Programme Hospitalier Recherche Clinique, Institut Pasteur, Inserm, French Public Health Agency.

The aim of this proof-of-concept study was to evaluate if trained dogs could discriminate between sweat samples from symptomatic COVID-19 positive individuals (SARS-CoV-2 PCR positive) and those from asymptomatic COVID-19 negative individuals. The study was conducted at 2 sites (Paris, France, and Beirut, Lebanon), followed the same training and testing protocols, and involved six detection dogs (three explosive detection dogs, one search and rescue dog, and two colon cancer detection dogs). A total of 177 individuals were recruited for the study (95 symptomatic COVID-19 positive and 82 asymptomatic COVID-19 negative individuals) from five hospitals, and one underarm sweat sample per individual was collected. The dog training sessions lasted between one and three weeks. Once trained, the dog had to mark the COVID-19 positive sample randomly placed behind one of three or four olfactory cones (the other cones contained at least one COVID-19 negative sample and between zero and two mocks). During the testing session, a COVID-19 positive sample could be used up to a maximum of three times for one dog. The dog and its handler were both blinded to the COVID-positive sample location. The success rate per dog (i.e., the number of correct indications divided by the number of trials) ranged from 76% to 100%. The lower bound of the 95% confidence interval of the estimated success rate was most of the time higher than the success rate obtained by chance after removing the number of mocks from calculations. These results provide some evidence that detection dogs may be able to discriminate between sweat samples from symptomatic COVID-19 individuals and those from asymptomatic COVID-19 negative individuals. However, due to the limitations of this proof-of-concept study (including using some COVID-19 samples more than once and potential confounding biases), these results must be confirmed in validation studies.

Solid organ transplantations (SOT) are performed successfully in selected HIV-infected patients. However, multiple and reciprocal drug-drug interactions are observed between antiretroviral (ARV) drugs and calcineurin inhibitors (CNIs) through CYP450 metabolization. Raltegravir (RAL), a novel HIV-1 integrase inhibitor, is not a substrate of CYP450 enzymes. We retrospectively reviewed the outcomes of 13 HIV-infected transplant patients treated by an RAL + two nucleosidic reverse transcriptase inhibitor (NRTI) regimen, in terms of tolerability, ARV efficacy (plasma viral load, CD4 cell count), drug interactions, RAL pharmacokinetics and transplant outcome. Thirteen patients with liver (n = 8) or kidney (n = 5) transplantation were included. RAL was initiated (400 mg BID) either at time of transplantation (n = 6), or after transplantation (n = 7). Median RAL trough concentration was 507 ng/mL (176-890), which is above the in vitro IC95 for wild type HIV-1 strains (15 ng/mL). Target trough levels of CNIs were promptly obtained with standard dosages of tacrolimus or cyclosporine. RAL tolerability was excellent. There was no episode of acute rejection. HIV infection remained controlled. After a median follow-up of 9 months (range: 6-14), all patients were alive with satisfactory graft function. The use of an RAL + two NRTI-based regimen is a good alternative in HIV-infected patients undergoing SOT.

Trichomonads closely related to the bovid parasite Tritrichomonas foetus were identified in the bronchoalveolar lavage sample from a patient with AIDS in association with Pneumocystis pneumonia. This human case of T. foetus-like infection emphasizes the zoonotic potential of trichomonads, although the existence of a human-host-adapted T. foetus strain cannot be excluded. CASE REPORTA 54-year-old woman was admitted to the intensive care unit of Mantes-la-Jolie hospital, presenting with fever, severe fatigue, and dyspnea with polypnea that had been increasing over the previous month. The patient was known to be seropositive for human immunodeficiency virus, which was revealed 3 years previously following pneumocystosis. At that time, an antiretroviral therapy was proposed but the patient denied the diagnosis. Since the patient had no history of blood transfusion or injection of illicit drugs, transmission by unprotected sex remained the presumed mode of human immunodeficiency virus contamination. In addition, the patient was overweight and had type 2 diabetes. Hemodynamic parameters were within normal limits. Blood gases were 52 mm Hg O 2 and 36 mm Hg CO 2 . A chest X-ray showed bilateral interstitial syndrome and several alveolar opacities. Bronchoalveolar lavage (BAL) was performed by fiber optic bronchoscopy and confirmed pneumocystosis. Interestingly, microscopic examination of a MayGrünwald-Giemsa-stained cytospin slide revealed numerous cells assumed to be trichomonad organisms, mixed with Pneumocystis parasites. The BAL sample was therefore immediately frozen for further analysis. Nasal oxygenation, intravenous injection of trimethoprim-sulfamethoxazole and methylprednisolone hemisuccinate, and subcutaneous injection of insulin were started, and recovery was rapid. On day 4, the patient was transferred to the Department of Infectious Diseases of the same institution where the investigations were completed. The CD4 cell count was 60 per mm 3 , with a CD4/CD8 ratio of 0.06.Plasma viral load was 5.34 log 10 copies/ml. Hypercalcemia with hyperparathyroidism was also noticed. The patient returned home 13 days after her hospitalization with trimethoprim-sulfamethoxazole per os. Antiretroviral therapy and exploration of hyperparathyroidism were scheduled.

The aim of this study is to evaluate if the sweat produced by COVID-19 persons (SARS-CoV-2 PCR positive) has a different odour for trained detection dogs than the sweat produced by non COVID-19 persons. The study was conducted on 3 sites, following the same protocol procedures, and involved a total of 18 dogs. A total of 198 armpits sweat samples were obtained from different hospitals. For each involved dog, the acquisition of the specific odour of COVID-19 sweat samples required from one to four hours, with an amount of positive samples sniffing ranging from four to ten. For this proof of concept, we kept 8 dogs of the initial group (explosive detection dogs and colon cancer detection dogs), who performed a total of 368 trials, and will include the other dogs in our future studies as their adaptation to samples scenting takes more time.The percentages of success of the dogs to find the positive sample in a line containing several other negative samples or mocks (2 to 6) were 100p100 for 4 dogs, and respectively 83p100, 84p100, 90p100 and 94p100 for the others, all significantly different from the percentage of success that would be obtained by chance alone.We conclude that there is a very high evidence that the armpits sweat odour of COVID-19+ persons is different, and that dogs can detect a person infected by the SARS-CoV-2 virus.