HCV cure: an appropriate moment to reduce cannabis use in people living with HIV? (ANRS CO13 HEPAVIH data)
grid.464064.40000 0004 0467 0503Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 35 boulevard Jean Moulin, 13005 Marseille, France
grid.412041.20000 0001 2106 639XCentre Hospitalier Universitaire (CHU) de Bordeaux, Pôle Médecine Interne, Service de Médecine Interne et Immunologie Clinique, Bordeaux Population Health Research Center UMR 1219, CIC-EC 1401, Université de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
Centre Hospitalier de Bourg-en-Bresse, Service d’Infectiologie, 900 Rte de Paris, 01012 Bourg-en-Bresse, France
grid.414106.60000 0000 8642 9959Réseau Ville-Hôpital, Service de Médecine Interne, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
grid.490638.00000000115336859Centre Hospitalier de Perpignan, Service des Maladies Infectieuses et Tropicales, 20 Av. du Languedoc, 66000 Perpignan, France
grid.412041.20000 0001 2106 639XISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, Université de Bordeaux, 146 Rue Léo Saignat 11, Bordeaux, France
grid.508487.60000 0004 7885 7602Université Paris Descartes, 12 Rue de l’École de Médecine, 75006 Paris, France
grid.428999.70000 0001 2353 6535INSERM U1223, Institut Pasteur, 25 rue du Docteur Roux, 75015 Paris, France
grid.411784.f0000 0001 0274 3893Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
grid.411784.f0000 0001 0274 3893Service Maladies Infectieuses et Tropicales, AP-HP, Hôpital Cochin, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
Abstract
Background
Thanks to direct-acting antivirals, hepatitis C virus (HCV) infection can be cured, with similar rates in HCV-infected and HIV–HCV co-infected patients. HCV cure is likely to foster behavioral changes in psychoactive substance use, which is highly prevalent in people living with HIV (PLWH). Cannabis is one substance that is very commonly used by PLWH, sometimes for therapeutic purposes. We aimed to identify correlates of cannabis use reduction following HCV cure in HIV–HCV co-infected cannabis users and to characterize persons who reduced their use.
Methods
We used data collected on HCV-cured cannabis users in a cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort of HIV–HCV co-infected patients, to perform logistic regression, with post-HCV cure cannabis reduction as the outcome, and socio-behavioral characteristics as potential correlates. We also characterized the study sample by comparing post-cure substance use behaviors between those who reduced their cannabis use and those who did not.
Results
Among 140 HIV-infected cannabis users, 50 and 5 had reduced and increased their use, respectively, while 85 had not changed their use since HCV cure. Cannabis use reduction was significantly associated with tobacco use reduction, a decrease in fatigue level, paying more attention to one’s dietary habits since HCV cure, and pre-HCV cure alcohol abstinence (p = 0.063 for alcohol use reduction).
Conclusions
Among PLWH using cannabis, post-HCV cure cannabis reduction was associated with tobacco use reduction, improved well-being, and adoption of healthy behaviors. The management of addictive behaviors should therefore be encouraged during HCV treatment.
Introduction
In Western countries, AIDS is no longer the principal cause of death in people living with HIV (PLWH) [1–3]. Accordingly, HIV infection can be considered a chronic disease [4] associated with multiple comorbidities in aging people. In contrast, recent medical advances in hepatitis C virus (HCV) infection, specifically direct acting antivirals (DAA), provide a quick cure [5], and represent an important turning point in HIV–HCV co-infected people’s lives. This clinical change impacts quality of life [6–10] and foster behavioral changes [10, 11]. As psychoactive substance use is highly prevalent in HIV–HCV co-infected patients [12–15], we may expect HCV cure to impact substance use behavior. The benefits of cannabis and cannabinoid use for HIV infection management and less severe treatment side-effects, are widely recognized [16, 17], and PLWH frequently report their therapeutic use [18–22]. However, cannabis use may also promote pulmonary disease [23] and cognitive impairments in PLWH [24]. As cannabis use [14, 15, 21] and cannabis dependence [25] are frequent in HIV–HCV co-infected patients, it is important to explore changes in use after HCV cure. Using data from a cross-sectional survey embedded in the ANRS CO13 HEPAVIH cohort, we aimed to identify correlates of cannabis use reduction following HCV cure in HIV–HCV co-infected cannabis users, and to characterize persons who reduced their use.
Material and methods
Study design and data collection
ANRS CO13 HEPAVIH is an ongoing French national multicenter prospective cohort of HIV–HCV co-infected patients. Initiated in 2005, it investigates clinical and socio-behavioral issues surrounding HIV–HCV coinfection [26]. A total of 1859 patients followed in 29 hospital wards throughout metropolitan France were included in the cohort between October 2005 and March 2016, in three consecutive phases. Designed and implemented in accordance with the Declaration of Helsinki, the cohort and nested surveys were approved by the ethics committee of Cochin University Hospital in Paris. Patients provided written informed consent to participate.
A cross-sectional survey nested in the ANRS CO13 HEPAVIH cohort was conducted between February 2018 and May 2019 to document patient-reported outcomes, with a focus on perceived changes after HCV cure. All patients enrolled in the cohort and still followed-up in participating clinical centers at the time of the survey were offered to participate. A self-administered questionnaire (SAQ) collected data. The cohort is observational, therefore counselling and advice potentially received by participants depended solely on their physician.
The SAQ included questions related to sociodemographic characteristics, HCV transmission mode, recent substance use, cannabis dependence using the Cannabis Abuse Screening Test (CAST) [27], and reason for using cannabis (therapeutic motive or not). Other questions asked about changes since HCV cure in patients’ use of psychoactive substances (tobacco, cannabis, alcohol, other substances), physical activity, attention paid to dietary habits, and body weight gain. For questions documenting changes in substance use after HCV cure, respondents had to choose one answer among the following four: “No, nothing has changed”, “Yes, my use has decreased”, “Yes, my use has increased”, “Not concerned (no use)”.
Study population
The population of the present study included HCV-cured cannabis users who participated in the cross-sectional survey and answered the SAQ item documenting perceived changes in cannabis use after cure. Patients who answered that they were not concerned by cannabis use were excluded from analyses.
Statistical analysis
First, descriptive statistics were used to present the study population’s main characteristics. Comparisons were performed between patients who reported a reduction in cannabis use after HCV cure and those who did not (Chi-square test for categorical variables, Wilcoxon rank-sum test for continuous variables). Logistic regression models were then run to identify correlates of decreased cannabis use following HCV cure (study outcome). Socio-demographic variables and behavioral changes since HCV cure were tested as potential correlates. Only variables with a liberal p-value < 0.20 in the univariable analyses were considered eligible for the multivariable model. The final multivariable model was built using a backward stepwise procedure. The likelihood ratio test (p < 0.05) was used to define the variables to maintain in the final model.
Second, characteristics of substance use after HCV cure were compared between patients who reduced their cannabis use and those who did not using Chi-square tests. All statistical analyses were performed using SAS software version 9.4 for Windows (SAS, Cary, NC, USA).
Results
Among the 448 survey participants, of the 421 HCV cured, two had no data on post-HCV cure changes in cannabis use. A total of 279 out of 419 patients reported no cannabis use (“Not concerned” answer) and were excluded from the analysis. The study population therefore comprised 140 individuals. Among them, 50 (35.7%) reported to have reduced their cannabis use after HCV cure, five had increased it, and 85 reported no change. The study sample mainly comprised men (74.3%), and median age was 55.7 years (Table 1). Six participants declared they quit cannabis.Variable Total
n (%)Cannabis use reducers n (%) Cannabis use non-reducers
n (%)p-value1 Univariable analyses Multivariable analysis OR 95% CI p-value aOR 95% CI p-value Gender 0.730 Male 104 (74.3) 38 (76.0) 66 (73.3) 1.15 0.52–2.56 0.730 Female 36 (25.7) 12 (24.0) 24 (26.7) 1 Age (median, [IQR]) (years) 55.7 [53.0–58.5] 56.1 [53.2–58.6] 55.4 [52.9–58.5] 0.995 1.00 0.93–1.07 0.984 HCV transmission mode 0.123 0.130 Drug injection 91 (65.0) 38 (76.0) 53 (58.9) 1 Sexual transmission 23 (16.4) 6 (12.0) 17 (18.9) 0.49 0.18–1.37 0.173 Other 26 (18.6) 6 (12.0) 20 (22.2) 0.42 0.15–1.14 0.089 Change in tobacco use2 < 0.001 < 0.001 0.014 No use 9 (6.4) 4 (8.0) 5 (5.6) 4.58 1.06–19.78 0.041 3.84 0.67–22.09 0.131 Reduction 57 (40.7) 35 (70.0) 22 (24.4) 9.11 3.96–20.96 < 0.001 4.32 1.58–11.78 0.004 No reduction 74 (52.9) 11 (22.0) 63 (70.0) 1 1 Change in alcohol use2 < 0.001 < 0.001 0.003 No use 39 (27.9) 22 (44.0) 17 (18.9) 9.54 3.61–25.24 < 0.001 7.71 2.39–24.87 < 0.001 Reduction 34 (24.3) 20 (40.0) 14 (15.6) 10.54 3.85–28.81 < 0.001 3.32 0.94–11.72 0.063 No reduction 67 (47.9) 8 (16.0) 59 (65.6) 1 1 Change in other substance use2 0.004 0.018 No use 108 (77.1) 35 (70.0) 73 (81.1) 1.20 0.43–3.35 0.730 Reduction 11 (7.9) 9 (18.0) 2 (2.2) 11.25 1.86–68.13 0.008 No reduction 21 (15.0) 6 (12.0) 15 (16.7) 1 Changes in physical activity2 0.238 0.244 Stable 85 (60.7) 26 (52.0) 59 (65.6) 1 Increase 39 (27.9) 16 (32.0) 23 (25.6) 1.58 0.72–3.47 0.256 Reduction 16 (11.4) 8 (16.0) 8 (8.9) 2.27 0.77–6.70 0.138 Changes in fatigue level2 0.021 0.023 0.073 Stable 63 (45.0) 15 (30.0) 48 (53.3) 1 1 Reduction 63 (45.0) 30 (60.0) 33 (36.7) 2.91 1.36–6.23 0.006 3.12 1.15–8.46 0.025 Increase 14 (10.0) 5 (10.0) 9 (10.0) 1.78 0.52–6.13 0.362 2.95 0.61–14.15 0.177 Changes in dietary habits2 < 0.001 < 0.001 0.045 Stable 92 (65.7) 21 (42.0) 71 (78.9) 1 1 Paying more attention 40 (28.6) 25 (50.0) 15 (16.7) 5.64 2.52–12.59 < 0.001 3.33 1.22–9.14 0.019 Paying less attention 8 (5.7) 4 (8.0) 4 (4.4) 3.38 0.78–14.69 0.104 3.01 0.48–18.79 0.237 Change in body weight 2 0.073 0.078 No change or reduction 84 (60.0) 24 (48.0) 60 (66.7) 1 Increase < 5 kg 33 (23.6) 14 (28.0) 19 (21.1) 1.84 0.80–4.25 0.153 Increase ≥ 5 kg 23 (16.4) 12 (24.0) 11 (12.2) 2.73 1.06–7.02 0.038
Post-HCV cure decrease in cannabis use was associated with tobacco use reduction, pre-HCV cure alcohol use abstinence (p = 0.063 for alcohol use reduction), a decrease in fatigue level and paying more attention to one’s dietary habits (Table 1).
After HCV cure, regular or daily cannabis use was reported by most patients (54.8%), recreational use being predominant (59.5% of patients). No patient was at high risk of cannabis dependence (Table 2).Variable Total Reduction in cannabis use after HCV cure Yes No p-value1 Reason for using cannabis (n = 126) 0.324 Therapeutic 51 (40.5) 16 (34.8) 35 (43.8) Recreational only 75 (59.5) 30 (65.2) 45 (56.3) Recent substance injection2 0.454 No 139 (99.3) 50 (100.0) 89 (98.9) Yes 1 (0.7) 0 (0.0) 1 (1.1) Cannabis dependence (n = 129)3 0.904 No risk 64 (49.6) 22 (48.9) 42 (50.0) Low risk 65 (50.4) 23 (51.1) 42 (50.0) High risk 0 (0.0) 0 (0.0) 0 (0.0) Opioid substitution therapy (n = 133) 0.462 No 107 (80.5) 37 (77.1) 70 (82.4) Current therapy 26 (19.6) 11 (22.9) 15 (17.7) Cannabis use frequency (n = 126) < 0.001 Never 6 (4.8) 6 (13.0) 0 (0.0) Sometimes 51 (40.5) 29 (63.0) 22 (27.5) Regularly or daily 69 (54.8) 11 (23.9) 58 (72.5) Other substance use4 0.041 No 127 (90.7) 42 (84.0) 85 (94.4) One or more 13 (9.3) 8 (16.0) 5 (5.6) AUDIT-C score 2.5 [0–5] 2 [0–4] 3 [0–5] 0.245 Alcohol use5 0.068 Not at risk 78 (55.7) 33 (66.0) 45 (50.0) At risk 62 (44.3) 17 (34.0) 45 (50.0) Tobacco use (n = 138) 0.001 No current use 19 (13.8) 11 (22.9) 8 (8.9) 1 to 5 cig/d 32 (23.2) 17 (35.4) 15 (16.7) 6 to 10 cig/d 41 (29.7) 12 (25.0) 29 (32.2) More than 10 cig/d 46 (33.3) 8 (16.7) 38 (42.2)
Those who reduced their cannabis consumption were more likely to use the drug less frequently, to have recently used other psychoactive substances (excluding alcohol and tobacco) and to smoke fewer tobacco cigarettes after HCV cure (p = 0.068 for alcohol use) (Table 2).
Discussion
In this study, approximately one third of PLWH reduced their cannabis use after being cured of HCV. This reduction was associated with a reduction in tobacco use, pre-HCV cure alcohol abstinence, a decrease in fatigue level, and paying greater attention to one’s diet.
These results confirm previous findings that HCV cure is accompanied by behavioral changes, including changes in substance use [10, 11]. However, data on these changes are scarce [28], particularly in the HCV cure era, and especially for cannabis use, which is highly prevalent and partly motivated by therapeutic goals in PLWH.
Concomitant reduction in tobacco use is important for PLWH who reduce their cannabis use, as they are highly exposed to tobacco-related harms, a major morbidity and mortality risk factor in this population [29–31]. Cannabis and tobacco use frequently co-occur [32], especially in Europe [33]. Moreover, both drugs seem to reinforce each other [34, 35]. Accordingly, cannabis use impairs the chances of tobacco cessation [36], including in HIV–HCV co-infected people [15]. This phenomenon has also been documented for polysubstance use generally speaking [37, 38].
Our results suggest that HCV cure is an appropriate moment to engage in addictive behavior management, especially using a holistic approach for all substances. Our findings also suggest that lifestyle modifications post-HCV cure may include dietary changes. This is in line with studies showing that HCV cure is associated with increased self-care [39, 40], ability and motivation to plan for the future, self-confidence, and empowerment [40, 41]. However, our results also suggest that a reduction in cannabis (and tobacco) use in the PLWH population does not translate into abstinence.
We did not find any association between a therapeutic motive for cannabis use and post-cure reduction. However, participants who reduced their use were more likely to have experienced a decrease in their level of fatigue. This result suggests that the level of therapeutic benefit which HCV cure brings may only lead to a marginal reduction. Having said that, we cannot exclude reverse causality whereby the decrease in fatigue is the consequence of reduced cannabis use.
One of the study’s main limitations is that it is based on self-reports. We also had no data on physicians’ attitude and counselling regarding substance use after HCV cure. Moreover, we were not able to take into account the time since HCV cure in our models, and therefore the persistence of the observed reductions in use. However, our results still provide clues about the potential of using HCV treatment as a teachable moment for addiction treatment in PLWH.
Conclusion
Among cannabis users living with HIV, post-HCV cure cannabis reduction was associated with tobacco use reduction, and approached significance for alcohol use reduction. The management of addictive behaviors should be emphasized during HCV treatment, and further research is needed to explore the psychosocial mechanisms at play in smoking behaviors among PLWH, especially regarding cannabis use.
Abbreviations
- CAST
- Cannabis abuse screening test
- DAA
- Direct acting antivirals
- HCV
- Hepatitis C virus
- PLWH
- People living with HIV
- SAQ
- Self-administered questionnaire
Acknowledgements
The authors thank all the members of the ANRS-CO-13-HEPAVIH study group. Special thanks to all the physicians and nurses involved in the follow-up of the cohort and all patients who took part in this study. Finally, we thank Jude Sweeney for the English revision and editing of our manuscript.
The ANRS CO13 HEPAVIH Study Group:
Scientific Committee: D. Salmon (co-Principal investigator), L. Wittkop (co-Principal Investigator & Methodologist), P. Sogni (co-Principal Investigator), L. Esterle (project manager), P. Trimoulet, J. Izopet, L. Serfaty, V. Paradis, B. Spire, P. Carrieri, M.A. Valantin, G. Pialoux, J. Chas, I. Poizot-Martin, K. Barange, A. Naqvi, E. Rosenthal, A. Bicart-See, O. Bouchaud, A. Gervais, C. Lascoux-Combe, C. Goujard, K. Lacombe, C. Duvivier,, D. Neau, P. Morlat, F. Bani-Sadr, L. Meyer, F. Boufassa,, B. Autran, A.M. Roque, C. Solas, H. Fontaine, D. Costagliola, L. Piroth, A. Simon, D. Zucman, F. Boué, P. Miailhes, E. Billaud, H. Aumaître, D. Rey, G. Peytavin, V. Petrov-Sanchez, A. Levier.
Clinical Centers (ward/participating physicians): APHP, Hôpitaux Universitaires Paris Centre, Paris (Médecine Interne et Maladies Infectieuses: D. Salmon, R. Usubillaga; Hépato-gastro-entérologie: P. Sogni; Anatomo-pathologie: B. Terris; Virologie:P. Tremeaux); APHP Pitié-Salpétrière, Paris (Maladies Infectieuses et Tropicales: C. Katlama, M.A. Valantin, H. Stitou; Médecine Interne: A. Simon, P. Cacoub, S. Nafissa; Hépato-gastro-entérologie: Y. Benhamou; Anatomo-pathologie: F. Charlotte; Virologie: S. Fourati); APHM Sainte-Marguerite, Marseille (Service d'Immuno-Hématologie Clinique: I. Poizot-Martin, O. Zaegel, H. Laroche; Virologie: C. Tamalet); APHP Tenon, Paris (Maladies Infectieuses et Tropicales: G. Pialoux, J. Chas; Anatomo-pathologie: P. Callard, F. Bendjaballah; Virologie: C. Amiel, C. Le Pendeven); CHU Purpan, Toulouse (Maladies Infectieuses et Tropicales: B. Marchou; Médecine interne: L. Alric; Hépato-gastro-entérologie: K. Barange, S. Metivier; Anatomo-pathologie: J. Selves; Virologie: F. Larroquette); CHU Archet, Nice (Médecine Interne: E. Rosenthal; Infectiologie: A. Naqvi, V. Rio; Anatomo-pathologie: J. Haudebourg, M.C. Saint-Paul; Virologie: A. De Monte, V. Giordanengo, C. Partouche); APHP Avicenne, Bobigny (Médecine Interne – Unité VIH: O. Bouchaud; Anatomo-pathologie: A. Martin, M. Ziol; Virologie: Y. Baazia, V. Iwaka-Bande, A. Gerber); Hôpital Joseph Ducuing, Toulouse (Médecine Interne: M. Uzan, A. Bicart-See, D. Garipuy, M.J. Ferro-Collados; Anatomo-pathologie: J. Selves; Virologie: F. Nicot); APHP Bichat – Claude-Bernard, Paris (Maladies Infectieuses:, A. Gervais, Y. Yazdanpanah; Anatomo-pathologie: H. Adle-Biassette; Virologie: G. Alexandre, Pharmacologie: G. Peytavin); APHP Saint-Louis, Paris (Maladies infectieuses: C. Lascoux-Combe, J.M. Molina; Anatomo-pathologie: P. Bertheau; Virologie:M.L. Chaix, C. Delaugerre, S. Maylin); APHP Saint-Antoine (Maladies Infectieuses et Tropicales: K. Lacombe, J. Bottero; J. Krause, P.M. Girard, Anatomo-pathologie: D. Wendum, P. Cervera, J. Adam; Virologie: C. Viala); APHP, Hôpitaux Paris Sud, Bicêtre, Paris (Maladies Infectieuses et Tropicales: D. Vittecocq; Médecine Interne: C. Goujard, Y. Quertainmont, E. Teicher; Virologie: C. Pallier); APHP Necker, Paris (Maladies Infectieuses et Tropicales: O. Lortholary, C. Duvivier, C. Rouzaud, J. Lourenco, F. Touam, C. Louisin: Virologie: V. Avettand-Fenoel, E. Gardiennet, A. Mélard); CHU Bordeaux Hôpital Pellegrin, Bordeaux (Maladies Infectieuses et Tropicales: D. Neau, A. Ochoa, E. Blanchard, S. Castet-Lafarie, C. Cazanave, D. Malvy, M. Dupon, H. Dutronc, F. Dauchy, L. Lacaze-Buzy, A. Desclaux; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas); CHU Bordeaux Hôpital Saint-André, Bordeaux (Médecine Interne et Maladies Infectieuses: P. Morlat, D. Lacoste, F. Bonnet, N. Bernard, M. Hessamfar, J, F. Paccalin, C. Martell, M. C. Pertusa, M. Vandenhende, P. Mercié, D. Malvy, T. Pistone, M.C. Receveur, M. Méchain, P. Duffau, C Rivoisy, I. Faure, S. Caldato; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas, P. Bellecave, C. Tumiotto); CHU Bordeaux Hôpital du Haut-Levêque, Bordeaux (Médecine Interne: J. L. Pellegrin, J. F. Viallard, E. Lazzaro, C. Greib; Anatomo-pathologie: P. Bioulac-Sage; Virologie: P. Trimoulet, S. Reigadas); Hôpital FOCH, Suresnes (Médecine Interne: D. Zucman, C. Majerholc; Virologie: M. Brollo, E. Farfour); APHP Antoine Béclère, Clamart (Médecine Interne: F. Boué, J. Polo Devoto, I. Kansau, V. Chambrin, C. Pignon, L. Berroukeche, R. Fior, V. Martinez, S. Abgrall, M. Favier; Virologie: C. Deback); CHU Henri Mondor, Créteil (Immunologie Clinique: Y. Lévy, S. Dominguez, J.D. Lelièvre, A.S. Lascaux, G. Melica); CHU Nantes Hôpital Hôtel Dieu, Nantes (Maladies Infectieuses et Tropicales: E. Billaud, F. Raffi, C. Allavena, V. Reliquet, D. Boutoille, C. Biron; M. Lefebvre, N. Hall, S. Bouchez; Virologie: A. Rodallec, L. Le Guen, C. Hemon); Hôpital de la Croix Rousse, Lyon (Maladies Infectieuses et Tropicales: P. Miailhes, D. Peyramond, C. Chidiac, F. Ader, F. Biron, A. Boibieux, L. Cotte, T. Ferry, T. Perpoint, J. Koffi, F. Zoulim, F. Bailly, P. Lack, M. Maynard, S. Radenne, M. Amiri, F Valour; Hépato-gastro-entérologie: J. Koffi, F. Zoulim, F. Bailly, P. Lack, M. Maynard, S. Radenne, C. Augustin-Normand; Virologie: C. Scholtes, T.T. Le-Thi); CHU Dijon, Dijon (Département d'infectiologie: L. Piroth, P. Chavanet M. Duong Van Huyen, M. Buisson, A. Waldner-Combernoux, S. Mahy, A. Salmon Rousseau, C. Martins); C. H. Perpignan, Perpignan (Maladies infectieuses et tropicales: H. Aumaître, Virologie: S. Galim); CHU Robert Debré, Reims (Médecine interne, maladies infectieuses et immunologie clinique: F. Bani-Sadr, D. Lambert, Y. Nguyen, J. L. Berger, M. Hentzien, Virologie: V. Brodard); CHRU Strasbourg (Le Trait d’Union: D. Rey, M Partisani, M.L. Batard, C. Cheneau, M. Priester, C. Bernard-Henry, E. de Mautort, P.Fischer, Virologie: P Gantner et S Fafi-Kremer).
Data collection: F. Roustant, P. Platterier, I. Kmiec, L. Traore, S. Lepuil, S. Parlier, V. Sicart-Payssan, E. Bedel, S. Anriamiandrisoa, C. Pomes, F. Touam, C. Louisin, M. Mole, C. Bolliot, P Catalan, M. Mebarki, A. Adda-Lievin, P. Thilbaut, Y. Ousidhoum, F. Z. Makhoukhi, O. Braik, R. Bayoud, C. Gatey, M. P. Pietri, V. Le Baut, R. Ben Rayana, D. Bornarel, C. Chesnel, D. Beniken, M. Pauchard, S. Akel, S. Caldato, C. Lions, A. Ivanova, A-S. Ritleg, C. Debreux, L. Chalal, J.Zelie, H. Hue, A. Soria, M. Cavellec, S. Breau, A. Joulie, P. Fisher, S. Gohier, D. Croisier-Bertin, S. Ogoudjobi, C. Brochier, V. Thoirain-Galvan, M. Le Cam.
Management, statistical analyses: P. Carrieri, M. Chalouni, V. Conte, L. Dequae-Merchadou, M. Desvallees, L. Esterle, C. Gilbert, S. Gillet, R. Knight, T. Lemboub, F. Marcellin, L. Michel, M. Mora, C. Protopopescu, P. Roux, B. Spire, S. Tezkratt, T. Barré, T. Rojas Rojas, M. Baudoin, M. Santos V. Di Beo, M.Nishimwe,, L Wittkop.
Funding
TB work is funded by ANRS | emergent infectious diseases. This study was sponsored and funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS).
Availability of data and materials
The datasets generated and analysed during the current study are not publicly available due to personal data but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Designed and implemented in accordance with the Declaration of Helsinki, the cohort was approved by the ethics committee of Cochin University Hospital in Paris. Patients provided written informed consent to participate.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.