Dual antiretroviral therapy as initial treatment for people living with HIV-1?

Emilie Dupont (1,2), Jean Cyr Yombi( 2) Published in the journal : November 2019 Category : Maladies infectieuses

Combined antiretroviral therapy (cART) has significantly improved the prognosis and life expectancy of people living with human immunodeficiency virus (PLWHIV). Current international guidelines recommend a triple therapy that conventionally combines two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and a third agent that is either a ritonavir- or cobicistat-boosted protease inhibitor (PI), either a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted or unboosted integrase inhibitor (INI). Due to the toxicity of NRTIs, alternative non-NRTI-based therapeutic regimens have been proposed. They initially had limited success compared to the standard triple therapy due to low efficacy, particularly in patients with high viral load and low CD4 cell counts. A new strategy combining lamivudine (3TC) with boosted PI or INI has yielded promising results, suggesting that modern dual therapies will become a reliable first-line treatment option for PLWHIV. Recently, the European AIDS Clinical Society guidelines have recommended dual therapy as the preferred regimen in treatment-naive patients in certain circumstances.

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A tetanus diagnosis in a patient with appropriate anti-tetanus serology

Dominique Henrion, Laurence Delbrassinne Published in the journal : January 2018 Category : Maladies infectieuses

We have here reported on an elderly patient who developed tetanus in spite of appropriate protective antibody levels. The clinical diagnosis could, however, not be confirmed by laboratory tests. A brief review on tetanus is provided, with the concluding remarks highlighting the necessity of regular vaccinations, even though vaccine escape may at times occur

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Pulmonary ascites in a train controller

Ha Mo Linh Lê (1), Patrick Gohy (1), Aude Schillaci (2), Didier Deltour (2), Andoni Laka (3), Patricia Schatt (4), Philippe Machiels (1) Published in the journal : December 2017 Category : Maladies infectieuses

The diagnosis of peritoneal tuberculosis is often delayed, given that this clinical condition has become rare in developed countries, while its presentation often proves to be indolent, with non-specific clinical features. In addition, the tests used to diagnose peritoneal tuberculosis do not enable us to distinguish this pathology from other abdominal diseases. Ziehl-Neelsen staining and polymerase chain reaction (PCR) analysis are not always sensitive. Culture growth can take up to 2 months before yielding results. While quick alternative non-invasive tests, such as plasmatic adenosine deaminase levels, may prove useful for diagnosis, laparoscopy remains the gold standard for peritoneal tuberculosis, allowing for both direct examination and tissue sampling in view of culture and histologic analysis.

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Listeria monocytogenes is a rare cause of bacterial peritonitis, associated with poor prognosis. Appropriate antibiotic therapy may limit the damage

Melina Terrana, Laurence Faugeras, Anne-Caroline Courtois, Lionel D’Hondt (1) Published in the journal : December 2017 Category : Maladies infectieuses

Spontaneous bacterial peritonitis affects approximately 30% of hospitalized cirrhotic patients (1). Similar cases have been reported in patients suffering from carcinomatous ascites or receiving peritoneal dialysis (2). The most common pathogens are E. coli, Klebsiella pneumonia, Streptococci spp, and Enterobacteriaceae spp (3). In a minority of cases (<5%), other microorganisms are found, such as Candida, anaerobic bacteria, and Listeria (3). Only 108 cases of PSB Listeria have been reported in the scientific literature since 1977 (4). Identifying these cases proves paramount, because they are mainly resistant to cefotaxime (5).

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Zika virus, fetal and neonatal consequences

Elise Osterheld, Emmanuel Scalais Published in the journal : June 2017 Category : Maladies infectieuses

Zika virus (ZIKV) is a flavivirus transmitted by mosquitoes of the Aedes genus, and whose transplacental transmission is responsible for severe neurologic damage in the fetus and newborn. The current brazilian epidemic already concerns 1.3 billion persons and has already spread to more than 50 countries, making it essential to better understand this virus, in order to establish preventive measures, to guide the care of pregnant women exposed to the ZIKV and to ensure an adequate follow-up of their infected children.

Key Words

Zika virus, congenital damage, microcephaly

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Aging with HIV, new reality, new challenges

Jean-Cyr Yombi, Jean-Christophe Marot Published in the journal : June 2017 Category : Maladies infectieuses

HIV/AIDS has been transformed into a manageable, chronic condition and the life expectancy of patients living with human immunodeficiency virus (HIV) is now comparable to those without the disease. This is mainly due to the emergence of combination antiretroviral (cARV) therapy. This situation poses many new problems and challenges: persistent inflammation leading to immune activation, multi-morbidities, accumulation of toxicity of antiretroviral treatments, ageing and, finally, overloading of health systems especially in low resource countries. In this article we discuss many of these challenges.

Key Words

HIV, ageing, heart, kidney, bone, neurocognitive impairement

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