European Journal of Medical Research - Deutsche AIDS ...

62 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
to immune reconstitution frequently presenting with atypical
clinical signs and symptoms.
Results: A 62 year old HIV-infected patient reported development
of a focal swelling of the dorsum of the left hand resembling
lipomatosis 2 weeks after switching to an antiretroviral
therapy regimen consisting of AZT, 3TC, and lopinavir. At that
time CD4 cell count was 247/l and viral load below the limit
of detection. Four months later therapy was changed to liponavir
monotherapy because of toxicity (anemia) and further two
months later the patient realised a similar swelling of the dorsum
of his right hand with progress over two months. The tumor
of the left hand was then diagnosed as tenosynovitis based
on magnet resonance tomography (MRT) revealing a non-infiltrating
fluidlike process with a size of 7x16x25 mm and peripheral
vascularisation consistant with an inflammatory process.
He complained about no pain or other signs and symptoms. He
had been on different combination therapies including non-nucleoside
and nucleoside analogue reverse transcriptase inhibitors
for three years with good immunological response
(CD4 cells 8/l, > 750.000 copies HIV-RNA copies/ml plasma
before therapy). He had never had lipomas before in his live
nor did any of his familiy members. After initiation of lopinavir
therapy increase of C-reactive protein (CRP) to 46.9 mg/l was
observed. Because of the close time relation of the hand
swelling and start of lopinavir treatment, the therapy was
switch to atazanavir 300mg QD, ritonavir 100mg BID, and
saquinavir 500mg BID. This was followed by immediate and
complete disappearance of the left and significant reduction of
the right dorsal hand lipomas within a few weeks. Six weeks
after the last therapy switch CRP had declined to 27.3 mg/l.
Conclusion: Tenosynovitis associated with protease inhibitor
therapy can be misdiagnosed as lipomatosis. Whether this patient
suffered from either immune reconstitution syndrome or
rather drug related toxicity remains unclear. Replacement of
lopinavir led to complete clinical resolution and drop of inflammatory
parameters.
B.26 (Vortrag)
Untreated HIV patients with undetectable virus –
What happens to the CD4 cells?
Eger J. 1 , Wolf E. 2 , Gölz J. 3 , Brust J. 4 , Ulmer A. 5 ,
Nzimegne-Gölz S. 3 , Mosthaf F. 6 , Vogel M. 7 , Rockstroh J. 7 ,
Leistner I. 8 , Mayr C. 8 , Carganico A. 9 , Mueller M. 5 ,
Jäger H. 1 , NoVi Study Group
1 HIV Research and Clinical Care Centre Munich, Munich,
Germany, 2 MUC Research, Munich, Germany,
3 HIV Outpatient Practice Kaiserdamm, Berlin, Germany,
4 Private Practice for Internal Medicine, Hematology and
Oncology, Mannheim, Germany, 5 HIV Outpatient Practice,
Stuttgart, Germany, 6 Private Practice for Hematology,
Oncology and Infectious Diseases, Karlsruhe, Germany,
7 University Hospital of Bonn, Bonn, Germany, 8 Ärzteforum
Seestraße, Berlin, Germany, 9 HIV Outpatient Practice, Berlin,
Germany
Background: To evaluate whether low level viral replication
in untreated HIV-1 patients will persistently prevent immunological
deterioration and disease progression.
Methods: Ongoing multi-centre cohort study in untreated
HIV-1 patients with low virus replication. Entry criteria were
a persistent viral load (VL) level 600/l to