European Journal of Medical Research - Deutsche AIDS ...

66 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
tained and min 3 NRTI were chosen for next treatment cycle
according to the results. We compared CD4+ T-cell count and
VL developing in each cycle with BL values.
Results: We included 30 pt (1/30 female; 29/30 male). 12/30
were excluded for various reasons: new treatment options,
protocol violation etc.. 17 patients completed week 48 and
were analyzed. Mean CD4-T-cellcount was 160/l (R: 10-
580/l), mean VL was 4,99 log (R: 2,4 – 5,88 log) at BL. The
time-on-NRTI/PI-cycle- ratio was 1,84. Due to permissive VL
elevation we could see a mean VL reduction in each cycle:
C1: -0,64 log (R: + 1,71 to – 4,18log), C2: -0,51log (R: +0,74
to – 1,72log), C3:-0,64log (R:+0,67 to -1,69log), C4: -0,78log
(R:+ 0,42 to -2,67log), C5: -0,82log (R: +0,01 to -3.04log)
compared to the VL at the end of the prior cycle.
Conclusion: We could see a significant decline within each cycle
attributed to a rest activity of the drug combinations. In
8/17 patients we could see a mild to moderate increase of CD4
T-cell within the cycles. Therefore we consider this strategy as
a further option in the mosaic of deep salvage therapy.
B.35 (Poster)
Frequency and reasons for ARV switch in heavily
pretreated patients in a 24 months observation
period. Results of the Radata-cohort
Lorenzen T. 1 , Staszewski S. 2 , Faetkenheuer G. 3 ,
Bogner J.R. 4 , van Lunzen J. 5 , Mutz A. 6 , Gute P. 7 ,
Arbter P. 8 , Bähr D. 1 , Stoehr A. 1 , Hoffmann C. 1 ,
Plettenberg A. 1 , for the Radata-studygroup
1 ifi-Institut für interdisziplinäre Medizin, Hamburg, Germany,
2 Universität Frankfurt, HIV-Center, Frankfurt, Germany,
3 Klinikum der Universität zu Köln, Klinik I für Innere
Medizin, Köln, Germany, 4 Medizinische Poliklinik, Klinikum
der Universität München Innenstadt, Infektionsambulanz,
München, Germany, 5 Universitätsklinikum Hamburg-
Eppendorf, Ambulanzzentrum Infektiologie, Hamburg,
Germany, 6 Klinikum Osnabrück, Infektionsambulanz,
Osnabrück, Germany, 7HIV-Schwerpunktpraxis, Frankfurt,
Germany, 8 Praxis für Allgemeinmedizin, Krefeld, Germany
Objective: Radata is an internet-based system which provides
planning of antiretroviral therapy (ART), according to resistance
analysis, adherence questionnaire, therapeutic drug
monitoring and external expert advice.
Methods: Of 637 patients included in the radata database,
224 patients with a follow up of at least 24 months were selected
and were analysed according to frequency and reasons
for switches of ART. All patients were put on a new ART at
the time of enrolment.
Results: Within the 24 months period of follow-up, 317 ART
switches in 146/224 patients (1.4 switches per patient, range
0-7) were observed. The main reason for switch was therapeutical
failure (n = 180, 50.4 %). Within this subgroup, elevated
viral load was the main reason in 117, CD4-T-cell decline in
17 and clinical progression in 7 cases. For 39 cases, the detailed
reason for switch due to therapeutical failure was not
stated by treating physician. Besides therapeutical failure,
switches due to drug related side effects were noted in 75 cases
(21.0 %). In 27 cases (7.6 %) simplification of regimen was
the primary reason for therapeutic change, 25 cases (7.0 %)
were switched due to inadequate adherence of patients and for
13 cases (3.6 %) study related conditions (protocol requirement)
were responsible. In 12 cases (3.4 %), comorbidities
such as acute illnesses or newly diagnosed gravidity led to the
switch. In 6 cases (1.7 %) physicians assumed unfavourable
drug interactions. In 19 cases (5.3 %) physicians did not state
a specific reason for change of therapy.
Conclusions: Despite intensive pre-treatment of the patients,
only half of the therapy switches over a period of 24 months
in this cohort were due to therapeutic failure. Other predominant
reasons were side effects, treatment simplification and
inadequate patient adherence.
B.36 (Vortrag)
Sexually transmitted infections in men having sex
with men with primary HIV infection
Lenz J.C.C. 1 , Jessen H. 1 , Jessen A.B. 1
1 Praxis Jessen/Jessen/Stein, Berlin, Germany
Objective: In the very early stage of HIV infection high levels
of HI virus are measured. Also at this stage individuals
with HIV are often not aware of their infection. Both may
contribute to the high proportions of HIV transmission in this
phase. Sexually transmitted infections (STI) are known to increase
both the risk to acquire HIV as well as to transmit HIV
to sex partners. Co-infections of HIV and STI in patients with
primary HIV infection (PHI) may represent an individual risk
factor that facilitated acquiring the new HIV infection as well
as a risk factor to transmit HIV to other sex partners. In this
study we want identify the rate of STI in patients with primary
HIV infection.
Methods: We performed a retrospective analysis of all men
having sex with men (MSM) with PHI in the years 2005 and
2006 in the database of a single center (Praxis Jessen, Berlin)
an HIV and STI practice. PHI was defined as presence of HIV
(measured by PCR) and three or less HIV specific bands in the
western blot. For these patients the charts were reviewed for
clinical signs and laboratory test (Syphilis, Gonorrhea, Chlamydia,
Hepatitis B and C) results indicative of symptomatic STI.
Results: We identified 22 individuals with PHI. In 4 (18%)
active infection with syphilis, chlamydia or gonorrhea was
found. In two other possibly sexually transmitted diseases
were present (campylobacter, unspecific urethritis). Over all
1/3 of the patients with PHI had infections that are possibly
sexually transmitted.
Conclusions: The presence of STI in about 1/3 of patients
with PHI in this center may represent an individual risk that
led to the HIV infection. It may also indicate that HIV and
STI have been acquired at the same time. This finding leads
us to conclude that screening for STI should be performed in
PHI. The identification and subsequent treatment of STI will
not only prevent negative consequences of STI, but also may
help to reduce the additional risk for onward transmission of
HIV caused by an active STI.
B.37 (Poster)
Antiretroviral (AR) treatment (ART) in the
German ClinSurv multicenter cohort -
An overview of HAART in Germany over the last
ten years
Kollan C. 1 , Kühne A. 1 , Hamouda O. 1 , for the ClinSurv
Study Group
1 Robert Koch Institut, Infektionsepidemiologie, Berlin,
Germany
Objective: With the available number of different AR-substances
(S) the number of drugs (ARV) and AR-regimen (R)