Team PreViST

Pathogenesis, Treatment and Prevention strategies of Viral Infections and Sexually Transmitted Infections

PreViST is evaluating interventions designed for infectious diseases prevention, control, and care. PreViST is focusing on chronic viral infections, emerging viral infections, and bacterial and viral sexually transmitted infections.
The team includes five research axes:

• Axis 1: HIV and STI including HPV (leader Q Le Hingrat):

Our research particularly focuses on pathogenesis (viral reservoir, restriction factors), antiretroviral drugs resistance (epidemiology, mechanisms) of HIV-1 and HIV-2 infections. We also set up innovative new antiretroviral strategies in Northern and Southern countries.

With regards to HIV prevention, HIV prophylaxis (PrEP) with oral TDF/FTC has been recommended in France since 2016. New long-acting injectable antiretroviral with new administration modalities (intramuscular, subcutaneous) are currently being approved and we will set up implementation studies in France.

HPV infections are the most prevalent worldwide sexually transmitted infections (STIs), and all cervical cancers are attributable to the persistence of high-risk HPV.

In keeping with our work on HIV and HPV, we will also address the epidemiology, antimicrobial resistance and prevention strategies of bacterial STIs.

• Axis 2: Emerging viral diseases and respiratory viruses (Dr N Peiffer-Smadja/Pr F-X Lescure):

Our team has been highly involved in the COVID and mpox emerging infectious diseases responses. We are involved in EU-RESPONSE, an adaptive European platform trial for emerging infectious diseases, to improve Europe’s responsiveness to pandemic crisis.

Our work will be focused on addressing the epidemiology of respiratory viral infections in various settings such as the emergency departments, intensive care units and hospitalization wards. With regards to SARS-CoV-2, the pathophysiology underlying post-acute COVID symptoms (PACS) long after the acute phase is still unknown. We will use the French COVID cohort biobank to identify biological markers that could be associated with PACS.

• Axis 3: Perinatology (Pr J Sibiude):

Our goal is to study the impact on pregnancy, and on exposed infants, of chronic or emerging viral infections and their treatments.

Neonatal sepsis due to bacterial infections is of major concern. We will conduct a study to validate a novel point-of-care multiplex to detect and characterize microorganisms responsible for neonatal sepsis in order to improve prevention of perinatal bacterial infections.

• Axis 4: Strategies for access to prevention and treatment of viral infections: decision support (Dr S Deuffic-Burban):

One of our research interests is the cost-effectiveness in chronic viral infections and in key populations.

HIV remains a major public health issue, and testing remains a weak step in the HIV care cascade in France, which might impair the achievement of the end of HIV transmission in 2030. Our goal will be to assess the frequency and describe the missed opportunities for HIV testing in these new HIV diagnoses. We aim at providing insights needed to reinforce or build new interventions to improve HIV testing coverage and reduce the number of people living with undiagnosed HIV. Partner notification practices may help to break transmission chains of STIs and HIV in inviting sexual partners of newly STI/HIV-diagnosed patients to test. In addition to public health issues, partner notification strategies lead to legal and regulatory issues. We aim at developing partner notification tools that are legally acceptable.

We will implement a decision model to compare the two PrEP strategies and establish cost-effectiveness performance benchmarks for Long-Acting injectable PrEP. This model will integrate oral and injectable PrEP costs and discontinuation, HIV incidence (and therefore PrEP effectiveness), and average HIV healthcare cost and life expectancy among those who acquired HIV.

STIs epidemics are important to take into consideration in men who have sex with men (MSM) who use PrEP, and among MSM living with HIV. Given that new effective biomedical prevention strategies are now available (meningococcal B vaccine, post-exposure prophylaxis with doxycycline), it seems therefore important to evaluate the impact of such prevention strategies at population level. We will therefore estimate the effectiveness, the cost, and the cost-effectiveness of biomedical prevention and screening strategies of STIs among MSM in France.

• Axis 5: Poverty/primary care (Pr N Vignier):

Recent emerging infectious diseases showed us the increased deleterious impact of pandemics in vulnerable populations. This aspect is very important to take into account in our research. A first step is to quantify precariousness of the population and to integrate a precariousness score in monitoring people living with HIV. Our research will also address different vulnerable populations: immigrant women, and Inmates population. Regarding primary care, we will evaluate the obstacles to the deployment of a health check-up for newcomer migrants in primary care.