en fr Care and Treatment of HIV-Infected Patients During Primary HIV-Infection Prise en charge du VIH au stade de la primo-infection Reportar como inadecuado




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1 CESP - Centre de recherche en épidémiologie et santé des populations

Abstract : In France, since 2013, HIV treatment has been recommended for all HIV-infected patients independently of their CD4 count. However, when to start anti-retroviral ARV treatment is still an issue. This thesis aims to explore the therapeutic management of HIV at the stage of PHI in different aspects: 1 we explored how physicians in France have applied the evolving guidelines for ART initiation since 1996 2 the impact of a transient ARV treatment at PHI on immuno-virological response during 2nd treatment and 3 identification of new biomarkers prognostic of HIV progression.Most of the work presented in this thesis is based on data from the ongoing ANRS PRIMO cohort that enrolled more than 1 500 HIV infected patients enrolled at PHI since June 1996 in 94 French hospitals. All patients were antiretroviral therapy naive at baseline.The first part of the thesis analyzes the implementation of the recommendations of ARV treatment initiation between 1996 and 2010 by physicians in France, in two distinct situations: in the chronic HIV-1 infection and during primary HIV-1 infection. We have shown that the recommendations of ARV treatment initiation were widely followed. Nevertheless, there was inertia in guidelines application when changes in the recommendations took place. The time to treatment when CD4 cell counts reach the threshold to treat can be improved. 96% of the patients initiated ART when they had a CD4 cell count below the threshold to treat at entry, while treatment was less timely initiated when the CD4 threshold was reached during active follow-up 78%, p



Autor: Evguenia Krastinova -

Fuente: https://hal.archives-ouvertes.fr/



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