We investigated people living with HIV (PLWH)'s exposure to COVID-19 pandemic stressors and their association with distress, psychological growth, and substance use. PLWH in the ANRS CO3 AQUIVIH-NA cohort's QuAliV study (Nouvelle Aquitaine, France) completed an adapted CAIR Lab Pandemic Impact Questionnaire (C-PIQ) and reported substance use between 9/2021 to 3/2022. We described cumulative stressor exposure (score 0-16) and explored variation by PLWH characteristics (demographic, HIV-related, risk factors, psychosocial). Associations with distress (score 0-23), psychological growth (score 0-20), and substance use were assessed using regression models. Participants reported exposure to a median of 2 (IQR: 1-4) stressors. Stressor exposure was higher in working-age (<60) and psychosocially vulnerable PLWH. Exposure to an additional stressor correlated with a 0.7-point increase in distress scores (95% C.I. 0.5-1.0, p<0.001), a 0.04-point increase (95% C.I. 0.01-0.07, p=0.002) in psychological growth scores in working-age PLWH. In older PLWH, additional stressor correlated with a 0.8-point (95% C.I. 0.4-1.2, p<0.001) increase in distress and a 0.1-point increase (95% C.I. 0.06-0.2, p=0.001) in growth scores. Each additional stressor was associated with 1.2 (95% C.I. 1.0-1.4, p=0.02) higher adjusted odds of cannabis use in working-age PLWH, and 1.2 (95% C.I. 1.0-1.4, p=0.004) higher adjusted odds of drug use. Exposure to stressors was linked to increased distress, cannabis and drug use but also growth. Providers should not only be aware of risk (of severe COVID-19) but also be mindful of the social and psychological challenges PLWH face as these may affect their retention in care, especially during challenging times.

A low allele burden (i.e., <20%) of the CALR driver mutation is found in 10.8% of CALR-mutated MPNs, mostly in essential thrombocythemia, and correlates with a milder phenotype and a more indolent evolution compared to patients with an allele burden ≥20%.

Objectives: The COVID-19 pandemic's impact on initiation and effectiveness of antiretroviral therapy (ART) in people diagnosed with HIV remains unclear. We evaluated critical delays in HIV care in people diagnosed before and during the pandemic in ex-Aquitaine, France. Methods: We considered adults diagnosed with HIV-1 in 2018–2021 and enrolled in the ANRS CO3 AQUIVIH-NA and followed them until October 10, 2022 for those diagnosed during the pandemic (April 01, 2020–December 31, 2021) and until March 31, 2020 for historical controls. We compared their characteristics at inclusion and the median time between diagnosis and ART initiation, ART initiation and viral suppression, and diagnosis and virologic, suppression (effective management). Results: Eighty-three individuals were diagnosed during the pandemic versus 188 during the prepandemic period. Median follow-up was 549 (interquartile range: 329–713) days. Populations were similar in sex, age, HIV acquisition mode, hospital type, and clinical characteristics at diagnosis; however, fewer were foreign-born during the pandemic (15.7% versus 33.5%, P = 0.003). The probability of ART initiation, therapeutic success, and effective management was higher in people living with HIV (PLWH) diagnosed during the pandemic in adjusted analyses (hazard ratio [HR]: 2.0; 95% CI: 1.5 to 2.7; HR: 1.7; 95% CI: 1.2 to 2.3; HR: 1.8; 95% CI: 1.3 to 2.6, respectively). Those diagnosed during the pandemic were 2.3 (95% CI: 1.2 to 4.1) times more likely to be virologically suppressed within six months of diagnosis compared with historical controls. Conclusions: Pandemic-related reorganizations may have resulted in newly diagnosed PLWH being prioritized; however, the lower proportion of foreign-born PLWH diagnosed during the pandemic period, likely because of reduced migration and potential delays in diagnosis, may contribute to these preliminary findings.

Background. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19. Methods. Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25-100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs). Results. The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P = .01; hypotension: 30.4% vs 15.3%, respectively, P < .001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval, .47-2.64]; P = .81), nor did organ dysfunction or secondary outcomes. Conclusions. Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19.

Background Venous thromboembolism is a major complication of coronavirus disease 2019 (COVID-19). We hypothesized that a weight-adjusted intermediate dose of anticoagulation may decrease the risk of venous thromboembolism COVID-19 patients.Methods In this multicenter, randomised, open-label, phase 4, superiority trial with blinded adjudication of outcomes, we randomly assigned adult patients hospitalised in 20 French centers and presenting with acute respiratory SARS-CoV-2. Eligible patients were randomly assigned (1:1 ratio) to receive an intermediate weight adjusted prophylactic dose or a fixed-dose of subcutaneous low-molecular-weight heparin during the hospital stay. The primary outcome corresponded to symptomatic deep-vein thrombosis (fatal) pulmonary embolism during hospitalization (COVI-DOSE ClinicalTrials.gov number: NCT04373707).Findings Between May 2020, and April 2021, 1000 patients underwent randomisation in medical wards (noncritically ill) (80.1%) and intensive care units (critically ill) (19.9%); 502 patients were assigned to receive a weight-adjusted intermediate dose, and 498 received fixed-dose thromboprophylaxis. Symptomatic venous thromboembolism occurred in 6 of 502 patients (1.2%) in the weight-adjusted dose group and in 10 of 498 patients (2.1%) in the fixed-dose group (subdistribution hazard ratio, 0.59; 95% CI, 0.22-1.63; P = 0.31). There was a twofold increased risk of major or clinically relevant nonmajor bleeding: 5.9% in the weight-adjusted dose group and 3.1% in the fixed-dose group (P = 0.034).Interpretation In the COVI-DOSE trial, the observed rate of thromboembolic events was lower than expected in patients hospitalized for COVID-19 infection, and the study was unable to show a significant difference in the risk of venous thromboembolism between the two low-molecular-weight-heparin regimens.Funding French Ministry of Health, CAPNET, Grand-Est Region, Grand-Nancy Metropole.Copyright & COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

We evaluated people living with Human Immunodeficiency Virus’ (PLWH) quality of life (QoL) and assessed whether their demographic, disease-related, socioeconomic, or behavioral characteristics were associated with poorer QoL. ANRS CO3 AQUIVIH-NA cohort participants (Nouvelle Aquitaine, France) were recruited to a cross-sectional study (2018–2020) and their QoL assessed (WHOQOL-BREF). We calculated median (Q1, Q3) QoL domain scores and assessed factors associated with poorer median QoL using bivariable and multivariable quartile regression. Of the 965 PLWH included, 98.4% were on antiretroviral therapy, 94.7% were virally-suppressed, 63.5% reported good/very good QoL. Median scores (0–100) were highest for physical (69;Q1, Q3: 56, 81) and environmental (69; 56, 75) QoL and lowest for social (56; 44, 69) and psychological (56; 44, 69) QoL. PLWH with ≥ 3 comorbidities, HIV-related stigma, or income of < 1500€/month had poorer median adjusted physical, psychological, social, and environmental QoL scores compared to reference groups. While more than half of PLWH reported good/very good QoL, we have not achieved good QoL in 90% of PLWH. Multi-morbidity, HIV-related stigma, and social determinants were consistently and independently associated with poorer QoL. Addressing structural factors in addition to those indirectly related to HIV is required to attain good QoL in all PLWH.

Aortitis is a rare pathology, represented by noninfectious and infectious causes, the latter being most often focal, with aneurysmal evolution and risk of rupture. Mortality of patients with aortitis is high and requires an adapted antibiotic therapy to reduce it. Background Determining the etiology of aortitis is often challenging, in particular to distinguish infectious aortitis (IA) and noninfectious aortitis (NIA). This study aims to describe and compare the clinical, biological, and radiological characteristics of IA and NIA and their outcomes. Methods A multicenter retrospective study was performed in 10 French centers, including patients with aortitis between 1 January 2014 and 31 December 2019. Results One hundred eighty-three patients were included. Of these, 66 had IA (36.1%); the causative organism was Enterobacterales and streptococci in 18.2% each, Staphylococcus aureus in 13.6%, and Coxiella burnetii in 10.6%. NIA was diagnosed in 117 patients (63.9%), mainly due to vasculitides (49.6%), followed by idiopathic aortitis (39.3%). IA was more frequently associated with aortic aneurysms compared with NIA (78.8% vs 17.6%, P < .001), especially located in the abdominal aorta (69.7% vs 23.1%, P < .001). Crude and adjusted survival were significantly lower in IA compared to NIA (P < .001 and P = .006, respectively). In the IA cohort, high American Society of Anesthesiologists score (hazard ratio [HR], 2.47 [95% confidence interval {CI}, 1.08-5.66]; P = .033) and free aneurysm rupture (HR, 9.54 [95% CI, 1.04-87.11]; P = .046) were significantly associated with mortality after adjusting for age, sex, and Charlson comorbidity score. Effective empiric antimicrobial therapy, initiated before any microbial documentation, was associated with a decreased mortality (HR, 0.23, 95% CI, .08-.71]; P = .01). Conclusions IA was complicated by significantly higher mortality rates compared with NIA. An appropriate initial antibiotic therapy appeared as a protective factor in IA.

We aimed to estimate the prevalence of depressive disorder in people living with HIV (PLWH) and evaluate its association with non-HIV-specific and HIV-specific factors in PLWH and in PLWH compared to the general population (GP). We used cross-sectional data from the QuAliV study, conducted within the ANRS-CO3 Aquitaine-AQUIVIH-NA cohort of PLWH in Nouvelle-Aquitaine (2018–2020), and a nationally-representative survey in the GP (EHIS-ESPS, 2014–2015), we included all participants aged ≥ 18 years old who had completed the Patient Health Questionnaire-8 (PHQ-8). Depressive disorder was defined as Patient Health Questionnaire-8 score greater or equal to 10. Its association with non-HIV-specific (demographic, socio-economic, behavioral, health status), HIV-specific factors (immuno-viral markers, antiretrovirals, level of perceived HIV-stigma), and HIV-status was assessed using Poisson regression models with robust variance in women and men separately. We included 914 PLWH (683 men/231 women). More than one in five PLWH had depressive disorder. It was strongly associated with being younger and experiencing severe pain in both sexes. Unemployment in women, being single, and lack of family ties in men were also associated with depressive disorder. More than 30% of our sample reported HIV-stigma, with a dose–response relationship between level of perceived HIV-stigma and depressive disorder. The crude prevalence of depressive disorder was 2.49 (95%CI 1.92–3.22) and 4.20 (95%CI 3.48–5.05) times higher in women and men living with HIV respectively compared to GP counterparts and 1.46 (95%CI 1.09–1.95) and 2.45 (95%CI 1.93–3.09) times higher after adjustment for non-HIV specific factors. The adjusted prevalence ratio of depressive disorder was not significantly different in HIV-stigma free women, but remained twice as high in HIV-stigma free men. The prevalence of depressive disorder compared to the GP tended to decrease with age in PLWH. Excess depressive disorder remains a major concern in PLWH. Our findings reaffirm the importance of regular screening. Tackling social inequalities and HIV-stigma should be prioritized to ensure that PLWH achieve good mental as well as physical health outcomes.

Objective: In March 2020, we implemented screening of the contacts of a COVID-19 cluster having occurred in the Lot-et-Garonne department, the first department of the Nouvelle-Aquitaine region to be affected by the active circulation of SARS-CoV-2. We aimed to describe the impact of this screening on the local SARS-CoV-2 outbreak. Methods: All high-risk contacts, as well as the individuals living in their households, were screened. We detailed the evolution of the number of confirmed COVID-19 cases in the Lot-et-Garonne department and the rest of the Nouvelle-Aquitaine region. Results: Among the 89 screened individuals, 10 new cases were confirmed, including 4 asymptomatic persons. In Lot-et-Garonne, the number of confirmed COVID-19 cases immediately decreased after this screening and no epidemic peak occurred, contrary to what was observed in the rest of the region. Conclusion: The early screening of high-risk contacts of COVID-19 cases and members of their household implemented a few days before the first lockdown probably helped to prevent the spread of the virus in the department.

Objectives: To determine whether hydroxychloroquine decreases the risk of adverse outcome in patients with mild to moderate coronavirus disease 2019 (COVID-19) at high risk of worsening. Methods: We conducted a multicentre randomized double-blind placebo-controlled trial evaluating hydroxychloroquine in COVID-19 patients with at least one of the following risk factors for worsening: need for supplemental oxygen, age >= 75 years, age between 60 and 74 years and presence of at least one co-morbidity. Severely ill patients requiring oxygen therapy >3 L/min or intensive care were excluded. Eligible patients were randomized in a 1:1 ratio to receive either 800 mg hydroxychloroquine on day 0 followed by 400 mg per day for 8 days or a placebo. The primary end point was a composite of death or start of invasive mechanical ventilation within 14 days following randomization. Secondary end points included mortality and clinical evolution at days 14 and 28, and viral shedding at days 5 and 10. Results: The trial was stopped after 250 patients were included because of a slowing down of the pandemic in France. The intention-to-treat population comprised 123 and 124 patients in the placebo and hydroxychloroquine groups, respectively. The median age was 77 years (interquartile range 58 -86 years) and 151/250 (60.4%) patients required oxygen therapy. The primary end point occurred in 9/124 (7.3%) patients in the hydroxychloroquine group and 8/123 (6.5%) patients in the placebo group relative risk 1.12; 95% CI 0.45-2.80). The rates of positive SARS-CoV-2 RT-PCR tests at days 5 and 10 were 72.8% (75/103) and 57.1% (52/91) in the hydroxychloroquine group, versus 73.0% (73/100) and 56.6% (47/83) in the placebo group, respectively. No difference was observed between the two groups in any of the other secondary end points. Conclusion: In this underpowered trial involving mainly older patients with mild to moderate COVID-19, patients treated with hydroxychloroquine did not experience better clinical or virological outcomes than those receiving the placebo. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

AbstractBackgroundThe efficacy of hydroxychloroquine in coronavirus disease 2019 (COVID-19) remains controversial.MethodsWe conducted a multicentre randomized double-blind placebo-controlled trial evaluating hydroxychloroquine in COVID-19 patients with at least one of the following risk factors for worsening: age ≥75 years, age between 60 and 74 years, and presence of at least one comorbidity, or need for supplemental oxygen (≤3 L/min). Eligible patients were randomized in a 1:1 ratio to receive either 800mg hydroxychloroquine on Day 0 followed by 400mg per day for 8 days or a placebo. The primary endpoint was a composite of death or tracheal intubation within 14 days following randomization. Secondary endpoints included mortality and clinical evolution at Day 14 and 28, viral shedding at Day 5 and 10.ResultsThe trial was stopped after 250 patients were included due to a slowdown of the pandemic in France. The intention-to-treat population comprised 123 and 124 patients in the placebo and hydroxychloroquine groups, respectively. The median age was 77 years and 151 patients required oxygen therapy. The primary endpoint occurred in nine patients in the hydroxychloroquine group and eight patients in the placebo group (relative risk 1.12; 95% confidence interval 0.45– 2.80; P=0.82). No difference was observed between the two groups in any of the secondary endpoints.ConclusionIn this trial involving mainly older patients with mild-to-moderate COVID-19, patients treated with hydroxychloroquine did not experience better clinical or virological outcomes than those receiving the placebo.

BACKGROUND:Symptomatic Primary Humoral Immunodeficiency Diseases (PHID) constitute a highly heterogeneous group of diseases characterized by a shared hypogammaglobulinemia, resulting in increased risk of recurrent or severe infections. Associations have been described with a variety of immunological abnormalities involving B and T-cell differentiation, T-cell activation and innate immunity. However, PHID discrimination remains based on B-lymphocyte abnormalities and other components of the immune system have not been sufficiently taken into account. We carried out unsupervised and supervised methods for classification in a cohort of 81 symptomatic PHID patients to evaluate the relative importance of 23 immunological parameters and to select relevant markers that may be useful for diagnosis and prognosis.RESULTS:We identified five groups of patients, among which the percentage of PHID complications varied substantially. Combining the set of markers involved in PHID supported the existence of two distinct mechanisms associated with complications. Switched memory B-cell attrition and CD8+ HLA-DR + activated T-cell increase were the prominent abnormalities observed in PHID complications. Furthermore, in a subgroup of 57 patients with common variable immunodeficiency, the classification that added CD8+ HLA-DR + to the consensual EUROclass classification was better than the EUROclass model in predicting complications.CONCLUSION:These results highlight the importance of T-cell activation that may improve discrimination of PHID patients in specific subgroups and help to identify patients with different clinical outcomes.

6).The sequence is distinct from a small number of sequences derived from rabies viruses in Vietnam, which suggests that China is a stronger candidate for the source of the virus than her native country.Although the case history could not provide evidence for interaction with a dog while her family was in Hong Kong Special Administrative Region, rabies was endemic within the colony at the time that the patient's family was resident.From 1980 through 1984, 5 human cases were recorded (9).Only 2 case-patients had clear evidence of a dog bite; histories for the remaining 3 cases provided no evidence for an animal bite.From 1956 to 1979, Hong Kong had been free of rabies, but the disease had reentered the colony shortly after its incidence had increased in the neighboring Chinese province of Guangdong.If Hong Kong was where the young girl was infected, it would indicate an incubation period of 4.5-6 years.Such long incubation periods are rare for rabies virus infections.An earlier epidemiologic study of 177 cases in Amritsar, India, demonstrated that rabies developed within 6 months of exposure in 90% of human cases (10).However, the thorough documentation of a small number of cases (1,2) suggests that clinicians need to be aware of the importance of including travel history over several years in cases of unexplained encephalitis.

To the Editor: Lymph node enlargement is a common medical problem that is usually caused by bacterial, viral, fungal, or protozoal agents (1). Malignancies or lymphoproliferative diseases are often found, especially in elderly patients (1). Bartonella henselae, the main causative agent of cat-scratch disease (CSD), appears to be the most common organism responsible for lymphadenopathy in adults and children (1). CSD has also been rarely associated with B. quintana (2). Recently, the epidemiology of B. quintana as an emerging source of human infection has changed because it has been isolated from the dental pulp of a domestic cat (3). Feral cats have also been found to be infected by B. quintana (4). We report a human case of B. alsatica lymphadenopathy. A 79-year-old woman came to a hospital in Agen, France, in February 2008 with a large painless axillary mass that she had noticed 10 days earlier. She reported that ≈1 month earlier she was scratched on her finger while butchering a wild rabbit. On examination, she did not have any other specific findings. Blood cell counts and levels of liver enzymes were normal. A large necrotic lymph node was surgically removed the next day. Her condition was treated with doxycycline (200 mg) for 3 weeks. Our laboratory received a fragment of the lymph node of the patient and a portion of the rabbit that had been cooked, boiled as a terrine, and stored in a freezer at –20°C in the home of the patient. DNA was extracted from these specimens by using a QIAamp Tissue Kit (QIAGEN, Hilden, Germany). The DNA was used as a template in 3 described PCRs specific for a portion of the B. alsatica 16S–23S intergenic spacer (ITS) region, ftsZ gene, and 16S rDNA (5). All results for the lymph node were positive for B. alsatica, and amplification products of the expected size were obtained from this extract. Sequences obtained shared 100% similarity with the corresponding 16S rDNA, ITS region, and ftsZ gene fragment of B. alsatica. However, the terrine specimen was negative for 16S rDNA, the ITS region, and the ftsZ gene. All negative controls showed typical results. B. alsatica have not been tested or found in our laboratory for several years. B. quintana subsp. Oklahoma, B. henselae subsp. Houston (ATCC 49882), B. vinsonii subsp. berkhoffi (URBVAIE25), B. vinsonii subsp. arupensis (ATCC 700727), and B. alsatica (CIP 105477 T) strains were used for immunofluorescence and Western blotting assays (5). A serum sample taken at admission was negative for B. alsatica by immunofluorescence assay. This result was accepted because serologic results may be negative during the onset of the disease (6). Western blotting with Bartonella spp. antigens (5) was positive for B. alsatica and after adsorption, only B. alsatica antigens retained all antibodies (Appendix Figure, panel A). Formalin-fixed, paraffin-embedded tissue specimens (3-μm thick) were stained with hematoxylin and eosin. Microscopic examination showed that the normal architecture of the lymph node was destroyed. Histologic changes were dominated by large irregular stellate or round granulomas with central neutrophil-rich necrosis (Appendix Figure, panel B). Granulomas were composed mainly of macrophages, whereas neutrophils in the necrotic areas were fragmented. These granulomas with abscess formation were similar to those described in CSD. Warthin-Starry staining showed bacteria in the necrotic center of the granulomas (Appendix Figure, panel C). Immunohistologic staining was used to demonstrate B. alsatica in the lymph node. Immunohistochemical analysis was performed by using a monoclonal antibody against B. alsatica with an immunoperoxidase kit previously described (7). Briefly, after deparaffinization, the tissue section was incubated with polyclonal-specific antibody to B. alsatica (8) diluted 1:1,000 in phosphate-buffered saline. Immunodetection was performed with biotinylated immunoglobulins, peroxidase-labeled streptavidin (HistoStain Plus Kit; Zymed, Montrouge, France), and amino-ethyl-carbazole as substrate. Slides were counterstained with Mayer hematoxylin for 10 min. Location of bacteria was superimposable on that in the Warthin-Starry–stained specimens, and clusters of microorganisms were seen in the inflammatory areas (Appendix Figure, panel D). We report lymphadenitis caused by B. alsatica. Our finding was confirmed by molecular, serologic, and staining methods. Bartonella spp. are zoonotic agents that infect erythrocytes of mammals in which they cause chronic bacteremia (9). B. alsatica was first identified in 1999 in Alsace, France, as an agent of bacteremia in healthy wild rabbits (10). However, in 2006, interest in B. alsatica increased when it was considered to be a human pathogen because it caused blood-culture–negative endocarditis in a patient who had contacts with rabbits (5). The present case confirms that B. alsatica could be a human pathogen, especially in persons who live in contact with rabbits and should be considered a cause of lymphadenopathy.

We reviewed 64 pregnancies in 26 women with Diamond-Blackfan anemia (DBA) included in the French and German DBA registries. Complications were seen in 42 pregnancies (66%) and included abortion, pre-eclampsia, in utero fetal death, intrauterine growth retardation, retroplacental hematoma, pre-term delivery and fetal malformations. Of the 34 children (53%) born alive, 13 had DBA. No correlations were found between pregnancy outcome and features of either maternal or child DBA. Pregnancies in DBA-affected women are at high risk, especially for complications likely to be of vascular-placental origin. Careful monitoring with prevention of severe anemia and early introduction of aspirin is suggested.

Diamond Blackfan anaemia (DBA) is a rare disorder characterised by pure red cell aplasia and inconstant congenital abnormalities. Few data are available concerning pregnancy in DBA affected women.

Background: Cases of lipodystrophy syndrome and metabolic disorders have been described since the onset of highly active antiretroviral therapy in HIV-infected patients. The aim of our study was to estimate the prevalence of lipodystrophy (LD) and to define the associated lipid profile of these patients. Methods: The following were determined for each patient: lipid profile (cholesterol and its subfractions, atherogenicity ratios, and triglycerides), blood glucose, and immunovirological markers (CD4+ cell count and plasma viral load). Patients were classified into two groups on the basis of whether or not they presented with clinical signs of LD. Results: Among 233 HIV-infected patients included in the study, 61 cases (26.1%) of lipodystrophy (LD) were noted. Compared with non-LD patients (NLD), LD patients were older men (P<10−4) with a lower CD4+ lymphocyte cell count (P<0.007) and more often at the AIDS stage (P<10−3) (OR=3.2 (95% CI: 1.47–6.2)). Multivariate analysis showed a correlation between LD cases and age (10 years older) (OR=1.78 (95% CI: 1.23–2.57), P<0.002) and the decrease in CD4+ cell count (100 CD4+/mm3 lower) (OR=1.31 (95% CI: 1.09–1.58), P<0.004). An analysis of lipid subfractions and atherogenicity ratios clearly indicated a proatherogenic lipid profile for the LD patients. Conclusions: The underlying physiopathological mechanism of LD is still unknown. However, the lipid profile of HIV-1-infected patients with a LD syndrome appears to place these patients at an increased risk of progression of atherosclerosis.

The authors describe the clinical and biological characteristics and the evolution of 100 patients with immunologic thrombocytopenic purpura (ITP). In 24 cases, ITP reveals or preceeds immunologic or hematologic pathologies.

Gaucher's disease is characterized by accumulation of glucocerebroside (caused by an autosomally inherited deficiency of glucocerebrosidase) in the cells of the reticuloendothelial system. We report the clinical, laboratory, radiologic features of 17 patients with type 1 Gaucher's disease.