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Master Thesis

Syndromes inflammatoires de reconstitution immunitaire à Histoplasma capsulatum var capsulatum chez des patients infectés par le VIH en Guyane Française : étude de cas

Abstract : Without antiretroviral therapy, american histoplasmosis is the primary cause of AIDS in French Guiana. Its incidence increases with the initiation of antiretroviral despite immune restoration. The main objective was to describe HIV-associated histoplasmosis IRIS cases in the HIV-infected patients cohort of French Guiana. A retrospective multicentric study was conducted from 01/01/1997 to 04/30/2007. The target population was represented by HIV patients who presented an incident episode of histoplasmosis within six months after initiation of antiretroviral therapy. Each case was described with a standardized questionnary. The primary endpoint was the presence of a paradoxical or infectious IRIS confirmed by an expert opinion. The expert confirmed 2 paradoxicals IRIS and 4 infectious IRIS among the 35 patients suspected of IRIS. The median age was 41.5 years. The symptoms had appeared in a mean time of 13 days after ARV initiation. The most frequent clinical signs were: fever, poor general condition, digestive disorders, pulmonary signs and adenomegaly. The most frequent paraclinical abnormalities were: anemia, liver function disturbance, moderate inflammation, elevated LDH, elevated ferritin and pulmonary interstitial syndrome. The median HIV viral load decreased 3 logs. The CD4 + T cells count increased in three patients and was stable in others. The CD8 + T cells count decreased in all patients. No patient died. IRIS associated with Hcc is rare. Its morbidity is important. Its mortality is low. The CD8 + T cells seem to play an important role in its pathogenesis. Screening for latent forms of histoplasmosis should be implemented before starting antiretroviral therapy.
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https://dumas.ccsd.cnrs.fr/dumas-01405771
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Submitted on : Wednesday, November 30, 2016 - 2:00:58 PM
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Régis de Reynal de Saint Michel. Syndromes inflammatoires de reconstitution immunitaire à Histoplasma capsulatum var capsulatum chez des patients infectés par le VIH en Guyane Française : étude de cas. Médecine humaine et pathologie. 2016. ⟨dumas-01405771⟩

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