In 2010, 25% of the causes of death among HIV-infected patients remained AIDS-related. Improved screening and earlier HIV treatment should lead to a smaller proportion of deaths due to AIDS. The majority of patients died of various causes, whereas their HIV infection was well controlled under treatment. Improving case management of HIV-infected patients should include a multidisciplinary approach (prevention, screening, treatment), especially in oncology. Smoking cessation should be a priority goal.

ObjectivesThe current study aimed at describing the distribution and characteristics of malignancy related deaths in human immunodeficiency virus (HIV) infected patients in 2010 and at comparing them to those obtained in 2000 and 2005.MethodsData were obtained from three national surveys conducted in France in 2010, 2005 and 2000. The underlying cause of death was documented using a standardized questionnaire fulfilled in French hospital wards involved in the management of HIV infection.ResultsAmong the 728 deaths reported in 2010, 262 were cancer-related (36%). After a significant increase from 28% in 2000 to 33% in 2005 and 36% in 2010, cancers represent the leading cause of mortality in HIV infected patients. The proportion of deaths attributed to non-AIDS/non-hepatitis-related cancers significantly increased from 2000 to 2010 (11% of the deaths in 2000, 17% in 2005 and 22% in 2010, p<0.001), while those attributed to AIDS-defining cancers decreased during the same period (16% in 2000, 13% in 2005 and 9% in 2010, p = 0.024). Particularly, the proportion of respiratory cancers significantly increased from 5% in 2000 to 6% in 2005 and 11% in 2010 (p = 0.004). Lung cancer was the most common cancer-related cause of death in 2010 (instead of non-Hodgkin lymphoma so far) and represented the leading cause of death in people living with HIV overall.ConclusionsCancer prevention (especially smoking cessation), screening strategies and therapeutic management need to be optimized in HIV-infected patients in order to reduce mortality, particularly in the field of respiratory cancers.

ObjectivesThe aim of this study was to describe the proportion of liver-related diseases (LRDs) as a cause of death in HIV-infected patients in France and to compare the results with data from our five previous surveys. MethodsIn 2010, 24 clinical wards prospectively recorded all deaths occurring in around 26 000 HIV-infected patients who were regularly followed up. Results were compared with those of previous cross-sectional surveys conducted since 1995 using the same design. ResultsAmong 230 reported deaths, 46 (20%) were related to AIDS and 30 (13%) to chronic liver diseases. Eighty per cent of patients who died from LRDs had chronic hepatitis C, 16.7% of them being coinfected with hepatitis B virus (HBV). Among patients who died from an LRD, excessive alcohol consumption was reported in 41%. At death, 80% of patients had undetectable HIV viral load and the median CD4 cell count was 349 cells/μL. The proportion of deaths and the mortality rate attributable to LRDs significantly increased between 1995 and 2005 from 1.5% to 16.7% and from 1.2‰ to 2.0‰, respectively, whereas they tended to decrease in 2010 to 13% and 1.1‰, respectively. Among liver-related causes of death, the proportion represented by hepatocellular carcinoma (HCC) dramatically increased from 5% in 1995 to 40% in 2010 (p = 0.019). ConclusionsThe proportion of LRDs among causes of death in HIV-infected patients seems recently to have reached a plateau after a rapid increase during the decade 1995−2005. LRDs remain a leading IntroductionAs a consequence of shared transmission routes, HIVinfected persons are at risk of other blood-borne and sexually transmitted infections. Hepatitis C virus (HCV) infection, which is predominantly transmitted parenterally, is common in this group. In northern countries, since the mid-1990s, several developments, such as the widespread use of combination antiretroviral therapy (cART) and better access to treatment for chronic hepatitis C, have contributed (1) to modifications of the natural history of chronic HCV infection in HIV-infected persons, and (2) to the emergence of liver-related diseases (LRDs) as a significant cause of mortality among coinfected individuals [1][2][3][4]. During the first decade following the advent of cART (1995−2005), the proportion of deaths attributable to LRDs in French HIV-infected patients has progressively increased and LRDs have become a leading cause of mortality [5][6][7][8]. This is likely to have been related to prolonged longevity as a result of decreasing AIDS-related mortality and longer exposure to chronic HCV infection. In parallel, large trials have demonstrated that HIV/HCV-coinfected patients may achieve a sustained virological response with combined treatment with pegylated interferon plus ribavirin, leading to histopathological improvement [9,10]. Continuing efforts to educate physicians and patients increased the access of HIV/HCV-coinfected patients to HCV treatment [11,12]. Finally, the eradication of HCV after therapy in HIV/HCV-coinfected patients is associate...

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In this work, we characterized a new, 160-kb, bla OXA-48 -harboring IncL/M-type plasmid isolated from a Klebsiella pneumoniae strain from France. Moreover, we report the transfer of a 60-kb OXA-48-encoding plasmid from Klebsiella pneumoniae to other Enterobacteriaceae in two patients. The emergence of carbapenemase-producing Enterobacteriaceae has become a major public health concern (1). Carbapenemases identified in Enterobacteriaceae are frequently class A ␤-lactamases, particularly KPC enzymes, and class B metallo-␤-lactamases. However, the emergence of Enterobacteriaceae strains producing class D carbapenemases such as OXA-48 has increasingly been reported (2). This enzyme, initially detected in a carbapenem-resistant Klebsiella pneumoniae strain in Turkey (3), has been identified extensively in that country as well as in other surrounding Mediterranean countries (2, 4). Since then, it has also been identified in Senegal, Kuwait, the Sultanate of Oman, and India, as well as in several European countries (2, 5-10). Although OXA-48 has most often been found in K. pneumoniae, it has also been identified in Escherichia coli, Enterobacter spp., Klebsiella oxytoca, Citrobacter freundii, Providencia rettgeri, and Serratia marcescens (2,7,8,10,11). In these strains, bla OXA-48 is usually associated with a Tn1999-type transposon (12) and has been observed in self-conjugative 60-to 70-kb plasmids exhibiting similar restriction profiles (5,6,11,12). It is considered that the current spread of bla OXA-48 is linked to the diffusion of a unique self-conjugative IncL/M plasmid, designated pOXA-48a, that was recently sequenced by Poirel et al. (13). However, the horizontal spread of bla OXA-48 -harboring plasmids in a single patient has not yet been reported.In this work, we report the transfer of a 60-kb OXA-48-encoding plasmid from K. pneumoniae to other Enterobacteriaceae in two patients. Moreover, we characterized a new, 160-kb, bla OXA-48 -carrying conjugative plasmid from a K. pneumoniae isolate.In 2010, we isolated six Enterobacteriaceae organisms resistant to ertapenem (MICs, 1.5 to 3 g/ml) (Table 1) from samples from two patients hospitalized at the University Hospital Center of Nancy, France. There was no direct epidemiological link between the two patients, who were both colonized during an outbreak which affected our hospital center between 2010 and 2012 (10). For patient 1 (a 61-year-old man with type 2 diabetes), ertapenem-resistant K. pneumoniae KP1 was isolated from an intra-abdominal abscess and feces in October 2010. Two additional ertapenem-resistant strains, designated K. pneumoniae KP1a and E. coli EC1, were recovered 2 months later, from rectal and perineal wound swabs, respectively. For patient 2 (a 64-year-old man with type 2 diabetes who was admitted for acute cholangitis), the ertapenem-resistant K. pneumoniae strain KP2 was isolated from blood cultures, abdominal samples, and rectal swabs. Two months later, rectal swabs evidenced fecal carriage of two additional ertapenem-resistant Enterobacteriac...