[Breastfeeding after breast cancer: survey to hospital health professionals in Alsace]. / Allaitement après cancer du sein : enquête auprès des professionnels de santé hospitaliers en Alsace.

OBJECTIVES: For women treated for a breast cancer and wanting childbearing, the issues of breastfeeding and its oncological safety are controversial. Therefore the aim of our study was to establish a state of knowledge of health professionals on this subject. METHODS: Two hundred and fifty questionnaires were distributed to hospital health professionals, in five Units of Obstetrics and Gynecology in Alsace. The results of our study were expressed as the number of responses, and percentage. RESULTS: Analysis of the answers to this questionnaire demonstrated that health professionals have a good theoretical knowledge of the subject and that breastfeeding is not contraindicated. Indeed, in case of breastfeeding, 90% of the hospital health professionals thought that the risk of recurrence was unchanged or decreased and 81% of them answered that the overall survival was unchanged or increased. However, on a practical view, none of these health professionals followed a woman who breastfed after a breast cancer. DISCUSSION AND CONCLUSION: Breastfeeding after breast cancer does not worsen the prognosis and seems even to improve it. Furthermore, women breastfeeding after a breast cancer have an improved life quality and recommend it to other patients. However, few women breastfeed after breast cancer and this is due to often non-justified reasons coming from their health professionals. Their role should be more to pass clear information and bring their support to breastfeeding to help the women to face their fears as well as encountered difficulties which are not specific, but felt in a more intensive way.

Three-year effectiveness of highly active antiretroviral treatment in the Luxembourg HIV cohort.

UNLABELLED: Clinical trials have shown that highly active antiretroviral treatment (HAART) is able to reduce HIV plasma viral loads to undetectable in 70% to 90% of patients and to increase CD4 cell counts. HAART in community settings (i.e., nonclinical trial situations) is reported to be much less effective. STUDY DESIGN: Observational study. PURPOSE: The aim of our study was to evaluate the effectiveness of protease inhibitor (PI)-based HAART in the Luxembourg HIV cohort after 36 months of treatment in previously treated and untreated patients. The secondary aim was to identify surrogate markers associated with long-term virologic and immunologic outcomes. PATIENTS AND METHOD: Seventy-three PI-naive patients, who started on HAART, combining one PI and two nucleoside reverse transcriptase inhibitors (NRTIs),with a follow-up of 3 years, were evaluated with plasma viral load and CD4 cell counts every 3 months and were analyzed retrospectively. Patients who had been treated previously with NRTI (n = 48) were at a more advanced stage of disease. RESULTS: Overall, there was a mean decrease in viral load compared to baseline of -1.89 log RNA copies/mL (SD = 1.40) that persisted at month 36. Sixty-two percent (62%) of patients reached an undetectable viral load (i.e., below 500 copies/mL): 82% and 53% of NRTI-naive and NRTI-experienced patients, respectively (p =.013). CD4 cell counts increased progressively in both groups with a sustained effect (mean increase of 146 cells/mL +/- 241) at month 36. NRTI-naive patients had a mean increase of 257 cells/mL (SD = 305), in contrast to experienced patients who had an increase of 108 cells/mL (SD = 206) at 3 years. Proportions of patients with a CD4 count under 200 cells/mL fell after 3 years for NRTI-naive (from 66% to 43%) and for experienced patients (from 32% to 13%). Predictors of short duration of viral load response were in decreasing order of importance: clinical AIDS, the use of saquinavir hard gel formulation as initial PI, and the number of NRTIs previously used. Viral load response was the only significant predictor of CD4 changes. CONCLUSION: In a community setting, effectiveness of PI-based HAART at 3 years is still achieved for most patients. NRTI-experienced patients have a good long-term response rate even if it is lower than NRTI-naive patients. A poor treatment response is associated with a more advanced stage of disease before HAART is introduced.