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- W12779530 abstract "Les infections fongiques sont les infections opportunistes (IO) les plus fréquentes au cours de l’infection par le VIH, même si leur incidence a diminué depuis l’instauration des multithérapies antirétrovirales (cART). Elles sont un bon marqueur de la sévérité du déficit immunitaire et s’observent généralement chez des patients naïfs de traitement, en échec thérapeutique ou non observant. La pneumocystose est la seconde IO la plus fréquente en France et la cryptococcose reste un problème majeur dans l’hémisphère sud. Avec le développement des voyages, les mycoses d’importation sont importantes à connaître car elles peuvent mimer d’autres infections, notamment une tuberculose. Ces infections ont, pour la grande majorité un tropisme pulmonaire, mais le bilan initial doit toujours tenir compte de la dissémination éventuelle chez les patients VIH+. Les délais d’initiation du traitement cART par rapport aux traitements antifongiques sont établis en fonction du risque de progression sida en l’absence de cART et du risque de toxicité cumulée et de syndrome de reconstitution immunitaire (IRIS) en cas d’instauration trop précoce. Les infections fongiques chez les patients VIH+ restent donc un problème d’actualité à l’ère des cART et les IRIS peuvent compliquer la prise en charge et nécessitent une gestion thérapeutique optimisée. Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime." @default.
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- W12779530 date "2013-10-01" @default.
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- W12779530 title "Infections fongiques pulmonaires chez les patients séropositifs pour le VIH" @default.
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- W12779530 doi "https://doi.org/10.1016/j.rmr.2013.02.005" @default.
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