Jean K.,French Institute of Health and Medical Research |
Jean K.,Imperial College London |
Jean K.,French National Conservatory of Arts and Crafts |
Jean K.,Institute Pasteur Paris |
And 12 more authors.
American Journal of Epidemiology | Year: 2016
Whether risk compensation could offset the preventive effect of early initiation of antiretroviral therapy (ART) on human immunodeficiency virus (HIV) transmission remains unknown. Using virological and behavioral data collected 12 months after inclusion in the TEMPRANO randomized trial of early ART (Abidjan, Côte d'Ivoire, 2009-2012), we estimated the risk of HIV transmission and compared it between the intervention (early ART; n = 490) and control (deferred ART; n = 467) groups. We then simulated increases in various sexual risk behaviors in the intervention group and estimated the resulting preventive effect. On the basis of reported values of sexual behaviors, we estimated that early ART had an 89% (95% confidence interval: 81, 95) preventive effect on the cumulative risk of HIV transmission over a 1-month period. This preventive effect remained significant for a wide range of parameter combinations and was offset (i.e., nonsignificant) only for dramatic increases in different sexual behaviors simulated simultaneously. For example, when considering a 2-fold increase in serodiscordance and the frequency of sexual intercourse together with a 33% decrease in condom use, the resulting preventive effect was 47% (95% confidence interval:-3, 74). An important reduction of HIV transmission may thus be expected from the scale-up of early ART, even in the context of behavioral change. © 2016 The Author.
Guehi C.,Unite de Soins Ambulatoire et de Conseil USAC |
Badje A.,French Institute of Health and Medical Research |
Gabillard D.,French Institute of Health and Medical Research |
Gabillard D.,Bordeaux University |
And 14 more authors.
AIDS Research and Therapy | Year: 2016
Background: HIV is usually associated with weight loss. World health Organization (WHO) recommends early antiretroviral (ART) initiation, but data on the progression of body mass index (BMI) in participants initiating early ART in Africa are scarce. Methods: The Temprano randomized trial was conducted in Abidjan to assess the effectiveness of early ART and Isoniazid (INH) prophylaxis for tuberculosis in HIV-infected persons with high CD4 counts below 800 cells/mm3 without any indication for starting ART. Patients initiating early ART before December 2010 were included in this sub-study. BMI was categorized as: underweight (<18.5kg/m2), normal weight (18.5-24.9kg/m2), overweight (25-29.9kg/m2) and obese (≥30kg/m2). At baseline and after 24months of ART, prevalence of being overweight or obese and factors associated with being overweight or obese were estimated using univariate and multivariate logistic regression. Results: At baseline, 755 participants (78% women; median CD4 count 442/mm3, median baseline BMI 22kg/m2) initiated ART. Among them, 19.7% were overweight, and 7.2% were obese at baseline. Factors associated with being overweight or obese were: female sex aOR 2.3 (95% CI 1.4-3.7), age, aOR for 5years 1.01 (95% CI 1.0-1.2), high living conditions aOR 2.6 (95% CI 1.5-4.4), High blood pressure aOR 4.3 (95% CI 2.0-9.2), WHO stage 2vs1 aOR 0.7 (95% CI 0.4-1.0) and Hemoglobin≥95g/dl aOR 3.0 (95% CI 1.6-5.8). Among the 597 patients who attended the M24 visit, being overweight or obese increased from 20.4 to 24.8% (p=0.01) and 7.2 to 9.2% (p=0.03) respectively and factor associated with being overweight or obese wasimmunological response measured as an increase of CD4 cell count between M0-M24 (for +50 cells/mm3: aOR 1.01; 95% CI 1.05-1.13, p=0.01). Conclusion: The weight categories overweight and obese are highly prevalent in HIV-infected persons with high CD4 cell counts at baseline, and increased over 24months on ART in this Sub-Saharan African population. © 2016 Guehi et al.
PubMed | ANRS Research Site, French Institute of Health and Medical Research, Médecins Sans Frontières and Alliance for International Medical Action ALIMA
Type: Journal Article | Journal: The American journal of tropical medicine and hygiene | Year: 2016
The 2014 Ebola epidemic has shown the importance of accurate and rapid triage tools for patients with suspected Ebola virus disease (EVD). Our objective was to create a predictive score for EVD. We retrospectively reviewed all suspected cases admitted to the Ebola treatment center (ETC) in Nzrkor, Guinea, between December 2, 2014, and February 23, 2015. We used a multivariate logistic regression model to identify clinical and epidemiological factors associated with EVD, which were used to create a predictive score. A bootstrap sampling method was applied to our sample to determine characteristics of the score to discriminate EVD. Among the 145 patients included in the study (48% male, median age 29 years), EVD was confirmed in 76 (52%) patients. One hundred and eleven (77%) patients had at least one epidemiological risk factor. Optimal cutoff value of fever to discriminate EVD was 38.5C. After adjustment on presence of a risk factor, temperature higher than 38.5C (odds ratio [OR] = 18.1, 95% confidence interval [CI] = 7.6-42.9), and anorexia (OR = 2.5, 95% CI = 1.1-6.1) were independently associated with EVD. The score had an area under curve of 0.85 (95% CI = 0.78-0.91) for the prediction of laboratory-confirmed EVD. Classification of patients in a high-risk group according to the score had a lower sensitivity (71% versus 86%) but higher specificity (85% versus 41%) than the existing World Health Organization algorithm. This score, which requires external validation, may be used in high-prevalence settings to identify different levels of risk in EVD suspected patients and thus allow a better orientation in different wards of ETC.