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Master Thesis

Description générale et évaluation de l’atteinte hépatique des patients VIH multi-infectés par les virus de hépatites dans la cohorte Aquitaine ANRS CO3, de janvier 1996 à décembre 2017

Abstract : Introduction: the prevalence of hepatitis viruses B (HBV), C (HCV) and delta (HDV) infection is more important in HIV patients, as they share the same modes of transmission. The joint multi-infection with VHB and VHC in HIV patients is not frequent and has been little studied. Material and methods: we conducted a study in HIV infected patient of the Aquitaine Cohort. The inclusion criteria were positivity Ag HBs for 6 months associated with positive HCV serology and positive HVC NRA for more than 6 months. Patients have been described according to their general characteristics and those related to HIV, HBV, HCV and HDV. We compared the patients depending on the liver disease (cirrhosis or no cirrhosis) and HDV status to identify cirrhosis risk-factors. Results: among 5507 patients followed from 1996 to 2016, 51 HIV-HBV-HCV multi-infected patients, including 6 HDV infected patients, were studied. HBV and HCV co-infection concerns 0.9% of HIV infected patients of the Aquitaine Cohort. Cirrhosis of the liver disease stage was documented for 28 patients (55%). HDV has not been researched in 43% of patients. The great majority of patients have been treated by HAART. HBV ADN has been indetected in 81% of patients and tenofovir has been given to 78% of patients. HCV eradication has been obtained for 68% of patients. Cirrhosis of the liver was significantly associated with a more important mortality rate. A lower T lymphocytes CD4 count at the time of multi-infection diagnosis and the absence of TDF + FTC treatment was significantly associated to the risk of cirrhosis. In HDV infected patients, the prevalence of cirrhosis was 83% versus 48% in non-HDV infected patients. Conclusion: multi-infection by the hepatits viruses in HIV infected patients increases the risk of cirrhosis and the mortality rate. A systematic screening for viral hepatitis viruses, including hepatitis D, and an adequate therapeutic strategy is essential. Despite the recent therapeutic advances, primary prevention remains a cornerstone in multi-infection care.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01911179
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Submitted on : Friday, November 2, 2018 - 2:47:45 PM
Last modification on : Wednesday, November 14, 2018 - 1:15:33 AM
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Ingrid Gabriel. Description générale et évaluation de l’atteinte hépatique des patients VIH multi-infectés par les virus de hépatites dans la cohorte Aquitaine ANRS CO3, de janvier 1996 à décembre 2017. Médecine humaine et pathologie. 2018. ⟨dumas-01911179⟩

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