La Direction g\u00e9n\u00e9rale de la sant\u00e9 a saisi le Haut Conseil de la sant\u00e9 publique (HCSP) pour avis sur une r\u00e9vision du protocole \u00ab greffe d\u00e9rogatoire VIH \u00bb, encadr\u00e9 par l\u2019arr\u00eat\u00e9 du 5 juillet 2021 et inspir\u00e9 du protocole HOPE Act (HIV Organ Policy Equity) mis en \u0153uvre aux \u00c9tats-Unis depuis 2016. Cette r\u00e9vision vise \u00e0 simplifier le recrutement des donneurs et des receveurs s\u00e9ropositifs pour le VIH dans le cadre des greffes d\u2019organes, \u00e0 la lumi\u00e8re des r\u00e9sultats positifs publi\u00e9s pour la cohorte am\u00e9ricaine sur la p\u00e9riode 2021-2026 et des r\u00e9sultats jug\u00e9s encourageants en France.<\/p>\n
Apr\u00e8s analyse des donn\u00e9es collect\u00e9es par l\u2019Agence de la biom\u00e9decine (ABM), des publications r\u00e9centes et des pratiques internationales, le HCSP valide l\u2019ensemble des modifications propos\u00e9es par le groupe d\u2019experts de l\u2019ABM. Pour les donneurs d\u00e9c\u00e9d\u00e9s, il recommande de privil\u00e9gier la preuve d\u2019une charge virale VIH n\u00e9gative au seuil de 50 copies\/ml au moment du don, m\u00eame en l\u2019absence d\u2019autres donn\u00e9es virologiques de suivi ant\u00e9rieur, d\u2019autoriser l\u2019inclusion des donneurs de la cat\u00e9gorie III de Maastricht (arr\u00eat circulatoire apr\u00e8s d\u00e9cision d\u2019arr\u00eat des th\u00e9rapeutiques) et de supprimer la biopsie h\u00e9patique syst\u00e9matique. Pour les donneurs vivants, il valide le remplacement de la biopsie r\u00e9nale syst\u00e9matique par l\u2019utilisation d\u2019un score de risque individuel fond\u00e9 sur un algorithme valid\u00e9. Pour les receveurs, il pr\u00e9conise de red\u00e9finir la notion d\u2019infection VIH \u00ab bien contr\u00f4l\u00e9e \u00bb sur la base de l\u2019appr\u00e9ciation de l\u2019\u00e9quipe m\u00e9dicale, en l\u2019absence d\u2019\u00e9chappement th\u00e9rapeutique r\u00e9cent et avec un seuil de charge virale fix\u00e9 \u00e0 200 copies\/ml.<\/p>\n
Sur le plan r\u00e9glementaire, le HCSP recommande de r\u00e9viser l\u2019arr\u00eat\u00e9 du 13 juillet 2021 afin d\u2019int\u00e9grer ces ajustements dans un cadre scientifique et juridique commun aux greffes d\u00e9rogatoires d\u2019organes provenant de donneurs infect\u00e9s par le VIH ou par les virus des h\u00e9patites B et C. Il encourage \u00e9galement la mise en place d\u2019\u00e9tudes multidisciplinaires, comparables aux travaux men\u00e9s sur la cohorte HOPE aux \u00c9tats-Unis, pour documenter \u00e0 l\u2019\u00e9chelle fran\u00e7aise et europ\u00e9enne les greffes d\u2019organes entre sujets s\u00e9ropositifs pour le VIH. Ces orientations s\u2019inscrivent dans une logique d\u2019\u00e9largissement s\u00e9curis\u00e9 de l\u2019acc\u00e8s \u00e0 la greffe pour les patients infect\u00e9s par le VIH, tout en harmonisant les pratiques avec les exp\u00e9riences \u00e9trang\u00e8res.\u00a0(contenu r\u00e9sum\u00e9 par l’IA)\u200bLire la Suite<\/a>\u200b<\/p>","protected":false},"excerpt":{"rendered":" La Direction g\u00e9n\u00e9rale de la sant\u00e9 a saisi le Haut Conseil de la sant\u00e9 publique (HCSP) pour avis sur une r\u00e9vision du protocole \u00ab greffe d\u00e9rogatoire VIH \u00bb, encadr\u00e9 par […]<\/p>\n","protected":false},"author":1,"featured_media":4174,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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