[Virologic evolution in HIV-infected subjects with an undetectable viral load in the first trimester of 1997]. / Evolution virologique des personnes infectées par le VIH à charge virale indétectable au 1er trimestre 1997.

OBJECTIVES: Assess the evolution of viral load in HIV-infected patients whose viral load was < 500 copies/ml during the first three months of 1997. PATIENTS AND METHODS: The viral load during the first three months of 1998 was recorded for comparison. Data were collected from the DM12 database implanted in the CISIH and concerned 2113 patients. RESULTS: Virological failure was observed in one-third of the patients in the study cohort whose viral load was undetectable in 1997 (< 500 copies/ml) as their load was > 500 copies/ml one year later in 1998. The percentage of patients in a situation of virological failure in 1998 who were taking tritherapy in 1997 (38%) was lower than that in those who were not (47%). The clinical and immunological characteristics were however similar. The difference in the therapeutic regimen would probably explain the difference. CONCLUSION: These findings demonstrate that virological failure is an important problem. Other analyses should be conducted in other cohorts to determine the influence of non compliance or resistance to antiretroviral treatments. Future therapeutic strategies should take into account the results of such studies.

[Initial antiretroviral prescriptions in patients with HIV. Second semester 1994-second semester 1996]. / Les primoprescriptions d'antirétroviraux chez les patients atteints par le VIH. Second semestre 1994-second semestre 1996.

OBJECTIVES: The nature of antiretroviral therapy has radically changed these last years. A study has been conducted on data obtained from the DMI2 information system to evaluate changes on treatments, immunity and transmission profile of the patient naive to antiretroviral therapy when initiating a therapy. METHODS: DMI2 is a national, multicentered database which contains medical, epidemiological and economic information on hospital care for HIV patients. This study, on 18,510 patients followed up in one of the fifty hospitals belonging to the Centers for Information and Care of Human immune Deficiency, was conducted from the second half of 1994 to the second half of 1996. RESULTS: The therapeutic changes seen on the whole seropositive population are also observed on these patients: the proportion of regimen with only one nucleoside analogue have decreased from 90.2% in 1994 to 7.5% in 1996. The proportion of treatment with two nucleoside analogues increased from 7.9% to 67.6%. The proportion of two nucleoside analogues with one protease inhibitor regimen increased from 1.9% in 1994 to 24.6% at the end of 1996. A study focused on the second semester of 1996 shows that the proportion of homo-bisexual patients initiating an antiretroviral treatment with a three antiretroviral agents combination (29.7%) is greater than the one in the IVDU group (20.4%) or in the heterosexual group (20.8%). CONCLUSION: These results show that a higher number of patient naive to the antiretroviral therapy initiate therapy earlier, with a two or three agents combination preferentially and at a better stage of immunity.