p<0.0001), history of HCV treatment (aHR = 0.53 [0.32; 0.90], p = 0.01) and smoking (past (aHR = 5.69 [1.56; 20.78]) and current (3.22 [0.93; 11.09]) versus never, p = 0.01) were associated with all-cause mortality independently of SVR, age, sex, alcohol use and metabolic disorders. CONCLUSION:Any LSM >12.5 kPa was strongly associated with all-cause mortality independently of SVR and other important covariates. Our results suggest that close follow-up of these patients should remain a priority even after achieving SVR.

Objectives Although common among patients coinfected with HIV and hepatitis C virus (HCV), sleep disturbances (SD) are still poorly documented in this population in the HCV cure era. This longitudinal study aimed at analysing SD in HIV-HCV coinfected patients and identifying their clinical and sociobehavioural correlates. Methods We used 5-year annual follow-up data from 1047 participants in the French National Agency for Research on Aids and Viral Hepatitis Cohort 13 'Hepatite et VIH' (ANRS C013 HEPAVIH) cohort of HIV-HCV coinfected patients to identify clinical (medical records) and behavioural (self-administered questionnaires) correlates of SD (mixed-effects logistic regression). SD were identified using one item documenting the occurrence of insomnia or difficulty falling asleep (ANRS 'Action Coordonnee 24' self-reported symptoms checklist), and two items documenting perceived sleep quality (Center for Epidemiologic Studies Depression and WHO Quality of Life HIV-specific brief scales). Results Seven hundred and sixteen (68.4%) patients with completed self-administered questionnaires reported SD at their most recent follow-up visit. In the multivariable model, hazardous alcohol consumption (Alcohol Use Disorders Identification Test-Consumption score 4 for men, 3 for women) (adjusted odds ratio =1.61; 95% confidence interval: 1.09-2.36), depressive symptoms (6.78; 4.36-10.55) and the number of other physical and psychological self-reported symptoms (1.10; 1.07-1.13) were associated independently with SD after adjustment for sex, age and employment status. HCV cure was not associated significantly with SD. Conclusion SD remain frequent in HIV-HCV coinfected patients and are associated with a series of modifiable behavioural risk factors. independent of HCV cure, improved screening and comprehensive management of alcohol use, physical and psychological self-reported symptoms and depression are essential in this population. Closer investigation of these risk factors of SDs may both increase sleep quality and indirectly improve patients' clinical outcomes. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.

An altered anti-EBV serologic profile is associated with an increased risk of Hodgkin's lymphoma (HL) and has been shown to precede HL diagnosis. Recent studies have provided evidence for the role of genetic factors controlling both anti- viral capsid antigen (VCA) and anti- Epstein-Barr nuclear antigen-1 (EBNA-1) immunoglobulin (Ig)G levels. Here, we conducted linkage and association studies to further search for genetic factors influencing either anti-VCA or anti-EBNA-1 IgG levels in a French familial sample recruited through cases of HL.

Background. - Hepatitis B reactivation has been observed in HIV-infected patients with isolated anti-HBc. However, the impact of isolated anti-HBc on liver fibrosis is not known in this population.Methods. - We investigated liver stiffness values (LSV) in a population of HIV-infected patients with isolated anti-HBc, and attempted to identify risk factors for high values.Results. - Fifty-one out of 69 patients (74%) had low LSV (<= 7.1 kPa). In univariate analysis, high LSV (>7.1 kPa) were associated with HCV coinfection, the duration of HIV infection, the duration of antiretroviral therapy and lipodystrophy. In age-adjusted multivariate analysis, HCV coinfection (OR 11.5; 95% CI, 3.0-62.9; P = 0.001) and lipodystrophy (OR 4.6; 95% CI, 1.1-20.7; P = 0.031) remained associated with high liver stiffness values.Conclusions. - Lipodystrophy was the only factor associated with high liver stiffness values in our population of HIV-infected patients with isolated anti-Hbc and extensive exposure to antiretroviral drugs active on HBV, apart from HCV coinfection Our study correlates to recent studies the results of which have shown that lipodystrophy, and more generally mitochondrial toxicity, was associated with advanced liver fibrosis in HIV/HCV co-infected patients. (C) 2013 Elsevier Masson SAS. All rights reserved.

Abstract : Antinuclear antibodies (ANA) are widely detected by immunofluorescence on HEp-2 cells in patients with connective tissue diseases and other pathological conditions. We evaluated the first-automated chemiluminescence immunoassay for the detection of ANA (LIAISON ANA screen, DiaSorin). This study was carried out simultaneously in two laboratories by testing 327 patient samples with clinically defined connective diseases, 273 routine samples for ANA screening, and 300 blood donors. A total of 268 out of 337 IIF-positive sera were positive with LIAISON ANA screen (79.5% of agreement) and 240 out of 263 IIF-negative sera were negative with LIAISON ANA screen (91.2% of agreement). After resolution of discrepant results, the concordance reached, respectively, 94.9% and 98.8%. The specificity was 99.3% and the sensitivity was 94%. Unlike results obtained by other ANA screening assays, we observed acceptable sensitivity and specificity. Despite the presence of HEp-2 cell extract, we failed to detect some antibodies as antinucleolar, antinuclear envelope, and antiproliferating cell nuclear antigen. This automated assay allows quick process to results and exhibits satisfactory sensitivity for the detection of the main ANA specificities of connective tissue diseases.

Screening and quantification of anti dsDNA antibodies are useful for positive diagnosis and follow-up of Systemic Lupus Erythematosus (SLE). Various assays exist based on different techniques which can influence the results. This study evaluated the specificity and the sentitivity of the Liaison (R) dsDNA Diasorin assay for the detection of anti dsDNA antibodies. We compared the results with those obtained with ELIA (R) dsDNA Pharmacia routinely used in our laboratory. The study has involved the sera of 153 systemic lupus erythematosus and 78 controls. The control group included 54 other autoimmune diseases and 24 patients without autoimmune markers. Liaison (R) dsDNA (Phormacia) assay offers a sensitivity of 91,5% and a specificity > 99%. Correlation with the ELIA (R) dsDNA assay is 0,68. The automated Liaison (R) dsDNA Diasorin assay demonstrates its value for the detection and quantification of anti dsDNA antibodies in SLE patients. (C) 2007 Publie par Elsevier Masson SAS.

Antinuclear antibodies (ANA) are widely detected by immunofluorescence on HEp-2 cells in patients with connective tissue diseases and other pathological conditions. We evaluated the first-automated chemiluminescence immunoassay for the detection of ANA (LIAISON ANA screen, DiaSorin). This study was carried out simultaneously in two laboratories by testing 327 patient samples with clinically defined connective diseases, 273 routine samples for ANA screening, and 300 blood donors. A total of 268 out of 337 IIF-positive sera were positive with LIAISON ANA screen (79.5% of agreement) and 240 out of 263 IIF-negative sera were negative with LIAISON ANA screen (91.2% of agreement). After resolution of discrepant results, the concordance reached, respectively, 94.9% and 98.8%. The specificity was 99.3% and the sensitivity was 94%. Unlike results obtained by other ANA screening assays, we observed acceptable sensitivity and specificity. Despite the presence of HEp-2 cell extract, we failed to detect some antibodies as antinucleolar, antinuclear envelope, and antiproliferating cell nuclear antigen. This automated assay allows quick process to results and exhibits satisfactory sensitivity for the detection of the main ANA specificities of connective tissue diseases.

SETTING: Department of Seine-Saint-Denis, France.OBJECTIVE: To compare the presentation and outcome of Mycobacterium kansasii infections according to human immunodeficiency virus (HIV) status.DESIGN: Retrospective analysis of all the medical charts of adults meeting the diagnostic criteria of the American Thoracic Society for M. kansasii infection between 1991 and 1995.RESULTS: Between 1991 and 1995, 35 cases (23 HIV- [6%] and 12 HIV+ [34%]) were found, giving an annual incidence of 0.5/100 000. The following particularities were common to both groups: 1) frequency and prominence of respiratory and general symptoms, 2) rarity of clinically apparent extra-thoracic involvement, 3) bacteriological confirmation mostly obtained with respiratory tract specimens, 4) favourable bacteriological outcome, and 5) low mortality attributable to the mycobacterial infection. The most striking differences concerned chest radiography: HIV- patients had apical cavitated and nodular lesions, while HIV+ patients exhibited a variety of other patterns, including alveolar infiltrates, miliary lesions and/or thoracic lymphadenopathy.CONCLUSION: Apart from pulmonary radiographic differences, presentation and short-term outcome of M. kansasii infections were similar in HIV+ and HIV- patients.

Objectifs – Préciser les formes cliniques des tuberculoses survenant sous corticothérapie prescrite pour une maladie inflammatoire (MI), les moyens du diagnostic, l'évolution de la tuberculose et de la MI sous traitement.Patients et méthodes – Analyse rétrospective de neuf observations de patients avec MI ou immunologique traitée par corticoı̈des, compliquée d'une tuberculose confirmée bactériologiquement, entre 1993 et 1998.Résultats – Huit patients avaient plus de 60 ans. La MI évoluait depuis deux mois à 22 ans, avec des doses moyennes journalières ou cumulées de corticoı̈de très diverses. Dans huit cas, plus de deux sites étaient impliqués. Le poumon ou la plèvre étaient atteints dans sept cas, les autres localisations étaient méningées (3) et ostéoarticulaires (3). Le retard diagnostique était lié aux atypies cliniques et radiologiques. Un seul patient a présenté des examens directs positifs. Trois décès et trois cas de séquelles majeures ont été observés. Dans cinq cas, un antécédent tuberculeux aurait pu être suspecté lors de la mise en route de la corticothérapie. Lorsque l'évolution de la tuberculose a été favorable, la MI n'a pas rechuté en cours de traitement antituberculeux, et les doses de corticoı̈des ont été maintenues ou diminuées.Conclusions – Les tuberculoses au cours d'une MI sous corticoı̈des peuvent être graves. Les moyens diagnostiques sont souvent en défaut, particulièrement en urgence, d'où la fréquence d'un traitement antituberculeux d'épreuve. Lors de la mise en route d'un traitement corticoı̈de au long cours, les arguments en faveur d'une tuberculose asymptomatique doivent être recherchés et un traitement prophylactique devrait alors être prescrit systématiquement.Objectives – The authors wanted to describe the clinical presentation and outcome of tuberculosis in patients receiving corticosteroids for an inflammatory disease, determine the means for diagnosis, evaluate risk factors, and suggest a rationale for empiric antituberculous treatment in high risk patients.Methods – A retrospective analysis was made of nine bacteriologically proven tuberculosis cases occurring under corticosteroid treatment for inflammatory or immune disorders, over a six-year period, in three French university hospitals.Results – Eight patients out of nine were over 60. The inflammatory disease had started from two months to 22 years before, cumulated and mean daily corticosteroid doses were heterogeneous. More than one organ was affected by tuberculosis in eight cases. Lungs or pleura were involved in seven cases, central nervous system in three cases, and bones or joints in three cases. Delay for diagnosis was important, because of atypical clinical presentations and rarity of positive smears (1/9). Three deaths and three cases of major sequels were noted. In five cases, a history of tuberculosis could have been suspected at the onset of corticosteroid therapy. No relapse of the inflammatory disease was observed during the treatment for tuberculosis.Conclusion – Tuberculosis can be devastating in patients receiving corticosteroids for an inflammatory disease. Usual diagnostic means are not reliable and early antituberculous treatment should be initiated in high-risk patients. When a corticosteroid treatment is prescribed, risk factors for tuberculosis (old age, emigration from a high-prevalence country, radiological sequels of pulmonary tuberculosis) should be carefully assessed, and prophylactic treatment should be systematically given.