Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Rouet F[original query] |
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Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014-2015
Rouet F , Nouhin J , Zheng DP , Roche B , Black A , Prak S , Leoz M , Gaudy-Graffin C , Ferradini L , Mom C , Mam S , Gautier C , Lesage G , Ken S , Phon K , Kerleguer A , Yang C , Killam W , Fujita M , Mean C , Fontenille D , Barin F , Plantier JC , Bedford T , Ramos A , Saphonn V . Clin Infect Dis 2017 66 (11) 1733-1741 Background: In 2014-2015, 242 individuals aged 2-89 were newly HIV-1 diagnosed in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods: We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C and B viruses (HCV, HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV, and HBcIgM Ab for HBV. We performed evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed health care practitioner were obtained from 193 cases and 1499 controls during interviews. Results: Cases were co-infected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (<130 days) HIV infections. Phylogeny of 202 HIV env C2V3 sequences showed a 198-sample CRF01_AE strains cluster, with time to most recent common ancestor (tMRCA) in September 2013 (95% highest posterior density, August 2012-July 2014), and a peak of 15 infections/day in September 2014. Three geospatial HIV hotspots were discernible in Roka and correlated with high exposure to the practitioner (P=0.04). Fifty-nine (38.6%) of 153 tested cases showed recent (<180 days) HCV infections. Ninety HCV NS5B sequences formed three main clades, one containing 34 subtypes 1b with tMRCA in 2012, and two with 51 subtypes 6e and tMRCAs in 2002-2003. Conclusions: Unsafe injections in Cambodia most likely led to an explosive iatrogenic spreading of HIV, associated with a long-standing and more genetically-diverse HCV propagation. |
Cluster of HIV infections associated with unsafe injection practices in a rural village in Cambodia
Saphonn V , Fujita M , Samreth S , Chan S , Rouet F , Khol V , Mam S , Mom C , Tuot S , Le LV , Ly PS , Ferradini L , Mean CV . J Acquir Immune Defic Syndr 2017 75 (3) e82-e86 In late 2014 in a rural village in Cambodia, a surge in HIV infections was reported and a rapid investigation identified 114 among 915 (12.4%) Roka commune residents being HIV infected, with 65% women and age ranging between 3 and 87 years. As a comparison, between January and November 2014, only 4 among 271 people in Roka commune (1.5%) were found HIV-positive. With only 1 public health care center for all villages in the commune, health services are largely shared by private health service providers including unlicensed informal health practitioners who conduct home visits and administer medical procedures, including medical injection, intravenous infusion, and blood draw. A case–control study was performed in December 2014, led by the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) and the University of Health Sciences (UHS), to identify risk factors associated with recently diagnosed HIV-positive cases in Roka commune. |
Cluster of HIV infections attributed to unsafe injection practices - Cambodia, December 1, 2014-February 28, 2015
Vun MC , Galang RR , Fujita M , Killam W , Gokhale R , Pitman J , Selenic D , Mam S , Mom C , Fontenille D , Rouet F , Vonthanak S . MMWR Morb Mortal Wkly Rep 2016 65 (6) 142-145 In December 2014, local health authorities in Battambang province in northwest Cambodia reported 30 cases of human immunodeficiency virus (HIV) infection in a rural commune (district subdivision) where only four cases had been reported during the preceding year. The majority of cases occurred in residents of Roka commune. The Cambodian National Center for HIV/AIDS (acquired immunodeficiency syndrome), Dermatology and Sexually Transmitted Diseases (NCHADS) investigated the outbreak in collaboration with the University of Health Sciences in Phnom Penh and members of the Roka Cluster Investigation Team. By February 28, 2015, NCHADS had confirmed 242 cases of HIV infection among the 8,893 commune residents, an infection rate of 2.7%. Molecular investigation of the HIV strains present in this outbreak indicated that the majority of cases were linked to a single HIV strain that spread quickly within this community. An NCHADS case-control study identified medical injections and infusions as the most likely modes of transmission. In response to this outbreak, the Government of Cambodia has taken measures to encourage safe injection practices by licensed medical professionals, ban unlicensed medical practitioners, increase local capacity for HIV testing and counseling, and expand access to HIV treatment in Battambang province. Measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed. Estimates of national HIV incidence and prevalence might need to be adjusted to account for unsafe injection as a risk exposure. |
Maternal HIV-1 disease progression 18-24 months postdelivery according to antiretroviral prophylaxis regimen (triple-antiretroviral prophylaxis during pregnancy and breastfeeding vs zidovudine/single-dose nevirapine prophylaxis): the Kesho Bora randomized controlled trial
Dioulasso B , Faso B , Meda N , Fao P , Ky-Zerbo O , Gouem C , Somda P , Hien H , Ouedraogo PE , Kania D , Sanou A , Kossiwavi IA , Sanogo B , Ouedraogo M , Siribie I , Valea D , Ouedraogo S , Some R , Rouet F , Rollins N , McFetridge L , Naidu K , Luchters S , Reyners M , Irungu E , Katingima C , Mwaura M , Ouattara G , Mandaliya K , Wambua S , Thiongo M , Nduati R , Kose J , Njagi E , Mwaura P , Newell ML , Mepham S , Viljoen J , Bland R , Mthethwa L . Clin Infect Dis 2012 55 (3) 449-460 BACKGROUND: Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. METHODS: From 2005 to 2008, HIV-infected pregnant women with CD4+ counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4+ counts of <200/mm(3). RESULTS: Among 824 randomized women, 789 had at least 1 study visit after cessation of ARV prophylaxis. Following delivery, progression risk up to 24 months postpartum in the triple ARV arm was significantly lower than in the AZT/sdNVP arm (15.7 vs 28.3; P =. 001), but the risks of progression after cessation of ARV prophylaxis (rather than after delivery) were not different (15.0 vs 13.8 18 months after ARV cessation). Among women with CD4+ counts of 200-349/mm(3) at enrollment, 24.0 (95 confidence interval [CI], 15.7-35.5) progressed with triple ARV, and 23.0 (95 CI, 17.8-29.5) progressed with AZT/sdNVP, whereas few women in either arm (<5) with initial CD4+ counts of >=350/mm(3) progressed. CONCLUSIONS: Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4+ cells of <350/mm(3), ARVs should not be discontinued in this group. CLINICAL TRIALS REGISTRATION: ISRCTN71468410. (2012 The Author.) |
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