European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
59
und einer antiretroviralen Behandlung zugeführt (non-AIDS
und AIDS Patienten ohne/mit Therapie). Neuropsychologische
Tests und eine Lumbalpunktion wurden durchgeführt und
Zytokinspiegel im Liquor mit einem speziellen Antikörper-
Chip bestimmt.
Ergebnisse: Alle Patienten unterschieden sich nicht hinsichtlich
ihres Alters und der CD4-Zellzahl. Die Viruslast war
bei allen behandelten Patienten im Blut und Liquor nicht
nachweisbar. Unbehandelte Frühstadienpatienten zeigten
schlechte Testergebnisse im Digit-Symbol-Test, dem Trail-
Making-Test und der Feinmotorikanalyse bei hohen Liquorspiegeln
von IL-4, IL-5 and GRO; behandelte Frühstadienpatienten
hatten bei hohen Spiegeln von pro-inflammatorischen
Zytokinen signifikant schlechtere Ergebnisse in der HIV-Demenz
Skala. Behandelte AIDS Patienten zeigen dagegen bei
hohen Spiegeln von ALCAM (CD166), Fas (CD95) und IL-
18 bessere Ergebnisse in der HIV-Demenz-Skala.
Diskussion: Die Studie konnte einen schwachen Zusammenhang
zwischen entzündlichen Reaktionen und neuropsychologischen
Defiziten im Zentralnervensystem von HIV-Patienten
mit oder ohne antiretrovirale Therapie feststellen. Interessant
ist, dass es offensichtlich einen frühzeitigen, direkt virusvermittelten
Schaden bei hoher Virusreplikation gibt, der durch
eine antiretrovirale Therapie nur unvollständig positive beeinflussbar
ist. In späten Stadien ist eine Virusreplikation unterhalb
der derzeitigen Nachweisbarkeitsgrenze in Zusammenhang
mit einer autoimmunologischen Dysfunktion des Immunsystems
als Mediator der fortschreitenden neuropsychologischen
Defizite wahrscheinlich.
B.18 (Vortrag)
Impact of depression on overall and health related
Quality of Life (QoL) in HIV- and cancer-patients
Wulff W. 1 , Kofahl-Krause D. 2 , Stoll M. 1 , Schmidt R.E. 1
1 Medical School Hanover, Clinical Immunology, Hannover,
Germany, 2Medical School Hanover, Haematology,
Haemostaseology and Oncology, Hannover, Germany
Aims: The estimates for lifetime prevalence of depression in
HIV patients differ between 22 and 45% compared to appr.
15% in non HIV infected people (1). Also in cancer patients
published prevalences of depression range between 1,5 and
53% (2). The impact of depression on overall or health related
QoL in these groups is very plausible but not well established.
HIV- and cancer-Patients were assessed by different tools for
QoL, depression and personality.
Methods: 50 HIV- and 54 cancer-Patients were assessed for
their overall QoL with the SEIQoL-DW interview (3) and the
MLDL questionnaire (4) and for their health related QoL with
the SF-36 questionnaire (5). Depression was assessed with the
BDI questionnaire (6) and personality with the FPI-R inventory
(7). Stepwise regression analyses were performed.
Results: (See Table 1)
Referring to the health related QoL depression is the first
factor for both HIV and cancer patients in the subscale health
perception explaining 40.6% of variance (HIV patients) and
39.8% (cancer patients). In the category mental health depression
is the first factor for the HIV group explaining 52.5% of
variance, but for the cancer group BDI-depression is only the
second factor explaining 12.2% of variance behind the the
first factor FPI-emotionality with 49.0%. The models for all
other subscales do not include BDI-depression or show it only
as the second or third factor explaining minor percentages of
variance.
Conclusions: Depression substantially influences QoL in
both HIV and cancer patients. The overall QoL seemed to be
even more affected than health related QoL. Regarding their
mental health HIV patients are more affected by depression
than cancer patients.
Remarks: 1 Himmelhoch et.al. 2005; 2 Trask 2004; 3 Boyle et.al.
1993; 4 v.Steinbüchel et.al. 1993; 5 Bullinger, Kirchberger 1998;
6 Hautzinger et.al. 1995; 7 Fahrenberg et.al. 2001
B.19 (Poster)
Management of a HIV-exposed pregnancy with
twin-to-twin transfusion syndrome (TTTS)
Kost B.P. 1 , Kästner R. 1 , Sovric M. 1 , Kainer F. 1 ,
Gingelmaier A. 1
1 I.UFK, LMU München, Frauenklinik-Innenstadt, München,
Germany
Objectives: Options and risks of an invasive intervention
(laser photocoagulation) in twin-to-twin transfusion syndrome
(TTTS) and HIV-infection in pregnancy.
Method: A case report
Results: HIV infection of a 27 year old III-para I-para with
monozygotic, diamniotic twins was diagnosed external in the
9th week of gestation. At that time no indication for antiretroviral
treatment was seen (viral load 2600 cp/ml, CD4 510
cells/l). In the 19+2 week of gestation a pronounced TTTS
with pathological color duplex sonography of the donor (195g)
and the acceptor (326g) with a massive polyhydramnion was
established. Concerning the wack prognosis the indication for a
laser photocoagulation was set. To reduce the risk of a vertical
HIV transmission a antiretroviral therapy with Kaletra and Tru-
Table 1