European Journal of Medical Research - Deutsche AIDS ...

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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 85 D.16 (Vortrag) Changes over time in risk of initial virological failure of antiviral therapy in Austria Sturm G. 1 , Sarcletti M. 2 , Geit M. 3 , Rieger A. 4 , Schmied B. 5 , Zangerle R. 2 1 Österr. HIV-Kohortenstudie, Innsbruck, Austria, 2 Medizinische Universität Innsbruck, Innsbruck, Austria, 3 AKH Linz, Linz, Austria, 4 Medizinische Universität Wien, Wien, Austria, 5 OWS Wien, Wien, Austria Aim of the study: Triple-combination antiviral therapy for HIV infection has been in use for a decade, but the extent to which treatment success has changed is uncertain. We examined risk of initial virological failure of antiviral therapy according to the year of starting therapy. Method: We included subjects from 5 HIV treatment centres in Austria who started combination antiviral therapy from 1996 to 2004. Based on the first viral load measurement from 9 to 15 months after combination antiviral therapy initiation, virological failure was defined as a viral load of more than 400 copies/mL. We used the following 2 inclusion strategies: (1) including all subjects, with missing VL measurement counted as virological failure (n = 1959; strategy A); (2) including all subjects with VL measurement (n = 1462; strategy B); Results: From 1996 to 2002, risk of virological failure fell from 69.2% to 31.7% for strategy A, 41.5% to 13.8% for strategy B. Missing viral load measurement one year after initial therapy decreased only to a small amount (27,8% and 17,9% for the years 1996 and 2004, respectively). Conclusions: Over a 9-year period of combination antiviral therapy use in clinical practice, risk of initial virological failure of treatment has decreased. These data suggest the trend is due to improvements in combination antiviral therapy regimens and greater effectiveness of their use. However, the rate of patients without viral load measurement one year after initial therapy is still unacceptably high. D.17 (Poster) Incidence of clinically significant renal events among patients treated with Tenofovir (TDF) in comparison to patients who never received TDF as part of their ART. Results of an observational cohort study Schewe K. 1 , Fenske S. 2 , Weitner L. 1 , Adam A. 1 , Buhk T. 2 , Stellbrink H.J. 2 1 Infektionsmedizinisches Centrum Hamburg, St. Georg, Hamburg, Germany, 2 Infektionsmedizinisches Centrum Hamburg, Grindelpraxis, Hamburg, Germany Objective: TDF is a highly potent NRTI used for the treatment of HIV-infected patients. Renal toxicity may occur with TDF use; however reported toxicity rates and severity vary across studies. We performed a retrospective analysis of our patient cohort to evaluate incidence of clinically significant renal toxicity in clinical practice and underlying risk factors Methods: Clinical and laboratory data from 1992 until Dec. 1st, 2006 are included in this analysis. Identification of patients (pts) reaching a composite endpoint of either 0,5mg/dl increase of serum creatinine (SCr) on a single occasion on treatment with TDF or pts who discontinued TDF due to renal events by screening of the data base. Comparison to HIV-treated pts who never received TDF. Results: Data of 1191 HIV-infected pts were analysed. Of 926 pts (69%)receiving antiretroviral therapy (ART), 492 pts (60%) had received TDF for a mean duration of 27.4 months (1125 patient-years (pt-yrs)), while 434 pts (40%) had never received TDF (mean observation: 51.4 months; 1871 pt-yrs). Pts on TDF were older (mean 46.1 vs. 43.8 yrs), had longer duration of ART (mean 8.36 vs. 4.63 yrs), lower CD4 nadir (207/ul vs. 302/ul) and lower current CD4 count (517/ul vs. 559/ul) than non-TDF pts. 18/492 TDF-pts experienced a 0.5 mg increase of SCr above baseline (BL) (incidence 1.8 /100 pt-yrs) compared to 21/434 pts in the non-TDF group (incidence: 1.1/100 pt-yrs). 9 pts discontinued TDF due to renal toxicity after a median of 9 months resulting in a partial (n=5) or complete (n=4) return of SCr to pre-TDF levels. 21 of the TDF treated patients met the prespecified composite endpoint (incidence: 1.9 per 100 pt-yrs).11 pts continued TDF despite elevated SCr; SCr returned to BL in 3 pts, remained elevated in 6 pts and further increased in 2 pts. In 6/18 pts with rising SCr glucosuria was present, proteinuria in 12/18 pts, low phosphate in 5/16 pts. Additional risk factors were present in 16/21(76%) TDF-patients with renal toxicity. Conclusion: In our cohort, the incidence of clinically significant renal toxicity was 1.9% in TDF-pts versus 1.1% in non- TDF pts. This difference may be mainly explained by additional renal risk factors like difference in age, duration of HAART and lower CD4 count in the TDF group D.18 (Poster) HIV-positive Schwangere – muß die Sectio wirklich immer sein? Kästner R. 1 , Sovric M. 2 , Müller M. 1 , Sonnenberg-Schwan U. 3 , Gingelmaier A. 4 1 Universitätsfrauenklinik München, Psychosomatik, München, Germany, 2 Universitätsfrauenklinik München, Geburtshilfe, München, Germany, 3 All Around Women Special, DAIG e.V., München, Germany, 4 Universitätsfrauenklinik München, Infektiologie, München, Germany Fragestellung: Warum erhalten in Deutschland HIV-positive Schwangere fast ausnahmslos eine Sectio? Methodik: Psychosomatischer Ansatz, um die Leitlinien unterschiedlicher Länder hinsichtlich ihrer Entstehung und Umsetzung zu hinterfragen, Literaturrecherche und persönliche Kommunikation mit Behandlern und Betroffenen in verschiedenen Ländern Ergebnisse: Zwischen 1999 und 2003 wurden in Deutschland mehr als 600 HIV-positive Schwangere in spezialisierten Zentren betreut und in 98,4% per Sectio entbunden. Demgegenüber entbinden in benachbarten europäischen Ländern und in den USA ca. 20 – 30 % bei Vorliegen optimaler Voraussetzungen vaginal, ohne eine höhere Rate an vertikalen Trans-
86 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 missionen. Dieselben optimalen Voraussetzungn liegen im deutschen Kollektiv in mindestens 50 % aller betreuten Fälle vor. Angst, organisatorische Schwierigkeiten und mangelnde Bereitschaft einen informed consent auch unter Einbeziehung der psychosomatischen Faktoren anzustreben erscheinen ursächlich für die anhaltend hohe Sectiorate. Schlussfolgerung: Ist die Schwangere compliant, nimmt eine HAART ein mit der die Viruslast unter der Nachweisgrenze liegt und fehlen geburtshilfliche Risikofaktoren, dann sollte ein hypothetischer Nutzen der primären Schnittentbindung deren Risiken gegenübergestellt werden und der Betroffenen die Möglichkeit zur Mitentscheidung eingeräumt werden. D.19 (Poster) Duration of NNRTI treatment after switch to a first Nevirapine- or Efavirenz-containing regimen. An observational cohort analysis Schewe K. 1 , Adam A. 1 , Goldbach J. 2 , Weitner L. 1 1 Infektionsmedizinisches Zentrum Hamburg, St. Georg, Hamburg, Germany, 2 Boehringer Ingelheim Pharma GmbH & Co. KG, Medizinische Wissenschaft, Ingelheim, Germany Purpose: To determine the duration of NNRTI treatment from switch to a first episode of nevirapine (NVP) or efavirenz (EFV) containing therapy in a HIV specialised practice. Methods: Observational cohort study of patients (pts) treated with NVP or EFV between January 2000 and December 2004. Fishers exact test or Chi2 tests, Kaplan-Meier estimates and log rank tests were used for the analysis. Results: 125 pts and 117 pts with NVP and EFV treatment were identified: male 93%, mean age 40.6 yrs, mean duration of HIV-infection 6.9yrs, mean duration of pre-treatment 3.7yrs with no sig. difference between the groups. Of pts with values available at baseline and at 1 year (NVP: 62pts, EFV: 42pts): Baseline viral load was higher among pts receiving EFV (51%
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