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St Pierre, Belgium

Dooko C.B.A.,UCare | De Wit S.,St Pierre University Hospital | Neuhaus J.,University of Minnesota | Palfreeman A.,University of Leicester | And 3 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

Background: HIV infection is associated with increased levels of inflammatory markers. Inflammation is hypothesized to play a role in the development of type 2 diabetes. Data addressing this issue among HIV-positive participants are limited. Methods: A cohort of 3695 participants without diabetes, taking antiretroviral therapy and with an average CD4+ count of 523 cells/mm3, were followed for an average of 4.6 years. Diabetes risk associated with baseline levels of high sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) was assessed using Cox proportional hazards regression models. Analyses considered baseline levels of factors associated with diabetes risk and HIV-related measures. Results: One hundred thirty-seven patients developed diabetes requiring drug treatment during follow-up (8.18 per 1000 person-years). Median levels of IL-6 and hsCRP were significantly higher among those who developed diabetes compared with those who did not: 3.45 versus 2.50 pg/mL for IL-6 and 4.91 versus 3.29 μg/mL for hsCRP (P < 0.001). Adjusted hazard ratios associated with a doubling of IL-6 and hsCRP were 1.29 (95% confidence interval: 1.08 to 1.55; P = 0.005) and 1.22 (95% confidence interval: 1.10 to 1.36; P < 0.001), respectively. Body mass index (P < 0.001), age (P = 0.013), coinfection with hepatitis B or C (P = 0.03), nonsmoking status (P = 0.034), and use of lipid-lowering treatment (P = 0.008) were also associated with an increased risk of diabetes. Conclusions: These findings indicate that low-grade systemic inflammation is an underlying factor in the pathogenesis of diabetes. Copyright © 2014 by Lippincott Williams & Wilkins. Source


Bruyand M.,French Institute of Health and Medical Research | Ryom L.,Copenhagen University | Shepherd L.,University College London | Fatkenheuer G.,University of Cologne | And 9 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: The association between combination antiretroviral therapy (cART) and cancer risk, especially regimens containing protease inhibitors (PIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs), is unclear. Methods: Participants were followed from the latest of D:A:D study entry or January 1, 2004, until the earliest of a first cancer diagnosis, February 1, 2012, death, or 6 months after the last visit. Multivariable Poisson regression models assessed associations between cumulative (per year) use of either any cART or PI/NNRTI, and the incidence of any cancer, non-AIDS-defining cancers (NADC), AIDS-defining cancers (ADC), and the most frequently occurring ADC (Kaposi sarcoma, non-Hodgkin lymphoma) and NADC (lung, invasive anal, head/neck cancers, and Hodgkin lymphoma). Results: A total of 41,762 persons contributed 241,556 person-years (PY). A total of 1832 cancers were diagnosed [incidence rate: 0.76/100 PY (95% confidence interval: 0.72 to 0.79)], 718 ADC [0.30/100 PY (0.28-0.32)], and 1114 NADC [0.46/100 PY (0.43-0.49)]. Longer exposure to cART was associated with a lower ADC risk [adjusted rate ratio: 0.88/year (0.85-0.92)] but a higher NADC risk [1.02/year (1.00-1.03)]. Both PI and NNRTI use were associated with a lower ADC risk [PI: 0.96/year (0.92-1.00); NNRTI: 0.86/year (0.81-0.91)]. PI use was associated with a higher NADC risk [1.03/year (1.01-1.05)]. Although this was largely driven by an association with anal cancer [1.08/year (1.04-1.13)], the association remained after excluding anal cancers from the end point [1.02/year (1.01-1.04)]. No association was seen between NNRTI use and NADC [1.00/year (0.98-1.02)]. Conclusions: Cumulative use of PIs may be associated with a higher risk of anal cancer and possibly other NADC. Further investigation of biological mechanisms is warranted. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source


Ismaili K.,Queen Fabiola Childrens University Hospital | Piepsz A.,St Pierre University Hospital
Pediatric Radiology | Year: 2013

This review includes an analysis of new developments in the field of renography, the predictive factors suggesting the need for pyeloplasty in cases of pelvi-utereric stenosis detected antenatally and integration of the pelvi-ureteric junction stenosis within the framework of antenatally detected hydronephrosis. © 2012 Springer-Verlag. Source


Cadiere G.-B.,St Pierre University Hospital
Obesity Surgery | Year: 2012

Background The Roux-en-Y gastric bypass (RYGB) performed laparoscopically (LRYGB) is the most frequently performed bariatric procedure in Belgium. However, late results in terms of weight loss or weight regain are inconsistent and may warrant a second procedure. This retrospective study analyzes the laparoscopic options for revisional surgery after LRYGB. Methods Between January 1, 2001 and December 31, 2009, 70 patients underwent a new laparoscopic procedure for poor weight loss or weight regain after LRYGB. The revisional procedure was performed a median of 2.6 years after the initial bypass operation. Fifty-eight patients were available for follow-up (82.9 %); 19 underwent distalization; and 39 a new restrictive procedure. Results The mean mass index (BMI) before the revisional procedure was 39.1±11.3 kg/m 2 (30.8-51.8), down from 42.7±19.7 kg/m2 (33.0-56.6) initially, which corresponded to a percentage of excess weight loss (EWL) of 12.4±9.3 % (-1.0-29.1). After the corrective procedure, with a follow-up of approximately 4 years, mean BMI was 29.6±12.4 kg/m 2 (18.0-45.5), for a significant additional percentage of EWL of 53.7±9.8 % (2.0-65.8). The overall complication rate was 20.7 %, and the reoperation rate was 7.3 %. The overall leak rate was 12.1 %. Patients suffering from leaks could consistently be treated conservatively or by stent placement. Two patients needed reconversion after distal bypass. The satisfaction index was good in just over 50 % of the patients. Conclusion Revisional laparoscopic surgery after RYGB performed for weight issues provides good additional weight loss but carries significant morbidity. Leaks can usually be handled non-surgically. Patient satisfaction is only fair. © Springer Science + Business Media, LLC 2012. Source


Apers L.,Institute of Tropical Medicine | Vanden Berghe W.,Institute of Tropical Medicine | De Wit S.,St Pierre University Hospital | Kabeya K.,St Pierre University Hospital | And 5 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Objective: To better understand risk factors for the sexual transmission of hepatitis C viral (HCV) infection among men who have sex with men (MSM). Design: Case-control study among HIV-infected MSM, attending AIDS Reference Centers in Belgium. Methods: Cases were HIV-infected MSM who were diagnosed with HCV between January 2010 and December 2013. For each case, 2 controls were randomly selected among the HIV-positive MSM who tested negative for HCV around the same time as the cases were identified. Consenting participants were interviewed with a questionnaire on risk factors. Medical records were abstracted to document past episodes of sexually transmitted infections (STIs). Associations between HCV infection and risk factors were explored using bivariate analysis followed by multiple logistic regression analysis. Results: A total of 52 cases and 90 controls were recruited. In multivariate analysis, douching before anal intercourse [adjusted odds ratio (AOR) 9.84, 95% CI: 2.26 to 42.78], fisting (AOR 3.54, 95% CI: 1.31 to 9.57), having intercourse with HIV-positive men (AOR 5.51, 95% CI: 1.87 to 16.20), and a documented gonorrhoea or chlamydial infection in the year before inclusion in the study (AOR 4.50, 95% CI: 1.11 to 18.31) were independently associated with incident HCV infection. Conclusions: Our study confirmed fisting and suffering from other STIs as risk factors for HCV and suggested an increased risk of HCV associated with serosorting. Furthermore, we identified anal douching as being associated with HCV infection. The role that douching plays in the acquisition of HCV infection and other STIs requires further research, as well as the effect of serosorting on STI transmission. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

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