title: [Early diagnosis and prevention of comorbidities among HIV-infected patients: the Orchestra Saint-Antoine Program].
abstract: OBJECTIVE
  The Saint-Antoine Orchestra Program aims at improving the clinical management of HIV-infected patients through access to care, prevention and early diagnosis of comorbidities.
  
  
  METHODS
  The program was initiated in December 2004 on the whole database. The following topics were concerned: cardiovascular risk factors, gynecological follow-up, anti-HBV vaccinal coverage, sexuality and prevention of STIs, therapeutic adherence and counsels to travelers. The program included several actions: diffusion of information to patients, development of a computerized chart (alert pop-ups), individualized prescription advice and recommendations for specialist referral.
  
  
  RESULTS
  The program was applied to 1959 patients whose initial characteristics were: mean age: 43+/-10 years; ratio M/W: 1466/493; European origin: 69%; sub-Saharan: 19%; mean duration of HIV infection: 9.3+/-6 years; naïve of antiretrovirals: 14%; mean CD4+count: 494+/-277/mm(3); HIV viral load inferior to 50 cp/ml: 62%. Among 1347 patients for whom cardiovascular risk factors were completely informed, 42% had two or more factors. In particular, 31% of them were smokers, 7% had an arterial pressure superior to 140/90 mmHg and 11% had LDL-cholesterolemia superior to 4.1 mmol/l. Among 1448 untreated patients, 70% were initially considered as adherent. Half of the concerned women had neither cervical smear nor mammography up to date. Among 67% patients with an informed complete HBV serology, 27% were seronegative among which 310 (86%) were eligible for the vaccine. Problems of sexual difficulties or prevention were initially discussed for 11% of patients. Among them, 14% had a problem of prevention and 148 (66%) recognized sexual difficulties.
  
  
  CONCLUSIONS
  The initiation of the Saint-Antoine Orchestra program has provided a unique opportunity to assess and improve the prevention and management of comorbidities in HIV patients. Also, this program aimed to improve professional practices.
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital Saint-Antoine, université Pierre-et-Marie-Curie-Paris-VI, APHP, 184, 75012 Paris, France. laurent.fonquernie@sat.ap-hop-paris.fr
authors.forename: L
authors.initials: L
authors.lastname: Fonquernie
authors.forename: S
authors.initials: S
authors.lastname: Clozel
authors.forename: J-P
authors.initials: JP
authors.lastname: Vincensini
authors.forename: F
authors.initials: F
authors.lastname: Boccara
authors.forename: B
authors.initials: B
authors.lastname: Rousselle
authors.forename: C
authors.initials: C
authors.lastname: Pitard
authors.forename: D
authors.initials: D
authors.lastname: Bollens
authors.forename: P
authors.initials: P
authors.lastname: Campa
authors.forename: J
authors.initials: J
authors.lastname: Pacanowski
authors.forename: K
authors.initials: K
authors.lastname: Lacombe
authors.forename: J-L
authors.initials: JL
authors.lastname: Meynard
authors.forename: M-C
authors.initials: MC
authors.lastname: Meyohas
authors.forename: P-M
authors.initials: PM
authors.lastname: Girard
mesh_terms: D000328:Adult; D003663:Decision Trees; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D011315:Preventive Medicine; D015397:Program Evaluation