Evolutions and characteristics of new HIV diagnoses among people who inject drugs in France between 2004 and 2019. (S..ropositivit.. au VIH: diagnostic, pr..vention et v..cu au temps de la Covid-19.) [French]

Based on data from mandatory HIV declarations in France, this article presents the characteristics of new HIV diagnoses among people who inject drugs (PWID), by their birthplace, for the period 2016-2019, and the evolutions of these characteristics since the 2004-2007 period. For 2016-2019, PWID represented 0.8% of all new HIV diagnoses declared, a decreased percentage compared to 2004-2007 (1.7%). The main evolutions observed are an increasing trend of PWID aged 50 years or over, an increase of unemployed PWID, a sharp rise in PWID from Eastern Europe and a decrease in those born in France, as well as an improvement in the early diagnosis indicator for PWID born in France that was not observed for those born abroad. Almost three-quarters of PWID had never been tested before their diagnosis. The rising proportion of unemployed PWID probably reflects worsened levels of precarity. The very high proportion of PWID never tested before the HIV diagnosis indicates that part of this population remains distant from the health system. These conclusions show the need to enhance targeted screening and support policies for PWID and migrants.

HIV diagnoses in transgender people, France 2012-2020. (S..ropositivit.. au VIH: diagnostic, pr..vention et v..cu au temps de la Covid-19.) [French]

Introduction - Transgender people are highly vulnerable to HIV infection and other STIs, due to behavioral, economic, or social factors. This work aims to describe HIV diagnoses in this population. Materials-methods - The data come from HIV mandatory reporting. We analysed HIV diagnoses in transgender people between 2012 and 2020. Two categories have been described, new diagnoses (people not knowing their HIV status before diagnosis), and first diagnoses in France for people already diagnosed in another country. Results - From 2012 to 2020, 253 new HIV diagnoses in transgender people were reported, i.e. 0.7% of diagnoses. After adjustment for underreporting and missing data, this number was estimated at 418 (95% CI [367-469]). Most of these people were trans women (87%), with a median age of 31 (38.5 for men). Trans women were more often born abroad (83%, mainly in South America) than trans men (52%). The probable mode of contamination was mainly sexual (98%). The most common reason for performing serology was recent exposure to HIV (33%), and 15% of diagnoses were made following a positive rapid diagnostic orientation test. One in five trans people were diagnosed with advanced infection (AIDS or <200 CD4 cells), and 37% of trans people were co-infected with another STI. Between 2012 and 2020, 115 first diagnoses in France in transgender people knowing their HIV status were reported. These diagnoses concern almost exclusively women (99%). After correction, their number is estimated at 169 (95% CI [137-201]) people. Discussion-conclusion - Transgender people newly diagnosed are mainly born abroad and sexually infected. They are often coinfected with a bacterial STI, highlighting their high level of sexual exposure and calls for a strengthening of diversified prevention in this population, including PrEP. New diagnoses at an advanced stage of infection are more common in foreign-born transgender people diagnosed several years after arrival in France, which is an argument to support HIV screening in this population. As well as new HIV diagnoses, the first diagnoses in France of people already diagnosed in another country, are an important issue in terms of setting up HIV medical care, whether for initiation or continued antiretroviral therapy.

The specific metabolome profiling of patients infected by SARS-COV-2 supports the key role of tryptophan-nicotinamide pathway and cytosine metabolism.

The biological mechanisms involved in SARS-CoV-2 infection are only partially understood. Thus we explored the plasma metabolome of patients infected with SARS-CoV-2 to search for diagnostic and/or prognostic biomarkers and to improve the knowledge of metabolic disturbance in this infection. We analyzed the plasma metabolome of 55 patients infected with SARS-CoV-2 and 45 controls by LC-HRMS at the time of viral diagnosis (D0). We first evaluated the ability to predict the diagnosis from the metabotype at D0 in an independent population. Next, we assessed the feasibility of predicting the disease evolution at the 7th and 15th day. Plasma metabolome allowed us to generate a discriminant multivariate model to predict the diagnosis of SARS-CoV-2 in an independent population (accuracy > 74%, sensitivity, specificity > 75%). We identified the role of the cytosine and tryptophan-nicotinamide pathways in this discrimination. However, metabolomic exploration modestly explained the disease evolution. Here, we present the first metabolomic study in SARS-CoV-2 patients which showed a high reliable prediction of early diagnosis. We have highlighted the role of the tryptophan-nicotinamide pathway clearly linked to inflammatory signals and microbiota, and the involvement of cytosine, previously described as a coordinator of cell metabolism in SARS-CoV-2. These findings could open new therapeutic perspectives as indirect targets.

Suivi clinique a 30 et 60 jours des patients ayant presente une forme moderee de COVID-19.

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2020

Comparaison des tests sérologiques SARS-CoV2 Euroimmun IgG, Abbott IgG et Wantai Ac totaux

Introduction La sérologie SARS-CoV2 est recommandée par la HAS pour le diagnostic de l’infection à SARS-CoV2 si la PCR est négative ou non faite et seulement à partir de j7 ou j14 après le début des symptômes. La HAS recommande l’utilisation de tests présentant une sensibilité ≥90–95 % et une spécificité ≥98 %. L’objectif de notre étude était de comparer les performances des tests sérologiques SARS-CoV2 Euroimmun IgG, Abbott IgG et Wantai Ac totaux dans ces indications. Leurs performances ont été évaluées sur 63 sérums de patients avec PCR SARS-CoV2 positive (avant j7, n=5 ;j7–j13, n=14 ;≥j14, n=44) et 98 sérums contrôles pré-pandémiques dont 42 provenant de patients avec un antécédent d’infection par un Coronavirus saisonnier. Matériels et méthodes Les sérums du groupe SARS-CoV2 ont été collectés entre le 8 avril et le 11 mai 2020 chez des patients hospitalisés avec une infection par le SARS-CoV2 confirmée par PCR. Les sérums contrôles pré-pandémiques ont été collectés avant novembre 2019. Les sérologies SARS-CoV2 ont été réalisées rétrospectivement par test ELISA (Euroimmun IgG et Wantai Ac totaux) et par chimioluminescence (Abbott IgG sur système Alinity-i). Les résultats ininterprétables (ratio 0,9-1-1) des tests Euroimmun et Wantai ont été considérés négatifs. Résultats La sensibilité des tests Euroimmun IgG, Abbott IgG et Wantai Ac totaux après j14 était de 94,9 % (37/39), 97,4 % (38/39) et 97,4 % (38/39), respectivement. Le seul faux négatif commun aux trois techniques correspondait à une patiente transplantée cardiaque. La sensibilité de ces mêmes tests après j7 était de 79,3 % (46/58), 87,9 % (51/58) et 94,8 % (55/58), respectivement. La spécificité de ces mêmes tests était de 91,8 % (90/98), 99,0 % (97/98) et 100 % (98/98), respectivement. Des sérologies SARS-CoV2 Euroimmun IgG faussement positives étaient observés chez des patients avec ou sans antécédent d’infection par des Coronavirus saisonniers (3/42 soit 7 % vs 5/56 soit 9 %). Les ratios des positifs du groupe contrôle étaient plus faibles que ceux du groupe infecté (médiane de 2,6 vs 7,7, p<0,006). Conclusion La sensibilité des tests sérologiques SARS-CoV2 répond aux exigences de la HAS (≥95 %) dès j7 (Wantai Ac totaux) ou j14 (Euroimmun IgG et Abbott IgG). L’immunodépression ou un prélèvement trop précoce (avant j7 ou j14) sont des situations confirmées comme particulièrement à risque de faux négatifs. La spécificité des tests annoncée par les fabricants (>98 %) a été vérifiée pour les tests Abbott IgG et Wantai Ac totaux. La spécificité du test Euroimmun IgG observée dans cette étude (91,8 %) ne correspondait pas à celle annoncée par le fabricant (98,5 %). Une vigilance particulière doit être apportée à l’interprétation des résultats positifs avec cette technique. Les performances des tests sérologiques SARS-CoV2 évalués ici sont bonnes dans l’ensemble. Les variabilités de performance observées devraient contribuer à l’amélioration de ces tests.

The specific metabolome profiling of patients infected by SARS-COV-2 supports the key role of tryptophan-nicotinamide pathway and cytosine metabolism (preprint)

BackgroundThe biological mechanisms involved in SARS-CoV-2 infection are only partially understood. Thus we explored the plasma metabolome of patients infected with SARS-CoV-2 to search for diagnostic and/or prognostic biomarkers and to improve the knowledge of metabolic disturbance in this infection.Materials and Methods                            We analyzed the plasma metabolome of 55 patients infected with SARS-CoV-2 and 45 controls by LC-HRMS at the time of diagnosis (D0). We first evaluated the ability to predict the diagnosis from the metabotype at D0 in an independent population. Next, we assessed the feasibility of predicting the disease evolution at the 7th and 15th day.ResultsPlasma metabolome allowed us to generate a discriminant multivariate model to predict the diagnosis of SARS-CoV-2 in an independent population (accuracy>74%, sensitivity, specificity>75%). We identified the role of the cytosine and tryptophan-nicotinamide pathways in this discrimination. However, metabolomic exploration modestly explained the disease evolution.DiscussionHere, we present the first metabolomic study in SARS-CoV-2 patients which showed a high reliable prediction of early diagnosis. We have highlighted the role of the tryptophan-nicotinamide pathway clearly linked to inflammatory signals and microbiota, and the involvement of cytosine, previously described as a coordinator of cell metabolism in SARS-CoV-2. These findings could open new therapeutic perspectives as indirect targets.