Most PrEP users were high risk MSM and opted for on demand PrEP. PrEP use was associated with a low HIV incidence and a high rate of condomless sex with a modest increase in bacterial STIs.

No abstract

Objectives The aim of the study was to assess whether the timing of combination antiretroviral therapy (cART) initiation, the choice of cART and virological response differ in migrants versus European natives in the north and east of Paris area, after dissemination of French recommendations for universal treatment. Methods Antiretroviral therapy‐naïve HIV‐1‐infected adults with at least two follow‐up visits at one of 15 participating centres between 1 January 2014 and 31 March 2015 were included in the study. Factors associated with cART initiation before 31 March 2015, with protease inhibitor (PI)‐containing cART among individuals initiating cART, and with 1‐year virological success after cART initiation were assessed using multivariable logistic regression models. Sex, age, region of origin [Western Europe, sub‐Saharan Africa (SSA) or other], HIV transmission group, baseline AIDS status, CD4 cell count and plasma viral load (VL), and hepatitis B and/or C virus infection were considered in the analyses. Results Among 912 individuals, only 584 (64%) started cART during the study period. After adjustment, migrants from SSA were half as likely to initiate cART and to have a subsequent virological response compared with individuals from Western Europe [adjusted odds ratio (aOR) 0.54; 95% confidence interval (CI) 0.36–0.82; and aOR 0.52; 95% CI 0.28–0.98, respectively]. PI‐containing cART was more frequently prescribed in migrants from SSA, in people with lower CD4 cell counts and in people with higher VL. Conclusions Even in the context of universal cART recommendations and of free access to care, migrants from SSA still have delayed access to cART and a lower virological response. Efforts are still necessary to provide immediate cART to all people living with HIV.

Introduction The distinction between epidermal necrolysis [EN; including Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and overlap syndrome] and erythema multiforme major (EMM) in children is confusing. We aimed to better describe and compare these entities. Materials and methods This French retrospective multicentre study included children ≤18 years old referred for EN or EMM between 1 January 2008 and 1 March 2019. According to pictures, children were reclassified into TEN/overlap, SJS or EMM/unclassified (SJS/EMM) groups and compared for epidemiological and clinical data, triggers, histology and follow‐up. Results We included 62 children [43 boys, median age 10 years (range 3–18)]: 16 with TEN/overlap, 11 SJS and 35 EMM. The main aetiologies were drugs in EN and infections (especially Mycoplasma pneumoniae) in EMM (P < 0.001), but 35% of cases remained idiopathic (TEN/overlap, 47%; SJS, 24%; EMM, 34%). The typical target lesions predominated in EMM (P < 0.001), the trunk was more often affected in EN (P < 0.001), and the body surface area involved was more extensive in EN (P < 0.001). Mucosal involvement did not differ between the groups. Two patients with idiopathic TEN died. Histology of EMM and EN showed similar features. The recurrence rate was 42% with EMM, 7% with TEN/overlap and 0 with SJS (P < 0.001). Sequelae occurred in 75% of EN but involved 55% of EMM. Conclusion Clinical features of EN and EMM appeared well demarcated, with few overlapping cases. Idiopathic forms were frequent, especially for EN, meaning that a wide and thorough infectious screening, repeated if needed, is indicated for all paediatric cases of EN/EMM without any trigger drug. We propose a comprehensive panel of investigations which could be a standard work‐up in such situation. Sequelae affected both EN and EMM.

Objective: To assess updated mortality and causes of death in people living with HIV (PLWH) in France. Design and Methods: We analyzed all deaths in PLWH followed up between 01/01/2020 and 31/12/2021 in 11 hospitals in the Paris region. We described the characteristics and causes of death among deceased PLWH, and evaluated the incidence of mortality and associated risk factors using a multivariate logistic regression. Results: Of the 12942 patients followed in 2020-2021, 202 deaths occurred. Mean annual incidence of death (95% confidence interval [CI]) was 7.8 per 1 000 PLWH (6.3–9.5). Forty-seven patients (23%) died from non-AIDS non-viral hepatitis (NANH)-related malignancies, 38 (19%) from non-AIDS infections (including 21 cases of COVID-19), 20 (10%) from AIDS, 19 (9%) from cardiovascular diseases (CVD), 17 (8.4%) from other causes, six (3%) from liver diseases and five (2.5%) from suicides/violent deaths. The cause of death was unknown in 50 (24.7%) patients. Risks factors for death were age (adjusted Odds Ratio (aOR) 1.93; 1.66–2.25 by additional decade), AIDS history (2.23; 1.61–3.09), low CD4 (1.95; 1.36–2.78 for 200–500/μL and 5.76; 3.65–9.08 for ≤ 200/μL versus > 500/μL), and viral load > 50 copies/mL (2.03; 1.33–3.08), both at last visit. Conclusions: NANH malignancies remained in 2020–2021 the first cause of death. COVID-19 accounted for more than half of the mortality related to non-AIDS infections over the period. Aging, AIDS history, and a poorer viro-immunological control were associated with death.