BACKGROUND:Doravirine, the most recent NNRTI, may advantageously replace etravirine in virally suppressed PWH. We evaluated the tolerance and efficacy of doravirine-based ART following a switch from etravirine-based ART. METHODS:SWEED is a national, multicentre, retrospective, observational study including adults with HIV-1 and plasma viral load (pVL) <50 copies/mL on etravirine-based ART, who switched to doravirine-based ART (same number of associated drugs) from 09/01/2019 in 10 French hospitals. The primary outcome was virological failure (VF: confirmed pVL ≥50 copies/mL or single pVL ≥50 with ART change) at week 48 (W48). Secondary outcomes included rates of strategy success (pVL <50 copies/mL with no ART change) and treatment discontinuations due to side effects, and changes in CD4 counts and weight. RESULTS:Among 109 participants (79% men; median age 59 years), median ART duration was 25 years, with 13 years of sustained viral suppression. Prior NNRTI failure was documented in 41% of participants, and 46% had resistance mutations to at least one NNRTI. ART consisted of 2-drug (53%) and 3-drug (42%) combinations. Median follow-up was 30 months. One VF occurred by W48 (0.9%, 95%CI: 0.0-5.0); viral suppression was regained without ART change. Four patients discontinued doravirine-based ART due to adverse events; strategy success rate was 91.7% (95% CI: 84.9-96.2) at W48. No significant changes in CD4 counts and weight were observed. CONCLUSION:Doravirine-based ART maintained virological suppression in PWH switching from etravirine-based ART, even in presence of prior NNRTI resistance. Its once-daily dosing, favourable safety profile, and minimal drug interactions support its use in long-term ART strategies.

We report the occurrence of low-level hepatitis B virus (HBV) viremia in people with HIV with controlled CD4 counts and isolated core antibody reactivity switched to long-acting injectable cabotegravir/rilpivirine. This series raises questions about the reintroduction of anti-HBV medications, presents the variation of several HBV markers alongside HBV-DNA and reveals an effective spontaneous immune response.

Introduction Dans un contexte d'accroissement continu des dépenses de santé, la création et la promotion de stratégies permettant de réduire les coûts sans compromettre l'efficacité des soins et la survie des patients, tout en ayant un potentiel impact positif sur leur qualité de vie, suscitent un intérêt majeur. Dans le cadre de la prise en charge du VIH, le recours à un conditionnement trimestriel (CT) des antirétroviraux pourrait permettre de réaliser des économies substantielles. Cette étude vise à évaluer l'impact budgétaire du recours à un CT des antirétroviraux en France, sur un horizon temporel allant de 2020 à 2024. Méthodes Cette étude d'impact budgétaire a été réalisée du point de vue de l'Assurance maladie, en prenant en compte le coût des antirétroviraux. Elle repose sur un modèle de simulation à base d'agents préalablement entraîné sur les données de la base DAT'AIDS, qui regroupe les informations relatives à la prise en charge de patients atteints du VIH issues du dossier médical électronique Nadis. L'analyse d'impact budgétaire a ainsi été menée en comparant les coûts engendrés par les trajectoires de traitement des patients, simulées à partir du modèle selon différents scénarios prédéfinis portant sur le taux de patients favorables au CT et son tarif. Résultats Pour chacun des 12 scénarios envisagés, les trajectoires ont été simulées en prenant comme point de départ les dernières données connues pour les 52,239 patients inclus dans DAT'AIDS. Les économies potentielles dues à l'utilisation du CT des antirétroviraux entre 2020 et 2024 variaient alors de 63,88 millions d'euros ([63,70 ; 64,10]) à 459,15 millions d'euros ([458,58 ; 459,66]) en fonction du scénario considéré. Ces économies étaient principalement liées au taux de patients favorables au CT. Conclusion Un conditionnement trimestriel des antirétroviraux pourrait ainsi entraîner d'importantes économies pour l'Assurance maladie, qui semblent principalement impactées par le taux de recours à ce conditionnement. Une enquête menée à l’échelle nationale par Jacomet et al. met notamment en avant un taux de 85,6 % d'avis favorables à un tel conditionnement chez un panel de 999 patients vivant avec le VIH interrogés, les principaux bénéfices perçus étant alors une confidentialité et une commodité accrues, ainsi qu'un risque amoindri de pénurie du traitement en fin de mois.

Background A pilot HIV testing programme, Au Labo sans Ordo (ALSO; “to the laboratory without prescription”) was implemented in two French Fast-Track Cities Initiative areas from 07/2019 to 12/2020. ALSO aimed to remove barriers to HIV testing by providing free testing with widespread access through all laboratories, extended opening hours, and no prescription requirements. Objectives Assessing the ALSO programme in terms of testing activity, user characteristics, and costs, compared to other HIV testing offers. Methods Laboratories and STI clinics reported the monthly numbers of tests performed and positive tests. Two short surveys were carried out 12 months apart in people who sought HIV testing. In each offer, the mean costs of HIV testing have been estimated according to negative or positive results using a microcosting approach. Results During the study period, 214/264 laboratories reported performing 38,941 ALSO tests that accounted for 7.2% of laboratory HIV testing activity. Positivity rates of ALSO and prescribed tests were similar (2.2/1000) but lower than that in STI clinics (6.0/1000). Heterosexual men, and individuals with multiple sexual partners, poor health insurance and few visits to GPs were more likely to use the ALSO offer than tests upon prescription. Compared to ALSO, STI clinic users were younger, more exposed to HIV and with a less favourable socio-economic situation. ALSO had low costs: €13 for a negative test, €163 for a positive test and €5,388 to identify an HIV-positive person (versus €9,068 in STI clinics and €20,126 with prescribed tests). Conclusion ALSO has attracted users less likely to visit STI clinics or to seek a prescribed test, particularly heterosexual men. Activities, user profiles and costs suggested the complementarity of the HIV testing offers and the relevance of making them coexist. French health authorities have decided to maintain and expand this programme to complement existing HIV testing offers.

Paget's disease of bone (PDB) has rarely been reported in people with HIV (PWH). We describe the prevalence and characteristics of patients with PDB in the French multicenter Dat'AIDS cohort. Among 49 698 PWH actively followed in 2022, 9 had a diagnosis of PDB. The overall prevalence of PDB was 0.02% [95% confidence interval (CI) 0.01-0.03]. The prevalence of PDB in PWH is very low and does not appear to differ from the non-HIV population.

UNAIDS has established targets to end the AIDS epidemic by 2030. Initial 90-90-90 targets were to ensure that 90% of all people with HIV know their status, 90% of all people with diagnosed HIV are receiving antiretroviral therapy (ART), and that 90% of all people receiving ART have viral suppression. These targets were updated to achieving 95-95-95 by 2025. 1 Frescura L Godfrey-Faussett P Feizzadeh AA El-Sadr W Syarif O Ghys PD Achieving the 95 95 95 targets for all: a pathway to ending AIDS. PLoS One. 2022; 17e0272405 Crossref PubMed Scopus (91) Google Scholar This treatment continuum, or cascade of care, divides the process by which individuals and populations progress from HIV acquisition to ongoing viral suppression into discrete steps. Most studies assessing the HIV care cascade provide cross-sectional estimates of the proportion of individuals in particular steps on a given date. 2 Cuzin L Allavena C Pugliese P et al. Can the "seek, test, treat, and retain" strategy be effective in France?. J Acquir Immune Defic Syndr. 2013; 62: e119-e121 Crossref PubMed Scopus (3) Google Scholar , 3 Vourli G Noori T Pharris A et al. Human immunodeficiency virus continuum of care in 11 European Union countries at the end of 2016 overall and by key population: have we made progress?. Clin Infect Dis. 2020; 71: 2905-2916 Crossref PubMed Scopus (14) Google Scholar However, these cascades of care offer incomplete pictures of the care continuum, because as the targets are being approached, they will have little capacity to change. Therefore, such cascades make poor evaluation markers for programmes designed to enhance engagement in care. Moreover, the cascades do not provide any information on the elapsed times between steps, nor between acquiring HIV and reaching viral suppression. This information is crucial to identify the barriers that delay access to ART and viral suppression and, hence, to limit new virus transmissions and thereby end the AIDS epidemic. Transition times across the HIV care continuum in Spain from 2005 to 2022: a longitudinal cohort studyThe great improvement in transition times through the HIV care cascade might put Spain on the verge of achieving the UNAIDS targets for HIV elimination. However, late diagnosis remains a challenge that should be addressed. Full-Text PDF

Introduction La prise en soins des personnes vivant avec le VIH (PVVIH) reste primordiale dans le contexte d’évolution de leur suivi. L'objectif de cette enquête de pratique était d’évaluer l'approche et la vision des jeunes infectiologues concernant la prise en soins des PVVIH pour les dix prochaines années. Méthode Le questionnaire a été élaboré par un comité scientifique et diffusé en 2023 via le Réseau des Jeunes Infectiologues Français (RéJIF) auprès de 680 jeunes infectiologues français. Résultats Cent vingt (120) infectiologues ont répondu : 52 participants (43 %) étaient des internes en cours de formation, et un quart étaient titulaires d'un diplôme universitaire spécialisé en VIH. Les trois quarts des répondants prenaient en charge des PVVIH en consultation, et pour la quasi-totalité des répondants en hospitalisation.Le VIH est placé en troisième position des thématiques d'intérêt d'infectiologie, avec une demande majoritairement exprimée (dans 84 % des cas) d'améliorer la place qui lui est accordée dans l'enseignement durant l'internat. L'infectiologie était perçue par les répondants comme devant avoir un rôle pour les dix années à venir principalement dans la prise en soins initiale des PVVIH, la gestion de l’échec thérapeutique, la gestion des cas complexes et des co-infections (hépatites/IST), ainsi que pour les modifications du traitement antirétroviral. Les jeunes infectiologues ont souligné le potentiel de la téléexpertise pour le renouvellement du traitement antirétroviral et la mise à jour du calendrier vaccinal. Conclusion L'intérêt des jeunes infectiologues pour la prise en soins des PVVIH a été confirmé par cette enquête nationale. La consolidation de la formation dédiée ainsi que le développement de la téléexpertise ciblée sont les axes de développement principaux identifiés pour l'avenir de la spécialité.

BACKGROUND:Aspirational targets to end AIDS by 2030 include having 95% of people with human immunodeficiency virus (HIV; PWH) diagnosed, 95% treated, and 95% with controlled viral load (VL). Our objective was to describe, using a large French prospective cohort, the median transition times through the cascade of care between 2009 and 2019.METHODS:We analyzed patients whose first HIV diagnosis was made between 1 January 2009 and 31 December 2019. Using the Kaplan-Meier method, we estimated the time to linkage to care (from HIV diagnosis to first biological assessment), to treatment (date of first antiretroviral therapy [ART] prescription), and to controlled VL (first value <200 copies/mL). Analyses were disaggregated by time periods and patients' characteristics. Censoring date was 31 December 2021.RESULTS:Among the 16 864 patients linked to care since 2009, the median [Q1; Q3] time from HIV diagnosis to controlled VL decreased from 254 [127-745] to 73 [48-132] days in 2009-2011 and 2018-2019, respectively. Transition times from linkage to care to first ART decreased from 67 [17; 414] in 2009-2011 to 13 [5; 26] days in 2018-2019, and from ART to controlled VL from 83 [35; 130] in 2009-2011 to 38 [28; 90] days in 2018-2019. Differences were observed depending on patients' characteristics.CONCLUSIONS:We describe drastic reductions in transition time through the cascade of care, allowing reduction in the transmission period following each new infection. Delayed diagnosis remains the main obstacle to ending AIDS in the next decade.

Objectives The impact of the systematic screening of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in men having sex with men (MSM) on these pathogens' epidemiology remains unclear. We conducted a modelling study to analyse this impact in French MSM. Methods We modelled NG and CT transmission using a site-specific deterministic compartmental model. We calibrated NG and CT prevalence at baseline using results from MSM enrolled in the Dat'AIDS cohort. The baseline scenario was based on 1 million MSM, 40 000 of whom were tested every 90 days and 960 000 every 200 days. Incidence rate ratios (IRRs) at steady state were simulated for NG, CT, NG and/or CT infections, for different combinations of tested sites, testing frequency and numbers of frequently tested patients. Results The observed prevalence rate was 11.0%, 10.5% and 19.1% for NG, CT and NG and/or CT infections. The baseline incidence rate was estimated at 138.2 per year per 100 individuals (/100PY), 86.8/100PY and 225.0/100PY for NG, CT and NG and/or CT infections. Systematically testing anal, pharyngeal and urethral sites at the same time reduced incidence by 14%, 23% and 18% (IRR: 0.86, 0.77 and 0.82) for NG, CT and NG and/or CT infections. Reducing the screening interval to 60 days in frequently tested patients reduced incidence by 20%, 29% and 24% (IRR: 0.80, 0.71 and 0.76) for NG, CT and NG and/or CT infections. Increasing the number of frequently tested patients to 200 000 reduced incidence by 29%, 40% and 33% (IRR: 0.71, 0.60 and 0.67) for NG, CT and NG and/or CT infections. No realistic scenario could decrease pathogens' incidence by more than 50%. Conclusions To curb the epidemic of NG and CT in MSM, it would not only be necessary to drastically increase screening, but also to add other combined interventions.

Objectives To analyse the occurrence of virological failure (VF) in patients starting ART with an integrase strand transfer inhibitor (INSTI)-based regimen in recent years, in relation with previous episodes of low-level viral load (LLVL). Patients and methods Patients starting a first ART between 1 January 2015 and 31 December 2020 based on two NRTIs and one INSTI were included if after virological control (two measures of VL < 50 copies/mL) they had a minimum of two additional VL measurements. Cox models adjusted for sex, age, acquisition group, hepatitis B or C coinfection, place of birth, year of ART initiation, CD4+ T cells and VL at ART initiation, duration of known HIV infection and of ART regimen were used to assess the association between the time to VF and the occurrence of LLVL. ART regimen was evaluated as time-varying covariate. Results LLVL was described in 13.7% and VF in 11% of the 3302 patients. LLVL was associated with VF [adjusted HR (aHR) 1.76, 95% CI 1.28-2.41], as well as age (aHR 0.97/year, 95% CI 0.96-0.98), CD4+ T cell count at ART initiation (aHR 0.93, 95% CI 0.87-0.98), heterosexual transmission (aHR 1.76, 95% CI 1.30-2.37) and being born abroad (aHR 1.50, 95% CI 1.17-1.93). Conclusions LLVL was related to VF. Even in the absence of subsequent failure, LLV episodes have a cost. Thus any VL value above 50 copies/mL should lead to enhanced adherence counselling.

Background In the past years, we observed a sharp increase of Syphilis, especially among male who have sex with male (MSM), either HIV-infected, or on pre-exposure prophylaxis (PrEP). Our aim was to assess syphilis prevalence and incidence among people living with HIV (PLWH) and PrEP users. Methods PLWH were included from 2010 to 2020 and PrEP users from 2016 to 2020 from the Dat'AIDS French cohort. We calculated syphilis prevalence and incidences for first infections, re-infections, and iterative infections (> 2 times). T-Tests, Wilcoxon tests and Chi2 test were used for descriptive analysis and multivariate logistic regression models were used to estimate Odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with syphilis. Results Among the 8 583 PLWH, prevalence of subject with past or present syphilis was 19.9%. These subjects were more likely MSM or transgender and aged over 35 years, but prevalence was lower in AIDS subjects. Same pattern was seen for incident infection and re-infection. Incidence was 3.8 per 100 person-years for infection and 6.5 per 100 person-years for re-infection. Among 1 680 PrEP users, syphilis prevalence was 25.8%, with an estimated 7.2% frequency of active syphilis. Risk of syphilis infection was higher in male and increased with age. Incidence was 11.2 per 100 person-years for infection and 11.1 per 100 person-years for re-infection. Conclusion Syphilis prevalence and incidence were high, especially in older MSM with controlled HIV infection and PrEP users, enhancing the need to improve syphilis screening and behavioral risk reduction counseling among high-risk subjects.

Introduction We examined comorbidities, comedications and polypharmacy among people living with HIV (PLHIV) and associated challenges with HIV antiretroviral therapy (ART). Methods A cross-sectional design was used in web-based surveys conducted during 2019 in France, Germany, Italy, and the UK. Pooled sample comprised 120 internists/infectious disease specialists managing ≥50 HIV patients, and 1171 adult PLHIV combined who participated in two separate surveys, the Positive Perspective Survey (n=483), and the Unmet Needs Survey (n=688). The outcomes were perceptions and behaviors towards ART based on PLHIV and healthcare provider (HCP) perspectives. Results According to HIV physicians, challenges associated with comedications were a major reason for their patients not starting ART, or stopping, switching, or skipping their HIV treatment after they started. In total, 16.8% of providers indicated that their patients had not started ART because of medical reasons/comorbidities that interfered with dosing (France 21.7%, Germany 15.4%, Italy 6.9%, and UK 24.1%). Other reasons cited by providers for patients not starting HIV treatment were: concerns about drug tolerability/ side effects (overall 34.6%, France 39.1%, Germany 34.6%, Italy 27.6%, and UK 37.9%); concerns about long-term toxicities (overall 26.2%, France 39.1%, Germany 26.9%, Italy 24.1%, and UK 17.2%), as well as concerns about drugdrug interactions (overall 16.8%, France 13.0%, Germany 26.9%, Italy 17.2%, and UK 10.3%). Averaged across all ART regimen types, the percentage of PLHIV in the Unmet Needs Study who indicated that they needed monitoring when taking other medications with their ART was 5.8%, 15.9%, and 24.1% among those with none, 1, or ≥2 non-HIV comorbidities, respectively. Within the Positive Perspectives Survey, overall prevalence of polypharmacy was 38.8% (France 41.9%,Germany 24.2%, Italy 40.8%, and UK 48.0%). Compared to those without polypharmacy, those reporting polypharmacy had lower odds of reporting viral suppression (adjusted odds ratio, AOR=0.40) and optimal overall health (AOR=0.65); they were however more likely to be worried about taking more medicines as they grew older (AOR=2.15), and to be more concerned how their ART might affect other medicines they took (AOR=2.35) (all p<0.05). Conclusions A significant unmet need remains for PLHIV relating to co-management of comorbidities and associated challenges such as polypharmacy. Polypharmacy was associated with suboptimal self-rated health and concerns about the risk of long-term negative impacts from ART intake. Holistic care that provides simplified regimens to medically complex patients can help improve treatment outcomes.

BACKGROUND:We aimed to evaluate the incidence rates between 2010 and 2015 for invasive cervical cancer (ICC), breast cancer (BC), and colorectal cancer (CRC) in people living with HIV (PLWH) in France, and to compare them with those in the French general population. These cancers are targeted by the national cancer-screening program.SETTING:This is a retrospective study based on the longitudinal data of the French Dat'AIDS cohort.METHODS:Standardized incidence ratios (SIR) for ICC and BC, and incidence rates for all three cancers were calculated overall and for specific sub-populations according to nadir CD4 cell count, HIV transmission category, HIV diagnosis period, and HCV coinfection.RESULTS:The 2010-2015 CRC incidence rate was 25.0 [95% confidence interval (CI): 18.6-33.4] per 100,000 person-years, in 44,642 PLWH (both men and women). Compared with the general population, the ICC incidence rate was significantly higher in HIV-infected women both overall (SIR = 1.93, 95% CI: 1.18-3.14) and in the following sub-populations: nadir CD4 ≤ 200 cells/mm3 (SIR = 2.62, 95% CI: 1.45-4.74), HIV transmission through intravenous drug use (SIR = 5.14, 95% CI: 1.93-13.70), HCV coinfection (SIR = 3.52, 95% CI: 1.47-8.47) and HIV diagnosis before 2000 (SIR = 2.06, 95% CI: 1.07-3.97). Conversely, the BC incidence rate was significantly lower in the study sample than in the general population (SIR = 0.56, 95% CI: 0.42-0.73).CONCLUSION:The present study showed no significant linear trend between 2010 and 2015 in the incidence rates of the three cancers explored in the PLWH study sample. Specific recommendations for ICC screening are still required for HIV-infected women and should focus on sub-populations at greatest risk.

Objectives: As trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. Study design: We performed a retrospective cohort study using data from the mainland French Dat'AIDS cohort. Methods: Data were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. Results: Between 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat'AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (-38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (-43.6%), P < 0.01, than in those born abroad (-23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was -46.7% among men who have sex with men (MSM), -43.5% for heterosexual women and -33.3% for heterosexual men. Conclusion: Our findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention. (C) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Background. The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV-coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat'AIDS cohort. Methods. This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors. Results. From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018. Conclusions. A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.

BACKGROUND In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count. METHODS To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis. RESULTS During the study period, 61 822 patients were followed in the Dat'AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39-33.47) months in 2007 to 0.77 (IQR, 0.37-1.60) months in 2017. A decrease in PHI (-35.1%) and PRHI (-25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8-2014.4) and 2013.1 (95% CI, 2011.3-2014.8), respectively. CONCLUSIONS Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017. CLINICAL TRIALS REGISTRATION NCT02898987.

BACKGROUND:We assessed prevalence of multimorbidity (MM) according to year of human immunodeficiency virus (HIV) diagnosis in elderly people living with HIV (PLWH). METHODS:This was a cross-sectional study of MM in PLWH aged ≥70 years from the Dat'AIDS French multicenter cohort. MM was defined as at least 3 coexistent morbidities of high blood pressure, diabetes mellitus, osteoporosis, non-AIDS cancer, chronic renal failure, cardiovascular and cerebrovascular disease, obesity, undernutrition, or hypercholesterolemia. Logistic regression models evaluated the association between MM and calendar periods of HIV diagnosis (1983-1996, 1997-2006, and 2007-2018). The secondary analysis evaluated MM as a continuous outcome, and a sensitivity analysis excluded PLWH with nadir CD4 count <200 cells/μL. RESULTS:Between January 2017 and September 2018, 2476 PLWH were included. Median age was 73 years, 75% were men, median CD4 count was 578 cells/μL, and 94% had controlled viremia. MM prevalence was 71%. HBP and hypercholesterolemia were the most prevalent comorbidities. After adjustment for age, gender, smoking status, hepatitis C and hepatitis B virus coinfection, group of exposure, nadir CD4 count, CD4:CD8 ratio, and last CD4 level, calendar period of diagnosis was not associated with MM (P = .169). MM was associated with older age, CD4/CD8 ratio <0.8, and nadir CD4 count <200 cells/μL. Similar results were found with secondary and sensitivity analyses. CONCLUSIONS:MM prevalence was high and increased with age, low CD4/CD8 ratio, and nadir CD4 count <200 cells/μL but was not associated with calendar periods of HIV diagnosis. Known duration of HIV diagnosis does not seem to be a criterion for selecting elderly PLWH at risk of MM.

Background: Cancer risk is higher in people living with HIV (PLWH) compared with the general population, and cancers related to age are expected to be most prevalent. Methods: We determined the spectrum and incidence rates of AIDS-defining cancers (ADC) and non–AIDS-defining cancers (NADC) and of lung, Hodgkin lymphoma (HL), head and neck (HNC), colon–rectum, anal, liver, breast, prostate, and urinary bladder cancers between January 2010 and December 2015 in the French Dat'AIDS cohort. Incidence rates were calculated by year and compared using the χ2 test for linear trend. Standardized incidence ratios [SIR (95% confidence interval)] were calculated relative to the French general population. Results: Among 44,642 patients, corresponding to 180,216.4 person-years (PY), 1,440 cancer cases occurred in 1,314 patients. ADC incidence was 191.4 (172.3–212.7)/105 PY and declined over time overall and in men, whereas NADC incidence was higher [548.8 (515.6–584.1)/105 PY] and did not change. In men, non-Hodgkin lymphoma was the most common cancer, but prostate cancer had the highest incidence among NADCs. Breast cancer was the most common cancer in women. SIRs were higher for cervical cancer [1.93 (1.18–3.14)], HNC in women [2.4 (1.4–4.2)], liver [overall: 3.8 (3.1–4.6); men: 3.2 (2.5–4.0); women: 12.9 (8.3–20.0)], and HL [overall: 13.8 (11.1–17.1); men: 16.2 (12.9–20.4); women: 6.2 (3.22–11.9)] but lower for lung [overall: 0.7 (0.6–0.9); men: 0.7 (0.5–0.8)], prostate [0.6 (0.5–0.7)], and breast cancers [0.6 (0.4–0.7)]. Conclusions: Spectrum of NADCs has changed, with prostate and breast cancers becoming the most common despite their lower SIR. Impact: These results confirm the need to maintain regular epidemiologic cancer monitoring in order to update screening guidelines.

Background Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV-infected people. Objective To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. Methods Retrospective study using longitudinal data from 44 642 patients in the French Dat'AIDS multicenter cohort. Patients' characteristics were described at KS diagnosis according to ART exposure and to HIV-plasma viral load (HIV-pVL) (<= 50 or >50) copies/mL. Results Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naive patients, 17.3% in ART-experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV-pVL <= 50 cp/mL, and 16 (66%) were treated with a boosted-PI-based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. Limitations Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. Conclusion Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV-pVL <= 50 cp/mL remain to be explored.