European Journal of Medical Research - Deutsche AIDS ...
European Journal of Medical Research - Deutsche AIDS ...
European Journal of Medical Research - Deutsche AIDS ...
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106 EUROPEAN JOURNAL OF MEDICAL RESEARCH<br />
June 27, 2007<br />
Kaever, V. (2005) Quantification <strong>of</strong> antiretroviral drugs in dried<br />
blood spot samples by means <strong>of</strong> liquid chromatography/tandem<br />
mass spectrometry. Rapid Commun. Mass Spectrom. 19, 2995–<br />
3001<br />
D.68 (Vortrag)<br />
Antiretroviral therapy <strong>of</strong> patients infected with<br />
drug-resistant HIV-strains: Analysis <strong>of</strong> the<br />
composition <strong>of</strong> the first-line regimen in patients<br />
with a documented date <strong>of</strong> HIV-infection in<br />
Germany<br />
Poggensee G. 1 , Kücherer C. 2 , Werning J. 1 , Bartmeyer B. 1 ,<br />
Fleischhauer C. 1 , Braun P. 3 , Cordes C. 4 , Jessen H. 4 ,<br />
Klausen G. 4 , Schewe K. 5 , Stoll M. 6 , vanLunzen J. 7 ,<br />
Hamouda O. 8<br />
1 Robert Koch-Institute, Department <strong>of</strong> Infectious Disease and<br />
Epidemiology, Berlin, Germany, 2 Robert Koch-Institute, HIV-<br />
Variability and Molecular Epidemiology, Berlin, Germany,<br />
3 private practitioner, Aachen, Germany, 4 private practitioner,<br />
Berlin, Germany, 5 private practitioner, Hamburg, Germany,<br />
6 Hannover <strong>Medical</strong> School, Internal Medicine, Hannover,<br />
Germany, 7 University Clinic Hamburg Eppendorf, Hamburg,<br />
Germany, 8 Robert Koch-Institute, Department <strong>of</strong> Infectious<br />
Disease and Epidemiology and the German Seroconverter<br />
Study Group, Berlin, Germany<br />
Objectives: Studies <strong>of</strong> the first-line regimen in patients with<br />
transmitted drug resistance are limited. Aim <strong>of</strong> this study was<br />
to investigate the influence <strong>of</strong> genotypic resistance test results<br />
on the choice <strong>of</strong> first-line treatment in patients with a documented<br />
date <strong>of</strong> HIV-infection with transmitted drug-resistance.<br />
Methods: Genotypic resistance testing was performed in all<br />
drug-naïve patients <strong>of</strong> the HIV-seroconverter cohort. Data acquisition<br />
took place between 1998 and 2005.<br />
Start <strong>of</strong> antiretroviral therapy and drug composition <strong>of</strong> firstline<br />
treatment were assessed. Proportions were given with interquartile<br />
ranges. Mantel-Haenzels X2test and Fisher’s exact<br />
test were used. Viral loads and CD4 counts were compared by<br />
the Kruskall-Wallis test. p-values were two sided and p-values<br />
<strong>of</strong> < 0.05 were considered significant.<br />
Results: Of 922 tested patients drug resistant HIV was identified<br />
in 130 patients. Susceptible strains were found in 792<br />
individuals. Any NRTI resistant HIV was found in 25 individuals<br />
(25/35). NRTI resistance alone was detected in 21<br />
patients (21/35). Combinations <strong>of</strong> NRTI with PI and/or<br />
NNRTI resistance were found in 4 patients (4/25). PI or<br />
NNRTI resistance alone was assessed in 5 (5/35) and 4<br />
(4/35) patients, respectively. The remaining 5 patients<br />
showed different combinations <strong>of</strong> multi-drug resistance.<br />
Antiretroviral therapy was prescribed for 35 patients (35/130)<br />
with predicted drug resistant HIV. Treatment regimen <strong>of</strong><br />
25 patients (25/35) included at least one inactive drug. One<br />
inactive drug was included in the regimen <strong>of</strong> 17 individuals.<br />
The regimen <strong>of</strong> 5 patients comprised 2 inactive drugs. In 3<br />
patients no active drug was included in the first-line regimen.<br />
The majority <strong>of</strong> mutations conferred AZT-resistance<br />
(11/35). Since 2002 72% <strong>of</strong> first-line treatments included<br />
AZT (p=0.011). Since 2003 no PI or NNRTI were included<br />
in first-line treatments <strong>of</strong> patients with predicted PI/NNRTI<br />
resistance. AZT was not included in the regimen <strong>of</strong> three<br />
patients who were infected with highly AZT-resistant<br />
HIV. CD4-cell counts and viral load did not differ<br />
between individuals treated with or without compromised<br />
drugs.<br />
Conclusions: More recently a trend to omit compromised PI<br />
and NNRTI drugs appeared.<br />
Supported by BMG, BMBF/Competence Network HIV/<strong>AIDS</strong><br />
D.69 (Poster)<br />
Ritonavir-boosted fosamprenavir dramatically<br />
increased tacrolimus drug concentrations in an<br />
HIV/HCV-infected patient with liver<br />
transplantation<br />
Schulbin H. 1 , Masuhr A. 1 , Stocker H. 1 , Müller M. 1 ,<br />
Broelsch C. 2 , Beckebaum S. 2 , Cicinnati V. 2 , Arasteh K. 1<br />
1 Vivantes Auguste-Viktoria Klinikum, Berlin, Germany,<br />
2 Universitätsklinikum Essen, Essen, Germany<br />
Introduction: Drug drug interactions with ritonavir-boosted<br />
protease inhibitors (PI) are increasingly troublesome, as HIVinfected<br />
patients require treatment for other conditions than<br />
HIV.<br />
Methods: We describe the case <strong>of</strong> an HIV/HCV co-infected<br />
patient who initiated the immunosuppressant tacrolimus following<br />
liver transplantation.<br />
Results: The 36 year old male with HIV/HCV-coinfection<br />
underwent liver transplantation in December 2005 for chronic<br />
liver failure. Along with his stable antiretroviral therapy consisting<br />
<strong>of</strong> fosamprenavir/ritonavir 700/100 mg, twice daily<br />
and c<strong>of</strong>ormulated ten<strong>of</strong>ovir/emtricitabine he was started on<br />
tacrolimus 5 mg, twice daily. 5 Days after the start <strong>of</strong> this<br />
treatment the serum tacrolimus concentration was 65,4<br />
ng/mL, which is more than six times the desired value <strong>of</strong> 10<br />
ng/ml. Only after the dosage was reduced to 0,25 mg q 3 days<br />
stable drug trough concentrations within the required concentration<br />
range could be achieved. Serum amprenavir concentrations<br />
were also monitored but were within the normal range as<br />
compared to historical controls.<br />
Conclusions: Enhanced tacrolimus exposure in patients receiving<br />
c<strong>of</strong>ormulated lopinavir ritonavir has been described<br />
before. However, no prospective controlled pharmacokinetic<br />
studies have been performed. This is the first report on an interaction<br />
between ritonavir-boosted fosamprenavir and<br />
tacrolimus. As the numbers <strong>of</strong> HIV-infected patients with solid<br />
organ transplantation will rise clinicians must be increasingly<br />
aware <strong>of</strong> potential drug interactions with PI and immunosuppressants<br />
such as tacrolimus.<br />
D.70 (Poster)<br />
Low dose Prednisolone helps to delay HAART<br />
initiation<br />
Ulmer A. 1 , Müller M. 1 , Stützer H. 2 , Frietsch B. 1<br />
1 Praxis Ulmer Frietsch Müller, Stuttgart, Germany,<br />
2 University <strong>of</strong> Cologne, IMSIE - Institute <strong>of</strong> <strong>Medical</strong><br />
Statistics, Köln, Germany<br />
Objective: HAART is the best and almost the only established<br />
treatment option for HIV infected individuals. But it is<br />
expensive and complicated, leading to limited access in developing<br />
countries with dramatic consequences, connected with<br />
side effects and potential resistances. An important issue is to<br />
find additional or alternative therapeutic options and to increase<br />
the independence <strong>of</strong> HAART. The study groups <strong>of</strong> Andrieu<br />
and ourselves have already published a CD4-stabilizing<br />
effect <strong>of</strong> Prednisolone. The number <strong>of</strong> patients and the time <strong>of</strong>