OBJECTIVES:To describe the characteristics, evolution and risk factors for long-term persistence of olfactory and gustatory dysfunctions (OGD) in COVID-19 outpatients.PATIENTS AND METHODS:We conducted a prospective study in SARS-CoV-2 infected outpatients with OGD. Weekly phone interviews were set up starting from COVID-19 onset symptoms and over the course of 60 days, using standardized questionnaires that included a detailed description of general symptoms and OGD. The primary outcome was the proportion of patients with complete recovery of OGD at D30. Rate and time to recovery of OGD, as well as risk factors for late recovery (>30 days), were evaluated using Cox regression models.RESULTS:Ninety-eight outpatients were included. The median time to onset of OGD after first COVID-19 symptoms was 2 days (IQR 0-4). The 30-day recovery rate from OGD was 67.5% (95% CI 57.1-75.4) and the estimated median time of OGD recovery was 20 days (95% CI 13-26). Risk factors for late recovery of OGD were a complete loss of smell or taste at diagnosis (HR=0.26, 95% CI 0.12-0.56, P=0.0005) and age over 40 years (HR=0.56, 95% CI 0.36-0.89, P=0.01).CONCLUSIONS:COVID-19 patients with complete loss of smell or taste and over age 40 are more likely to develop persistent OGD and should rapidly receive sensorial rehabilitation.

Mycoplasma genitalium (MG) est le 3e germe responsable d'urétrite chez l'homme après Neisseria gonorrhoeae (NG) et Chlamydia trachomatis (CT). Cependant, le portage asymptomatique est fréquent. Par ailleurs, la résistance aux antibiotiques (azithromycine, moxifloxacine) engendre des difficultés thérapeutiques. Entre 2017 et 2018, dans notre centre, MG était systématiquement cherché par PCR en association à NG et CT. Notre travail décrit les caractéristiques épidémiologiques, cliniques et thérapeutiques des patients diagnostiqués avec une infection à MG durant cette période. Étude rétrospective descriptive monocentrique (Cegidd et SMIT) ayant inclus tous les patients avec une PCR positive pour MG du 01/01/2017 au 31/12/2019. Variables recueillies : âge, sexe, orientation sexuelle, statut VIH, prise de prophylaxie pré-exposition VIH (PrEP), site infecté, germes associés, symptômes, traitements prescrits, contrôle PCR à 6 semaines du traitement, test de résistance en cas de contrôle positif. Sur 5586 patients dépistés, 397 (7 %) avaient une PCR positive pour MG, 319 hommes (80 %) et 78 femmes (20 %), d'un âge médian 29 ans ; 135 patients étaient infectés par le VIH (34 %) et 52 (13 %) sous PrEP. Comparativement aux patients avec PCR négative pour MG, les patients positifs étaient plus souvent des hommes (OR 2,19 [1,70–2,82]), plus souvent infectés par le VIH (OR 3,44 [2,75–4,3]) et plus souvent sous PrEP (OR 4,89 [3,51–6,83]). La PCR était positive dans les urines chez 139/319 patients (43 %), au niveau cervico-vaginal chez 77/78 (99 %) et anal chez 202/323 (62 %). Une co-infection à CT et à NG était trouvée dans 15 % et 7 % des cas, respectivement. Des symptômes étaient rapportés par 46 patients (11 %), dont 28 urétrites, 3 cervicites et 13 rectites. Parmi les patients symptomatiques, 18 (39 %) étaient coinfectés par CT ou NG. Deux cent soixante-dix patients (68 %) avaient reçu un traitement, azithromycine (AZM) chez 249 patients (92 %), doxycycline (DC) chez 13 patients (5 %) et moxifloxacine (MXF) chez 4 patients (1 %). Un contrôle PCR post-traitement était réalisé chez 103 patients (38 %) et restait positif dans 74 % des cas. Une résistance aux macrolides avait été documentée pour 9 souches testées sur 14. En 2me ligne, l'AZM était prescrite chez 24/76 patients (32 %), la MXF chez 23/76 patients (31 %) et la DC chez 8/76 patients (11 %). Le contrôle PCR après 2nde ligne de traitement, réalisé chez 43 patients, montrait un taux d'éradication de 44 %. Dans notre population, MG a été trouvé chez 7 % des patients prélevés et était significativement associé à une infection VIH, à la prise de la PreP et au sexe masculin. La majorité des patients était asymptomatique et la prise en charge de ces patients à haut risque de réinfection était complexe pour le praticien.

BACKGROUND Several studies have shown that NNRTI/PI-based triple therapy could be safely administered as a 4 days (4D) or 5 days (5D) a week maintenance strategy. We report here our experience of using an integrase inhibitor (INSTI)-based 4D/5D regimen in virologically suppressed HIV patients. METHODS This cohort study enrolled adult patients on ART with viral load (VL) <50 copies/mL for >1 year, who switched to an INSTI-based triple regimen given 4D/5D a week. The primary endpoint was the virological efficacy rate at Week (W) 48, with virological failure defined as confirmed VL ≥50 copies/mL. RESULTS A total of 73 patients were included (n = 28 for 4D, n = 45 for 5D): 54 men (74%), median (IQR) age 51 (45-57) years, ART duration 10 (6-18) years and duration of viral suppression 5 (2-9) years at baseline. As of 25 March 2019, the median follow-up was 21 (14-35) months, with a total of 161 patient-years of follow-up; all patients had reached the W24 visit, 66 (90%) W48 and 34 (47%) W96. Four patients discontinued the strategy: virological failure (n = 2) at W60 and W67, respectively, switch for renal toxicity (n = 1) at W28 and switch to rilpivirine/dolutegravir (n = 1) at W65. Overall the rate of virological success (95% CI) was 100% (94%-100%) at W24 and W48 and 93.7% (79.8%-98.2%) at W96. CONCLUSIONS While waiting for the final results of the large randomized QUATUOR ANRS-170 study, our real-life results suggest that the use of an intermittent maintenance triple-drug regimen given as a weekend (2 or 3 days) off is as effective with an INSTI-based regimen as with a PI or an NNRTI.

OBJECTIVE:The objective was to evaluate the association between age-related comorbidities (ARCs) and 5-year HIV-related excess mortality in people living with HIV aged ≥60 years.DESIGN:Cohort study using relative survival analysis (Estève's model).SETTING:The French multicentre prospective Dat'AIDS cohort that involves 12 French hospitals.PARTICIPANTS:Inclusion of 1415 HIV-1 infected patients actively followed aged ≥60 years on January 2008, with a 5-year follow-up period in the late combination antiretroviral therapy era.RESULTS:Among 1415 patients included, 154 died. By multivariable analysis, factors predictive of 5-year HIV-related excess mortality were non-AIDS-related cancer (adjusted excess HR (aEHR)=2.94; 95% CI 1.32 to 6.57), cardiovascular disease (aEHR=6.00; 95% CI 2.45 to 14.65), chronic renal disease (aEHR=4.86; 95% CI 2.24 to 10.53), cirrhosis (aEHR=3.58; 95% CI 1.25 to 10.28), hepatitis C co-infection (aEHR=3.63; 95% CI 1.44 to 9.12), body mass index<18.5 kg/m² (aEHR=4.10; 95% CI 1.61 to 10.48) and having a CD4 cell count ≤200/mm3 (aEHR=5.79; 95% CI 2.28 to 14.69).CONCLUSIONS:ARCs, particularly cardiovascular disease and chronic renal disease, are predictive of HIV-related excess mortality, with an increase in hazard similar to that of CD4 cell count.TRIAL REGISTRATION NUMBER:NCT02898987.

OBJECTIVESTo analyse the frequency and causes of treatment discontinuation in patients who were treated with an integrase strand transfer inhibitor (INSTI), with a focus on neuropsychiatric adverse events (NPAEs).METHODSPatients in 18 HIV reference centres in France were prospectively included in the Dat'AIDS cohort. Data were collected from all patients starting an INSTI-containing regimen between 1 January 2006 and 31 December 2016. All causes of INSTI-containing regimen discontinuations were analysed, and patients' characteristics related to discontinuation due to NPAEs were sought.RESULTSINSTIs were prescribed to 21315 patients: 6274 received dolutegravir, 3421 received elvitegravir boosted by cobicistat, and 11620 received raltegravir. Discontinuation was observed in 12.5%, 20.2% and 50.9% of the dolutegravir-, elvitegravir- and raltegravir-treated patients, respectively (P < 0.001). Discontinuation for NPAEs occurred in 2.7%, 1.3% and 1.7% of the dolutegravir-, elvitegravir-, and raltegravir-treated patients, respectively (P < 0.001). In the multivariate analysis, discontinuation for NPAEs was related to dolutegravir versus elvitegravir (HR = 2.27; 95% CI 1.63-3.17; P < 0.0001) and versus raltegravir (HR = 2.46; 95% CI 2.00-3.40; P < 0.0001), but neither gender (HR for women = 1.19; 95% CI 0.97-1.46; P = 0.09) nor age (P = 0.12) was related. The association with abacavir was not retained in the final model.CONCLUSIONSAlthough discontinuation for side effects was less frequent with dolutegravir than with boosted elvitegravir, discontinuation for NPAEs, although rare (2.7%), was more frequent with dolutegravir. No patient characteristic was found to be associated with these side effects in this very large population.

BACKGROUND:In recent years, dolutegravir monotherapy has been explored as a drug-reduced regimen for HIV patients.METHODS:This was a retrospective observational study, including patients virologically suppressed for ≥6 months, without previous virological failure (VF) under integrase inhibitors (INIs), who had been switched to dolutegravir monotherapy (50 mg/day). The primary aim was to report the proportion of VF at week 48 (W48) and week 96 (W96) of dolutegravir monotherapy. The evolution from baseline to W48 of residual viraemia on ultra-deep sequencing and HIV DNA was also evaluated.RESULTS:Sixty-one patients were included. Prior to switching to dolutegravir monotherapy, they had a median (IQR) of 15.4 (6.5-19.9) years of antiretroviral exposure, 5.8 (3.2-10.3) years of viral suppression and 687 (461-848) CD4+ cells/mm3. They remained on dolutegravir monotherapy for a median (IQR) of 100 (29-148) weeks. Forty-two out of 61 patients (68.9%) reached W48 and 32 out of 61 patients (52.5%) reached W96. VF occurred in three patients, with the emergence of INI resistance. VF occurred before W24 and in patients pre-exposed to INIs. At W48, the probability of VF (Kaplan-Meier analysis) was 5.6% (95% CI = 1.8%-16.4%). The same result was obtained at W96. Detectable residual viraemia did not increase and median HIV DNA did not change significantly (2.4 log/106 cells at baseline and 2.3 log/106 cells at W48). Dolutegravir plasma concentration was above the IC90 in 41/41 samples, from 22 patients.CONCLUSIONS:Long-term follow-up showed a low risk of VF under dolutegravir monotherapy, in a selected population of patients with previous long-term virological suppression and low HIV reservoir.

Objective. - To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015. Methods. - We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. Results. - We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load >5 log copies/mL were less likely to receive NNRTI (OR = 0.08) or INSTI regimens (OR = 0.69) than bPIs. Patients with initial CD4(+) T cell count <200/mm(3) were less likely to receive an NNRTI (OR = 0.28) or an INSTI regimen (OR = 0.52) than a bPI. Women were less likely to receive an NNRTI (OR = 0.79) or an INSTI regimen (OR = 0.71) than a bPI; although this depended on age. Conclusion. - The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4(+) T cell count, and in women. (C) 2018 Elsevier Masson SAS. All rights reserved.

Objectives: To investigate the dynamics of HIV-1 variants archived in cells harbouring drug resistance-associated mutations (DRAMs) to lamivudine/emtricitabine, etravirine and rilpivirine in patients under effective ART free from selective pressure on these DRAMs, in order to assess the possibility of recycling molecules with resistance history. Patients and methods: We studied 25 patients with at least one DRAM to lamivudine/emtricitabine, etravirine and/or rilpivirine identified on an RNA sequence in their history and with virological control for at least 5 years under a regimen excluding all drugs from the resistant class. Longitudinal ultra-deep sequencing (UDS) and Sanger sequencing of the reverse transcriptase region were performed on cell-associated HIV-1 DNA samples taken over the 5 years of follow-up. Results: Viral variants harbouring the analysed DRAMs were no longer detected by UDS over the 5 years in 72% of patients, with viruses susceptible to the molecules of interest found after 5 years in 80% of patients with UDS and in 88% of patients with Sanger. Residual viraemia with <50 copies/mL was detected in 52% of patients. The median HIV DNA level remained stable (2.4 at baseline versus 2.1 log(10) copies/10(6) cells 5 years later). Conclusions: These results show a clear trend towards clearance of archived DRAMs to reverse transcriptase inhibitors in cell-associated HIV-1 DNA after a long period of virological control, free from therapeutic selective pressure on these DRAMs, reflecting probable residual replication in some reservoirs of the fittest viruses and leading to persistent evolution of the archived HIV-1 DNA resistance profile.

Afin de compléter les informations de morbidité sévère des patients vivants avec le VIH ou de documenter les patients en rupture de soins parmi les perdus de vue de la cohorte, un accès aux données du Sniiram est envisagé par la cohorte hospitalière de patients infectés par le VIH (FHDH ANRS C04). Dans cette perspective, une étude de la faisabilité d'une stratégie d'appariement indirect a été réalisée dans un service hospitalier disposant d'une file active importante de patients infectés par le VIH. Tous les patients infectés par le VIH hospitalisés ou ayant consulté dans le service de maladies infectieuses (SMIT) de la Pitié-Salpêtrière en 2014 et pour lesquels les données étaient recueillies localement par le logiciel Nadis ont été inclus. Un algorithme de chaînage a été établi à partir de variables communes entre le PMSI enrichi des données de consultations, et le logiciel Nadis. Les taux d'appariement ont été estimés en faisant varier les variables de données non-sensibles (sexe, âge, mois-année de sortie d'hospitalisation, durée de séjour, mois-année de la consultation) et sensibles (mois et année de naissance, date d'entrée d'hospitalisation et date de consultation). L'adéquation de l'identification des patients était contrôlée par le NIP (numéro d'identification des personnes) présent dans les deux bases. En 2014, des données de 3362 patients correspondant à 11 938 consultations, 863 hospitalisations de jour et 188 hospitalisations complètes ont été recueillies via Nadis. Le taux d'appariement obtenu avec l'ensemble des données sensibles et non-sensibles était de 85 %. Avec l'ensemble des données non-sensibles, le taux d'appariement était de 11 %. L'adjonction d'une donnée sensible augmentait le taux d'appariement à 16 % s'il s'agissait de la date d'entrée d'hospitalisation, à 25 % pour le mois et l'année de naissance, et à 71 % pour la date de consultation. Ce travail confirme la faisabilité de l'appariement et la nécessité d'utilisation des variables sensibles pour le réaliser. Parmi ces variables, le mois et l'année de la consultation était la variable la plus discriminante.

BACKGROUND AND PURPOSE:The lack of antiretroviral (ARV) backbone activity associated with raltegravir has been proposed as the main explanation for virological relapse observed in patients with undetectable viraemia who are switched from a ritonavir-boosted protease inhibitor (PI) to raltegravir. However ARV activity remains difficult to assess in this context. The aim of our study was to precisely assess the ARV backbone activity in patients with undetectable viraemia who underwent raltegravir switching strategies and to evaluate the efficacy of such switching strategies based on the genotypic sensitivity score (GSS). METHODS:Patients with a plasma human immunodeficiency virus type 1 (HIV-1) RNA level of <50 copies/mL on a stable two ARV-class regimen were enrolled if they switched one of their ARV drugs to raltegravir 400 mg twice daily. The GSS was calculated using a genotyping test performed on the HIV-1 RNA of the last plasma measurement with a HIV-1 RNA level of >50 copies/mL before the switch and on the results of all previous genotyping tests. The primary endpoint was the proportion of patients with a plasma HIV-1 RNA level of <50 copies/mL at week 24. RESULTS:Fifty-six patients were enrolled in this study. The proportion of patients with a plasma HIV-1 RNA level of <50 copies/mL at week 24 was 92.9 % (range 83.0-97.2 %) in the intent-to-treat analysis and 98.1 % (90.0-99.7 %) in per-protocol analysis. When the backbone was fully active, the proportion was 100.0 % (86.7-100.0 %) at week 24 and week 48 in the per-protocol analysis. We observed a decrease in plasma total cholesterol and triglycerides of -12.7 % (p = 0.005) and -26.5 % (p = 0.001), respectively. CONCLUSIONS:Raltegravir switching strategies are effective when the associated backbone is fully active according to the GSS. In the context of undetectable viraemia, where ARV activity remains difficult to assess, the determination of the GSS requires the entire ARV history of the patient and all previous HIV-RNA genotyping test results.

La consanguinité est une relation entre deux personnes qui partagent un ancêtre commun. Elle est habituellement définie comme le résultat d’une reproduction sexuée entre deux individus apparentés. En d’autres termes, les mariages consanguins se réfèrent à des unions contractées entre des individus biologiquement liés. Ces unions sont encore fréquentes et constituent des pratiques très répandues dans certaines régions du monde. La région la plus concernée s’étend de la rive sud de la mer méditerranée à travers le Moyen-Orient, la Mésopotamie, le Golfe persique et l’Inde subcontinentale jusqu’au sud-est de l’Asie. Sur la base des données disponibles, il apparaît que les couples apparentés au second degré ou plus et leur progéniture représentent 10,4 % de la population mondiale actuelle. Leurs conséquences sur la fréquence des maladies à déterminisme génétique sont importantes et notamment en ce qui concerne les maladies autosomales récessives. Les études de jumeaux et d’adoption et les estimations du risque de survenue de troubles mentaux chez les apparentés de sujets atteints dans les études familiales ont confirmé l’existence d’une composante génétique dans la vulnérabilité à de nombreuses affections psychiatriques. Les techniques récentes d’examen du génome entier ou étude d’association pangénomique, en anglais genome-wide association study (GWAS), permettent d’identifier de plus en plus de gènes impliqués dans les troubles mentaux majeurs tels que la schizophrénie, l’autisme et le trouble bipolaire. Les études d’épidémiologie génétique auprès de populations consanguines et/ou constituant un isolat géographique mettent en évidence une augmentation des taux de mortalité et de morbidité infantiles, de la fréquence des maladies monogéniques récessives et une concentration accrue de maladies communes multifactorielles comme les troubles psychotiques. Elles confirmeraient l’existence d’un lien significatif entre consanguinité et troubles mentaux et l’augmentation du risque au sein de la descendance des couples consanguins. Ces études sur les liens entre consanguinité et troubles psychotiques sont peu nombreuses. Les rares données dont nous disposons semblent pourtant en faveur d’une augmentation de la fréquence de la schizophrénie et des troubles bipolaires dans la descendance de parents consanguins. La découverte récente des variants génétiques rares et leurs implications dans les troubles psychotiques constituent un argument en faveur de l’hypothèse « maladie commune-variants rares ». Dans ce cadre, l’étude de familles consanguines pourrait contribuer à tester les liens entre ces variants rares et quelques phénotypes et à établir des descriptions d’associations génotype/phénotype. Le développement de techniques nouvelles en génétique moléculaire devrait favoriser de telles études. L’ensemble de ces aspects mettent en évidence l’importance de l’étude des populations consanguines dans la compréhension du rôle des déterminants génétiques dans les pathologies psychiatriques et soulignent l’intérêt du conseil génétique pour ces communautés à hauts risques de troubles mentaux. Ils peuvent permettre également la mise en place de politiques de prévention et de sensibilisation sur les risques liés aux unions consanguines.Consanguinity is a relationship between two people who share a common ancestor. It is usually defined as resulting from sexual reproduction between two related individuals. In other words, consanguineous marriages refer to unions which are contracted between two biologically linked individuals. These unions remain frequent and are widely practiced in certain areas of the globe. The most frequently concerned regions extend from the southern shore of the Mediterranean Sea, across the Middle East, Mesopotamia, the Persian Gulf and sub continental India extending into Southeast Asia. Based on available data, it appears that couples who are second-degree relations or closer and their offspring represent 10.4% of the world's current population. The consequences on the rates of genetically determined diseases are significant, especially in autosomal recessive diseases. Twin and adoption studies as well as risk estimations for the occurrence of mental disorders in families of patients who suffer from mental disorders have confirmed the existence of a genetic component in the vulnerability to numerous psychiatric diseases. Recent techniques examining the entire genome or pan-genomic association studies (Genome-Wide Association Studies or GWAS), have enabled us to identify increasing numbers of genes that are implicated in major mental disorders such as schizophrenia, autism and bipolar disorders. Epidemiological genetic studies in consanguineous populations and/or within geographic isolates have shown an increased rate in infant mortality and morbidity, monogenetic recessive diseases and common multifactorial diseases such as psychotic disorders. These confirm the existence of a significant link between consanguinity, mental disorders and increased risk within the offspring of consanguineous couples. Studies concerning the links between consanguinity and psychotic disorders are few. Rare available data seem to plead in favour of an increased frequency of schizophrenia and bipolar disorder in the offspring of consanguineous parents. The recent discovery of rare genetic variants and their implications in psychotic disorders represents an argument in favour of the “common disease-rare variants” hypothesis. Within this framework, the study of consanguineous families could contribute to testing the links between these rare variants and certain phenotypes and to establish descriptive genotype-phenotype associations. The development of new techniques in molecular genetics should facilitate such studies. All of these aspects show the importance of studying consanguineous populations in order to better understand the role of genetic determinants in psychiatric pathologies and to highlight the interest of genetic counselling in communities with increased risks of mental disorders. This may also enable governments to enact prevention policies and to launch awareness campaigns concerning the risks of consanguineous marriages.

Abstract Background: Etravirine (ETR) is recommended as twice-daily dosing in pretreated patients. There are no data regarding the use of ETR once daily in HIV-experienced patients with prior resistance to first-generation non-nucleoside reverse transcripase inhibitors (NNRTIs).Objectives: To evaluate the capacity of once-daily ETR to maintain suppressed viremia over 48 weeks after switching from ETR twice daily in NNRTI-experienced patients.Methods: In this pilot open-label study, patients with plasma viral load (pVL) <50 copies/mL on a stable ETR 200 mg bid regimen were enrolled to switch to ETR 400 mg qd and followed up over 48 weeks. The primary endpoint was the proportion of patients with pVL <50 copies/mL at week 24. Secondary endpoints included the rate of pVL< 50 copies/mL at week 48, ETR pharmacokinetic parameters, and tolerability and resistance profile.Results: Twenty-four patients were included. They had extensive antiretroviral treatment for a median of 14 years (range, 1-19). All except for 2 had prior resistance to NNRTIs. Seven patients discontinued ETR once daily prior to week 48 for virological failure (3), protocol deviation (3), and side effects (1). At week 24, 95% of patients maintained pVL< 50 copies/mL (95% CI, 78.4-99.7) and 85% at week 48 (95%CI, 65.6-95.8). Two of the 3 patients with virological failure had ETR resistance mutations prior to initiation. The median ETR Ctrough level remained stable after switching from twice daily 515 ng/mL (340-758) to once daily 422 ng/mL (264-655).Conclusion: These results suggest that ETR is effective as a once-daily regimen in patients with prior NNRTI experience when HIV is sensitive to ETR. The stability of Ctrough concentrations on a once-daily regimen confirms the once-daily profile of the drug in experienced patients.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Background: It is unclear how stable low-level viral replication and CD4 cell numbers can be maintained under highly active antiretroviral therapy (HAART). This study was designed to analyse whether HIV-specific responses in stable partially controlled patients during antiretroviral therapy (ART) differ from those observed in complete HAART failure and whether they contribute to the control of viral load (VL). Methods: Three groups of patients were selected according to plasma HIV RNA levels during 18 months of ART: persistently low VL (LoVL; HIV RNA <10 000 copies/ml; n = 28), undetectable VL (UnVL; HIV RNA <200 copies/ml; n = 29) and high VL (HiVL; HIV RNA >10 000 copies/ml; n = 14). T-cell responses were studied using lymphoproliferative and interferon (IFN)-γ-ELISpot assays against HIV-p24, -gp160, recall antigens, and 15 pools of HIV-(Gag + RT) peptides. Results: Frequencies of IFN-γ-producing CD4 T cells against HIV-p24 were higher in LoVL than in UnVL or HiVL groups [median, 131, 47 and 23 spot-forming cells (SFC)/1 × 106 peripheral blood mononuclear cells (PBMC), respectively; P = 0.012 and P = 0.047]. Lymphoproliferative responses to HIV-p24 and recall antigens were similar in LoVL and UnVL groups but lower in HiVL (P = 0.004). Frequencies of HIV-specific CD8 T cells were higher in LoVL than in UnVL (1340 versus 410 SFC/1 × 106 PBMC; P = 0.001). They correlated negatively with VL in the LoVL and HiVL (r, −0.393, P = 0.039 and r, −0.643, P = 0.024, respectively) and positively correlated with anti-HIV CD4 cell frequencies in the LoVL group only (r, 0.420; P = 0.026). Conclusion: Persistently low viral replication (<10 000 copies/ml) during ART stimulates high frequencies of HIV-specific CD4 and CD8 T cells compared to full virus suppression or complete ART failure. The association of high anti-HIV activity with large numbers of HIV-specific CD8 T cells contribute to the control of viral replication.

OBJECTIVE:The Nadis electronic medical patient record allows real time constitution of a database including the clinical, therapeutic, biological, and epidemiological features of HIV-positive patients.METHODS:Data concerning HIV-infected patients followed-up in 6 French University Hospitals was collected. Data quality was assessed on a regular basis in each center.RESULTS:The 6 first University hospitals using Nadis agreed to group their data on March 15, 2004, concerning 6236 patients having consulted at least once in the previous year. Among these, 29% were female patients, 80% were under treatment on March 15, 2004, 9% were off treatment, 29% were co-infected by hepatitis B or C virus, 57% had an undetectable viral load, 15% of the treated patients were in a worrying immunovirological situation, 358 were diagnosed HIV-positive in 2003. 35% of these "new patients" were women, the mode of infection was sexual in 80%, 45% were under treatment on March 15, 04. This recent data allowed us to have an accurate assessment of this population's management in 2004.