High prevalence of Mycoplasma genitalium infection and macrolide resistance in patients enrolled in HIV pre-exposure prophylaxis program.

OBJECTIVES: Limited data on Mycoplasma genitalium infection has been reported among PrEP users. The aim of this study was to estimate the prevalence and macrolide resistance of M. genitalium infection among enrollees in a French PrEP program. PATIENTS AND METHODS: M. genitalium infection screening was systematically and prospectively proposed to patients of the Bordeaux PrEP program (between January 2016 and February 2017). Macrolide resistance was evaluated in M. genitalium-positive patients. RESULTS: Among 89 clients, M. genitalium infection prevalence was 10% (mainly asymptomatic) with a high rate of macrolide resistance (58%). CONCLUSIONS: Because of a high level of macrolide resistance, a systematic search for M. genitalium macrolide resistance associated-mutations may be recommended in PrEP users before initiating the antibiotic therapy.

[Thrombotic thrombocytopenic purpura associated with interferon therapy in a HIV and HCV co-infected woman]. / Purpura thrombotique thrombocytopénique induit par l'interféron chez une femme co-infectée par le VIH et le VHC.

INTRODUCTION: Causes of acquired thrombotic thrombocytopenic purpura (TTP) are multiple and rarely iatrogenic. CASE REPORT: A 40-year-old, HIV and hepatitis C virus co-infected woman was treated with interferon and ribavirine and developed a TTP confirmed by the presence of anti-ADAMTS 13 antibodies. The outcome was favourable when treatment was discontinued and rituximab infusion administered. CONCLUSION: The occurrence of anemia and thrombocytopenia in patients treated with interferon and ribavirine is not always related to direct toxicities of these treatments. The ADAMS 13 testing may help the clinician to diagnose iatrogenic acquired TTP.

[Adherence between antibiotic prescriptions and guidelines in an internal medicine ward: an evaluation of professional practices]. / Adéquation entre les prescriptions antibiotiques et les recommandations dans un service de médecine interne : une démarche d'évaluation des pratiques professionnelles.

INTRODUCTION: This is an evaluation of professional practices (EPP) on antibiotic therapy in an internal medicine ward. MATERIAL AND METHODS: A 6-month prospective review of antibiotic prescriptions and their comparisons with local and national guidelines (drug, daily dose, administration, and duration) were performed. RESULTS: Antibiotic therapy on 227 infectious episodes was collected. According to local guidelines, we found 56% of totally respected (lower respiratory tract infections: 38%, urinary tract infections: 88% and skin infections: 73%), 33% of partially respected and 11% of non-appropriate prescriptions. Considering national guidelines for lower respiratory tract infections as references, the results were: totally respected prescriptions 81%, partially respected prescriptions 16%, and non-appropriate prescriptions 3%. CONCLUSION: This evaluation of the prescriptions allowed setting up long-lasting actions to improve clinical practice. This approach anticipates the procedures of EPP that will be needed for hospital accreditation and highlights the importance of considering several guidelines for the interpretation of the results.

Menopause and HIV infection: age at onset and associated factors, ANRS CO3 Aquitaine cohort.

The aim of the paper is to describe the characteristics of postmenopausal HIV-infected women and to investigate the factors associated with an earlier onset of menopause in a hospital-based cohort. Information was collected using a self-administered questionnaire. A Cox model was used to determine factors associated with menopause. Among the 404 women who completed the questionnaire, 69 were naturally postmenopausal at the time of the study (median age at onset: 49 years, premature menopause <40 years: 12%). The onset of menopause was studied among the 41 women still menstruating at the enrollment in the cohort, and who experienced menopause during follow-up. African origin (hazard ratio [HR] = 8.16; 95% confidence interval [CI] = 2.23-29.89) and history of injecting drug use (IDU) (HR = 2.46; 95% CI = 1.03-5.85) were associated with an increased risk of earlier menopause. Women with a CD4 cell count <200 cells/mm(3) tended to reach menopause earlier (HR = 2.25; 95% CI = 0.94-5.39). Earlier occurrence of menopause seems to be associated with factors already reported in HIV-negative women (IDU, ethnicity) and with HIV-related immunodeficiency.

Multidisciplinary network in heart failure management in a community-based population: results and benefits at 2 years.

OBJECTIVE: To study the effects of a network using simple routine tools, in a community-based population. METHODS: This is a non-randomized controlled study. Cardiosaintonge network set up on January 1st 2004, offered coordinating care involving general practitioners, cardiologists, nurses, physical therapists and dieticians to patients with heart failure. RESULTS: After 2 years, 362 patients were included, 129 in the network and 233 in the usual care control group. The 2 groups were different for age but not for gender. The readmission rate was of 2.5 days per patient included in the network versus 4.8 in the control group. Twenty four patients (19%) died in the network and 82 (35%) in the control group (p=0.001). Survival analysis estimated a median survival time of >4 months (median survival not achieved within the follow-up) for the network group and 20 months for the non-network group (p=0.0004). The Cox model, adjusting on gender, age and NYHA stage determined the independent role of the network on longer survival since, the adjusted hazard ratio was of 0.37 for the network group (p=0.02). The Duke quality of life score marked a global improvement since admission, at months 6, 12, 18 and 24. CONCLUSIONS: Cardiosaintonge network permits less readmissions and longer survival with better quality of life for patients with chronic heart failure.