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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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH<br />
85<br />
D.16 (Vortrag)<br />
Changes over time in risk <strong>of</strong> initial virological<br />
failure <strong>of</strong> antiviral therapy in Austria<br />
Sturm G. 1 , Sarcletti M. 2 , Geit M. 3 , Rieger A. 4 ,<br />
Schmied B. 5 , Zangerle R. 2<br />
1 Österr. HIV-Kohortenstudie, Innsbruck, Austria,<br />
2 Medizinische Universität Innsbruck, Innsbruck, Austria,<br />
3 AKH Linz, Linz, Austria, 4 Medizinische Universität Wien,<br />
Wien, Austria, 5 OWS Wien, Wien, Austria<br />
Aim <strong>of</strong> the study: Triple-combination antiviral therapy for<br />
HIV infection has been in use for a decade, but the extent to<br />
which treatment success has changed is uncertain. We examined<br />
risk <strong>of</strong> initial virological failure <strong>of</strong> antiviral therapy according<br />
to the year <strong>of</strong> starting therapy.<br />
Method: We included subjects from 5 HIV treatment centres in<br />
Austria who started combination antiviral therapy from 1996 to<br />
2004. Based on the first viral load measurement from 9 to 15<br />
months after combination antiviral therapy initiation, virological<br />
failure was defined as a viral load <strong>of</strong> more than 400<br />
copies/mL. We used the following 2 inclusion strategies: (1) including<br />
all subjects, with missing VL measurement counted as<br />
virological failure (n = 1959; strategy A); (2) including all subjects<br />
with VL measurement (n = 1462; strategy B);<br />
Results: From 1996 to 2002, risk <strong>of</strong> virological failure fell<br />
from 69.2% to 31.7% for strategy A, 41.5% to 13.8% for strategy<br />
B. Missing viral load measurement one year after initial<br />
therapy decreased only to a small amount (27,8% and 17,9%<br />
for the years 1996 and 2004, respectively).<br />
Conclusions: Over a 9-year period <strong>of</strong> combination antiviral<br />
therapy use in clinical practice, risk <strong>of</strong> initial virological failure<br />
<strong>of</strong> treatment has decreased. These data suggest the trend is<br />
due to improvements in combination antiviral therapy regimens<br />
and greater effectiveness <strong>of</strong> their use. However, the rate<br />
<strong>of</strong> patients without viral load measurement one year after initial<br />
therapy is still unacceptably high.<br />
D.17 (Poster)<br />
Incidence <strong>of</strong> clinically significant renal events<br />
among patients treated with Ten<strong>of</strong>ovir (TDF) in<br />
comparison to patients who never received TDF as<br />
part <strong>of</strong> their ART. Results <strong>of</strong> an observational<br />
cohort study<br />
Schewe K. 1 , Fenske S. 2 , Weitner L. 1 , Adam A. 1 , Buhk T. 2 ,<br />
Stellbrink H.J. 2<br />
1 Infektionsmedizinisches Centrum Hamburg, St. Georg,<br />
Hamburg, Germany, 2 Infektionsmedizinisches Centrum<br />
Hamburg, Grindelpraxis, Hamburg, Germany<br />
Objective: TDF is a highly potent NRTI used for the treatment<br />
<strong>of</strong> HIV-infected patients. Renal toxicity may occur with<br />
TDF use; however reported toxicity rates and severity vary<br />
across studies. We performed a retrospective analysis <strong>of</strong> our<br />
patient cohort to evaluate incidence <strong>of</strong> clinically significant<br />
renal toxicity in clinical practice and underlying risk factors<br />
Methods: Clinical and laboratory data from 1992 until Dec.<br />
1st, 2006 are included in this analysis. Identification <strong>of</strong> patients<br />
(pts) reaching a composite endpoint <strong>of</strong> either <br />
0,5mg/dl increase <strong>of</strong> serum creatinine (SCr) on a single occasion<br />
on treatment with TDF or pts who discontinued TDF due<br />
to renal events by screening <strong>of</strong> the data base. Comparison to<br />
HIV-treated pts who never received TDF.<br />
Results: Data <strong>of</strong> 1191 HIV-infected pts were analysed. Of<br />
926 pts (69%)receiving antiretroviral therapy (ART), 492 pts<br />
(60%) had received TDF for a mean duration <strong>of</strong> 27.4 months<br />
(1125 patient-years (pt-yrs)), while 434 pts (40%) had never<br />
received TDF (mean observation: 51.4 months; 1871 pt-yrs).<br />
Pts on TDF were older (mean 46.1 vs. 43.8 yrs), had longer<br />
duration <strong>of</strong> ART (mean 8.36 vs. 4.63 yrs), lower CD4 nadir<br />
(207/ul vs. 302/ul) and lower current CD4 count (517/ul vs.<br />
559/ul) than non-TDF pts.<br />
18/492 TDF-pts experienced a 0.5 mg increase <strong>of</strong> SCr<br />
above baseline (BL) (incidence 1.8 /100 pt-yrs) compared to<br />
21/434 pts in the non-TDF group (incidence: 1.1/100 pt-yrs).<br />
9 pts discontinued TDF due to renal toxicity after a median <strong>of</strong><br />
9 months resulting in a partial (n=5) or complete (n=4) return<br />
<strong>of</strong> SCr to pre-TDF levels. 21 <strong>of</strong> the TDF treated patients met<br />
the prespecified composite endpoint (incidence: 1.9 per 100<br />
pt-yrs).11 pts continued TDF despite elevated SCr; SCr returned<br />
to BL in 3 pts, remained elevated in 6 pts and further<br />
increased in 2 pts. In 6/18 pts with rising SCr glucosuria was<br />
present, proteinuria in 12/18 pts, low phosphate in 5/16 pts.<br />
Additional risk factors were present in 16/21(76%) TDF-patients<br />
with renal toxicity.<br />
Conclusion: In our cohort, the incidence <strong>of</strong> clinically significant<br />
renal toxicity was 1.9% in TDF-pts versus 1.1% in non-<br />
TDF pts. This difference may be mainly explained by additional<br />
renal risk factors like difference in age, duration <strong>of</strong><br />
HAART and lower CD4 count in the TDF group<br />
D.18 (Poster)<br />
HIV-positive Schwangere – muß die Sectio<br />
wirklich immer sein?<br />
Kästner R. 1 , Sovric M. 2 , Müller M. 1 ,<br />
Sonnenberg-Schwan U. 3 , Gingelmaier A. 4<br />
1 Universitätsfrauenklinik München, Psychosomatik, München,<br />
Germany, 2 Universitätsfrauenklinik München, Geburtshilfe,<br />
München, Germany, 3 All Around Women Special, DAIG e.V.,<br />
München, Germany, 4 Universitätsfrauenklinik München,<br />
Infektiologie, München, Germany<br />
Fragestellung: Warum erhalten in Deutschland HIV-positive<br />
Schwangere fast ausnahmslos eine Sectio?<br />
Methodik: Psychosomatischer Ansatz, um die Leitlinien unterschiedlicher<br />
Länder hinsichtlich ihrer Entstehung und Umsetzung<br />
zu hinterfragen, Literaturrecherche und persönliche<br />
Kommunikation mit Behandlern und Betr<strong>of</strong>fenen in verschiedenen<br />
Ländern<br />
Ergebnisse: Zwischen 1999 und 2003 wurden in Deutschland<br />
mehr als 600 HIV-positive Schwangere in spezialisierten Zentren<br />
betreut und in 98,4% per Sectio entbunden. Demgegenüber<br />
entbinden in benachbarten europäischen Ländern und<br />
in den USA ca. 20 – 30 % bei Vorliegen optimaler Voraussetzungen<br />
vaginal, ohne eine höhere Rate an vertikalen Trans-