La Direction g\u00e9n\u00e9rale de la sant\u00e9 (DGS) a sollicit\u00e9 l\u2019avis du Haut Conseil de la sant\u00e9 publique (HCSP) sur la r\u00e9vision du protocole fran\u00e7ais de greffes d\u2019organes entre donneurs et receveurs tous deux infect\u00e9s par le VIH, initialement fix\u00e9 en annexe \u00e0 l\u2019arr\u00eat\u00e9 du 5 juillet 2021. Ce protocole est calqu\u00e9 sur le dispositif am\u00e9ricain HOPE Act (HIV Organ Policy Equity), mis en place aux \u00c9tats-Unis en 2016 pour \u00e9largir l\u2019acc\u00e8s \u00e0 la transplantation pour les personnes vivant avec le VIH tout en garantissant leur s\u00e9curit\u00e9. Les r\u00e9sultats positifs du protocole am\u00e9ricain sur la p\u00e9riode 2021\u20132026 et les donn\u00e9es encourageantes en France ont conduit \u00e0 envisager une simplification des crit\u00e8res de recrutement des donneurs et des receveurs.<\/p>\n
Apr\u00e8s analyse des donn\u00e9es collect\u00e9es par l\u2019Agence de la biom\u00e9decine (ABM), de la litt\u00e9rature r\u00e9cente et des pratiques d\u2019autres pays, 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 l\u2019information d\u2019une charge virale inf\u00e9rieure \u00e0 50 copies\/mL au moment du don, m\u00eame en l\u2019absence d\u2019autres donn\u00e9es virologiques ant\u00e9rieures, d\u2019autoriser l\u2019inclusion des donneurs de cat\u00e9gorie Maastricht III (arr\u00eat circulatoire apr\u00e8s d\u00e9cision d\u2019arr\u00eat des th\u00e9rapeutiques de maintien en vie) et de supprimer la biopsie h\u00e9patique syst\u00e9matique. Pour les donneurs vivants, il pr\u00e9conise de remplacer la biopsie r\u00e9nale syst\u00e9matique par un score de risque individuel fond\u00e9 sur un algorithme valid\u00e9. Pour les receveurs, il propose de red\u00e9finir la notion d\u2019infection \u00ab bien contr\u00f4l\u00e9e \u00bb sur la base de l\u2019appr\u00e9ciation de l\u2019\u00e9quipe m\u00e9dicale, en s\u2019assurant de l\u2019absence d\u2019\u00e9chec th\u00e9rapeutique r\u00e9cent et en retenant un seuil de charge virale \u00e0 200 copies\/mL.<\/p>\n
Le HCSP recommande par ailleurs de r\u00e9viser l\u2019arr\u00eat\u00e9 du 13 juillet 2021 afin d\u2019int\u00e9grer ces adaptations dans un cadre scientifique et r\u00e9glementaire commun pour les greffes exceptionnelles d\u2019organes provenant de donneurs infect\u00e9s par le VIH ou par les virus des h\u00e9patites B et C. Il encourage enfin la mise en place d\u2019\u00e9tudes multidisciplinaires, sur le mod\u00e8le de la cohorte HOPE aux \u00c9tats-Unis, portant sur les greffes d\u2019organes r\u00e9alis\u00e9es entre personnes vivant avec le VIH en France et en Europe. Ces \u00e9volutions s\u2019inscrivent dans une logique d\u2019\u00e9largissement encadr\u00e9 de l\u2019acc\u00e8s \u00e0 la transplantation pour les patients infect\u00e9s par le VIH, tout en veillant \u00e0 la s\u00e9curit\u00e9 des pratiques et \u00e0 l\u2019harmonisation internationale des protocoles.\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 (DGS) a sollicit\u00e9 l\u2019avis du Haut Conseil de la sant\u00e9 publique (HCSP) sur la r\u00e9vision du protocole fran\u00e7ais de greffes d\u2019organes entre donneurs et 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