Unmatched Case-Control Study on Late Presentation of HIV Infection in Santiago, Cape Verde (2004-2011)

Access to free antiretroviral therapy (ART) in Sub-Saharan Africa has been steadily increasing over the past decade. However, the success of large-scale ART programmes depends on timely diagnosis and early initiation of HIV care. 

This study characterizes late presenters to HIV care in Santiago (Cape Verde) between 2004 and 2011, and identifies factors associated with late presentation for care. We defined late presentation as persons presenting to HIV care with a CD4 count below 350 cells/mm³. An unmatched case-control study was conducted using socio-demographic and behavioural data of 368 individuals (191 cases and 177 controls) collected through an interviewer-administered questionnaire, comparing HIV patients late and early presented to care. Logistic regression was performed to estimate odds ratio and 95% confidence intervals. 

Results show that 51.9% were late presenters for HIV. No differences were found in gender distribution, marital status, or access to health services between cases and controls. Participants who undertook an HIV test by doctor indication were more likely to present late compared with those who tested for HIV by their own initiative. Also, individuals taking less time to initiate ART are more likely to present late. 

This study highlights the need to better understand reasons for late presentation to HIV care in Cape Verde. People in older age groups should be targeted in future approaches focused on late presenters to HIV care.

Full article at:   http://goo.gl/ixv7Pb

By:  Moreira AL1, Fronteira I2, Augusto GF3, Martins MR4.

• 1Ministry of Health, Palácio do Governo, Várzea-Praia C.P. 47, Santiago-Cape Verde. antonio.moreira@ms.gov.cv.
• 2Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, Lisbon 1349-008, Portugal. ifronteira@ihmt.unl.pt.
• 3Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, Lisbon 1349-008, Portugal. figueiredo.augusto@ihmt.unl.pt.
• 4Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon (IHMT-UNL), Rua da Junqueira 100, Lisbon 1349-008, Portugal. mrfom@ihmt.unl.pt. 
• Int J Environ Res Public Health. 2016 Mar 15;13(3). pii: E320. doi: 10.3390/ijerph13030320.

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The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic

The HIV care continuum has received considerable attention in recent years, however few care continua focus on the population of patients who are diagnosed during an inpatient hospital admission. We aimed to describe the HIV care continuum for patients newly diagnosed during hospitalization through 24-month follow-up. 

A retrospective chart review of HIV patients diagnosed at Grady Memorial Hospital from 2011 - 2012 was performed and records were matched to Georgia Department of Public Health HIV/AIDS surveillance data. Descriptive statistics and statistical tests of independence were utilized. 

Ninety-four new diagnoses were confirmed during the two-year study period. Median age was 43 years old (IQR 30 - 51), 77% were male, 72% were non-Hispanic Black, 31% were men who have sex with men (MSM) and 77% were uninsured. Median CD4 count at diagnosis was 134 cells/µL (IQR 30 - 307). Eighty-four percent received their diagnosis prior to hospital discharge, 68% linked to care by 90 days, 73% were retained for 12 months, 48% were virologically suppressed by 12 months, 58% were retained for 24 continuous months and 38% achieved continuous VS during the initial 24 months after diagnosis. 

Late diagnosis is a persistent problem in hospitalized patients. Despite relative success with linkage to care and 12-month retention in care, a minority of patients maintained retention and VS for 24 continuous months.

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By:  Colasanti J1, Goswami ND2, Khoubian JJ3, Pennisi E4, Root C5, Ziemer D6, Armstrong W7, Del Rio C8.

• 1Emory University, Medicine , 49 Jesse Hill Jr Drive , Division of Infectious Diseases , Atlanta, Georgia, United States , 30303 ; jcolasa@emory.edu.
• 2Atlanta, United States ; neela.goswami@emory.edu.
• 3Los Angeles, United States ; jacob.khoubian@gmail.com.
• 4Atlanta, United States ; alpennisi@dhr.state.ga.us.
• 5Atlanta, United States ; cmroot@emory.edu.
• 6Atlanta, United States ; dziemer@GMH.EDU.
• 7Emory University, Infectious Disease, Atlanta, Georgia, United States ; wsarmst@emory.edu.
• 8Emory University, Hubert Department of Global Health , 1518 Clifton Rd. NE , CNR Building , Room 7011 , Atlanta, Georgia, United States , 30322 ; cdelrio@emory.edu. 
• AIDS Res Hum Retroviruses. 2016 Mar 22.

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Suboptimal HIV Testing Uptake among Men Who Engage in Commercial Sex Work with Men in Asia

PURPOSE:

Men who have sex with men and are sex workers (MSMSW) are disproportionately affected by the growing and emerging HIV epidemic. As sex work and same-sex behavior are heavily stigmatized and often illegal in most Asian countries, HIV research focusing on MSMSW has been limited. The goal of this analysis is to examine HIV testing practices and identify correlates of HIV testing among MSMSW in Asia.

METHODS:

The Asia Internet MSM Sex Survey, an online cross-sectional survey of 10,861 men who have sex with men (MSM), was conducted in 2010. Data on sociodemographic characteristics, HIV testing behaviors, and sexual behaviors were collected. Five hundred seventy-four HIV-negative/unknown respondents reported receiving payment for sex with men at least once in the past 6 months and were included for analysis. Multivariable logistic regression was conducted to identify independent correlates of HIV testing in the past year.

RESULTS:

About half (48.6%) of the participants have been tested for HIV at least once within the past year, and 30.5% have never been tested. We also found that MSMSW participants who engaged in risky behaviors were less likely to be tested.

CONCLUSION:

While one might expect a high HIV testing rate among MSMSW due to the risks associated with engaging in sex work, we found that HIV testing uptake is suboptimal among MSMSW in Asia. These results suggest that targeted HIV prevention and testing promotion among MSMSW are needed.

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By:  Jin H1, Friedman MR2, Lim SH3, Guadamuz TE4, Wei C5.

• 1 Center for Public Health Research , San Francisco Department of Public Health, San Francisco, California.
• 2 Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health , Pittsburgh, Pennsylvania.
• 3 Center of Excellence for Research in AIDS, University of Malaya , Kuala Lumpur, Malaysia .
• 4 Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University , Nakorn Pathom, Thailand .
• 5 Department of Epidemiology and Biostatistics, University of California , San Francisco, San Francisco, California. 
• LGBT Health. 2016 Mar 16.

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Economic & Health Implications from Earlier Detection of HIV Infection in the United Kingdom

Purpose: 

To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.

Patients and methods: 

A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).

Results: 

In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).

Conclusion: 

The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

Purchase full article at:   https://goo.gl/6wGaAh

By:  Vladimir Zah,^1,2 Mondher Toumi¹

¹Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France; ²ZRx Outcomes Research Inc., Mississauga, Canada

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Late HIV Testing in a Cohort of HIV-Infected Patients Followed in Puerto Rico

Objective

Late HIV testing (LT) defined as an AIDS diagnosis within a year of first positive HIV test is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce.

Methods

Multivariable logistic regression analysis was used to identify factors associated with LT and Cochran-Armitage test to describe LT trends in an HIV infected cohort followed at a specialized HIV clinic in Puerto Rico.

Results

From 2000 to 2011, 47% of eligible patients were LT, with lower median CD4 count (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL), when compared to non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrolment and past history of IDU significantly increased LT odds whereas history of amphetamine use decreased LT odds. Stratified by mode of transmission, only men who have sex with men (MSM), had a significant reduction in the proportion of LT, from 67% in 2000 to 33% in 2011.

Conclusion

These results suggest a gap in early HIV detection in Puerto Rico that decreased only among MSM. A closer evaluation of HIV testing guideline implementation among non MSM in the Island is needed.

Below:  Distribution of time to AIDS diagnosis (in months) among 377 late testers (LT)

Below:  

Figure 3a: Yearly trends of LT overall and by gender

Figure 3b: Yearly trends of LT by mode of transmission

Figure 3c: Yearly trends of LT for heterosexual mode of transmission by gender

Full article at:  http://goo.gl/uOikx0

By:  Katherine Y. Tossas-Milligan, MS, PhD(c), Robert F. Hunter-Mellado, MD, MS, Angel M. Mayor, MD, MS, Diana M. Fernandez-Santos, EdD, MS, and Mark S. Dworkin, M.D., M.P.H.T.M.

Katherine Y. Tossas-Milligan, Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612, USA;

Contributor Information.

Corresponding author and reprints requests: Katherine Y. Tossas-Milligan, MS, Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL 60612, USA, Email: ude.ciu@2assotk phone: 773-590-6231 fax: 312.996.0064

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Korean Patients Presenting with Advanced Human Immunodeficiency Virus Disease: Epidemiological Features by Age Group

We explored factors influencing presentation with advanced human immunodeficiency virus (HIV) disease by age group. Data were derived from a city-wide cross-sectional survey of 759 HIV-infected adults living in Seoul, Korea. The significance of each observed factor was assessed via multivariate logistic regression. 

Of subjects aged 20-34 years, lower educational level had a positive influence on presentation with advanced HIV disease; those recently diagnosed with HIV were more likely to be presented with advanced HIV disease. Of the subjects aged 35-49 years, those w ith advanced HIV disease were more likely to have been diagnosed during health check-ups or via clinical manifestations. Of the subjects aged ≥ 50 years, presentation with advanced HIV disease was significantly more common in older subjects and less common among individuals diagnosed with HIV in 2000-2006. 

In conclusion, a lower educational level in younger subjects and more advanced age in older subjects positively influence the presentation of advanced HIV disease.

Full article at:   http://goo.gl/wa5zKL

By:  Cho Ryok Kang,1,7 Ji Hwan Bang,1,2 Sung-Il Cho,1,3 Kui Nam Kim,4 Hee-jin Lee,4 Bo Yeong Ryu,1,7 Soo Kyung Cho,1,7 Young Hwa Lee,1,3 Myoung-don Oh,1,5 and Jong-Koo Lee1,6

¹Seoul Center for Infectious Disease Control, Seoul, Korea.

²Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

³Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea.

⁴Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea.

⁵Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁶Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁷Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author.

Address for Correspondence: Ji Hwan Bang, MD. Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center 20 Boramaero 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-3209, Fax: +82.2-831-2826, Email:moc.liamg@hcribdnuor

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Costs per Diagnosis of Acute HIV Infection in Community-Based Screening Strategies: A Comparative Analysis of Four Screening Algorithms

BACKGROUND:

In nonhealthcare settings, widespread screening for acute human immunodeficiency virus (HIV) infection (AHI) is limited by cost and decision algorithms to better prioritize use of resources. Comparative cost analyses for available strategies are lacking.

METHODS:

To determine cost-effectiveness of community-based testing strategies, we evaluated annual costs of 3 algorithms that detect AHI based on HIV nucleic acid amplification testing (EarlyTest algorithm) or on HIV p24 antigen (Ag) detection via Architect (Architect algorithm) or Determine (Determine algorithm) as well as 1 algorithm that relies on HIV antibody testing alone (Antibody algorithm). The cost model used data on men who have sex with men (MSM) undergoing community-based AHI screening in San Diego, California. Incremental cost-effectiveness ratios (ICERs) per diagnosis of AHI were calculated for programs with HIV prevalence rates between 0.1% and 2.9%.

RESULTS:

Among MSM in San Diego, EarlyTest was cost-savings (ie, ICERs per AHI diagnosis less than $13.000) when compared with the 3 other algorithms. Cost analyses relative to regional HIV prevalence showed that EarlyTest was cost-effective (ie, ICERs less than $69.547) for similar populations of MSM with an HIV prevalence rate >0.4%; Architect was the second best alternative for HIV prevalence rates >0.6%.

CONCLUSIONS:

Identification of AHI by the dual EarlyTest screening algorithm is likely to be cost-effective not only among at-risk MSM in San Diego but also among similar populations of MSM with HIV prevalence rates >0.4%.

Purchase full article at:  http://goo.gl/mzHFRR

By:  Hoenigl M1, Graff-Zivin J2, Little SJ3.

• 1Division of Infectious Diseases, University of California-San Diego Division of Pulmonology Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.
• 2School of International Relations and Pacific Studies and Department of Economics, University of California-San Diego.
• 3Division of Infectious Diseases, University of California-San Diego 
• Clin Infect Dis. 2016 Feb 15;62(4):501-11. doi: 10.1093/cid/civ912. Epub 2015 Oct 27.

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Ten Years of Screening and Testing for Acute HIV Infection in North Carolina

OBJECTIVE:

To describe demographic and behavioral characteristics of persons with acute HIV infection (AHI) over time.

METHODS:

We conducted a retrospective assessment of AHI identified through the Screening and Tracing Active Transmission (STAT) program from 2003 to 2012 in North Carolina (NC). AHI was identified using pooled nucleic acid amplification for antibody negative samples and individual HIV-1 RNA for antibody indeterminate samples. The STAT program provides rapid notification and evaluation. We compared STAT-collected demographic and risk characteristics with all persons requesting tests and all non-AHI diagnoses from the NC State Laboratory of Public Health.

RESULTS:

The STAT Program identified 236 AHI cases representing 3.4% of all HIV diagnoses. AHI cases were similar to those diagnosed during established HIV. On pretest risk-assessments, AHI cases were 

• predominately black (69.1%), 
• male (80.1%), 
• young (46.8% < 25 years), 
• and men who have sex with men (MSM) (51.7%). 

Per post-diagnosis interviews, the median age decreased from 35 (interquartile range 25-42) to 27 (interquartile range 22-37) years, and the proportion <25 years increased from 23.8% to 45.2% (trend P = 0.04) between 2003 and 2012. AHI men were more likely to report MSM risk post-diagnosis than on pretest risk-assessments (64%-82.9%; P < 0.0001). Post-diagnosis report of MSM risk in men with AHI increased from 71.4% to 96.2%.

CONCLUSIONS:

In NC, 3.4% of individuals diagnosed with HIV infection have AHI. AHI screening provides a real-time source of incidence trends, improves the diagnostic yield of HIV testing, and offers an opportunity to limit onward transmission.

Purchase full article at:   http://goo.gl/3K9Jlq

By:  Kuruc JD1, Cope AB, Sampson LA, Gay CL, Ashby RM, Foust EM, Brinson M, Barnhart JE, Margolis D, Miller WC, Leone PA, Eron JJ.

• 1*Division of Infectious Disease, Department of Medicine (https://www.med.unc.edu/medicine), University of North Carolina at Chapel Hill, Chapel Hill, NC;†Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC; and‡Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
• J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):111-9. doi: 10.1097/QAI.0000000000000818. 

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Factors Associated with the First Antiretroviral Therapy Modification in Older HIV-1 Positive Patients

Background

Rates of first antiretroviral therapy (cART) modifications are high in most observational studies. The age-related differences in treatment duration and characteristics of first cART modifications remain underinvestigated. With increasing proportion of older patients in HIV population it is important to better understand age-related treatment effects.

Methods

Patients were included into this analysis, if being cART naïve at the first visit at the clinic. Follow-up time was measured from the first visit date until first cART modification or 28 February 2013. First cART modification was defined as any change in the third drug component i.e. protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), integrase inhibitor or fusion inhibitor. Cox proportional hazard models were used to identify factors related to first cART modification in three age groups: <30, 30–50 and >50.

Results

In total 2027 patients with 14,965 person-years of follow-up (PYFU) were included. The oldest group included 136 patients with 1901, middle group 1202 with 8416 PYFU and youngest group consisted of 689 patients with 4648 PYFU. Median follow-up time was 5.8 (IQR 3.4–9.4) years, median time on first cART was 4.4 (IQR 2.1–8.5) years. 72.4 % of patients started PI-based and 26.1 % NNRTI-based regimen. In total 1268 (62.5 %) patients had cART modification (non-adherence 30.8 %, toxicity 29.6 %). Durability of first cART was the best in patients over 50 y.o. (log-rank test, p = 0.001). Factors associated with discontinuation in this group were late presentation (HR 0.45, [95 % CI 0.23–0.90], p = 0.02) and PI use (HR 2.17, [95 % CI 1.18–4.0], p = 0.01).

Conclusions

Rates of first cART modifications or discontinuation were comparable in all groups; however older patients were significantly longer on first cART regimen.

Full article at:   http://goo.gl/rDV72Q

By:  Justyna D. Kowalska, Joanna Kubicka, Ewa Siwak, Piotr Pulik, Ewa Firląg-Burkacka, Andrzej Horban, and The Polish Observational Cohort of HIV/AIDS Patients (POLCA) Study Group

Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

Department for Adult’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland

Justyna D. Kowalska, Email: moc.liamg@akslawokdj.

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#TestMeEast: A Campaign to Increase HIV Testing in Hospitals & to Reduce Late Diagnosis

Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly 

We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. 

During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.

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By:   Bath R1, O'Connell R1, Lascar M1, Ferrand R2, Strachan S3, Matin N1, Bassnet I1, Orkin C1,4.

• 1 Barts Health NHS Trust , London , UK.
• 2 London School of Hygiene and Tropical Medicine , London , UK.
• 3 Positively UK , London , UK.
• 4 HIV Medicine, Infection and Immunity , Royal London Hospital , London , UK. 

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Late Antiretroviral Therapy (ART) Initiation Is Associated with Long-Term Persistence of Systemic Inflammation and Metabolic Abnormalities

Objectives

HIV-induced immunodeficiency is associated with metabolic abnormalities and systemic inflammation. We investigated the effect of antiretroviral therapy (ART) on restoration of insulin sensitivity, markers of immune activation and inflammation.

Methods

Immunological, metabolic and inflammatory status was assessed at antiretroviral therapy initiation and three years later in 208 patients from the ANRS-COPANA cohort. Patients were compared according to their pre-ART CD4⁺ cell count (group 1: ≤ 200/mm³, n = 66 vs. group 2: > 200/mm³, n = 142).

Results

Median CD4⁺ cell count increased in both groups after 3 years of successful ART but remained significantly lower in group 1 than in group 2 (404 vs 572 cells/mm³). Triglyceride and insulin levels were higher or tended to be higher in group 1 than in group 2 at ART initiation (median: 1.32 vs 0.97 mmol/l, p = 0.04 and 7.6 vs 6.8 IU, p = 0.09, respectively) and remained higher after three years of ART (1.42 vs 1.16 mmol/L, p = 0.0009 and 8.9 vs 7.2 IU, p = 0.01). After adjustment for individual characteristics and antiretroviral therapy regimens (protease inhibitor (PI), zidovudine), insulin levels remained significantly higher in patients with low baseline CD4⁺cell count. Baseline IL-6, sCD14 and sTNFR2 levels were higher in group 1 than in group 2. Most biomarkers of immune activation/inflammation declined during ART, but IL-6 and hsCRP levels remained higher in patients with low baseline CD4⁺ cell count than in the other patients (median are respectively 1.4 vs 1.1 pg/ml, p = 0.03 and 2.1 vs 1.3 mg/ml, p = 0.07).

Conclusion

After three years of successful ART, low pretreatment CD4⁺ T cell count remained associated with elevated insulin, triglyceride, IL-6 and hsCRP levels. These persistent metabolic and inflammatory abnormalities could contribute to an increased risk of cardiovascular and metabolic disease.

Below:  Distribution of inflammatory markers according to CD4 T cell count at ART initiation

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By:  

Mathilde Ghislain, Laurence Meyer, Cécile Goujard

Inserm UMRS1018, CESP, Epidemiology of HIV and STI, Le Kremlin-Bicêtre, France

Jean-Philippe Bastard, Jacqueline Capeau, Soraya Fellahi

Tenon Hospital, AP-HP, Department of Biochemistry and Hormonology, Paris, France

Jean-Philippe Bastard, Jacqueline Capeau, Soraya Fellahi, Corinne Vigouroux

Inserm UMRS 938, Centre de Recherche Saint-Antoine, Paris, France

Jean-Philippe Bastard, Jacqueline Capeau, Soraya Fellahi, Corinne Vigouroux

Sorbonne Universities, UPMC, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France

Laurence Meyer, Cécile Goujard

Paris-Sud university, Le Kremlin-Bicêtre, France

Laurence Meyer

Bicêtre Hospital, AP-HP, Department of Public Health, Le Kremlin-Bicêtre, France

Laurence Gérard

Saint-Louis Hospital, AP-HP, Department of Clinic Immunopathology, Paris, France

Thierry May

Teaching hospital of Nancy, Brabois Hospitals, Department of Infectious and Tropical Diseases, Vandoeuvre les Nancy, France

Anne Simon

Pitié-Salpétrière Hospital, AP-HP, Department of Internal Medicine and Clinical Immunology, Paris, France

Corinne Vigouroux

Saint-Antoine Hospital, AP-HP, Common Laboratory of Biology and Molecular Genetics, Paris, France

Cécile Goujard

Bicêtre Hospital, AP-HP, Department of Internal Medicine, Le Kremlin-Bicêtre, France

ANRS-COPANA Cohort Study Group

Inserm-ANRS, Paris, France

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