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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 97 children have an increased atherogenic risk profile based on either TG levels and/or sdLDL. A careful clinical follow up of children on HAART is required to monitor atherogenic complications. D.45 (Poster) HIV or ART? Gender differences in the causal attribution of symptoms and adverse events Kremer H. 1 , Sonnenberg-Schwan U. 1 , Arendt G. 1 , Brockmeyer N. 2 , Ulmer A. 3 , Graefe K. 4 , Starke W. 5 , for the German Competence Network HIV/AIDS 1 German AIDS Society, All Around Women Special, Bochum, Germany, 2 Ruhr-University, Clinic for Dermatology, Bochum, Germany, 3 Praxis Ulmer/Fritsch/Müller, Stuttgart, Germany, 4 ifi - Institute for Interdisciplinary Medicine, Hamburg, Germany, 5 Praxis Starke, Wiesbaden, Germany Objective: This multicenter study examines differences between men and women with HIV on physical symptoms, symptom severity, and the causal attribution of those symptoms as related to HIV disease, antiretroviral treatment (ART), or other reasons. Method: A total of 163 patients (55% male, 45% female) filled in a self-report questionnaire consisting of information on their ART, a comprehensive physical symptom checklist including a rating of symptom severity and the most likely cause: HIV, ART or other/unknown reasons. Self reported laboratory abnormalities were compared to laboratory reports provided by their physicians. Results: Women and men did not differ on the means of perceived symptom severity, sum of symptoms (28 ±15), and percentage of symptoms attributed to ART (27 ±22%). However, men attributed their symptoms significantly more often to HIV than women (25 ±23% vs. 16 ±20%, p = .01) and less often to other/unknown reasons (47 ±28% vs. 58 ±27%, p = .02). In contrast, women were significantly more likely to attribute laboratory abnormalities to ART (p = 0.04) and to discontinue Kaletra due to side effects (p = .03). Conversely, men were significantly more likely to take Kaletra than women (p < .01) and to have elevated triglycerides (p = .01). Overall, patients reported only between 5 to 30% of the detected laboratory abnormalities. There were no gender differences on awareness of laboratory abnormalities, except for women being significantly more likely than men to be aware of elevated creatinine levels (p = .02) and to change ART due to elevated creatinine levels (p = .02). Conclusions: Results suggest that people with HIV attribute about half of their symptoms neither to HIV nor to ART. The finding that men are more likely than women to relate their symptoms to HIV may have implications for the motivation to remain on the same ART regimen, even if side effects occur. In contrast, women may be more prudent in avoiding side effects of ART. The striking lack of awareness of laboratory abnormalities in both men and women may indicate a potential gap in physician-patient communication. The causal attributions of physical symptoms and laboratory abnormalities differ between men and women, which has implications for clinical practice and research. D.46 (Vortrag) Der Uridin-Spiegel im Plasma korreliert mit klinischen und laborchemischen Markern der mitochondrialen Toxizität Eckert R. 1 , Schirmer D. 1 , Winzer R. 1 , Heinz W. 1 , Leyh M. 1 , Guhl C. 1 , Klinker H. 1 , Langmann P. 2 1 Medizinische Klinik und Poliklinik II der Universität Würzburg, Schwerpunkt Infekiologie, Würzburg, Germany, 2 Praxis für Gastroenterologie und Infektiologie, Karlstadt, Germany Hintergrund: Mitochondriale Toxozität wird unter anderem durch Hemmung der DNA-Polymerase g vermittelt. Experimentell konnte gezeigt werden, dass das Nukleosid Uridin diese Toxizitätseffekte verhindern kann. Fragestellung: Im zeitlichen Verlauf sollte an einem größeren Kollektiv untersucht werden, ob die Uridinspiegel mit klinischen Befunden unter ART, mit der ART oder Nebenwirkungen korrelieren. Methodik: Messung der Uridinplasmaspiegel erfolgte mittels HPLC und UV-Detektion. Von 182 HIV-Patienten (m/w: 137/45; Durchschnittsalter: 41 Jahre) wurden Spiegel bestimmt, per T-Test analysiert und mit klinischen und laborchemischen Parametern korreliert. Ergebnisse: Patienten im CDC-Stadium C (n=33) hatten mit 5,28±1,68mol/l einen deutlich niedrigeren mittleren Uridinspiegel als Patienten im Stadium A (n=98, 6,19±1,9mol/l) und B (n=51, 6,36±2,2mol/l). Bei Patienten, die dideoxy-NRTIs erhielt (n=43), fanden sich die niedrigsten Uridinspiegel der 4 Therapiegruppen (mit dideoxy-NRTI, NRTI, NRTI-frei, ohne Therapie) mit einem MW von 5,7±1,63mol/l. Der Uridinspiegel der Patienten, die mit NRTIs, aber ohne dideoxy-NRTIs behandelt wurden (n=111), betrug 6,15±2,13mol/l und war bei den Patienten ohne NRTIs (n=7) im Mittel bei 6,34±2,74mol/l. Patienten ohne ART (n=21) wiesen die höchsten Uridinspiegel auf (6,53±1,55mol/l). Dabei waren die Werte therapienaiver Patienten (n=16) mit 6,39±1,66mol/l im Vergleich zu Patienten in Therapiepause (n=5) mit 6,99±1,14mol/l erniedrigt (p>0,05). Während sich unter dideoxy-NRTI ein Abfall im Therapieverlauf nachweisen ließ, zeigte sich im Verlauf der HIV- Erkrankung ohne Therapie tendenziell ein Anstieg der Uridinspiegel. Auch Therapie mit non-dideoxy-NRTI führte im Verlauf (1,5 Jahren) zu einem leichten Anstieg der Uridinspiegel. Klinische Befunde wie Fettleber und Auftreten eines Diabetes mellitus waren ebenfalls mit niedrigen Uridinspiegeln korreliert. Schlussfolgerung: Die Korrelation des Uridinspiegels mit klinischen Befunden der mitochondrialen Toxizität zeigt sowohl hinsichtlich der Therapie als auch für den zeitlichen Verlauf eine schlüssige Übereinstimmung. Ob unter Substitutionstherapie eine inverse Korrelation von Uridinspiegeln und Reversibilität von Toxizität zu sehen ist, sollte genauer untersucht werden.
98 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 D.47 (Vortrag) Effects of HIV protease inhibitor regimen on platelet function and endogenous thrombin potential (ETP) von Hentig N.H. 1 , Graff J. 1 , Foerster A.K. 1 , Staszewski S. 2 , Klauke S. 3 , Gute P. 4 , Harder S. 1 1 J.W.Goethe-University Hospital, Clinical Pharmacology, Frankfurt am Main, Germany, 2 J.W.Goethe-University Hospital, Medical HIV Treatment and Research Unit, Frankfurt am Main, Germany, 3 IFS Stresemannallee, Frankfurt am Main, Germany, 4 Infectiologicum Friedensstrasse, Frankfurt am Main, Germany Introduction: More recently, thromboembolic complications in HIV patients have been described. Especially the influence of protease inhibitors on platelet activation and coagulation are currently under discussion. Methods: HIV positive, protease inhibitor naive patients (n=20) were investigated before and 4-8 weeks after the start of a protease inhibitor (PI) including combination therapy. Therapy consisted of boosted PI regimen (n=14) plus reverse transcriptase inhibitors (NRTI) or a double PI regimen (n=6)without NRTI comedication. Protease inhibitors administered were saquinavir (n=15), lopinavir (n=7), fosamprenavir (n=2) and atazanavir (n=2), all co-administered with low-dose ritonavir. CD 62P, PAC1, platelet-monocyte interaction [CD41, CD11b (all mean fluorescence intensity)] and CD40L (%+ platelets) were assessed by flow cytometry. To investigate the influence of platelets on coagulation the endogenous thrombin potential (ETP) was determined. Results: CD62P, PAC1 and CD11b expression remained unchanged. In contrast, CD41 (from 446±214 to 605±184, mean±sd, p
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