European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
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sons. For on of the three patients still on TPV/r and without
showing any other obvious conditions or comedication, aggregation
of platelets showed a decrease in ADP and collagen
induced aggregation.
In contrast to our laboratory findings, clinically only mild
episodes of epistaxis and menorrhagia were observed in only
one patient respectively. Nevertheless the effect of ART on
coagulation parameters needs to be taken into account and
further studies are needed to evaluate and understand this interaction.
D.55 (Poster)
Determination of HLA-B*5701 status prior to
Abacavir exposure results in higher prescription
frequencies and lower rates early therapy
terminations
Kohrgruber N. 1 , Fischer G. 2 , Rieger A. 1
1 Univ. Klinik für Dermatologie, Medizinische Universität
Wien, Abteilung für Allergologie, Immunologie und infektiöse
Hauterkrankungen, Wien, Austria, 2 Univ. Klinik für
Blutgruppenserologie und Transfusionsmedizin, Medizinische
Universität Wien, Wien, Austria
Background: Treatment with Abacavir (ABC) results in a
hypersensitivity reaction (HSR) in about 8% of patients. The
risk of HSR may limit ABC prescription or may result in premature
treatment cessation, both due to precaution of physicians
and patients. Pretesting for HLA-B*5701 prior to ABC
initiation results in significant reduction of HSR incidence
and thus may lead to a change of prescription frequencies and
a more sustained adherence to ABC.
Methods: In this single centre study, we prospectively collected
data about ABC prescription frequencies and early
therapy cessations after a pre-test for HLA-B*5701 was introduced
in August 2005. Those data were compared to retrospectively
evaluated data about the period before HLA-
B*5701 testing was performed. All patients with > 60 days of
follow-up were included.
Results: After HLA-B*5701 testing was introduced, 141
ABC naïve patients started ABC therapy between August 05
and November 06. 5 (3.5%) patients discontinued ABC in <
42 days based on patients (n=3) or physicians decisions
(n=2). Reasons for patients driven terminations were anticipation
of HSR (n=1) or misinterpretation of unrelated symptoms
(n=2), physicians withdrew ABC because of symptoms
highly presumptive HSR (n=1) or secondary syphilis misdiagnosed
as HSR (n=1). In comparison, 157 patients initiated
ABC without HLA-B*5701 prescreening between 1997 and
2005 at a mean per year prescription rate of 19.9 (± 12.3; 1-
38). A mean of 15.7 % (± 7.9; 6-30) stopped ABC thereafter
during the first 42 treatment days because of HSR related
reasons. Retrospectively, 5 ABC treated patients of initially
undetermined HLA status were tested B*5701 positive.
Three of those 5 subjects stopped ABC during the initial 42
days, 2/5 HLA-B*5701+ patients tolerated ABC for 3 and 4
years, respectively.
Conclusion: HLA-B*5701 predetermination results in more
confident and thus more frequent ABC prescriptions and decreased
rates of ABC terminations unrelated and related to
HSR.
D.56 (Poster)
Gastrointestinal bleeding due to livercirrosis
under HAART- a case report
Degen O. 1 , Hertling S. 1 , Kreuzberg C. 1 , Zoufaly A. 1 ,
van Lunzen J. 1
1 University medical center Hamburg-Eppendorf, Hamburg,
Germany
Objective: Liver-relate death in HIV positive patients was the
most frequent cause of non-AIDS-related death in the D:A:D
Study. Most of the patients in this trial were HBV or HCV
coinfected. However in clinical practice there are increasing
numbers of patients with steatosis or fibrosis of the liver without
comorbidity as viral hepatitis or alcohol abuse. We report
a patient with development of esophageal bleeding due to cirrhosis
of the liver under long term HAART.
Case report: Case report of a 76 year old Caucasian patient
HIV positive since 1987. Risk of infection was MSM. He is
after esophageal candidiasis in stage CDC C3. In 1987 a
healed hepatitis B was found. ART was started in 1996 and he
was treated with more than 18 drugs from all available classes.
Until today the liver function was normal without elevation
of liver enzymes and normal blood coagulation and other
synthesis factors. The patient is rare drinking alcohol. 1999 a
abdominal ultrasound was performed with signs of liver
steatosis, a gastroscopy in 2002 was without pathological
findings. In 2004 the ART was switched to AZT, 3TC, TFV
and Tipranavir. In Mai 2006 we found anemia with Hb of
10.8 g/dl, the haemocult-test was positive.
The ultrasound showed advanced damage of the liverparenchym
without singes of decompensation. No thrombosis
of the V. portae in the Duplex. The hepatitis serology was
negative for B and A, as 1987 with a healed hepatitis B. No
autoimmunhepatits or lack of alpha-1 antitrypsin. In liverbiopsie
the parenchyma was fine dropted fatty degenerated.
The gastroscopy showed hypertensive gastropathie and III°
esophageal varicosis with red spots. A ligation therapy of the
varicosis was done and a beta blocker was added to therapy.
The PI in the ART was switched from Tipranavir to
Darunavir.
Discussion: In this case we report a HIV positive patient with
gastrointestinal bleeding due to hypertensive gastropathie and
esophageal varicosis by liver cirrosis. The only known risk
factor is HAART over 10 years. Physicians should be aware
of liver damage in patient under HAART also when the routinely
performed liver function test and enzymes were normal.
D.57 (Poster)
Attenuation kognitiver Funktionen unter HAART
mit ddI, ddC und d4T im Vergleich zu HAART
ohne ddI, ddC und d4T
Hudelmaier B. 1 , Reichelt D. 2 , Oelker-Güneberg U. 3 ,
Klönne K. 4 , Gregor N. 1 , Summ O. 1 , Biehl K. 1 , Evers S. 1 ,
Husstedt I.W. 1
1 UKM Münster, Neurologie, Münster, Germany, 2 UKM
Münster, Innere Medizin D, Münster, Germany, 3 UKM
Münster, Medizin D, Münster, Germany, 4 UKM Münster,
Medizin B, Münster, Germany
Seit der Einführung von HAART hat sich die Überlebenszeit
nach Feststellung der Diagnose HIV-assoziierte Enzephalopathie
(HIVE) von ca. 12 Monaten auf ca. 43 Monate erhöht.