Tesis sobre el tema "VIH/Hépatite C"
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Di, Martino Vincent. "Histoire naturelle de l'hépatite C chez les patients immunodéprimés". Paris 7, 2001. http://www.theses.fr/2001PA077185.
Texto completoGuitton, Emmanuelle. "Influence de la co-infection virale chez les patients VIH : approche pharmacoépidémiologique". Toulouse 3, 2006. http://www.theses.fr/2006TOU30280.
Texto completoHepatitis C infection (HCV) concerns 10% to 30% of HIV patients. The aim of our research was to explore the influence of HCV co infection in HIV patients with data from the French Pharmacovigilance database and from a regional cohort of HIV and coinfected patients. We showed that hepatic or haematological troubles occurred more frequently in coinfected patients. In the cohort study, clinical and immunological worsening of HIV infection seems to be faster in co infected patients, despite the lack of statistically significant difference. This work underlines the differences in the therapeutic management of the HIV and HIV+HCV patients (ARV drugs, modifications or withdrawal of ARV drugs). The risk of the occurrence of hepatic or haematological troubles with ARV drugs is a possible explanation. The cohort should be continued to increase the number of patients included
Couturier, Sarah. "Synthèse et étude de 3'-desoxy-3'-C-methylnucléosides pyrimidiques". Montpellier 2, 2004. http://www.theses.fr/2004MON20183.
Texto completoNeau, Didier. "Aspects viro-immunologiques de l'hépatite chronique C au cours de l'infection par le VIH". Bordeaux 2, 2001. http://www.theses.fr/2001BOR28865.
Texto completoHCV infection is frequent and potentially severe in HIV-infected patients. In order to better understand the interactions between an immunocompromised host and HCV, different virological and immunological aspects of HCV-HIV were investigated. In the context of a clinical trial concerning 68 patients, we evaluated the efficacy of anti-HCV-treatment in HIV infection. We studies 1) the kinetics of plasma HCV load under interferon and its relationship with intra-hepatic HCV load 2) HCV variability (complexity and diversity of quasispecies) 3) TCD4 proliferative responses to HCV antigens, HIV p24, and tuberculin, to evaluate the predictive value of these different parameters on the response to anti-HCV treatment. Our results showed that the kinetics of HCV load under therapy in HIV coinfection was not significantly different of that observed in immunocompetent patients. Plasma load correlated with intra-hepatic load, which was significantly lower in patients treated with a protease inhibitor at the time of the biopsy. Plasma HCV quasispecies complexity before treatment was comparable with that observed in a group of HCV-infected patients. In contrast with immunocompetent patients, it did not predict response to treatment. Anti-HCV treatment modified the profile of quasispecies in 70 % of the patients. Genetic diversity was different according to the genotype. Initial proliferative response to HCV antigens did not predict the efficiency of the treatment. However, a profile of persisting immunological responders was significantly associated with viral clearance during immunological sequential follow-up
Laouénan, Cédric. "Utilisation des modèles dynamiques pour l'évaluation des traitements de l'hépatite C". Paris 7, 2014. http://www.hal.inserm.fr/tel-01077435.
Texto completoSince 2011, the introduction of triple therapies combining a protease inhibitor (PI), telaprevir or boceprevir, with the pegylated-interferon and the ribavirin (Peg-IFN/RBV) marked a milestone for anti hepatitis C virus (HCV) therapy. However, the response to treatment in cirrhotic patients remains unclear and poses serious safety problems. Vira kinetic models, analyzed by nonlinear mixed effect models (NLMEM), are a powerful tool for understanding the response to treatment. We have demonstrated, by means of clinical trial simulation, the power of the Wald tes1 within NLMEM to detect a HCV drug's antiviral effectiveness difference. This approach, even for a small number of samples, provided consistently higher power to the standard approach based on a non parametric Wilcoxon test on the viral load decay. However, we have highlighted an inflation of the type I error with the Wald test when the number of patients is low and have proposed a permutation correction. We applied this approach to estimate the antiviral effectiveness of the triple therapies in cirrhotic patients and non-responders to a prior therapy (ANRS MODCUPIC). We hav( shown that over 99% of the viral replication was blocked by PI, with a significantly superior effectiveness of telaprevir compared to boceprevir and suboptimal effectiveness of Peg-IFN/RBV. Finally, by modeling the kinetics of blood parameters, we demonstrated that the concentrations of Peg-IFN and RBV are associated with, respectively, anemia and thrombocytopenia which are frequently observed in these patients
Marcellin, Fabienne. "Perceptions et comportements des personnes vivant avec le VIH co-infestées par le virus de l'hépatite C". Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5001.
Texto completoBetween 25,000 and 30,000 people are co-infected with HIV and hepatitis C virus (HCV) in France, with major clinical repercussions. Major therapeutic advances have been made in recent years thanks to the development of direct-acting antivirals for HCV treatment, with very good efficacy and safety profiles. In the same time, while the number of co-infected patients has globally decreased among HIV-infected patients, new groups at risk of HCV transmission have emerged in this population, such as men who have sex with men (MSM). Co-infected patients’ day-to-day experience with the disease remains poorly documented. In this work, we analyze the perceptions (quality of life, functional impact of fatigue) and behaviors (sexual risk behaviors, addictive behaviors) of co-infected patients and their relationships with clinical parameters, and we try to determine to what extent such data can be used to improve the management of co-infection and to better target HCV prevention actions
Schnuriger, Aurélie. "Etude des caractéristiques immunologiques et virologiques associées à la guérison de l'infection par le virus de l'hépatite C au cours d'une infection par le VIH". Paris 6, 2007. http://www.theses.fr/2007PA066262.
Texto completoAlatrakchi, Nadia. "Etude des réponses cellulaires th1 au cours des infections persistantes à VIH-1 et virus apparentés (VIH-2) ou associés (VHC)". Paris 7, 2005. http://www.theses.fr/2005PA077193.
Texto completoTo better understand the role of the immune responses in persistent chronic viral infections, I studied T cell immune responses, especially Thl, in persistent infections such as HIV-1, related virus such as HIV-2 or associated virus such as HCV. Three models of HIV infection with a relative control of virus replication were chosen: long term non progressors of HIV-1 infection co-infected with HCV, stable partially controlled subjects with HIV-1 infection during antiretroviral therapy; and subjects with HIV-2 infection. Strong virus specific Thl responses were found in the 3 groups of subjects and were associated with strong anti-viral CD8 T cell responses. Indeed, these virus specific T cell responses were inversely associated to the virus replication. Altogether these data emphasize the crucial role of Thl in maintaining efficient CD8 responses, therefore suggesting their contribution to maintain the balance between the host and the virus during chronic viral infections such as HIV or HCV
Dichamp, Isabelle. "Pathogenèse de l'infection à VIH-1 : rôle des protéines virales Tat et Nef". Besançon, 2006. http://www.theses.fr/2006BESA0006.
Texto completoWe demonstrated the effect of the second codmg exon ofTat to the control ofHIV-1 NF-κB¬ dependent and TAR-independent HIV-1 transcription in T cells. Thus, our results show an important role of the second coding exon of Tat in the activation of NF -κB, the HIV -1 LTR : stimulation, resulting in enhanced viral replication in T cells. During HIV ffiCV coinfections, we demonstrated that the HCV Core protein via interaction with HIV-1 Nef could enhance the NF-κB activation and the HIV-1 LTR stimulation mediated by HIV-1 Nef. Thus, the size of the viral macrophagic reservoirs could be increased for the two yiruses. Nef is a : multifunctional protein which interacts with cellular and viral proteins. By different experiments, we demonstrated that HIV -1 Nef protèin interacts specifically and directly with EFIA2 both in vitro and in vivo
Hagège, Meoïn. "Sortir et s'en sortir ? : parcours de santé et vulnérabilités de sortants de prison qui vivent avec le VIH ou une hépatite C". Paris, EHESS, 2016. http://www.theses.fr/2016EHES0096.
Texto completoThe health of inmates and released inmates is a public health problem seldom studied in France. The case study of men living with HIV and/or hepatitis C in the greater Parisian region is central to this PhD research. It aims to shed light on the life course and health trajectories before, during and after incarceration. These trajectories are constructed from data gathered through a three-pronged field work (observation, a series of biographical interviews and a survey). The study was conducted in and outside of prison to describe prisoners' experiences of care and treatment and the work done by healthcare and social work professionals. Hepatitis C is considered less important and severe than HIV, which explains the more frequent delays in recourse to care upon release and less challenging and stigmatizing experiences of the illness. Treatment interruptions are short and are part of the multiple adjustments that patients undertake to cope with release. These adjustments involve the tedious administrative procedures to (re)gain access to health and social welfare but also an embodied experience of release, (re)negotiation of personal and professional relationships. The interactions between the released inmates, their kin and the professionals who take care of them are described within the power structures in which they are embedded. In their institutional experience, patients are simultaneously regarded as subjects meant to interiorize health norms and asked to become self-reliant responsible individuals. Lastly, the trajectories of these men and women are inscribed in a process of progressing social vulnerability, exacerbated by HIV and HCV status, incarcerations and their release from prison. Prison release is lived as a liminal moment in the trajectories, as they pass from prison back into the city. The temporality is particular: it is constructed around activities and support relationships rather than based on linear chronological time; as a result prison release is full of uncertainty and seems interminable
Nguyen, Truong Tam. "Co-infection VIH/VHC : développement et mise en oeuvre d’outils paracliniques pour la prise en charge dans le pays à ressource limitée et la personnalisation thérapeutique". Thesis, Montpellier, 2015. http://www.theses.fr/2015MONT3508/document.
Texto completoChronic viral hepatitis is a major public health issue worldwide in the field of infectious dis and mostly affects resource-constrained countries. The challenge for the resource-limited countries is to implement the strategies for screening and management of viral hepatitis, particularly for hepatitis C among people who inject drugs.In this thesis we have evaluated new tests and strategies to improved diagnosis and therapeutic monitoring of HCV and HIV infection in low resource setting. The first study evaluated the performances of HIV testing using filter paper (DSS – Dried serum spot) compared with rapid tests during the early phase of HIV infections. A total of 39 serum samples form newly diagnosed HIV infected persons was included. Fourth generation immunoassays (ElecsysCombi PT test reactive and Liaison XL test reactive) identified 34 out of 39 HIV early infections using dried serum spot, whereas the Determine TM HIV-1/2 rapid test detected 24 out of 39 HIV positive serum (87.2% vs 61.5% respectively, p = 0.009). Fourth generation Ag/Ab immunoassays performed on DSS had good performance for HIV testing during the early phases of HIV infection. In the second study, we conducted a cross-sectional study aimed to assess the proportion of clinically significant fibrosis in HIV/HCV-co-infected patients followed in Viet Tiep Hospital in Haiphong, Northern Vietnam. From February to March 2014, 104 HIV-HCV coinfected patients receiving antiretroviral therapy (ART) were prospectively enrolled. 93 (89.4%) had detectable HCV RNA, median 6.19 (4.95-6.83 Log10 IU/mL). Patients were mainly infected with genotypes 1a/1b (69%) and genotypes 6a/6e (26%). 43 patients (41.3%) had fibrosis ≥ F2 including 24 patients (23.1%) with extensive fibrosis (F3) and/or cirrhosis (F4). Using Fibroscan® as a gold standard, the high threshold (2) of AST-to-platelet ratio index (APRI) had very good performances for the diagnosis of extensive fibrosis/cirrhosis (Se: 90%, Sp: 84%, AUROC=0.93, 95%CI: 0.86-0.99).In the last study, the impact of pegylated interferonα (PegINFα) and ribavirin therapy on T cell immune response was explored in HIV/HCV coinfected patients. Concentrations of 25 cytokines and CD8+ T cell activation were monitored in HCV/HIV co-infected patients. Results were compared between patients retrospectively classified as sustained virological responders (SVR, n=19) and non-responders (NR, n = 11). High pretreatment concentrations of IP-10 (CXCL-10) and MCP-1 (CCL-2) were associated with poor anti-HCV response. Highest rise in MIP-1β; and MCP-1 levels was observed four weeks after anti-HCV treatment initiation in SVR compared to NR, whereas a decrease of IL-8 concentration was associated with treatment failure (p= 0.052). Treatment based on drugs having immunomodulating activities may benefits from immunomonitoring using multiplex techniques. In conclusion, improving access to HIV and HCV diagnosis and monitoring are critical toward the control of these infections. Our work performed illustrate how dried blood spot, point of care testing, Fibroscan and simplified assays may contribute to HIV and HCV care in low resource setting. Key word : Co-infection HIV-HCV, IV drug user, dried blood Spot, liver fibrosis, fibroscan, APRI, Pegylated interferon, Vietnam
Rodriguez, Christophe. "Dynamique adaptative des virus hautement variables à un nouvel environnement réplicatif". Phd thesis, Université Paris-Est, 2012. http://tel.archives-ouvertes.fr/tel-00916824.
Texto completoBach, Guillaume. "Identification d'espèces moléculaires de lysophosphatidylcholine présentant des activités adjuvantes en vue d'un développement clinique". Phd thesis, Université Claude Bernard - Lyon I, 2009. http://tel.archives-ouvertes.fr/tel-00583087.
Texto completoCondamine, Ducreux Iris. "Réseaux de sociabilités des personnes utilisant des drogues par injection : expositions, vigilances et protections face aux risques". Electronic Thesis or Diss., Paris, EHESS, 2024. http://www.theses.fr/2024EHES0052.
Texto completoIn France, the prevalence of HIV has considerably decreased during the 2000s in people who inject drugs, however the prevalence of hepatitis C remains very high. Most cases of new hepatitis C infections are among people who inject drugs. Numerous studies have studied the impact of the sharing of injection equipment, but they have often focused on analyzing the determinants of sharing or the social processes involved in the sharing relationships. Only a few studies have taken into consideration the social and structural dimensions of the environment that may lead to at risk for these practices. The aim of this thesis project is to improve our knowledge, by studying the ways in which the injection equipment is shared, and the type of sociability as well as the social supports within this population. The project also looks into the interrelationships between these dimensions and how they impact the transmission of hepatitis C and HIV.The multidisciplinary RESEAU study was conducted out in Paris and Seine-Saint-Denis, France, between 2017 and 2018 in adults who inject drugs, in two drug-user risk reduction centers. This thesis uses a mixed-method approach. It combines a quantitative survey including descriptive analysis of part of the RESEAU survey data, multivariate analysis, and network analysis, with a qualitative survey including thematic analysis of qualitative interviews, analysis of qualitative comments from questionnaires and ethnographic observations. Scores measuring different sociabilities and risk situations were created to group the variables of interest. This type of method provides a complementary and nuanced approach to link sociabilities and at-risk practices. The network of sociabilities between drug-using partners was explored using Respondent-Driven Sampling, in which recruited individuals named their injection partners. In total, 149 people out of an overall network of 384 consumption partners responded to the questionnaire, including those named and 42 people were interviewed in a qualitative semi-directive interview. Within the overall network, two complex structures have been identified. These sub-networks differ in shape, size, composition, and practices. My results show that belonging to a network that is more concentrated in terms of link density increases the risk of engaging in at-risk practices; and more generally of finding oneself in at-risk situation. Sociabilities with people who inject drugs also increase these risks. Conversely, sociabilities with people who don't inject drugs reduce them. It is emphasized that these (measures of) sociabilities are neither correlated nor inversely correlated, revealing the independence of these two types of sociabilities. Each type of sociabilities does not prevent the existence of the other: they are not in competition. It is therefore necessary to give to each of them its own space for analysis, which is what I propose throughout this thesis.Despite these results and the difficulties encountered to maintain a relationship with one's consumption partners, some of these relationships represent a real support for vigilance against risk. I propose a typology of protective figures: the supervisor, the sterile equipment supplier, the gesture helper, the good practice referent, and the consumption limiter. This thesis reveals the complexity of the influence of the social networks of people who inject drugs on their practices
Jaouen-Jouvencel, Anne-Christine. "Variabilité du génome du virus de l'hépatite C dans la région HVR 1 du gène E2 : étude sur 22 patients co-infectés par le VHC et le VIH". Bordeaux 2, 2000. http://www.theses.fr/2000BOR23063.
Texto completoCapot, Rullier Anne. "L'hépatite chronique virale C chez les sujets co-infectés par le virus de l'immunodéficience humaine : histologie, étude de la fibrose, détection intrahépatique du virus de l'hépatite C et comparaison avec les sujets immunocompétents". Bordeaux 2, 2001. http://www.theses.fr/2001BOR23002.
Texto completoJoubert, Nicolas. "Synthèse et évaluation de nouveaux nucléosides ciblant l'hépatite C dans un système réplicon". Phd thesis, Université d'Orléans, 2006. http://tel.archives-ouvertes.fr/tel-00250329.
Texto completoYaya, Issifou. "Comportements de santé et styles de vie des patients coinfectés par le VIH et VHC : impact sur l'accès aux soins et l'évolution clinique de l'hépatite C". Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0750/document.
Texto completoObjectives: The main objectives of this thesis are: 1) analysis of the evolution of the epidemiological profile of co-infected HIV-HCV patients initiating the treatment of hepatitis C; 2) assessment of the impact of health behaviors and lifestyles on the clinical course of the diseaseResults: I was able to highlight that the profile of co-infected HIV-HCV patients initiating treatment for hepatitis C has changed in France with the evolution of treatments.My work has shown that, in HIV-HCV coinfected patients, high coffee consumption (3 cups per day or more) decreases the risk of advanced liver fibrosis. This beneficial effect of coffee is also observed in co-infected HIV-HCV patients with high alcohol consumption. In addition, my work has shown a dose-dependent relationship between the frequency of cocoa consumption and the reduced risk of advanced liver fibrosis in coinfected HIV-HCV patients. Furthermore, my analyzes did not reveal a significant effect of coffee consumption on the risk of advanced liver fibrosis in coinfected HIV-HCV women. Finally, one of the striking results of the relationship between HCV and known risk of obesity is that healing increases this risk in the long term.Conclusion: Interventions to modify certain lifestyles and behaviors have the potential to reduce the risk of developing or worsening comorbidities, particularly after HCV healing, an event now achievable for all co-infected patients
Héraud, Bousquet Vanina. "Traitement des données manquantes en épidémiologie : application de l’imputation multiple à des données de surveillance et d’enquêtes". Thesis, Paris 11, 2012. http://www.theses.fr/2012PA11T017/document.
Texto completoThe management of missing values is a common and widespread problem in epidemiology. The most common technique used restricts the data analysis to subjects with complete information on variables of interest, which can reducesubstantially statistical power and precision and may also result in biased estimates.This thesis investigates the application of multiple imputation methods to manage missing values in epidemiological studies and surveillance systems for infectious diseases. Study designs to which multiple imputation was applied were diverse: a risk analysis of HIV transmission through blood transfusion, a case-control study on risk factors for ampylobacter infection, and a capture-recapture study to estimate the number of new HIV diagnoses among children. We then performed multiple imputation analysis on data of a surveillance system for chronic hepatitis C (HCV) to assess risk factors of severe liver disease among HCV infected patients who reported drug use. Within this study on HCV, we proposedguidelines to apply a sensitivity analysis in order to test the multiple imputation underlying hypotheses. Finally, we describe how we elaborated and applied an ongoing multiple imputation process of the French national HIV surveillance database, evaluated and attempted to validate multiple imputation procedures.Based on these practical applications, we worked out a strategy to handle missing data in surveillance data base, including the thorough examination of the incomplete database, the building of the imputation model, and the procedure to validate imputation models and examine underlying multiple imputation hypotheses
Mohamed, Sofiane. "Recherche de mutations induisant des résistances aux antiviraux chez des patients atteints du virus de l'immunodéficience humaine de type 1, du virus de l'hépatite B et de l'hépatite C". Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5000/document.
Texto completoMolecular biology based assays are invaluable tools for the patients follow-up. They can help to establish the prognosis, guide for the treatment decisions and assess the virological response to therapy. Highly variable viruses like Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) which have a quasispecies distribution. Selection pressure on viral replicative environment such as an antiviral drug treatment, generally lead to a redistribution of the viral quasispecies with an increasing of the best adapted viral mutant. Our work allowed in this context to validate the clinical impact of majority but also minority mutations through the implementation of several sequencing techniques (pyrosequencing, high-throughput sequencing and allele-specific PCR). We also validated the use of a simple, reliable and routinely software solution by clinician for clinical interpretation of the mass of data generated by high-throughput sequencing. Finally, in the context of the diagnostic testing, we clinically validated in a cohort of patients infected with HBV, use the Dried Blood Spot technique as a supporting noninvasive diagnostic alternative sampling, especially for populations that have no access to conventional health structures and developing countries
Chaabna, Karima. "Spatio-temporal description of AIDS-related cancers incidence in north and sub-Saharan Africa and of mortality in HIV-infected patients in Algeria and hepatitis C prevalence in patients with non-Hodgkin lymphoma in Algeria". Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10105.
Texto completoHéraud, Bousquet Vanina. "Traitement des données manquantes en épidémiologie : Application de l'imputation multiple à des données de surveillance et d'enquêtes". Phd thesis, Université Paris Sud - Paris XI, 2012. http://tel.archives-ouvertes.fr/tel-00713926.
Texto completoTanguy, Gae͏̈lle. "Etude de la qualité de vie dans l'hépatite chronique virale C avant et pendant le traitement". Montpellier 1, 1998. http://www.theses.fr/1998MON11032.
Texto completoLoko, Marc-Arthur. "Epidémiologie clinique de la prise en charge des patients co-infectés par le VIH et le virus de l’hépatite C à partir des cohortes ANRS CO 03 Aquitaine et ANRS CO 13 HEPAVIH". Thesis, Bordeaux 2, 2009. http://www.theses.fr/2009BOR21693/document.
Texto completoChronic hepatitis C virus (HCV) infection is common in patients with human immunodeficiency virus (HIV). HIV-HCV Co-infection is associated with more severe and more rapid progression of HCV, leading to increased incidence of fibrosis, cirrhosis, and end-stage liver disease. Our work is devoted to the description of HIV-HCV co-infected patients (2006-2008). We also evaluated the prevalence and factors associated with liver steatosis in these patients. Lastly, we addressed the issue of the non-invasive assessment of liver fibrosis. The management of HIV-HCV co-infected patients should comprise a systematic screening of liver steatosis. The assessment of liver fibrosis using two non-invasive tests (eg Fibroscan-Apri, Fibroscan-Fibrotest) should be considered. In case of discordance between the results of these tests, a liver biopsy must be performed
Rémy, André-Jean. "Elaboration et validation d'un indicateur spécifique de qualité de vie dans l'hépatite chronique C : comparaison avec un indicateur général de qualité de vie". Montpellier 1, 1996. http://www.theses.fr/1996MON11038.
Texto completoPelletier, Pascale. "Porphyrie cutanée tardive et infection par les virus des hépatites B, C, G, et le virus VIH. Etude de 53 cas en Languedoc-Roussillon". Montpellier 1, 1999. http://www.theses.fr/1999MON11138.
Texto completoKabinda, Maotela Jeff. "Problématique du risque résiduel transfusionnel du VIH et des hépatites B et C en République Démocratique du Congo: un problème de santé publique". Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209042.
Texto completoLa transfusion sanguine est un acte médical, qui a pour but d’apporter au malade du sang ou ses dérivés. Elle est le résultat d’une chaîne d’activités complexes au cours de laquelle interviennent différentes catégories de personnel médical et paramédical, par conséquent elle ne peut pas être considérée comme un acte anodin. Elle reste entachée de beaucoup de risques, qui peuvent être, de type infectieux, immunologiques, hémodynamiques et métaboliques.
Afin de lutter contre ces risques, la sécurité transfusionnelle (l’ensemble des mesures visant à éliminer les risques immunologiques et infectieux liés à la transfusion des produits sanguins a été définie par l’OMS qui de surcroit en a précisé les 3 composantes principales qui sont: a) la disponibilité du sang. b) l’innocuité du sang. c) l’utilisation judicieuse de produits sanguins labiles.
Notre travail s’est focalisé sur l’un de ces aspects à savoir l’innocuité du sang. En effet, tandis que les pays du Nord sont à la recherche des virus émergents et commencent à déclarer que les risques viraux sont de plus en plus maîtrisés, l’Afrique se trouve encore dans la phase d’implantation de politiques et stratégies de sécurité transfusionnelle sous l’impulsion de l’OMS .L’incidence des risques viraux globalement supérieures à celle des pays du Nord est différente d’un pays à un autre.
Le risque résiduel (qui est un risque qui subsiste après la réponse au risque ou après l'application de mesures d'atténuation du risque) viral transfusionnel peut être attribué à quatre facteurs :a) l’erreur technique la plupart du temps humaine ;b) un variant viral non reconnu par certains réactifs ;c) un don infectieux séronégatif chez un porteur chronique ;d) ou un don réalisé chez un sujet très récemment infecté (« fenêtre silencieuse »).
Hypothèses :
Les hypothèses émises pour ce travail étaient :
- La connaissance, les attitudes et les pratiques de la population générale, des donneurs de sang et des prestataires de soins ne sont pas adéquates vis-à-vis de la sécurité transfusionnelle.
- La sécurité transfusionnelle en RDC n’est pas suffisante associée à un taux élevé des dons familiaux, une prévalence élevée des marqueurs viraux, le risque résiduel de virus de VIH, VHB et VHC devrait être considérable.
Objectif :
Contribuer à l’amélioration de la transfusion sanguine en RD Congo en apportant des informations évidentes et actualisées, susceptibles de contribuer à la réduction de la morbidité liée aux maladies transmissibles par le sang.
Méthodologie
Ce travail regroupe huit études. Une première étude retrace l’historique de l’implantation des services de transfusion sanguine et les différents résultats obtenus. Les 3 études suivantes évaluent la connaissance, l’attitude et la pratique des différents intervenants (la population générale, les donneurs de sang et les prestataires de soins) de la chaine de la transfusion sanguine. Deux études se focalisent sur la séroprévalence des hépatites et l’estimation du risque résiduel des hépatites B, C et du VIH. Les deux dernières études ont porté sur les séroprévalences des hépatites B, C et du VIH chez les receveurs (femmes enceintes et enfants de 6-59 mois).
La première étude fut une synthèse des données des rapports annuels du Centre National de Transfusion Sanguine avec comme objectif de jeter un regard sur l’organisation du système transfusionnel et ses réalisations.
La deuxième étude était une étude transversale menée d’une manière aléatoire auprès de 416 personnes âgées de 18 à 65 ans, résidant dans les trois zones de santé de la ville de Bukavu à l’Est de la RDC. Elle avait comme objectif l’évaluation des connaissances, attitudes et pratiques en matière de don de sang dans la population générale.
La troisième étude transversale descriptive et analytique a concerné 595 donneurs de sang de la ville de Bukavu. Son objectif était d’évaluer les connaissances, attitudes, pratiques et comportements chez les donneurs de sang du Sud-Kivu et identifier les facteurs de risque des marqueurs viraux.
La quatrième étude qui était transversale, a porté sur tout le personnel des soins :médecins, infirmiers, sage femmes, agents de formation rapide en activité dans les services hospitaliers du Sud-Kivu. Elle a eu comme objectif l’évaluation des connaissances, attitudes et pratiques des prestataires en matière de transfusion sanguine, d’infections VIH et d’hépatites B et C dans la province du Sud-Kivu.
La cinquième étude fut celle de suivi de cohorte des donneurs de sang bénévoles et non rémunérés. Son objectif était d’évaluer la séroprévalence des hépatites B et C chez les donneurs de sang bénévoles et non rémunérés.
La sixième étude a consisté aussi à l’étude de cohorte de donneurs de sang bénévoles à Bukavu. Son l’objectif était de déterminer les taux d’incidences du VIH, AgHBs et VHC chez les donneurs bénévoles du sang et estimer le risque résiduel du VIH, AgHBs et VHC chez les donneurs de sang de Bukavu.
La septième étude était une étude transversale sur les femmes enceintes de la communauté de Maniema (RD Congo). Elle avait comme objectif de déterminer la prévalence de VHB, VHC et VIH chez la femme enceinte et identifier les facteurs de risque.
Enfin la huitième étude était aussi une étude transversale sur les enfants de 6 à 59 mois de la communauté de Maniema (RD Congo). Elle avait comme objectif de déterminer la prévalence de VHB, du VHC et du VIH chez les enfants de 6 à 59 mois et en déterminer les facteurs de risque.
Résultats
Le système transfusionnel en République Démocratique du Congo est en phase d’implantation. En douze ans, c'est-à-dire de 2 001 à 2 012, il y a eu 112 882 donneurs bénévoles de sang mobilisés, plus de 80 % de produits sanguins sécurisés et plus de 80% des besoins couverts. Par ailleurs 89 688 infections du VIH ont pu être évitées par la qualification systématique des produits sanguins. Pendant la même période, 8 461 personnes ont pu être formées en transfusion sanguine. Mais il y a eu surtout une régression des marqueurs viraux. C’est ainsi que pour le VIH la prévalence est passée de 4,7% à 2,1 % entre 2 001 et 2 012 tandis que l’hépatite B a connu une régression de 7,1% à 3,5% pendant la même période. Pour l’hépatite C, ce taux est passé de 11,8% à 2,3% entre 2 004 et 2 012.
Dans la population générale la pratique de don de sang est très peu connue, nos travaux ont montré que :61% de la population ne connaissaient pas la pratique de don de sang. Certains aspects (risque infectieux viral) de la sécurité transfusionnelle ne sont pas très connus par le premier maillon de la chaine transfusionnelle (donneur de sang) et les prestataires de soins. En effet les résultats de nos études ont montré que 23,5% de donneurs de sang avaient un bon score de connaissance sur les aspects de la sécurité transfusionnelle et 11,7% prestataires avaient un bon score de la connaissance et de la pratique sur la sécurité transfusionnelle. Notre travail a montré que la prévalence des trois virus chez les donneurs de sang est importante :dans une série la séroprévalence était pour le VHB de 4,8%, pour le VHC de 3,9% et pour le VIH de 1,6%. Dans une autre série la prévalence était de 4,2% et 3,8% respectivement pour les hépatites B et C tandis que la coïnfection VHB et VHC a été évaluée à 2,2%.
L’estimation du risque résiduel a montré que le risque résiduel est très élevé dans notre pays. Ce risque résiduel est de 1/1 515 dons pour le VIH soit 6 dons de sang sur 10 000 seraient séropositifs alors qu’ils étaient testés négatifs. Pour les hépatites B et C, le risque résiduel était de 1/329 pour le VHC et de 1/126 dons pour l’hépatite B. Pour 1 000 dons de sang testés au virus de l’hépatite B, 8 seraient séropositifs alors qu’ils avaient été déclarés négatifs au test. Pour le virus de l’hépatite C, ce sont 3 personnes pour 1 000 dons de sang.
Au niveau des principaux receveurs :la séroprévalence du VIH chez les femmes enceintes était de 4,1 %, mais elle était plus importante, 15,6%,chez les femmes enceintes qui avaient un antécédent de transfusion sanguine (OR =4,9 et p=0,02).La prévalence du VHB était de 5,9 % mais plus élevée chez la femme enceinte avec antécédent de transfusion (12,5%) et de tatouage (24,2%) et la prévalence du VHC était de 4,1% et plus élevée chez la femme avec antécédent de transfusion sanguine (12,5%).
Chez les enfants les résultats étaient les suivants :la prévalence du VHB observée dans notre étude était de 3,6%, mais cette prévalence était de 6,6% chez les enfants avec un antécédent de transfusion sanguine. Elle était de 5,7% chez les enfants dont la mère avait eu une transfusion sanguine lors de la grossesse. La prévalence du VHC était de 2,8%. Elle était plus élevée chez les enfants qui avaient un antécédent de transfusion (7,6%) et dont la mère avait un antécédent de transfusion sanguine (11,1%). La séroprévalence du VIH était de 3,7%. Une prévalence plus élevée du VIH était observée chez les enfants avec une histoire personnelle de transfusion sanguine (11,4%) et une histoire maternelle de transfusion (9,8%).
Conclusion
Les résultats de ce travail montrent que la sécurité transfusionnelle est précaire. Cette précarité se situe à plusieurs niveaux :au niveau des services ayant la transfusion en charge par suite d’insuffisance dans l’organisation et dans le financement. Ensuite au niveau des acteurs c.-à-d. la population générale et les institutions sanitaires, par l’insuffisance des notions de base de la sécurité transfusionnelle et de prévention des maladies virales transmissibles par le sang.
Les résultats de ce travail montrent que la séroprévalence des marqueurs du VIH, des hépatites B et C est importante et leur risque résiduel est considérable.
Il est utile de procéder au renforcement des capacités de tous les acteurs de la chaine transfusionnelle en appliquant certaines stratégies innovantes proposées dans ce travail (utilisation des sociologues, anthropologues dans les séances de sensibilisation de la population…), l’éducation de la population, des techniques éfficaces de dépistage afin d’espérer réduire le risque infectieux lié à la transfusion sanguine.
Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished
Tigrett, Sylvia. "Détection sensible du virus de l’hépatite C et étude protéomique de la sclérose en plaques via un enrichissement innovant et sélectif de biomarqueurs". Electronic Thesis or Diss., Montpellier, 2016. http://www.theses.fr/2016MONT3501.
Texto completoThe fight against pathologies, especially inflammatory or chronic ones, needs new strategies to propose an improved and personalized medicine. The search for biomarkers deals with this challenge. A novel screening system based on an activated scavenger molecule is described here. Due to its implication in the elimination of non-self and altered-self, this activated scavenger has the ability to interact with biomolecules that cause pathologies or that result from the pathological imbalance. It is therefore very probable that the ligands of this scavenger count a high proportion of biomarkers. This functional screening may then help understand the physiopathology and might even identify potential diagnostic companions or drug candidates. This approach is applied to Hepatitis C, a condition of known viral etiology, and to multiple sclerosis, a more complex neuropathology
Tigrett, Sylvia. "Détection sensible du virus de l’hépatite C et étude protéomique de la sclérose en plaques via un enrichissement innovant et sélectif de biomarqueurs". Thesis, Montpellier, 2016. http://www.theses.fr/2016MONT3501.
Texto completoThe fight against pathologies, especially inflammatory or chronic ones, needs new strategies to propose an improved and personalized medicine. The search for biomarkers deals with this challenge. A novel screening system based on an activated scavenger molecule is described here. Due to its implication in the elimination of non-self and altered-self, this activated scavenger has the ability to interact with biomolecules that cause pathologies or that result from the pathological imbalance. It is therefore very probable that the ligands of this scavenger count a high proportion of biomarkers. This functional screening may then help understand the physiopathology and might even identify potential diagnostic companions or drug candidates. This approach is applied to Hepatitis C, a condition of known viral etiology, and to multiple sclerosis, a more complex neuropathology
Coléon, Séverin. "Réponse antivirale des cellules dendritiques plasmacytoides contre des cellules infectées via la formation d'une synapse interferogénique". Thesis, Lyon, 2019. http://www.theses.fr/2019LYSEN071.
Texto completoType I interferon (IFN-I) is critical for antiviral defense, and plasmacytoid dendritic cells (pDCs) are a predominant source of IFN-I during virus infection. pDC-mediated antiviral responses are stimulated upon physical contact with infected cells, during which immunostimulatory viral RNA is transferred to pDCs, leading to IFN production via the nucleic acid sensor TLR7. Using dengue (DENV), hepatitis C (HCV), and zika (ZIKV) viruses, we demonstrate that the contact site of pDCs with infected cells is a specialized platform we term the interferogenic synapse, which enables viral RNA transfer and antiviral responses
Ulveling, Damien. "Analyse génomique de la coinfection par le virus VIH et VHC". Thesis, Paris, CNAM, 2016. http://www.theses.fr/2016CNAM1066/document.
Texto completoOver 170 million people worldwide are infected by HCV and 37 million by HIV. Both viruses share the same modes of transmission, and HIV/HCV coinfection is common and represents a key element in the management of patients infected with HIV. Since the appearance of HAART, liver diseases have become the leading cause of death in HIV/HCV coinfected patients. The natural history and prognosis of hepatitis C are more severe in case of coinfection with HIV due to accelerated rate of fibrosis progression and rapid progression to cirrhosis and its complications. Factors accelerating liver fibrosis are known today such as the lack of recourse to anti-HCV treatment, active HCV replication and excessive alcohol consumption. There is increasing evidence that genetic variants contribute to liver fibrosis in HCV monoinfection, but this aspect has been little studied in HIV/HCV coinfection.I have exploited the genotype information from 494 coinfected patients from the cohort ANRS CO13 HEPAVIH. These patients are very-well documented regarding the history of their HIV/HCV infection and are very carefully followed-up, especially regarding the status of liver fibrosis. I have performed two genome-wide association studies to identify polymorphisms associated with the severity of fibrosis from complete data of 292 patients. The first study has dealt with the quantification of liver stiffness by Fibroscan® and an association with the 3p25 region has been identified, also replicated in monoinfection HCV. Two genes involved in cell signaling and structure of holding mechanisms (CAV3) but also in HCV replication (RAD18) appear as good candidates. The second study has unraveled two significant associations by comparing the METAVIR score group (F0F1F2 vs F3F4), especially in the CTNND2 gene implicated in a network of interactions with molecular mechanisms involved in liver diseases.These results are under publications in peer-review international scientific journals. These new insights into the molecular mechanisms of liver fibrosis in patients with HIV/HCV co- infection may help to define new targets for drug development or new diagnostic tests, to improve patient care
Jeanmougin, Marc. "Imputation HLA et analyse génomique de la coinfection VIH/VHC". Thesis, Paris, CNAM, 2017. http://www.theses.fr/2017CNAM1164/document.
Texto completoAssociation genomics aims at finding links between the genome and some traits or illnesses. Today, the most frequent studies in this field are genome wide association studies (GWAS), which analyze as many genome variants (mainly Single Nucleotide Polymorphisms) as possible, without any a priori on their biological function. However, genotyping methods used in these studies may be insufficient to get reliable information in higly variable regions such as the HLA which plays a crucial role in immunity, and the genetic variants of such regions are often predicted using bioinformatics approaches. During my PhD, I have created a new tool, HLA-Check, that allows to rate the plausibility of HLA alleles from the genotypes obtained from genotyping chips. I also assesses its performances and showed that it was able to point out individuals with a wrong HLA typing, in order to retype them or remove them from the study. An article documenting this tool was published in BMC Bioinformatics. I have also performed a genome-wide association study on cirrhosis outbreak in individuals coinfected with HIV (human immunodeficiency virus) and HCV (hepatitis C virus). Because of similar infection routes (blood-related), co-infection with those two viruses are frequent, and the infection by HIV enhances HCV activity and increases liver fibrosis leading to cirrhosis and death of co-infected patients. Our study has dealt with 306 co-infected patients from the ANRS CO-13 HEPAVIH cohort. I could point out three statistically significant signals, two of them being highly relevant for their involvement in liver diseases (gene CTNND2 and gene MIR7-3HG). The identification of these new variants should lead to a better understanding of the molecular mechanisms involved in cirrhosis, and should contribute to the rational developement of new diagnostic or therapeutic strategies. A publication is under way
Roux, Perrine. "Observance thérapeutique des patients multitraités : le cas de la toxicomanie". Thesis, Aix-Marseille 2, 2010. http://www.theses.fr/2010AIX20651/document.
Texto completoThe epidemic of Human Immunodeficiency Virus (HIV) has profoundly changed the relationship between medicine and humans and vice versa. On the one hand, the intense stigmatization associated with HIV infection has made the disease more complex than for any other pathology. On the other hand, the chronicization of infection has forced care providers to investigate in greater detail the intimate relationship between patient and treatment, and more particularly, the therapeutic adherence. My research work aimed to investigate this latter argument in greater detail, favoring a less paternalistic approach toward therapeutic adherence in HIV-infected patients and applying this approach to multi-treated populations with comorbidities such as drug dependence and hepatitis C. Through several articles, we tried to put in evidence that a model of care that includes patient’s perception about care may lead to better understand non-adherence to treatment (ongoing drug use, drug injection or treatment diversion). In fact, injection cessation or reduction of opioid consumption in dependent individuals is a non-linear process which could take a long time, and which is often punctuated with relapse. Our findings showed the positive impact of access to adequate care to treat not only the disease but also the harm related to non adherence to treatment. The idea is to promote a more deliberative relationship between physician and patient, including a harm reduction approach