Team 2 : Clinical epidemiology of chronic viral diseases

Responsable(s) :
  • Fabrice CARRAT @ : fabrice.carrat at

About the team

The CLEPIVIR team brings together components of U1136 involved in clinical epidemiology of chronic viral diseases. Researchers coordinate leading thematic cohorts of persons living with HIV, chronic viral hepatitis C, B and Delta, and co-infections. They also develop and use specific statistical methods for estimating treatment effect from observational data. 

HIV, viral hepatitis, and co-infections share similar clinical and public health issues related to quantifying the benefit, risks, and cost-effectiveness of antivirals on the long term and to evaluating the risk of comorbidities – notably cancer, cardiovascular or metabolic complications, and strategies to prevent them. We will bring together among the largest cohort studies on these infections in the world to address these issues. 

One of our major commitment is to provide the national health authorities with data on care (including antiviral access, use, cost, efficacy and safety) at the national level in order to guide the public-health policy on these chronic infections.  

We describe below the main projects.

- Living with HIV: long-term prognostic and therapeutic strategies effectiveness 

The FHDH-ANRS CO4 cohort is a hospital multicentre open cohort with on-going inclusion since 1989. Patients are eligible if they are infected by HIV1 or HIV2 and are managed in a participating centre. The database includes data from 125 hospitals corresponding to over 153,000 patients seen at least once between 1992 and 2015, and covers above 60% of those under care in France. The research projects are mainly focused around the biggest advantage of the database, its size. We will explore long term effects of antiretroviral treatment and risk of comorbidities  (cancer, cardiovascular diseases) associated with aging, describe the epidemiology of HIV infection in patients in hospital care in France. The database is also used to evaluate the public health impact of antiretroviral drugs, with regular contracts involving 3 partners (INSERM, INSERM Transfert, Pharmaceutical company) to assess use, impact and cost-effectiveness of the new drugs made available.

- Viral hepatitis. Quantifying the clinical benefits and risks of treatment with direct acting antiviral agents in chronic hepatitis C; identifying factors associated with a functional cure in chronic hepatitis B. 

The ANRS CO22 HEPATHER cohort is a national multicentre observational study of subjects with past or present viral hepatitis B (>6000) or C (>14,000). The cohort was set-up in August 2012, is sponsored and supported by ANRS-INSERM, was awarded an ANR-EQUIPEX and received an additional support from pharmaceutical companies. The main objective of the cohort is to assess the clinical efficacy and safety of these new treatments, and to identify which will most likely improve overall health. The cohort, includes a centralized biobank at cohort entry and individual linkage to national medico-administrative databases. See (WEBLINK) for additional details. We will explore the impact of sustained virological response on comorbidities, and most notably cardiovascular diseases or the risk of cancer. As regards HBV, most of our researches will focus on identifying the determinants of loss of HBsAg – which is considered as a functional cure.. 

- Co-infection: The interplay between HIV and viral hepatitis, therapeutic and public health issues 

New markers, such as anti-hepatitis B core antibodies, hepatitis B core-related antigen, interferon-gamma inducible protein 10 and HBV-RNA, have been gaining attention in HBV mono-infected patients for their ability to predict HBsAg loss, liver fibrosis and hepatocellular carcinoma. In HIV-HBV co-infected patients, these markers have close implications with the immune system and HIV replication, putting into question their capacity to predict HBsAg loss and disease severity. In order to address those issues, we will capitalize on our previous findings drawn from the French multicenter HIV-HBV cohort 

The second part of our investment in viral hepatitis and HIV coinfection addresses the issue of identifying the best strategies to screen and treat viral hepatitis in resource-limited countries with projects in Cameroun and Côte d’Ivoire.

- Methods. Measures of treatment effect in observational studies 

Our researches in this theme will mostly be centered on evaluating and comparing different statistical approaches to causal inference of treatment effect from observational cohort data. Among various topics, we will: 

• compare the performance of various alternative models for linking drug exposure in terms of cumulative duration/dose with beneficial or adverse effect;

• compare MSM and G-estimation of structural nested models introducing resistance as effect modification to validate HIV1 genotypic drug resistance algorithm (collaboration with team3);

• compare different measures of treatment effects when the proportional hazards (PH) assumption is suspected not to be valid.;

• explore methods to combine relevant information from several heterogeneous sources into a single one, in order to increase the analytic capacities. 


Members of the team

Nom Contact Statut / Fonction
Xian ABULIZI xian.abulizi at Ingénieur d'Etude / Doctorant-e
Niswati AHAMADA niswati.ahamada at Attaché-e de Recherche Clinique
Adel AMIROUCHE adel.amirouche at Attaché-e de Recherche Clinique
Douae AMMOUR douae.ammour at Attaché-e de Recherche Clinique
Khadija AMRANI khadija.taibi at Attaché-e de Recherche Clinique
Maxime ANGOT maxime.angot at Développeur
Lydie ANTOINE lydie.antoine at Attaché-e de Recherche Clinique
Loubna AYOUR loubna.ayour at Attaché-e de Recherche Clinique
Jessica AZZI jessica.azzi at Stagiaire de Master
Aliou BALDE aliou.balde at Etudiant-e / Doctorant-e
Elizabeth BELMONTE-ZALAR elizabeth.belmonte at Attaché-e de Recherche Clinique
Jaouad BENHIDA jouad.benhida at Attaché-e de Recherche Clinique
Djourhra BETRAOUI SI AHMED Attaché-e de Recherche Clinique
Fabienne CABY fabienne.caby at PHC
Thierry CALVEZ thierry.calvez at CH contractuel
Fabrice CARRAT fabrice.carrat at PU-PH
Frédéric CHAU frederic.chau at Data manager, développeur Senior
Caroline CHEVALIER caroline.chevalier at Attaché-e de Recherche Clinique
Romuald CRUCHET romuald.cruchet at Stagiaire de Master
Hafida DABARHI hafida.dabarhi at Attaché-e de Recherche Clinique
Cécile DEBACQUE Attaché-e de Recherche Clinique
Manel DEBBA-PAVARD manel.debba-pavard at Attaché-e de Recherche Clinique
Lorenza DEZANET lorenza.dezanet at Post-Doctorant-e
Céline DORIVAL celine.dorival at Chef de projet
Léa DUCHESNE lea.duchesne at Doctorant-e
Simplice DZAMITIKA simplice.dzamitika at Attaché-e de Recherche
Imane EL ATMANI imane.el-atmani at Attaché-e de Recherche Clinique
Philippe FLANDRE philippe.flandre at Chargé de Recherche
Sandrine FRANCOIS sandrine.francois at Attaché-e de Recherche Clinique
Léa GARESSUS lea.garessus at ARC
Pierre-Marie GIRARD pierre-marie.girard at PU-PH
Isabelle GODEREL isabelle.goderel at TCH
Ophélia GODIN ophelia.godin at Post-Doctorant-e
Héloïse GOIN heloise.goin at Attaché-e de Recherche Clinique
Sophie GRABAR sophie.grabar at MCU-PH
Marguerite GUIGUET marguerite.guiguet at Chargé de Recherche
Warda HADI warda.hadi at Attaché-e de Recherche Clinique
Céline HEROLD Attaché-e de Recherche Clinique
Meshak KAKUDJI meshak.kakudji at Stagiaire de Master
Esma KARAYIGIT esma.karayigit at ARC / Attaché-e de Recherche Clinique
Karine LACOMBE karine.lacombe at MCU-PH
Anne LALIGANT anne.laligant at Attaché-e de Recherche Clinique
Nathanael LAPIDUS nathanael.lapidus at MCU-PH
Séverine LECLERCQ severine.leclercq at Ingénieur d'Etude / Informaticien-ne
Amandine LEGENDRE amandine.legendre at Attaché-e de Recherche Clinique
Hana LENEMAN hana.leneman at Ingénieur d'Etude / Statisticien-ne
Laurence LIÈVRE laurence.lievre at Ingénieur d'Etude / Informaticien-ne
Clovis LUSIVIKA clovis.lusivika at Doctorant-e
Edouard MAHIEU edouard.mahieu at Stagiaire de Master
Hugues MELLIEZ hugues.melliez at Praticien Hospitalier / Doctorant-e
Rym MONARD rym.monard-ext at Attaché-e de Recherche Clinique
Priscilla MONFALET priscilla.monfalet at Développeur
Kim Tu An NGO at ARC
Cherifa OUAZZI cherifa.ouazzi at Attaché-e de Recherche
Grégory PANNETIER gregory.pannetier at TCH / Informaticien-ne
François PINOT francois.pinot at Attaché-e de Recherche Clinique
Chloé POMES chloe.pomes at Attaché-e de Recherche Clinique
Valérie POTARD valerie.potard at Statisticien-ne
Hélène ROUL helene.roul at Ingénieur d'Etude / Data manager
Odile STAHL odile.stahl at Biostatiticien-ne
François TEOULE francois.teoule at Attaché-e de Recherche Clinique
Florence TREBALAG florence.trebalag at Développeur
Thomas VERGER thomas.verger at Attaché-e de Recherche Clinique