European Journal of Medical Research - Deutsche AIDS ...

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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 101 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.
102 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 Wenn auch die Inzidenz der HIVE abgenommen hat, so ist als Resultat der wesentlich besseren therapeutischen Möglichkeiten die Prävalenz angestiegen und leichtere Formen der HIVE werden in großen Patientenkollektiven bei bis zu 30 % festgestellt. Nebenwirkungen von HAART betreffen das zentrale und periphere Nervensystem. Bekannt sind distal symmetrische Polyneuropathien durch ddC, ddI und d4T, die in Kombination mehrer diese Substanzen bei bis zu 25 % pro Jahr auftreten. Als Ursache wird eine Alteration der Mitochondrien angesehen, ein Mechanismus, der jedoch alle Organsysteme betreffen kann. Zur Frage, ob unter diesen Substanzen auch Veränderungen kognitiver Funktion auftreten können, wurde bei 60 Patienten, die als Bestandteil der HAART mit ddI, ddC oder d4T als Monotherapie (n=60) behandelt worden waren, ereigniskorrelierte Potenziale (ERP) abgeleitet. Als Vergleichskollektiv dienten Patienten mit HAART ohne ddI, ddC und d4T (n=120). Die statistische Analyse ergab keine signifikanten Unterschiede bezüglich Alter, CD4-Zellen, Viruslast und CDC-Stadien zwischen beiden Gruppen. Die Analyse der ereigniskorrelierten Potenziale wies eine statistisch signifikante Latenzverzögerung für die Komponenten P3 (p
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