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Virologie

Université Paris 6 A Derrache Dr A Maiga Dr G Carcelain Dr AG Marcelin Pr V Calvez. Virologie. Université Paris 7 Dr D Descamps Dr G Peytavin Université Bordeaux 2 Dr B Masquelier. Diagnostic Tests sérologiques Diagnostic chez l’enfant Suivi du traitement Mesure de la charge virale

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Virologie

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  1. Université Paris 6 A Derrache Dr A Maiga Dr G Carcelain Dr AG Marcelin Pr V Calvez Virologie • Université Paris 7 • Dr D Descamps • Dr G Peytavin • Université Bordeaux 2 • Dr B Masquelier

  2. Diagnostic Tests sérologiques Diagnostic chez l’enfant Suivi du traitement Mesure de la charge virale (détection de la virémie résiduelle) Prise en charge de l’échec Virologie

  3. Diagnostic Tests sérologiques Virologie

  4. Tests ELISA

  5. Tests rapides

  6. Tests salivaires

  7. Problèmes ? Faux négatifs : exceptionnels Faux positifs : très rares

  8. Diagnostic Tests sérologiques Diagnostic chez l’enfant Virologie

  9. Avantages du papier buvard Possible Étapesinutiles 1 2 3 4

  10. Diagnostic Tests sérologiques Diagnostic chez l’enfant Suivi du traitement Mesure de la charge virale (détection de la virémie résiduelle) Virologie

  11. Échec à ABC+3TC+fosAPV/r chez un patient naïf (SOLO) 1 000 000 Pro : M36IRT : None Pro : M36I, M46I, I50VRT : M184V Pro : M36I, M46I, I50VRT : L74V, M184V 100 000 Pro : M36I, M46I, I50VRT : M184I Viral load (copies/ml) 10 000 1 000 1 000 copies/ml 400 copies/ml * 100 50 copies/ml 10 0 20 40 60 80 100 120 140 160 180 Weeks on therapy * Switch to 908/r bid Sax et al

  12. Marcelin AG et al. Los Angeles CROI 2007 abs 662 AIDS 2007 Development of drug resistance in a sub-saharan cohort of HIV1-infected adult patients receiving fixed-dose combination of stavudine30mg/lamivudine/nevirapine as standard first-line regimen OBJECTIVE: To characterize the resistance patterns at the time of failure after a first line regimen containing d4T+3TC+NVP as a fixed-dose combination in Mali. RESULTS:Out of the 109 patients included in the study, 83 (76%) had a VL < 200 copies/mL at a median time of 6.7 months after initiation. Among the 26 patients with detectable VL (median VL = 4150 copies/mL; range: 209 – 404000 copies/mL), viruses were not amplifiable in 4 cases.

  13. The intensity of virological monitoring is associated with resistance to first line HAART in HIV-1 infected adults receiving 1st line therapy according to WHO guidelines: a systematic analysis of cohort and trial data Gupta RK, Hill A, Sawyer W, Cozzi-Lepri A, Phillips AN, von Wyl V, Yerly S, Gunthard HF, Gilks C, Pillay D

  14. 48 week GA resistance rates

  15. 48 week TOTAL resistance rates

  16. Diagnostic Tests sérologiques Diagnostic chez l’enfant Suivi du traitement Mesure de la charge virale (détection de la virémie résiduelle) Prise en charge de l’échec Virologie

  17. d4T, AZT TAMs 3TC, FTC 184 ABC, ddI, TDF 65, 74 Résistance acquise aux NRTIs

  18. IDV, RTV, SQV, LPV (46, 54, 82, 84, 90) NVF (30, 90) TPV (36, 58, 69, 89) FosAPV, DRV (32, 47, 54, 50, 84) ATV (50) Résistance acquise aux IPs

  19. CRF02_AG BAMAKO CRF18_cpx F2 G B CRF09_cpx CRF06_cpx CRF01_AE CRF02_AG A CRF02_AG SEGOU CRF01_AE A G CRF09_cpx CRF18_cpx F2 B CRF06_cpx As previously describe, the predominant subtype circulating in Mali is CRF02_AG (A. Derache et al, Antivir Ther. 2007), and isin agreement with data from others coutries in West Africa. Recombinant CRF06_cpx proportion increase in 2006 and new complex recombinants appear, such as CRF09_cpx and CRF18_cpx. These results suggest an evolution in the dynamic of viral recombination in Mali.

  20. Prevalence of Resistance Mutations in Antiretroviral Naïve Chronically HIV-infected Patients in 2006/2007: a French Nationwide Study Diane Descamps, Brigitte Montes, Marie-Laure Chaix, Sophie Pakianather, Francis Barin, Georges Dos Santos, Anne Krivine, Constance Delaugerre, Jacques Izopet, Anne-Geneviève Marcelin, Anne Maillard, Laurence Morand-Joubert, Coralie Pallier, Jean-Christophe Plantier, Catherine Tamalet, Vincent Calvez, Bernard Masquelier, Françoise Brun-Vézinet1, Dominique Costagliola on behalf the ANRS AC-11 Resistance Group.

  21. PatientsCharacteristics D Descamps et al IHDRW 2008 Abs 140

  22. ODYSSEE 0DYSSEE p value 2001 2006/2007 number of patients 363 466 PI 0.8 4.7 0.001 virus with mutations, % [IC95] IC 95% [0.3-1.7] [1.9 - 11.3] 1 class ARV 3.3 [2.1-5.5] 7.9 [5.3 -11.8] NRTI 3.4 5.8 0.101 2 classes ARV 0.6 [0.2- 1.5] 2.6 [0.6-9.6] 0.001 IC 95% [2.1 - 5.4] [2.9-11.1] 3 classes ARV - 0.1 [0.01-0.71] NNRTI 0.3 2.8 0.005 IC 95% [0.08-1.41] [1.2-6.7] Mutations to at least 1 ARV (%) 3.9 10.6 < 0.001 IC 95% [2.6 - 6.0] [6.7-16.3] Weighted prevalence (% ) of virus with mutations to ARV classes D Descamps et al IHDRW 2008, Abs 140

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