European Journal of Medical Research - Deutsche AIDS ...
European Journal of Medical Research - Deutsche AIDS ...
European Journal of Medical Research - Deutsche AIDS ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH<br />
89<br />
D.26 (Poster)<br />
Efficacy <strong>of</strong> efavirenz-based HAART after<br />
switching from a protease inhibitor<br />
Khaykin P. 1 , Brenda D. 1 , Carlebach A. 2 , Knecht G. 3 ,<br />
Müller A. 1 , Stürmer M. 4 , Staszewski S. 1<br />
1 Klinikum der J.W.Goethe Unversität Frankfurt, HIVCEN-<br />
TER, Frankfurt, Germany, 2 Private Practice Friedenstrasse,<br />
Frankfurt, Germany, 3 Private Practice IFS, Frankfurt,<br />
Germany, 4 Klinikum der J.W.Goethe Unversität Frankfurt,<br />
Department <strong>of</strong> Virology, Frankfurt, Germany<br />
Objective: The aim <strong>of</strong> this database analysis was to investigate<br />
the efficacy and safety <strong>of</strong> efavirenz (EFV)-based<br />
HAART after switching from protease inhibitor (PI)-based<br />
regimens.<br />
Methods: Data were analyzed from 50 HIV+ patients who<br />
were taking two or three NRTIs and one PI or boosted PI<br />
(PI/r) and then switched the PI to EFV. The reasons for<br />
switching were side effects, virologic failure, and non-compliance.<br />
Summary <strong>of</strong> results: 22/50 patients were still on the EFV at<br />
the time <strong>of</strong> analysis. Viral load in the OT analysis decreased<br />
from 4.9 log10 to 1.6 log10 copies/ml. Of the patients who<br />
discontinued EFV, reasons given were virologic failure in<br />
20%, adverse events in 22% and non-compliance in 14% <strong>of</strong><br />
the patients. Patients who showed virologic failure had prior<br />
experience with different therapy regimens or showed 2 or 3-<br />
class resistance. Among the patients who stopped EFV therapy<br />
due to adverse events, CNS side effects were the most<br />
common.<br />
Conclusions: Modification <strong>of</strong> a HAART regimen may lead to<br />
viral suppression if EFV is substituted for a PI or PI/r. However,<br />
some patients in our study demonstrated adverse events<br />
or virologic failure. Most <strong>of</strong> the patients who discontinued<br />
EFV had 2- or 3-class resistance in their treatment history.<br />
D.27 (Poster)<br />
Darunavir (TMC114) in highly pre-treated<br />
HIV-1-infected patients: Clinical experience<br />
obtained from routine clinical practice<br />
Schmied B. 1 , Cichon P. 1 , Egle A. 2 , Geit M. 3 ,<br />
Gmeinhart B. 4 , Haas B. 5 , Kanatschnigg M. 6 , Kapper A. 5 ,<br />
Rieger A. 4 , Sarcletti M. 7 , Schlag M. 8 , Taylor N. 2 ,<br />
Zangerle R. 7<br />
1 Otto Wagner Hospital, II. <strong>Medical</strong> Department Pulmological<br />
Centre SMZ Baumgartner Höhe, Vienna, Austria,<br />
2 III. <strong>Medical</strong> Department University <strong>of</strong> Salzburg, Division <strong>of</strong><br />
Hematology , Oncology and Infectious Diseases, Salzburg,<br />
Austria, 3 General Hospital <strong>of</strong> Linz, Department <strong>of</strong><br />
Dermatology and Venerology, Linz, Austria, 4 University <strong>of</strong><br />
Vienna <strong>Medical</strong> School, Department <strong>of</strong> Dermatology, Division<br />
<strong>of</strong> Immunology, Allergy and Infectious Diseases, Vienna,<br />
Austria, 5 General Hospital – Graz West, I. <strong>Medical</strong><br />
Department, Graz, Austria, 6 General Hospital Klagenfurt, I.<br />
<strong>Medical</strong> Department, Klagenfurt, Austria, 7 University <strong>of</strong><br />
Innsbruck, Department <strong>of</strong> Dermatology and Venereology,<br />
Innsbruck, Austria, 8 Janssen-Cilag Pharma GmbH, Vienna,<br />
Austria<br />
Background: The activity <strong>of</strong> boosted Darunavir (DRV/r,<br />
600/100 mg bid), a novel protease inhibitor (PI), against PIresistent<br />
virus has been proven in clinical trials. A Named Patient<br />
Program allowed to assess treatment results obtained in<br />
routine care settings.<br />
Objective: To evaluate the safety and efficacy <strong>of</strong> DRV/r containing<br />
ART when used in routine clinical practice and factors<br />
influencing outcomes.<br />
Methods: 31 HIV-1-infected patients were included. Patients<br />
were at least 3-class-experienced. All were naïve to DRV.<br />
Median baseline CD4 cell count: 160 (2-914), median HIVviral<br />
load: 3,99Log10 (1,69-6,18), 5 subjects had viral load<br />
(VL) < 50 c/ml. Patients were followed up according to local<br />
standard <strong>of</strong> care. Genotypes were used to determine DRVspecific<br />
resistance-associated mutations (DRV-RAMs) and<br />
genotypic sensitivity scores (GSS) for the optimized backbone<br />
regimen (OBR).<br />
Results: At cut-<strong>of</strong>f (Feb 07), treatment with DRV/r was initiated<br />
in 28 patients. The OBR contained 2 or 3 NRTIs.<br />
TMC125 was added in 4 patients. Ten subjects (36%) used<br />
Enfuvirtide (ENF), there<strong>of</strong> 7 (25%) naïvely. Median followup<br />
time: 25 weeks (range 4-84). 16/23 subjects (70%) reached<br />
VL2<br />
DRV-RAMs, respectively. Response at week 12 was decreased<br />
in patients with a GSS <strong>of</strong> £ 0,5 (less than 1 fully active<br />
drug in OBR) and in the presence <strong>of</strong> > 2 DRV-RAMs.<br />
There was no difference in response <strong>of</strong> ENF-users (ENFnaïve)<br />
as compared to ENF non-users, however, in patients<br />
using ENF naïvely, ENF represented the only fully active<br />
drug in the OBR.<br />
Conclusions: DRV-based cART showed very good safety<br />
and efficacy in a group <strong>of</strong> highly pre-treated patients in routine<br />
care settings. Careful consideration <strong>of</strong> treatment history,<br />
DRV-RAMs and GSS can help to design the optimal DRVbased<br />
cART. Further follow up <strong>of</strong> efficacy and safety is needed<br />
to prove long-term outcomes.<br />
D.28 (Vortrag)<br />
Transfer <strong>of</strong> autologous gene-modified T lymphocytes<br />
in HIV-infected patients with advanced<br />
immunodeficiency and multidrug resistant virus<br />
von Laer D. 1 , von Lunzen J. 2 , M87o study group<br />
1 Georg-Speyer-Haus, Frankfurt am Main, Germany,<br />
2 Universitätskrankenhaus Eppendorf, Infektiologie, Hamburg,<br />
Germany<br />
Aims: Drug toxicity and viral resistance limit long-term efficacy<br />
<strong>of</strong> antiviral drug treatment for HIV infection. Thus, alternative<br />
therapies need to be explored.<br />
Methods: Here, we tested the infusion <strong>of</strong> T lymphocytes<br />
transduced with a retroviral vector (M87o) that expresses an<br />
HIV entry inhibitory peptide (maC46). Gene-modified autologous<br />
T cells were infused into 10 HIV-infected patients with<br />
advanced disease and multidrug resistant virus during antiretroviral<br />
combination therapy.<br />
Results: T cell infusions were tolerated well with no severe<br />
side effects. A significant increase <strong>of</strong> CD4 counts was observed<br />
post infusion. At the end <strong>of</strong> the one-year follow-up, the<br />
CD4 counts <strong>of</strong> all patients were still around or above baseline.<br />
Gene-modified cells could be detected in peripheral blood,<br />
lymph nodes and bone marrow throughout the one-year fol-