Background The arrival of highly effective, well tolerated direct-acting antiviral agents (DAA) led to a dramatic decrease in HCV prevalence. HIV-HCV coinfected patients are deemed a priority population for HCV elimination, while a rise of recently acquired HCV infections in MSM has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort. Methods Retrospective analysis of a prospective HIV-infected cohort from 2012 to 2018. Determination of HCV prevalence, incidence, proportion of viremic patients, treatment uptake and mortality rate in the full cohort and by HIV risk factors. Results From 2012 to 2018, 50861 HIV-infected patients with a known HCV status were followed-up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100PY to 1.25/100PY in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in IVDU (35.6%). In MSM, treatment at acute phase represented 30.0% of treatments in 2018. Conclusions A major shift in HCV epidemiology was observed in HIV-infected patients in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.
With growing numbers of construction sites, aggregate supply in the Ile-de-France region (Paris and the surrounding area) will be a major issue in the coming years. This means that dialogue is needed between stakeholders to build and evaluate scenarios together for the future in this area of aggregate supply and waste reclamation. This work had the goal of describing, analysing and discussing the first evaluation of potential scenarios from the thematic and methodological standpoint, asking questions about issues of sustainable circularity in the aggregate sector in Ile-de-France. In the state of the art, tools for objective evaluation are being widely developed in the sector, whereas tools for subjective evaluation remain largely unexplored, hence this work. As results, we have given structure to what challenges will be raised for a circular economy for supplying aggregates in Ile-de-France. However, the challenges are not even for all of the issues, scenarios and impacts.
Background Maintenance ART with dolutegravir-based dual regimens have proved their efficacy among HIV-1-infected subjects in randomized trials. However, real-life data are scarce, with limited populations and follow-up. Objectives We assessed virological failure (VF) and resistance-associated mutations (RAMs) on dolutegravir maintenance regimens in combination with rilpivirine or with lamivudine or emtricitabine (xTC) and analysed the factors associated with VF. Methods Between 2014 and 2018, all HIV-1-infected adults included in the Dat’AIDS cohort and starting dolutegravir/rilpivirine or dolutegravir/xTC as a maintenance dolutegravir-based dual regimen were selected. VF was defined as two consecutive HIV RNA values >50 copies/mL or a single value >400 copies/mL. We compared cumulative genotypes before initiation of a maintenance dolutegravir-based dual regimen with genotype at VF. Results We analysed 1374 subjects (799 on dolutegravir/rilpivirine and 575 on dolutegravir/xTC) with a median follow-up of 20 months (IQR = 11–31) and 19 months (IQR = 11–31), respectively. VF occurred in 3.8% (n = 30) of dolutegravir/rilpivirine subjects and 2.6% (n = 15) of dolutegravir/xTC subjects. Among subjects receiving dolutegravir/rilpivirine, two genotypes harboured emerging RAMs at VF: E138K on NNRTI (n = 1); and E138K+K101E on NNRTI and N155H on INSTI (n = 1). Among subjects receiving dolutegravir/xTC, no new RAM was detected. The only predictive factor of VF on dolutegravir/rilpivirine was the history of failure on an NNRTI-based regimen (adjusted HR = 2.97, 95% CI = 1.28–6.93). No factor was associated with VF on dolutegravir/xTC. Conclusions In this large real-life cohort, dolutegravir/rilpivirine and dolutegravir/xTC sustained virological suppression and were associated with a low rate of VF and RAM emergence. Careful virological screening is essential before switching to dolutegravir/rilpivirine in virologically suppressed patients with a history of NNRTI therapy.
The members of the 'And The Dat'AIDS study group' are given in the Appendix.
Lors du programme ANR « AGREGA », un portail internet contributif (« ePLANETe.Blue ») a été mobilisé. Il a permis d'accompagner les acteurs de la filière d'approvisionnement de la Région Ile-de-France en granulats de construction nécessaires au Grand-Paris dans une démarche de représentation collective des interactions entre stratégies d'économie circulaire et enjeux de soutenabilité du territoire francilien. Dans une logique d'économie circulaire, la filière francilienne d'approvisionnement en granulats peut être abordée comme un système produitsservices (SPS) orienté-produit. Si l'on s'intéresse plus largement aux enjeux de soutenabilité sociale, environnementale et économique liés à l'inscription de cette filière dans le territoire francilien, un SPS orienté-usage peut être objectivé. Le portail internet « ePLANETe.Blue » permettrait à des acteurs de ce territoire d'aller plus loin en coproduisant une méthodologie d'évaluation ad hoc destinée à favoriser un couplage structurel entre ces deux SPS. ABSTRACT. During an ANR (French National Research Agency) project called "AGREGA", a contributory Web portal (ePLANETe.Blue) was developed. It supported actors involved in the supply chain of the construction of aggregates, which was needed in the Paris area. This was done in a process of collective compromises between strategies of the circular economy and issues of the supply chain in the Ile-de-France region. From a circular economy perspective, this supply chain can be considered as a product-oriented product-service system (PSS). From a more regional perspective regarding social, economic and ecological sustainability issues, the same supply chain could be considered as a use-oriented PSS. The "ePLANETe.Blue" Web portal was designed to help actors and stakeholders get involved in the co-production of an ad hoc evaluation methodology which could facilitate a structural coupling between those two types of PSSs.acteur devra choisir entre « 0 » qui signifie « Pas de pertinence » (valeur par défaut), « 1 » pour « Pertinence faible », et « 4 » pour « Pertinence forte » (voir figure 8.). Figure 8. Indicateurs dans la grille de représentation [DOU 18]. Dans le cadre AGREGA, la GKR a été utilisée de manières ex-ante et ex-post, comme un complément aux sessions d'évaluation de 5 scénarios : Aménagements du territoire autour du Grand Paris Express ; Grand Paris, une Métropole Durable ; Ouverture du Canal Seine-Nord Europe ; Développement de plateformes multimodales ; Construction du Grand Paris ; et « Zéro déchets ». Le travail d'identification de la pertinence des indicateurs a conduit à proposer une liste d'indicateurs susceptibles d'être utilisés lors des évaluations. Évaluation multicritère de la performance grâce à l'outil K4U Des enjeux de performances aux critères d'évaluationLa galerie « K4U » (Kerbabel for You) du portail « ePLANETe.Blue » propose aux utilisateurs une méthode de coproduction d'algorithmes permettant d'évaluer la performance d'un système selon plusieurs critères de soutenabilité, par exemple le soci...
Background Two-drug regimens based on integrase strand transfer inhibitors (INSTIs) and boosted PIs have entered recommended ART. However, INSTIs and boosted PIs may not be suitable for all patients. We aimed to report our experience with doravirine/lamivudine as maintenance therapy in people living with HIV (PLWH) followed in French HIV settings. Methods This observational study enrolled all adults who initiated doravirine/lamivudine between 1 September 2019 and 31 October 2021, in French HIV centres participating in the Dat’AIDS cohort. The primary outcome was the rate of virological success (plasma HIV-RNA < 50 copies/mL) at Week (W)48. Secondary outcomes included: rate of treatment discontinuation for non-virological reasons, evolution of CD4 count and CD4/CD8 ratio over follow-up. Results Fifty patients were included, with 34 (68%) men; median age: 58 years (IQR 51–62), ART duration: 20 years (13–23), duration of virological suppression: 14 years (8–19), CD4 count: 784 cells/mm3 (636–889). Prior to switching, all had plasma HIV-RNA < 50 copies/mL. All but three were naive to doravirine, and 36 (72%) came from a three-drug regimen. Median follow-up was 79 weeks (IQR 60–96). Virological success rate at W48 was 98.0% (95% CI 89.4–99.9). One virological failure occurred at W18 (HIV-RNA = 101 copies/mL) in a patient who briefly discontinued doravirine/lamivudine due to intense nightmares; there was no resistance at baseline and no resistance emergence. There were three strategy discontinuations for adverse events (digestive disorders: n = 2; insomnia: n = 1). There was no significant change in CD4/CD8 ratio, while CD4 T cell count significantly increased. Conclusions These preliminary findings suggest that doravirine/lamivudine regimens can maintain high levels of viral suppression in highly ART-experienced PLWH with long-term viral suppression, and good CD4+ T cell count.
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