15 octobre 2020 Articles scientifiques

Source : The Lancet Published online October 5, 2020 Auteur : RECOVERY Collaborative Group

ANALYSE

Commentateur

Dr Martine Tebacher

Résumé L’association lopinavir-ritonavir a été proposée comme traitement contre la COVID-19 sur la base de résultats in vitro, de données précliniques et d’études observationnelles. Pourtant un essai randomisé montre qu’elle n’apporte pas de bénéfice chez les patients hospitalisés pour une forme sévère de COVID-19. L’essai a été mené dans 176 hôpitaux du Royaume-Uni et l’association a été comparée au traitement standard. Les patients volontaires inclus dans le groupe « lopinavir-ritonavir » recevaient ces deux médicaments aux doses respectives de 400 mg et 100 mg par voie orale pendant 10 jours ou jusqu’à la sortie de l’hôpital. Cet essai faisait partie du programme RECOVERY incluant d’autres groupes pour évaluer l’hydroxychloroquine, la dexamethasone, ou l’azithromycine. Au total, 1616 patients ont reçu association lopinavir–ritonavir et 3424 les soins standards. Parmi eux, respectivement 23% et 22% des patients sont décédés dans les 28 jours (RR 1.03, 95% CI 0.91–1.17; p=0.60) sans différence entre les sous-groupes de patients. Conclusion Les auteurs n’ont pas non plus observé de différence sur la durée d’hospitalisation qui a été de 11 jours en médiane dans les deux groupes (5-28). Et chez les personnes n’étant pas sous ventilation artificielle au moment de l’inclusion, il n’y a pas eu non plus de différence significative sur le risque de passer en ventilation artificielle ou le risque de décès (RR 1.09, 95% CI 0.99–1.20; p=0.092).

BACKGROUND

Lopinavir–ritonavir has been proposed as a treatment for COVID-19 on the basis of in vitro activity, preclinical studies, and observational studies. Here, we report the results of a randomised trial to assess whether lopinavir–ritonavir improves outcomes in patients admitted to hospital with COVID-19.

13 octobre 2020 Articles scientifiques

Source : The Lancet Published online October 12, 2020

Auteur : Richard L Tillett, Joel R Sevinsky, Paul D Hartley, Heather Kerwin, Natalie Crawford, Andrew Gorzalski, Chris Laverdure, Subhash C Verma, Cyprian C Rossetto, David Jackson, Megan J Farrell, Stephanie Van Hooser, Mark Pandori


BACKGROUND

The degree of protective immunity conferred by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently unknown. As such, the possibility of reinfection with SARS-CoV-2 is not well understood. We describe an investigation of two instances of SARS-CoV-2 infection in the same individual.

INTRODUCTION

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a detectable immune response, but the susceptibility of previously infected individuals to reinfection with SARS-CoV-2 is not well understood. SARS-CoV-2 infection results in generation of neutralising antibodies in patients.1 However, the degree to which this immune response indicates a protective immunity to subsequent infection with SARS-CoV-2 has not yet been elucidated. In studies of immunity to other coronaviruses,2–9 loss of immunity can occur within 1–3 years. Cases of primary illness due to infection followed by a discrete secondary infection or illness with the same biological agent can best be ascertained as distinct infection events by genetic analysis of the agents associated with each illness event. Reports of secondary infection events with SARS-CoV-2 have been published from Hong Kong,10 the Netherlands and Belgium,11 and Ecuador.12 We present a case report of an individual who had two distinct COVID-19 illnesses from genetically distinct SARS-CoV-2 agents.


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12 octobre 2020 Articles scientifiques

Source : J Acquir Immune Defic Syndr  Volume 85, Number 2, October 1, 2020

Auteur : Smitha Gudipati, Indira Brar, Shannon Murray, John E. McKinnon, Nicholas Yared, and Norman Markowitz


BACKGROUND

COVID-19 disease has spread globally and was declared a pandemic on March 11, 2020, by the World Health Organization. On March 10, the State of Michigan confirmed its first 2 cases of COVID-19, and the number of confirmed cases has reached 47,182 as of May 11, 2020, with 4555 deaths.

INTRODUCTION

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus first detected in December 2019 in Wuhan, Hubei Province, China.1 Many of the initial cases had a common exposure to the Huanan Wholesale Seafood Market that also traded live animals.2 SARS-CoV-2 was then identified on January 7, 2020, by the Chinese Center for Disease Control and Prevention, which then disclosed the genomic sequence on January 11, 2020.3 The World Health Organization named the infection caused by SARS-CoV-2, COVID-19. Since the initial detection of COVID-19, the disease has spread globally and was declared a pandemic on March 11, 2020, by the World Health Organization.4 In the United States, Detroit, Michigan, had become a “hotspot” of COVID-19 infected patients with the number of confirmed cases reaching 47,182 as of May 8, 2020, with 4555 deaths in Michigan (fourth most deaths in the United States).5 Currently, little is known if patients living with HIV (PLWH) are at a higher risk of severe COVID-19 or if antiretroviral medications used to treat HIV are protective against severe COVID-19. Tenofovir has been shown in vitro to tightly bind to the SARS-CoV-2 RNA-dependent RNA polymerase.6 Alternatively, lopinavir–ritonavir has already been shown to have no benefit beyond standard care in a large randomized control trial.7,8 In addition, little is known if and how frequently PLWH mount the intense cytokine response leading to cytokine storm and severe COVID-19. We describe our single-center experience in Detroit, Michigan, of COVID19 in patients infected with HIV-1. We reviewed patients’ demographics, clinical characteristics of both their HIV and COVID-19 coinfections, the antiviral and antiretroviral treatments they received, and their clinical outcomes.


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12 octobre 2020 Articles scientifiques

Source : AIDSNovember 01, 2020 – Volume 34

Auteur : Yousaf B. Hadi , Syeda F.Z. Naqvi , Justin T. Kupec and Arif R. Sarwari


OBJECTIVE

We studied clinical outcomes of COVID-19 infection in patients living with HIV (PLH) in comparison to non-HIV population.

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) related disease (COVID-19) has emerged as the major health crisis of 2020 [1]. Its impact on patients with preexisting infection with HIV has hitherto not been studied extensively. Recently, the Centers for Disease Control and Prevention (CDC) highlighted that patients living with HIV may be at a heightened risk of severe illness from SARS-CoV-2 as compared to the general population [2]. This postulated increased risk was attributed to both biological immune compromise and comorbidities as well as socially produced burdens. However, others have suggested that the use of antivirals in this population may confer relative protection from the virus [3]. Considering the large global burden of patients living with HIV, data on COVID-19 infection in these patients are scarce and are limited to case reports and small case series, which do not allow for comparison of outcomes with non-HIV populations [4,5]. We aimed to utilize a multicentre research network to study outcomes in patients with COVID-19 with preexisting HIV infection in comparison to those without HIV coinfection.


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Source : BMJ GH Auteur : Wim Van Damme and al.

ANALYSE

Commentateur

Dr Moitry Marie

Objectifs et Résultats

Un article qui tente de comprendre pourquoi les trajectoires de l’épidémie varient visiblement d’un contexte (pays) à l’autre
  • Il liste les différents facteurs qui pourraient expliquer ces disparités, à la fois liés aux caractéristiques du virus (infectiosité, potentiel mutagène, capacité à survivre en dehors de l’autre…), à l’hôte (susceptibilité au virus, voies de transmission, immunité post infectieuse…), à l’environnement physique (conditions climatiques et atmosphériques…).
  • Il évoque également les effets de l’environnement humain (démographie, conditions socio-économiques conditions d’hygiène, mobilité…), et des comportements : compliance aux mesures collectives (confinement) et individuelles (hygiène des mains, port du masque…).
  • Il rappelle que les effets propres de ces différents facteurs sont difficiles (voire impossible…) à quantifier, au moins pour le moment
  • Enfin, il fait également le point sur les connaissances actuelles sur l’épidémie et ses trajectoires potentielles.

Points intéressants 

  • il rappelle que des pandémies liées à des virus émergeants restent exceptionnelles…. Un effet (entre autres) de la circulation visiblement “continue” du virus quel que soit le contexte ? (Comme le HIV ?)


31 juillet 2020 Articles scientifiques

Source : Daniel P. Oran, AM, and Eric J. Topol, MD Auteur : Annals of Internal Medicine , 2020 American College of Physicians

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout the world since the first cases of coronavirus disease 2019 (COVID-19) were observed in December 2019 in Wuhan, China. It has been suspected that infected persons who remain asymptomatic play a significant role in the ongoing pandemic, but their relative number and effect have been uncertain. The authors sought to review and synthesize the available evidence on asymptomatic SARS-CoV-2 infection. Asymptomatic persons seem to account for approximately 40% to 45% of SARS-CoV-2 infections, and they can transmit the virus to others for an extended period, perhaps longer than 14 days. Asymptomatic infection may be associated with subclinical lung abnormalities, as detected by computed tomography. Because of the high risk for silent spread by asymptomatic persons, it is imperative that testing programs include those without symptoms. To supplement conventional diagnostic testing, which is constrained by capacity, cost, and its one-off nature, innovative tactics for public health surveillance, such as crowdsourcing digital wearable data and monitoring sewage sludge, might be helpful.  

31 juillet 2020 Articles scientifiques

Source : BMJ 2020;370:m2993 | doi: 10.1136/bmj.m2993 Auteur : Owen Dyer

Most US states are missing key indicators in the data they publish about the course of the covid-19 pandemic, says a report presented by Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC). The report by Resolve to Save Lives, a New York based non-profit group led by Frieden, examined the covid-19 “dashboards” of all 50 states and the District of Columbia.1 Indicators critical to understanding the pandemic’s course were often missing, it found. Not a single state currently reports the average turnaround time of a polymerase chain reaction (PCR) test, as press reports abound of tests in many regions taking a week or more to come back, a delay that renders testing nearly useless in controlling the disease’s spread. The test positivity rate goes unreported by 25% of states. Resolve to Save Lives, which is part of the global health organisation Vital Strategies, listed 15 indicators that are routinely used in other countries’ reporting and examined the performance of each US state on each indicator. These indicators include syndromic reporting of influenza-like illness, reported by 10 states, and covid-like illness, reported by 18 states. These two are considered leading indicators, allowing a faster response than the trailing indicators of hospital admissions and deaths.

30 juillet 2020 Articles scientifiques

Source : BMJ Global Health 2020 Auteur : Van Damme W, et al.

ABSTRACT

It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability—by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.


Source : Medrxiv (PRE-PRINT)

Auteur : Takahashi and al.


ABSTRACT

Vous A growing body of evidence indicates sex differences in the clinical outcomes of coronavirus disease 2019 (COVID-19)1-4. However, whether immune responses against SARS-CoV-2 differ between sexes, and whether such differences explain male susceptibility to COVID-19, is currently unknown. In this study, we examined sex differences in viral loads, SARS-CoV-2-specific antibody titers, plasma cytokines, as well as blood cell phenotyping in COVID-19 patients. By focusing our analysis on patients with mild to moderate disease who had not received immunomodulatory medications, our results revealed that male patients had higher plasma levels of innate immune cytokines and chemokines including IL-8, IL-18, and CCL5, along with more robust induction of non-classical monocytes. In contrast, female patients mounted significantly more robust T cell activation than male patients during SARS-CoV-2 infection, which was sustained in old age. Importantly, we found that a poor T cell response negatively correlated with patients age and was predictive of worse disease outcome in male patients, but not in female patients. Conversely, higher innate immune cytokines in female patients associated with worse disease progression, but not in male patients. These findings reveal a possible explanation underlying observed sex biases in COVID-19, and provide important basis for the development of sex-based approach to the treatment and care of men and women with COVID-19.

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