AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a...AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.展开更多
AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple car...AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery(LIMA)-saphenous venous grafting(SVG).RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups(7.8% vs 10.3%,P = 0.49). Early postoperative morbidity included myocardial infarction(4.2% vs 3.8%,P = 0.80),stroke(1.2% vs 3.8%,P = 0.14),and mediastinitis(5.3% vs 2.3%,P = 0.11). At 8-year follow-up,Kaplan-Meier-estimated survival(74.2% vs 58.9%,P = 0.02) and Kaplan-Meier-estimated event-free survival(all cause deaths,myocardial infarction,stroke,target vessel revascularization,heart failure)(61.7% and 41.1%,P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival(P = 0.40) and event-free survival(P = 0.13) in comparison with LIMA-SVG use.CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.展开更多
基金Supported by Inserm-ANRS(French National Institute for Health and Medical Research-ANRS/France REcherche Nord and Sud Sida-hiv Hépatites)
文摘AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.
文摘AIM To investigate the survival benefit of bilateral internal mammary artery(BIMA) grafts in patients with left ventricular dysfunction.METHODS Between 1996 and 2009,we performed elective,isolated,primary,multiple cardiac arterial bypass grafting in 430 consecutive patients with left ventricular ejection fraction ≤ 40%. The early and long-term results were compared between 167 patients undergoing BIMA grafting and 263 patients using left internal mammary artery(LIMA)-saphenous venous grafting(SVG).RESULTS The mean age of the overall population was 60.1 ± 15 years. In-hospital mortality was not different between the two groups(7.8% vs 10.3%,P = 0.49). Early postoperative morbidity included myocardial infarction(4.2% vs 3.8%,P = 0.80),stroke(1.2% vs 3.8%,P = 0.14),and mediastinitis(5.3% vs 2.3%,P = 0.11). At 8-year follow-up,Kaplan-Meier-estimated survival(74.2% vs 58.9%,P = 0.02) and Kaplan-Meier-estimated event-free survival(all cause deaths,myocardial infarction,stroke,target vessel revascularization,heart failure)(61.7% and 41.1%,P < 0.01) were significantly higher in the BIMA group compared with the LIMA-SVG group in univariate analysis. The propensity score matching analysis confirmed that BIMA grafting is a safe revascularization procedure but there was no long term survival(P = 0.40) and event-free survival(P = 0.13) in comparison with LIMA-SVG use.CONCLUSION Our longitudinal analysis suggests that BIMA grafting can be performed with acceptable perioperative mortality in patients with left ventricular dysfunction.
