Suchergebnisse

"La pandémie due au virus SARS-CoV-2 a vu la mise en œuvre de stratégies visant à sauver un maximum de vies humaines tout en préservant au mieux les structures fondamentales de la société. Cette crise sanitaire a constitué une expérience inédite pour notre société confrontée à une intensification remarquable des usages du numérique. Elle a été révélatrice aussi de ses forces et de ses faiblesses, accentuant des inégalités sociales, et révélatrice de la valeur que l'on donne à la vie. Ce contexte inédit, marqué par l'urgence, les incertitudes scientifiques et des ressources limitées, a obligé le réexamen de dilemmes éthiques : celui de décider qui doit vivre et qui laisser mourir, celui concernant des privations de liberté d'une ampleur importante et la nécessité de se protéger collectivement de la maladie, celui d'une injonction faite à tous de se confiner, mais d'une obligation faite à certains de continuer à travailler en présence ou à distance. Le Comité consultatif national d'éthique (CCNE) et le Comité national pilote d'éthique du numérique (CNPEN) ont d'emblée été présents pour répondre aux questions d'éthique adressées notamment par le ministère des Solidarités et de la Santé et le secrétariat d'État au numérique, mais également pour s'autosaisir et identifier des points de vigilance permettant d'éclairer les décisions aux échelles individuelle, collective, gouvernementale et sociale. Les quatorze contributions publiées permettent aujourd'hui de tirer les enseignements de cette période, empreinte d'incertitude et de souffrance, mais aussi marquée par l'innovation"

BackgroundThe number of patients on second‐line highly active antiretroviral therapy (HAART) regimens is increasing in resource‐limited settings. We describe the outcomes after 24 months for patients on LPV/r‐based second‐line regimens followed up by the ESTHER programme in Phnom Penh, Cambodia.MethodsSeventy patients who initiated second‐line HAART regimens more than 24 months earlier were included, and immuno‐virological data analyzed. HIV RNA viral load was determined by real‐time RT‐PCR. HIV‐1 drug resistance was interpreted according to the ANRS algorithm.ResultsOf the 70 patients, two were lost to follow up, three died and 65 (92.8%) remained on second‐line treatment after 24 months of follow up (median duration of treatment: 27.4 months). At switch to second‐line, the median CD4 T cell count was 106 cells/mm3 and the median viral load was 4.7 Log10. Second‐line regimens prescribed were ddI/3TC/LPV/r (65.7%), ddI/TDF/LPV/r (10.0%), ddI/AZT/LPV/r (8.6%) and TDF/3TC/LPV/r (7.1%). The median CD4 T cell gain was +258 cells/mm3 at 24 months (n = 63). After 24 months of follow up, 92.3% (60/65) of the patients presented undetectable viral loads, giving an overall treatment success rate of 85.7% (CI: 75.6‐ 92.0) in intent‐to‐treat analysis.ConclusionsThese data suggest that a LPV/r‐based second‐line regimen is associated with a high rate of virological suppression and immune reconstitution after 24 months of follow up in Cambodia.

IntroductionA key objective of combined antiretroviral therapy (cART) is to reach and maintain high CD4 cell counts to provide long‐term protection against AIDS‐defining opportunistic infections and malignancies, as well as other comorbidities. However, a high proportion of patients present late for care. Our objective was to assess CD4 cell count recovery up to seven years in naïve patients initiating cART with at least three drugs in usual clinical care.MethodsFrom the French Hospital Database on HIV, we selected naïve individuals initiating cART from 2000 with at least two years of follow‐up. Participants were further required to have achieved viral load suppression by six months after initiating cART and were censored in case of virological failure. We calculated the proportion of patients (Kaplan‐Meier estimates) who achieved CD4 recovery to >500/mm3 according to baseline CD4 cell count.ResultsA total of 15,025 patients were analyzed with a median follow‐up on ART of 65.5 months (IQR: 42.3–96.0). At cART initiation, the median age was 38.6 years (IQR: 32.2–46.0), 9734 (64.8%) were men, median CD4 cell count was 239 (IQR: 130–336) and 2668 (17.8%) had a prior AIDS event. Results are presented in the Table 1.
KM estimates of achieving a CD4 cell count >500/mm3 over time according to baseline CD4 cell count at cART initiation












Baseline CD4+cell count, Median (IQR)
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7




CD4<200 (n=5909), 100 [39–156]
8% (7–9)
21% (20–22)
33% (31–34)
43% (42–45)
52% (50–54)
60% (58–61)
61% (59–62)


200≤CD4<350 (n=5751), 269 [235–305]
40% (39–42)
61% (60–62)
73% (72–74)
81% (580–82)
85% (84–86)
88% (87–89)
90% (89–91)


350≤CD4<500 (n=2252), 404 [374–443]
74% (72–76)
87% (85–88)
91% (90–92)
94% (93–95)
95% (93–96)
96% (95–98)
97% (95–98)




ConclusionsThis study shows that CD4 cell counts continue to increase seven years after cART initiation, whatever the baseline CD4 cell count. Failing to achieve CD4 recovery with continuous viral load suppression is rare for naïve patients initiating cART in routine clinical practice, but takes substantially longer in patients who initiate antiretroviral therapy at low CD4 cell counts.