[Hepatitis A seroprevalence in HIV-infected patients]. / Séroprévalence de l'hépatite A chez des patients infectés par le VIH.

OBJECTIVE: The authors had for aim to prospectively study the hepatitis A seroprevalence of an HIV-infected population, followed-up in an outpatient clinic (CISIH Strasbourg). DESIGN: Blood tests were performed on all patients from September 2003 to March 2004 to screen for hepatitis A (total antibodies with Elisa). RESULTS: The overall seroprevalence was 219/514 (56.6%), similar in male and female patients. It increased with age, especially in European patients (P = 0.003). The seroprevalence was lower in European subjects: 46.3% (while it reached 100% in sub-Saharan Africans), the prevalence was similar whatever the HIV risk group (46% in homosexual as well as in heterosexual patients, 44% in intravenous drug users). Hepatitis B or C co-infection did not increase the seroprevalence of hepatitis A. The hepatitis A seroprevalence was similar in various CD4 T cell count categories. CONCLUSIONS: Our results stress the utility of hepatitis A serology in HIV-infected patients (more than 50% of European patients are non immune), and the importance of assessing hepatitis A vaccination.

[Structured therapeutic interruption in patients infected with HIV-1 experiencing a block in their antiretroviral treatment: preliminary results]. / Interruption thérapeutique programmée chez des patients infectés par le VIH-1 en échec d'un traitement antirétroviral: résultats préliminaires.

Structured therapeutic interruption (STI) has been offered to HIV-1 infected patients with virological failure (viral load > 1500 copies/mL) of potent antiretroviral therapy (ART) (three or four drugs for at least one year). CD4 lymphocyte count, HIV-1 viral load, clinical status, were assessed every month during STI and after ART reintroduction. Genotype analysis by plasma virus sequencing was done before and after treatment interruption. The results of 14 patients who resumed ART for at least two months are presented. Median duration of STI was 7.5 months (range: 2-13 months). Median CD4 count was low (45/mm3) when treatment was stopped, and decreased during STI (-37/mm3 after six months). Several patients exhibited important CD4 diminutions. Viral load slightly increased (+0.83 log at M6). Few clinical events occurred: one: severe HIV-related prurigo and one CMV viremia. Reversion of resistance mutations was only seen in 2/13 (15: 4%) patients (who had previously a major CD4 deficiency, and a long treatment history), a partial reversion occurred in 5/13 (38.5%) subjects, and the mutations didn't change in the other cases (genotyping non interpretable in the last patient). ART reintroduction induced a good immune response: CD4/mm3 after six months, with significant increases in 10/14 subjects. There was an initial viral response (median viral load: -2.34 log at M1), but a quick rebound most often occurred. However, viral load remained < 50 copies/mL in four patients. In conclusion, a rapid and important decline in CD4 cell count can occur when treatment is discontinued, in patients with virological failure of ART, but the clinical risk appears to be limited. Treatment re-initiation induces a good response, but virologically transient in most cases. Patients with a shift to wild-type virus seem to have a better response.

Efavirenz as a substitute for protease inhibitors in HIV-1-infected patients with undetectable plasma viral load on HAART: a median follow-up of 64 weeks.

We investigated, in a prospective cohort follow-up study, whether substituting efavirenz (EFV) for protease inhibitors (PIs) could be safe in HIV-infected patients with optimal viral suppression achieved on PI-containing regimens. In patients with undetectable plasma viral load (pVL) <50 copies/ml who were naive to therapy with nonnucleoside reverse transcriptase inhibitors (NNRTIs), PIs were replaced by EFV whereas associated nucleoside analogs (NAs) were retained. 62 patients were enrolled. Median follow-up on EFV was 64 weeks (2-88 weeks). Side effects due to EFV occurred in 48 patients. Two patients experienced a high level viral rebound due to diminished compliance; 55 (88.7%) maintained a pVL <50 copies/ml; 3 showed one episode of viremia (52-89 copies/ml); 2 stopped EFV before any VL control. Mean CD4 cell count did not change significantly. One AIDS patient experienced a single cutaneous recurrence of Kaposi's sarcoma after 40 weeks on EFV. Replacing PI with EFV in patients with optimal pVL suppression appears to be safe both virologically and immunologically.

[Phage-typing and tetracycline resistance in Salmonella panama strains of animal origin in the Federal Republic of Germany (1969-1975) (author's transl)]. / Lysotypie und Tetracyclin-Resistenz von Salmonella panama-Stämmen tierischen Ursprungs in der Bundesrepublik Deutschland (1969-1975).

505 out of 1369 S. panama strains isolated mainly from animals, foods, and feedstuffs from 1969 to 1975 were phage-typed. 41% (= 207) of the S. panama isolates examined originated from swine, 26% from cattle and calves, 15% from dogs, and 13% were from other animal species and materials. 465 strains (=92%) showed typical reactions. 23% were specified as phage-type A, 24% as phage-type B and 36% as phage-type G. Phage-types D, E, and F did not occur. In swine, being the most frequent carriers of S. panama, phage-types A, B, and G had nearly the same shares. In dogs, phage-type G predominated to which nearly one half of the examined S. panama isolates from this species belonged. 205 (=41%) out of 505 strains examined for their resistance to antibiotics proved to be tetracycline-resistant. All 123 strains of phage-type B were tetracycline-resistant, all 35 strains of phage-type C were tetracycline-sensitive. 5 strains of phage-type A exhibited transferable tetracycline-resistance determinants.