Measles seroprevalence in human immunodeficiency virus-infected adults born in the era of measles vaccination.

OBJECTIVE: Widespread use of the measles vaccine should lead to the elimination of this disease. Here, we study the seroprevalence of measles in a cohort of adults living with HIV born after the introduction of measles vaccine in France and attempt to identify risk factors for the absence of serum measles antibody. DESIGN: In this multi-centre cross-sectional study, adult outpatients born after 1980 were screened for the presence of measles IgG antibody. Demographic and clinical data were obtained from the standardized electronic medical record system. Univariate and multivariate logistic regressions were performed to identify factors associated with the absence of measles antibodies. RESULTS: Between April 2019 and April 2020, 648 participants were enrolled. The median age was 33 years, 53.6% were born outside of France, and 74% were considered as socially deprived. Plasma HIV RNA was undetectable in 86% of patients. Among 603 evaluable patients, measles serology was positive in 87.2%. Only 81.8% of the patients with documented vaccination tested positive for measles IgG. Younger age was significantly associated with the absence of measles serum antibodies ( P  = 0.004 for each 10-year lower), as was birth in France ( P  < 0.001) and absence of social vulnerability ( P  = 0.04). CONCLUSION: The current study revealed a low seroprevalence of measles compared with that previously reported in France 6 years earlier and to the expected rate to achieve herd immunity. Checking vaccination record should be systematically carried out in patients living with HIV to fill the immunity gaps.

Assessment of drug-drug interaction in an elderly human immunodeficiency virus population: Comparison of 3 expert databases.

AIMS: Polypharmacy increase the risk of drug-drug interactions (DDIs) in the elderly population living with human immunodeficiency virus (HIV). Several expert databases can be used to evaluate DDIs. The aim of the study was to describe actual DDIs between antiretroviral drugs and comedications in an elderly population and to compare grading of the DDIs in 3 databases. METHODS: All treatments of HIV-infected subjects aged 65 years and older were collected in 6 French HIV centres. Summary of Product Characteristic (SPC), French DDI Thesaurus (THES), and Liverpool HIV DDI website (LIV) were used to define each DDI and specific grade. DDIs were classified in yellow flag interaction (undefined grade in SPC and THES or potential weak interaction in LIV), amber flag interaction (to be considered/precaution of use in SPC and THES and potential interaction in LIV) and red flag interaction (not recommended/contraindication in SPC and THES and do not administer/contraindication in LIV). RESULTS: Among 239 subjects included, 60 (25.1%) had at least 1 DDI for a total of 126 DDIs: 23/126 red flag DDIs were identified in 17 patients. All these 23 DDIs were identified in LIV. THES and SPC missed 6 and 1 red flag DDIs, respectively. Seven of 23 red flag DDIs were identified in the 3 databases concomitantly. CONCLUSION: Polypharmacy is frequent in this elderly HIV population leading to DDI in a quarter of the subjects. The discrepancies between databases can be explained by differences in analysis methods. A consensus between databases would be helpful for clinicians.

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV-1 infection: results from a longitudinal study in the French ANRS Primo cohort.

INTRODUCTION: Previous studies have reported better immunovirological characteristics in women compared with men after HIV seroconversion. We investigated whether differences persisted under long-term antiretroviral therapy (ART) in individuals treated since acute and early HIV-1 infection (AHI). METHODS: Data were obtained for 262 women and 1783 men enrolled between 1996 and 2017 in the French multicentre ANRS PRIMO cohort. We modelled the viral response, long-term immune recovery and HIV DNA decay in the 143 women and 1126 men who initiated ART within the first three months of infection. RESULTS: The participants were mostly white. The mean age was 37 years at AHI diagnosis. Pre-ART viral loads were lower in women than men, 5.2 and 5.6 log10 copies/mL (p = 0.001). After ART initiation, women more rapidly achieved viral suppression than men (adjusted hazard ratio: 1.33, 95% confidence interval 1.09 to 1.69). They also experienced a faster increase in CD4+ T-cell count and CD4:CD8 ratio during the first months of treatment. Sex-related differences in CD4+ T-cell counts were more pronounced with increasing age. This led to a sustained mean difference of 99 to 168 CD4+ T-cells/µL depending on age between women and men at 150 months of ART. Moreover, CD4:CD8 ratio of women was higher than that of men by 0.31, at 150 months of ART. There was no statistically significant difference between sexes for the levels of HIV DNA over time (mean estimate at the last modelling point: 1.9 log10 copies/106 PBMCs after 70 months of ART for both sexes). CONCLUSIONS: The high level of immune recovery and decrease in total HIV DNA levels achieved after ART initiation during AHI reinforce the importance of early diagnosis of HIV infection and immediate ART initiation. The immunological benefit of being female increased throughout prolonged ART duration, which may give women additional protection from adverse clinical events and premature ageing.

[The needs and expectations of HIV patients before starting a therapeutic patient education program]. / Besoins et attentes des patients vivant avec le VIH dans la perspective de la mise en place d'un programme d'éducation thérapeutique.

OBJECTIVES: The purpose of this study was to identify and quantify needs and expectations among HIV patients with a view to developing and implementing a therapeutic patient education program. MATERIALS AND METHODS: A qualitative study using semi-structured interviews was conducted to identify patient education needs. A quantitative study based on a personal questionnaire was subsequently conducted at the teaching hospitals of Nantes and Angers (France). RESULTS: The study was based on a sample of 351 patients (73% of the sample were men and 27% were women). The mean age of the participants was 45.7 years. 73% of the patients stated that they had spoken to a hospital practitioner, while just 29% claimed to have spoken to nurses. 83% stated that they were satisfied with the availability of nursing staff. 88% considered that practitioners explained their treatment decisions, while 80% stated that they had been asked for their opinion. Of the 301 patients treated, 97% felt that they were able to correctly take their medication, while 48% felt that they had no knowledge of HIV-related complications. 68% of the patients expressed concerns about infection risks, particularly young patients (p< 0.001). Concerning the side effects of treatment (lipodystrophy, pain, insomnia, physical changes), half of the patients felt that they had been adequately informed. In terms of emotional support, 79% of the patients stated that they had someone to talk to in the event of a problem. Half of the patients felt isolated and 19% felt discriminated against. Three quarters of the patients did not wish to discuss their financial difficulties, their work problems or the death of a close relative due to HIV infection. Finally, patients treated for more than ten years felt a stronger need to join an association (p = 0.001). CONCLUSION: The results suggest the need to improve patients' ability to express their needs, particularly those who are not members of an association. In addition to the implementation of a therapeutic education program, a social support program is also needed.