OBJECTIVES:This study assessed real-world effectiveness and safety of switching to dual therapy regimens consisting of an integrase inhibitor (INSTI), and reverse transcriptase inhibitor (RTI), among suppressed people living with HIV in Europe. METHODS:This observational cohort enrolled adults with HIV from 28 sites across Europe who were switching to a two-drug regimen of an INSTI plus a nucleoside reverse transcriptase inhibitor or non-nucleoside reverse transcriptase inhibitor while suppressed [viral load (VL) <50 copies/mL]. Participants were followed from regimen start date (baseline) until the earliest of 96 weeks, regimen discontinuation, loss to follow-up, or death. The primary endpoints were suppression, low-level viraemia (VL ≥50 to <200 copies/mL), and high-level viraemia (VL ≥200 copies/mL) at 24-, 48- and 96-weeks post-baseline, and virologic failure (VF) within 96 weeks (2 consecutive VLs ≥50 copies/mL or 1 VL ≥50 copies/mL followed by regimen discontinuation). Adverse events and discontinuations were also described. RESULTS:737 individuals switched to DTG + 3TC (536, 72.7%), DTG + RPV (186, 25.2%) and other INSTI+RTI regimens (15, 2.0%). At 24-,48-, and 96 weeks of follow up, >98% of individuals with VL data maintained suppression; among VLs ≥50 copies/mL, most (19/23; 82.6%) were low-level viraemia. Five individuals (<1%, DTG + 3TC:2; DTG + RPV:3) experienced VF. Forty-seven non-serious drug-related AEs were reported by 38 participants (5.4%); 2 people experienced serious AEs (0.3%). Regimen discontinuations were infrequent (n = 39, 5.3%) and most commonly attributed to tolerability issues (n = 17). CONCLUSIONS:Among suppressed people living with HIV in a real-world setting, INSTI+RTI two-drug regimens were highly effective and well tolerated over 96 weeks of follow-up.

Introduction:Socioeconomic, behavioral, and psychosocial factors-beyond just biological and hormonal factors-drive sex differences in HIV outcomes. The PROBI study evaluated treatment acceptability, perceived toxicity, and health-related quality of life (HRQL) among people living with HIV (PLWH) switching from multiple antiretroviral therapy to oral dual therapy. Higher treatment discontinuation rates were observed among women, prompting this analysis of sex-based HRQL differences. Methods:HRQL, treatment acceptability, and symptom burden data were collected at treatment switch (D0) and at 1 and 6 months afterward (M1 and M6). Higher scores indicated greater symptom burden (HIV-SI), better HRQL (PROQOL-HIV), or better treatment acceptability. Sex differences were analyzed using appropriate statistical tests, with overtime changes assessed via mixed-effects linear regression models. Results:The study included 260 PLWH (35% women, n = 92), with a mean age of 51 ± 12 years. Compared to men, women were more frequently born in sub-Saharan Africa (46% vs. 12%), had lower educational attainment (20% vs. 41% with university degrees), and higher rates of obesity (29% vs. 9% with BMI ≥ 30). While no virologic failures occurred, treatment discontinuation was higher among women (15% vs. 5%). Over time, all participants showed improvements in symptom burden (-2 points), treatment-related HRQL (+5 points), mental/cognitive HRQL (+4 points), and treatment acceptability (+6 points). However, women consistently demonstrated worse cognitive and mental HRQL scores compared to men (mean difference: -7 points). Conclusion:While dual therapy improved treatment acceptability and HRQL for both sexes, women maintained lower mental and cognitive HRQL scores. Enhanced patient-provider communication may help identify HRQL changes, especially among women who face higher treatment discontinuation risk. Trial Registration:ClinicalTrials.gov identifier: NCT04788784.

Background:Simplification of antiretroviral regimens has the potential to improve both patient-reported outcomes (PROs) and therapeutic adherence in people living with HIV (PLWH). Dual therapy with dolutegravir (DTG) plus lamivudine (3TC) demonstrated good safety and efficacy, but its impact on PROs remains to be documented. Objectives:To evaluate PROs among adult PLWH switching from standard multi-drug therapy to the DTG/3TC combined therapy Dovato®. Design:A non-comparative, 6-month observational study in 25 French medical centers. Methods:Sociodemographic and biomedical data were collected from medical records and PROs from self-administered questionnaires at treatment switch (Day, D0) and at months (M) 1 and 6. Primary endpoints included changes between D0 and M6 in perceived toxicity, treatment acceptability, PLWH's preferences, and the score value of the treatment impact dimension of health-related quality of life (HRQL) (PROQOL-HIV) during follow-up. Secondary endpoints encompassed scores in other HRQL dimensions and self-reported symptoms. Multivariable standard and mixed-effects linear regression models were used to identify factors associated with PRO values and changes over time. Additionally, binary logistic regression was used to identify factors associated with the discontinuation of combined DTG/3TC regimen. Results:In the study population (260 PLWH, 64.6% male, mean ± SD age: 51 ± 12 years, 16 ± 10 years since HIV diagnosis), 20 individuals stopped treatment during follow-up, without resumption. Men, individuals previously receiving abacavir/3TC/DTG, and those with better daily comfort and perceived treatment efficacy were less likely to stop treatment. Treatment impact-related HRQL, acceptability of treatment, and number of self-reported symptoms significantly improved at M1 and M6. Mental and cognitive HRQL improved at M6. Conclusion:Dolutegravir and lamivudine dual oral therapy improved several dimensions in HRQL and delivered a simplified treatment regimen designed for eligible patients, supporting a patient-centered approach to managing HIV care. Attention should be maintained on the reasons for treatment discontinuation, especially among women. Trial registration:Patient-Reported Outcomes HV BItherapy (PROBI) was registered as number NCT04788784 on https://clinicaltrials.gov/study/NCT04788784?term=PROBI&rank=2.

We read with great interest the recent paper from Martín-Carmona et al., who found that HIV does not increase the mortality risk after hepatitis C virus (HCV) cure from direct-acting antivirals (DAA) in people with advanced liver fibrosis [1].By publishing long-term followup data, the authors provide valuable insights into the unresolved question of whether or not HIV increases the risk of mortality after HCV cure.

An oral two-drug regimen (O2DR) in the form of a once-a-day single tablet is now recommended for treatment switching and treatment initiation for HIV. In clinical care, the process of treatment change refers to adaptation issues, both individual and within the care relationship. The study aim is to present the determinants involved in the acceptability of switching to O2DR in the PROBI (Patient-Reported Outcomes BItherapy) qualitative study. The study includes 30 interviews: 15 were conducted with doctors caring for people living with HIV, 15 were conducted with patients who had been offered a change of treatment. A double analysis was carried out: lexicometric analysis to highlight the structuring of the discourse around the change in treatment and a thematic analysis to understand the associated issues more precisely. The results highlighted common concerns with respect to switching to O2DR. Also, the caregiver-patient relationship was a central determinant in treatment switching. Information, knowledge and representations of O2DR are also factors facilitating treatment change and should be taken into account for doctors’ and patients’ adherence.

We assess the performances of the Alinity M STI assay (Abbott Molecular) in comparison to the Xpert CT/NG assay (Cepheid). We first retrospectively used a collection of 70 frozen samples of which 33, 31, and 6 were positives for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and both micro-organisms respectively. The Alinity M STI and the Xpert CT/NG results were in accordance for all. The mean difference in cycle threshold values between the Xpert CT/NG and the Alinity M STI were -1.6 and 0.0 for CT and NG respectively. Then 214 fresh samples collected from 121 patients were prospectively tested with both instruments. Anal swabs, throat swabs, vaginal swabs, and urines accounted each for about 25%. Seven (3.2%) samples of which 5 anal swabs, provided inconclusive results with the Alinity M STI. In conclusion, the Alinity M STI is an accurate device for the microbiological diagnosis of NG and CT infections.

Objectives Migrants from high HIV, hepatitis B virus (HBV) or hepatitis C virus (HCV) endemicity regions have a great burden of these infections and related diseases in the host countries. This study aimed to assess the predictive capacity of the Test Rapide d'Orientation Diagnostique (TROD) Screen questionnaire for HIV, HBV and HCV infections among migrants arriving in France.Design An observational and multicentre study was conducted among migrants. A self-questionnaire on demographic characteristics, personal medical history and sexual behaviours was completed.Setting The study was conducted in the centres of the French Office for Immigration and Integration (OFII).Participants Convenience sampling was used to select and recruit adult migrants between January 2017 and March 2020.Outcome measures Participants were tested for HIV, HBV and HCV with rapid tests. For each infection, the test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy.Results Among 21 133 regular migrants seen in OFII centres, 15 343 were included in the study. The participants’ mean age was 35.6 years (SD±11.1). The prevalence (95% CI) of HBV, HCV and HIV was 2.0% (1.8% to 2.2%), 0.3% (0.2% to 0.4%) and 0.3% (0.2% to 0.4%), respectively. Based on the sensitivity–specificity curve analysis, the cut-off points (95% CI) chosen for the risk score were: 2.5 (2.5 to 7.5) for HBV infection in men; 6.5 (0.5 to 6.5) for HBV infection in women; 9.5 (9.5 to 12.5) for HCV infection; and 10.5 (10.0 to 18.5) for HIV infection. Test performance was highest for HIV (AUC=82.15% (95% CI 74.54% to 87.99%)), followed by that for HBV in men (AUC=79.22%, (95% CI 76.18% to 82.26%)), for HBV in women (AUC=78.83 (95% CI 74.54% to 82.10%)) and that for HCV (AUC=75.95% (95% CI 68.58% to 83.32%)).Conclusion The TROD screen questionnaire showed good overall performance for predicting HIV, HBV and HCV infections among migrants in OFII centres. It could be used to optimise screening for these infections and to propose rapid screening tests to those who are at high risk.Trial registration number NCT02959684.

Vaccine prevention strategies play a crucial role in the management of people living with HIV (PLWH). The aim of this study was to assess vaccination coverage and identify barriers to vaccine uptake in PLWH in the Paris region. A cross-sectional survey was conducted in PLWH in 16 hospitals in the Paris region. The vaccination status, characteristics, opinions, and behaviors of participants were collected using a face-to-face questionnaire and from medical records. A total of 338 PLWH were included (response rate 99.7 %). The median age of participants was 51 years (IQR: 41 -58). Vaccination coverage was 77.3 % for hepatitis B (95 % CI: 72.3 -81.8 %), 62.7 % for hepatitis A (57.3 -67.9 %), 61.2 % for pneumococcal vaccines (55.8 -66.5 %), 56.5 % for diphtheria/tetanus/poliomyelitis (DTP) (51.0 -61.9 %), 44.7 % for seasonal influenza (39.3 -50.1 %), 31.4 % for measles/mumps/rubella (26.4 -36.6 %) and 38.5 % for meningococcal vaccine (13.9 -68.4 %). The main reason for vaccine reluctance was related to the lack of vaccination proposals/reminders. The overall willingness to get vaccinated was 71.0 % (65.9 -75.8 %). In the multivariable analysis, several factors were associated with a higher vaccine uptake; for DTP vaccine: higher education level, having vaccination records, being registered with a general practitioner; for seasonal influenza vaccine: age > 60 years, higher education level, being employed. The overall vaccination coverage was suboptimal. Development of strategies reducing missed opportunity to offer vaccines is needed.

PURPOSE:The influence of human immunodeficiency virus (HIV) infection on clinical outcomes in patients receiving (chemo)radiation therapy (RT) for squamous cell carcinoma of the anus (SCCA) is debated. The objective of this study was to compare efficacy and safety according to HIV status in patients with SCCA treated with C/RT. METHODS AND MATERIALS:Between January 2015 and April 2020, 488 patients with a known HIV status (17.6% HIV+) were treated with radiation therapy for SCCA and included in the FFCD-ANABASE multicentric prospective cohort. Clinical outcomes including overall survival (OS), locoregional recurrence-free survival, colostomy-free survival, response rate at 4 to 6 months, cancer-specific survival, relapse-free survival, and severe acute and late toxicity were compared between HIV+ and HIV- patients. RESULTS:The median follow-up was 35.8 months. HIV+ patients were younger (P < .01) and predominantly male (P < .01). Intensity modulated radiation therapy was performed in 80.7% of patients, and 80.9% received concurrent chemotherapy. A higher proportion of HIV+ patients received induction chemotherapy compared with HIV- patients. No statistically significant difference in overall treatment time or severe acute and late toxicities was found between HIV+ and HIV- patients. In univariate analyses, OS (HR = 2.1 [CI 95% 1.2;3.5], P = .007), locoregional recurrence-free survival (HR = 1.7 [1.1;2.7], P = .02), and colostomy-free survival (HR = 1.7 [1.1;2.6], P = .01) were significantly shorter in HIV+ patients than in HIV- patients. Response rate, cancer-specific survival, and relapse-free survival were not significantly different. The recurrence site was significantly different according to HIV status. In the multivariate analysis, prognostic factors for OS were a World Health Organization performance status of ≥1 for the whole population, as well as HIV+ status for the subgroup of women. CONCLUSIONS:HIV+ patients treated with chemo-RT for SCCA have poorer clinical outcomes, especially women. No difference was found in toxicity according to HIV status with intensity modulated radiation therapy technique.

OBJECTIVE:Adherence to antiretroviral treatment (ART) plays a key role in achieving viral suppression in people living with HIV. We aimed to quantify ART adherence in the entire French HIV-infected population treated in 2019 and to determine factors of influence. METHODS:People living with HIV were identified using HIV diagnosis according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria, HIV-specific laboratory tests, and prescription of antiretrovirals in 2019. Adherence was measured using the medication possession ratio (MPR; actual divided by theoretical number of tablets). Variables of interest included sex, age, type of ART, relevant comorbidities, and receiving supplementary universal health coverage for low-income citizens (CMUc). RESULTS:Of the n = 211 124 people living with HIV identified between 2006 and 2019, we included n = 140 607 on ART with two or more prescription fills in 2019 in this analysis. In total, 87.5% of people living with HIV were receiving ART in 2019. Mean ± standard deviation MPR was 82.5 ± 22.7%; 57% of people living with HIV had an MPR ≥90%, and 12.7% had an MPR <50%. Those with an MPR ≥90% significantly differed between males and females (59.1% and 52.8%, respectively; p < 0.001), and between CMUc recipients and non recipients (54.1% and 57.6%, respectively; p < 0.001). MPR ≥90% rate was lower for those with chronic nephropathy (50.2%), renal failure (46.6%), and tuberculosis (50.1%), and for those using psychoactive substances (52.3%). Factors associated with MPR ≥90% in multivariable analysis were older age, male sex, not receiving CMUc, more recent HIV diagnosis, and triple (vs. dual) ART. CONCLUSION:In 2019, the average MPR in people living with HIV was 82.5% according to the comprehensive French health care database. Besides sociodemographic variables such as older age, male sex, and not being a CMUc recipient (i.e. of low socioeconomic status), more recent HIV diagnosis and triple therapy were independently associated with better adherence, possibly reflecting advances in ART tolerability and dosing.

BACKGROUND:Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. METHODS:Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. RESULTS:During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. CONCLUSION:Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.

BACKGROUND:This study aimed to compare the humoral responses to mRNA COVID-19 vaccination in people living with HIV (PWH) and HIV-negative individuals. METHODS:We included PWH with an undetectable viral load under ART and HIV-negative participants from the French nationwide ANRS COV-POPART cohort who had received two doses of vaccine as a primary vaccination. We compared humoral response between controls and PWH, stratified by CD4 cell count (<200/mm3 and ≥200/mm3 CD4 cell counts) at 1, 6, and 12 months after primary vaccination. RESULTS:A total of 1776 participants were included in this analysis, 684 PWH (99% were on ART, median CD4 counts 673 cells/mm3) and 1092 controls. At 1 month, after adjustment on age, sex, and BMI, PWH had lower seroneutralization titers than controls, and PWH with <200 CD4 cell/mm3 had lower anti-Spike SARS-CoV-2 IgG antibodies. Same results were found at 6 months. However, in participants who received a booster dose between 6 and 12 months postprimary vaccination, we did not observe differences between PWH and controls at 12 months. CONCLUSION:PWH had high responses to primary mRNA COVID-19 vaccination. In those who received a booster dose after 6 months, the humoral response at 12 months increased to similar levels to controls, even in those with low CD4 counts at baseline.

Introduction Clinical research has focused on risk factors and treatment for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), particularly in people with a comorbidity including the human immunodeficiency virus (HIV), but little attention has been paid to the care pathway. This article aims to show how living with HIV may have been a biopsychosocial burden or boost in care pathways for Covid-19. Method People living with HIV (PLHIV) from 9 clinical centers were invited to participate in this qualitative study. The sampling was purposive with a maximum variation in their sociodemographic profiles. Semi-structured interviews were conducted until data saturation, then coded for thematic analysis, using an inductive general approach. Results We interviewed 34 PLHIV of which 20 had SARS-COV-2 once. They were 24 males, 26 born in France; median age: 55. Twenty had a CD4 number above 500, and all were on antiretroviral therapy (ART). HIV appeared as a burden when Covid-19 symptoms reminded HIV seroconversion, fear of contamination, and triggered questions about ART effectiveness. HIV was not considered relevant when diagnosing Covid-19, caused fear of disclosure when participants sought SARS-COV-2 testing, and its care in hospitals was disrupted by the pandemic. ART-pill fatigue caused avoidance for Covid-19 treatment. As a boost, living with HIV led participants to observe symptoms, to get advice from healthcare professionals, and screening access through them. Some participants could accept the result of screening or a clinical diagnosis out of resilience. Some could consider ART or another drug prescribed by their HIV specialist help them to recover from Covid-19. Conclusion Living with HIV could function as a burden and/or a boost in the care pathways for Covid-19, according to patients’ relationship to their HIV history, comorbidities and representation of ART. Covid-19 in PLHIV needs further qualitative study to gain a more comprehensive assessment of the pandemic’s consequences on their lives and coping strategies.

Introduction L'étude PROBI visait à évaluer les motivations rapportés par des PvVIH en suppression virologique qui changent de traitement pour une bithérapie DTG/3TC (STR) ainsi que les motifs liés à l'arrêt de ce nouveau traitement. Matériels et méthodes PROBI est une étude prospective, mono-bras, en vie réelle dont les données ont été recueillies à l'initiation de DTG/3TC (M0) puis 1 (M1) et 6 mois plus tard (M6). Outre les motifs d'initiation et d'arrêt de DTG/3TC, l'étude comprenait une échelle d'acceptabilité du traitement ainsi qu'une échelle de toxicité et de préférence perçue, auto-évaluées par les patients. Un modèle de régression logistique multivariée sur les motifs d'arrêt a complété l'analyse. Résultats Entre avril 2021 et mai 2023, 260 PvVIH ont été inclus dans 25 centres, dont 65 % d'hommes de 51 ans (±12) en moyenne. A M0, 99 % avaient une charge virale < 50 copies/mL. Les principales raisons d'initiation du DTG/3TC (choix multiples) étaient l'allègement ou simplification du traitement pour 86,9% (n=226) des patients, la prévention de toxicité à long terme pour 19,2% (n=50) et des effets indésirables pour 22,3% (n= 58) (dont toxicité rénale (n=18)).Au cours de l'étude, 20 patients (7,7%) ont arrêté le DTG/3TC avec comme principales raisons rapportées (choix multiples) des troubles neuropsychiatriques (n=9), des demandes spécifiques des patients (n=6, ex : "perte d'appétit" (n=1)), des troubles digestifs (n=5), des troubles ostéoarticulaires (n=4), d'autres signes cliniques non précisés (n=4) ou une prise de poids (n=3).Après ajustement sur l'âge et la durée d'infection au VIH, les facteurs associés à l'arrêt du DTG/3TC étaient le fait d'être une femme avec un Odd Ratio ajusté (ORa) (IC 95%) de 3,09 (1,05 - 9,57) et la prise d'antidépresseurs au cours des 6 derniers mois (ORa (IC95%) 4,65 (0,88 - 20,55) (p=0,05)). A l'inverse, les patients sous traitement DTG/3TC/ABC avant l'étude et ceux rapportant un meilleur score à la dimension confort au quotidien et efficacité perçue (échelle de toxicité) étaient moins susceptibles d'arrêter le DTG/3TC au cours de l'étude, avec un ORa de 0,05 (IC95%) (0,00 - 0,30) et un ORa de 0,95 (IC95%) (0,91 - 0,98), respectivement. Conclusion Dans PROBI, l'allègement, la prévention de la toxicité et des effets indésirables étaient les principaux motifs d'un changement vers DTG/3TC. Les PvVIH qui ne recevaient pas de nouvelles molécules antirétrovirales et qui percevaient une meilleure efficacité et un meilleur impact sur leur quotidien arrêtaient moins leur traitement par DTG/3TC. Suivre l'impact sur la qualité de vie de ce changement de traitement reste important particulièrement chez les femmes ou chez les patients sous antidépresseurs.Liens d'intérêts déclarés :Conflits d'intérêt avec Viiv Healthcare, Gilead et Merck. Etude financée par Viiv Healthcare mais avec indépendance de l'équipe de recherche sur les choix opérées pour le schéma d'étude, le recueil, l'analyse et l'interprétation des résultats.

Les personnes vivant avec le VIH (PVVIH) bénéficient de traitements efficaces permettant de stabiliser leur maladie. Toutefois, les PVVIH sont plus touchées par des comorbidités. Les objectifs de cette étude étaient d'estimer la mortalité des PVVIH et l'impact des autres comorbidités sur la mortalité. Une cohorte de PVVIH a été constituée entre 2006 et 2019 à partir du Système national des données de santé (SNDS) et suivies jusqu'en 2019. Ils ont été appariés à des témoins selon l'âge et le sexe. La mortalité a été comparée entre les deux groupes. Les comorbidités ont été identifiées à partir d'algorithmes utilisés dans cette base de données (codes CIM-10 des ALD et/ou d'hospitalisations, médicaments, etc.). Un modèle de Cox a permis d'estimer le risque accru de décès. L'impact des comorbidités a été estimé en ajustant ce modèle sur ces comorbidités. Un total de 173 712 PVVIH et leurs témoins ont été suivis. L'âge moyen à l'inclusion était de 42 ans et 66 % étaient des hommes. Une augmentation significative des taux de mortalité a été observée chez les PVVIH avec un Hazard Ratio (HR) de 2,1 (IC95 %=[2,0; 2,2]). Le HR était de 1,961 (IC95%=[1,898; 2,027]) pour les hommes et de 2,966 (IC95%=[2,767; 3,180]) pour les femmes. Le HR était plus élevé chez les jeunes PVVIH : 3,5 [sujets 18-30[ans, 3,7 [30-40[, 2,9 [40-50[, 1,7 [50-60[, 1,5 [60-70[, 1,4 [70-80 [. La surmortalité était essentiellement due aux maladies infectieuses: le HR est passé de 2,1 à 1,6 après ajustement sur les maladies infectieuses. L'infection à VIH double le risque de décès comparativement à une population de sujets non affectée par cette maladie et appariée par âge et sexe et les maladies infectieuses expliquent la moitié de cette surmortalité. La surmortalité relative est plus élevée chez les femmes et les jeunes patients. Des actions de santé publiques pourraient permettre d'améliorer cette situation. VIH ; Comorbidités ; Mortalité ; Surmortalité Les auteurs déclarent ne pas avoir de liens d'intérêts.