Les besoins des personnes vivant avec le VIH/sida en Suisse

[Table des matières] 1. Zusammenfassung. 2. Introduction et contexte de l'étude. 3. Méthode. 4. Besoins des personnes vivant avec le VIH/sida, amis et partenaires. 5. Etudes donnant des indications sur certaines catégories de besoins des personnes séropositives. 5.1.Programme national VIH/sida de 1999 à 2003. 5. 2. Test de dépistage du VIH. 5.3. Prophylaxie post exposition VIH (PEP). 5.4. La sexualité des personnes vivant avec le VIH/sida. 5.5. Discriminations institutionnelles à l'encontre des personnes vivant avec le VIH en Suisse. 5.6. Evaluation de la stratégie de prévention du sida en Suisse sur mandat de l'Office fédéral de la santé publique : sixième rapport de synthèse. 5.7. Activité de prévention du sida des médecins de premier recours, le counselling pré-test. 5.8. Comparaison 1989/1997 : est-ce que l'amélioration du traitement médical se répercute aussi sur la perception des patients de leur maladie ? 5.9. Histoires individuelles avec le VIH, bien-être psychophysique, coping, charge psychosociale. 5.10. Etude médico-ethnologique sur la prise en charge et les choix thérapeutiques. 5.11. Qualité des soins d'un service ambulatoire spécialisé dans le suivi des patients infectés par le VIH, le point de vue des patients. 5.12. Prévention de la transmission du VIH dans les prisons suisses : analyse secondaire sur la base de la littérature disponible. 5. 13. Recommandations. 5.14. Formation VIH/sida 1989-1999. 5.15. Etude sur les nouveaux traitements du VIH/sida dans la perspective des patients. 5.16. Projet SESAM. 5.17. Etude : Evaluation du site HivNet. 5.18. Etudes relatives à la paupérisation des personnes vivant avec le VIH. 5.19. Travail, revenu et pauvreté chez les personnes vivant avec le VIH/sida de la "Swiss Cohort Study". 5.20. Séropositivité, sida et les assurances sociales. 5.21. Politiques et pratqieus cantonales en matière de prévention VIH/sida et d'éducation sexuelle à l'école. 5.22. Données épidémiologiques sur le VIH/sida issues du système de surveillance. 5.23. Données descriptives issues de la Swiss HIV Cohort Study. 6. Tableau récapitulatif : conclusions et recommandations.

Evolution des mises sur le marché de préservatifs en Suisse : 1986-2009.

La promotion de l'utilisation de préservatifs lors de relations sexuelles est un élément central de la stratégie de prévention du VIH/Sida en Suisse. Depuis 1986, l'Unité d'Evaluation de Programmes de Prévention de l'Institut Universitaire de Médecine Sociale et Préventive de Lausanne effectue le suivi de la mise à disposition de préservatifs sur le marché suisse. D'abord entrepris dans le cadre de l'évaluation de la stratégie nationale de prévention du VIH/Sida de l'OFSP, ce suivi s'effectue depuis 2000 dans le cadre du monitoring de cette prévention.

Nocardiose disséminée à Nocardia brasiliensis chez un patient ambulatoire [Disseminated nocardiosis due to Nocardia brasiliensis in an ambulatory patient].

We report the case of a 76-year-old man with generalized nocardiosis. The microbiologic pattern, the different clinical manifestations and the treatment of nocardiosis are discussed in general. In the particular case of our patient the disease manifested itself primarily as a subcutaneous abscess, a metastasis secondary to pulmonary nocardiosis. The disease was caused by a Nocardia brasiliensis, which is rarely seen in Europe and which does not usually cause a generalized form of nocardiosis.

Evaluation des effets de la campagne de prévention "Mission : possible" de l'Aide suisse contre le sida (2008)

L'Office fédéral de la santé publique (OFSP) a donné pour mandat à l'IUMSP d'évaluer la campagne " Mission : Possible " de l'Aide suisse contre le sida (ASS), réalisée en 2008. Il s'agit d' une campagne de prévention du VIH/sida s'adressant exclusivement aux hommes qui ont des relations sexuelles avec des hommes (HSH). Elle a été mise en oeuvre par l'Aide suisse contre le sida, sur mandat de l'Office fédéral de la santé publique. L'objectif stratégique de " Mission: Possible " consiste à freiner la propagation du VIH parmi les HSH. Actuellement, une partie importante des infections à VIH sont le fait de rapports sexuels non protégés avec des partenaires sexuels en phase de primo-infection, c'est-à-dire la phase suivant directement le contage et durant laquelle la quantité de virus dans le sang est particulièrement élevée. L'ambition de la campagne Mission Possible était de briser les chaînes d'infection ainsi créées en incitant tous les HSH à observer strictement les règles du safer sex, trois mois durant, soit le temps nécessaire pour que les personnes récemment infectées sortent de la phase de primo-infection. Ainsi, le risque de nouvelles transmissions diminuerait de façon globale et l'épidémie serait ralentie. Au terme des trois mois, les HSH étaient incités à faire un test VIH gratuit (sur présentation d'un bon à présenter dans les centres de dépistage et conseils anonymes : policliniques universitaires et certaines antennes de l'ASS). La campagne reposait sur une importante mobilisation communautaire, c'est-à-dire l'implication de tous les acteurs de la scène gaie en Suisse (journaux et sites internet, associations et établissements gais). [Introd. du résumé p. 9] Site internet de la campagne "Mission : possible": http://www.missionp.ch/fr/home/

Nouveautés en médecine ambulatoire [Innovations in ambulatory care]

During 2008, we selected 8 studies of interest. It seems important to continue to treat high tension for old patients. To give a good medication against pain, to maintain activity and to reassure patient is the treatment for acute back pain; surgery for spinal stenosis has better results than other treatments at two years of evolution. Pregabalin seems to provide clinically benefit to patients with fibromyalgia. Helicobacter pylori test and treat has the same results than proton pomp inhibitor in initial management of dyspepsia; extending triple therapy beyond 7 days is unlikely to be a clinical useful strategy. Syphilis testing algorithms using treponemal tests for initial screening could be inversed. Finally, selective reporting of clinical trials results for antidepressant are relatively frequent.

International consensus guidelines on the management of cytomegalovirus in solid organ transplantation.

Cytomegalovirus (CMV) remains one of the most common infections after solid organ transplantation, resulting in significant morbidity, graft loss, and occasional mortality. Management of CMV varies considerably among transplant centers. A panel of experts on CMV and solid organ transplant was convened by The Infectious Diseases Section of The Transplantation Society to develop evidence and expert opinion-based consensus guidelines on CMV management including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues.

Efficacy of levofloxacin in the treatment of experimental endocarditis caused by viridans group streptococci.

Levofloxacin was investigated against viridans group streptococci in vitro and in rats with experimental aortic endocarditis. The MIC(90)s of levofloxacin and ciprofloxacin for 20 independent isolates of such bacteria were 1 and 8 mg/L, respectively. Rats were infected with two types of organism: either fully susceptible to levofloxacin MIC < or = 0.5 mg/L) or borderline susceptible (MIC 1-2 mg/L). Fully levofloxacin-susceptible bacteria comprised one penicillin-susceptible (MIC 0.004 mg/L) Streptococcus gordonii, and one penicillin-tolerant as well as one intermediate penicillin-resistant (MIC 0.125 mg/L) isogenic strains. Borderline levofloxacin-susceptible bacteria comprised one penicillin-susceptible Streptococcus sanguis and one highly penicillin-resistant Streptococcus mitis (MIC 2 mg/L). Rats were treated for 5 days with drug dosages simulating the following treatments in humans: (i) levofloxacin 500 mg orally once a day (q24 h), (ii) levofloxacin 500 mg orally twice a day (q12 h), (iii) levofloxacin 1 g orally q24 h, (iv) ciprofloxacin 750 mg orally q12 h, and (v) ceftriaxone 2 g iv q24 h. Levofloxacin was equivalent or superior to ceftriaxone, and was successful in treating experimental endocarditis irrespective of penicillin resistance. Nevertheless, standard levofloxacin treatment equivalent to 500 mg q24 h in human was less effective than twice daily 500 mg or once daily 1 g doses against borderline-susceptible organisms. Ciprofloxacin, used as a negative control, was ineffective and selected for resistant isolates. This underlines the importance of MIC determinations when treating severe streptococcal infection with quinolones. In the case of borderline-susceptible pathogens, total daily doses of 1 g of levofloxacin should be considered.

Pharmacokinetic variability of extended interval tobramycin in burn patients.

BACKGROUND: Aminoglycosides are mandatory in the treatment of severe infections in burns. However, their pharmacokinetics are difficult to predict in critically ill patients. Our objective was to describe the pharmacokinetic parameters of high doses of tobramycin administered at extended intervals in severely burned patients. METHODS: We prospectively enrolled 23 burned patients receiving tobramycin in combination therapy for Pseudomonas species infections in a burn ICU over 2 years in a therapeutic drug monitoring program. Trough and post peak tobramycin levels were measured to adjust drug dosage. Pharmacokinetic parameters were derived from two points first order kinetics. RESULTS: Tobramycin peak concentration was 7.4 (3.1-19.6)microg/ml and Cmax/MIC ratio 14.8 (2.8-39.2). Half-life was 6.9 (range 1.8-24.6)h with a distribution volume of 0.4 (0.2-1.0)l/kg. Clearance was 35 (14-121)ml/min and was weakly but significantly correlated with creatinine clearance. CONCLUSION: Tobramycin had a normal clearance, but an increased volume of distribution and a prolonged half-life in burned patients. However, the pharmacokinetic parameters of tobramycin are highly variable in burned patients. These data support extended interval administration and strongly suggest that aminoglycosides should only be used within a structured pharmacokinetic monitoring program.

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy.

The purpose was to evaluate the influence of radiologist's experience on the diagnostic yield and complications of a percutaneous liver biopsy (PLB) method. Six hundred patients underwent an ultrasound-guided PLB by an inexperienced operator in 25.2% of cases (experience of less than 15 percutaneous liver biopsies performed alone--group I) or by an experienced operator (experience of more than 150 percutaneous liver biopsies--group II). The two groups were well-matched with respect to sex, age, percentage with viral hepatitis without histological cirrhosis, number of needle passes, history of liver biopsy and pain before the biopsy. A histological diagnosis was available in 97.3% of cases without any significant difference between the two groups ( P=0.25). However, group II samples were significantly longer and contained more portal tracts ( P=0.01). Pain was mild immediately and 6 h after the biopsy, without significant difference between both groups. Eight vasovagal reactions (five in group II) and one arteriobiliary fistula (in group II) occurred. With the method of PLB used for this study, operator's experience did not influence either the final histological diagnosis or the degree of pain suffered.

Valganciclovir to prevent or treat cytomegalovirus disease in organ transplantation.

Cytomegalovirus (CMV) is generally considered the most significant pathogen to infect patients following organ transplantation. Significant improvements have been achieved in the management of CMV disease over recent years, especially since the introduction of oral drugs such as oral ganciclovir followed by valganciclovir (VGC), a prodrug of ganciclovir with enhanced bioavailability. Several randomized controlled trials have shown that VGC is an efficacious and convenient oral drug to prevent or treat CMV disease in solid-organ transplant recipients. In this article, we discuss the clinical and pharmacological experience with the use of VGC for the management of CMV in solid-organ transplant recipients. Finally, novel strategies to further reduce the incidence of CMV disease after transplantation are also reviewed.

Edulcorants: entre mythe et réalité [Sweeteners: between myth and reality]

As the prevalence of obesity and diabetes are continually increasing, the use of "false sugars" otherwise known as sweeteners, and their associated health issues are being more and more discussed. A higher sugared power, less calories as well as a moderated or non-existent effect on blood sugar would lead to believe that sweeteners are helpful. However, we CANNOT say that they are THE solution as they can contain calories, may have some undesired effects, and moreover they ease the conscience without actually allowing a weight loss with their sole use. They are to be used with judgment, wittingly and especially when comparing sweetened products. The sweetener myth is often far from reality. It is therefore important to give our patients the means to analyze their dietary intake with regard to their sweeteners ingestion.