European Journal of Medical Research - Deutsche AIDS ...

106 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
Kaever, V. (2005) Quantification of antiretroviral drugs in dried
blood spot samples by means of liquid chromatography/tandem
mass spectrometry. Rapid Commun. Mass Spectrom. 19, 2995–
3001
D.68 (Vortrag)
Antiretroviral therapy of patients infected with
drug-resistant HIV-strains: Analysis of the
composition of the first-line regimen in patients
with a documented date of HIV-infection in
Germany
Poggensee G. 1 , Kücherer C. 2 , Werning J. 1 , Bartmeyer B. 1 ,
Fleischhauer C. 1 , Braun P. 3 , Cordes C. 4 , Jessen H. 4 ,
Klausen G. 4 , Schewe K. 5 , Stoll M. 6 , vanLunzen J. 7 ,
Hamouda O. 8
1 Robert Koch-Institute, Department of Infectious Disease and
Epidemiology, Berlin, Germany, 2 Robert Koch-Institute, HIV-
Variability and Molecular Epidemiology, Berlin, Germany,
3 private practitioner, Aachen, Germany, 4 private practitioner,
Berlin, Germany, 5 private practitioner, Hamburg, Germany,
6 Hannover Medical School, Internal Medicine, Hannover,
Germany, 7 University Clinic Hamburg Eppendorf, Hamburg,
Germany, 8 Robert Koch-Institute, Department of Infectious
Disease and Epidemiology and the German Seroconverter
Study Group, Berlin, Germany
Objectives: Studies of the first-line regimen in patients with
transmitted drug resistance are limited. Aim of this study was
to investigate the influence of genotypic resistance test results
on the choice of first-line treatment in patients with a documented
date of HIV-infection with transmitted drug-resistance.
Methods: Genotypic resistance testing was performed in all
drug-naïve patients of the HIV-seroconverter cohort. Data acquisition
took place between 1998 and 2005.
Start of antiretroviral therapy and drug composition of firstline
treatment were assessed. Proportions were given with interquartile
ranges. Mantel-Haenzels X2test and Fisher’s exact
test were used. Viral loads and CD4 counts were compared by
the Kruskall-Wallis test. p-values were two sided and p-values
of < 0.05 were considered significant.
Results: Of 922 tested patients drug resistant HIV was identified
in 130 patients. Susceptible strains were found in 792
individuals. Any NRTI resistant HIV was found in 25 individuals
(25/35). NRTI resistance alone was detected in 21
patients (21/35). Combinations of NRTI with PI and/or
NNRTI resistance were found in 4 patients (4/25). PI or
NNRTI resistance alone was assessed in 5 (5/35) and 4
(4/35) patients, respectively. The remaining 5 patients
showed different combinations of multi-drug resistance.
Antiretroviral therapy was prescribed for 35 patients (35/130)
with predicted drug resistant HIV. Treatment regimen of
25 patients (25/35) included at least one inactive drug. One
inactive drug was included in the regimen of 17 individuals.
The regimen of 5 patients comprised 2 inactive drugs. In 3
patients no active drug was included in the first-line regimen.
The majority of mutations conferred AZT-resistance
(11/35). Since 2002 72% of first-line treatments included
AZT (p=0.011). Since 2003 no PI or NNRTI were included
in first-line treatments of patients with predicted PI/NNRTI
resistance. AZT was not included in the regimen of three
patients who were infected with highly AZT-resistant
HIV. CD4-cell counts and viral load did not differ
between individuals treated with or without compromised
drugs.
Conclusions: More recently a trend to omit compromised PI
and NNRTI drugs appeared.
Supported by BMG, BMBF/Competence Network HIV/AIDS
D.69 (Poster)
Ritonavir-boosted fosamprenavir dramatically
increased tacrolimus drug concentrations in an
HIV/HCV-infected patient with liver
transplantation
Schulbin H. 1 , Masuhr A. 1 , Stocker H. 1 , Müller M. 1 ,
Broelsch C. 2 , Beckebaum S. 2 , Cicinnati V. 2 , Arasteh K. 1
1 Vivantes Auguste-Viktoria Klinikum, Berlin, Germany,
2 Universitätsklinikum Essen, Essen, Germany
Introduction: Drug drug interactions with ritonavir-boosted
protease inhibitors (PI) are increasingly troublesome, as HIVinfected
patients require treatment for other conditions than
HIV.
Methods: We describe the case of an HIV/HCV co-infected
patient who initiated the immunosuppressant tacrolimus following
liver transplantation.
Results: The 36 year old male with HIV/HCV-coinfection
underwent liver transplantation in December 2005 for chronic
liver failure. Along with his stable antiretroviral therapy consisting
of fosamprenavir/ritonavir 700/100 mg, twice daily
and coformulated tenofovir/emtricitabine he was started on
tacrolimus 5 mg, twice daily. 5 Days after the start of this
treatment the serum tacrolimus concentration was 65,4
ng/mL, which is more than six times the desired value of 10
ng/ml. Only after the dosage was reduced to 0,25 mg q 3 days
stable drug trough concentrations within the required concentration
range could be achieved. Serum amprenavir concentrations
were also monitored but were within the normal range as
compared to historical controls.
Conclusions: Enhanced tacrolimus exposure in patients receiving
coformulated lopinavir ritonavir has been described
before. However, no prospective controlled pharmacokinetic
studies have been performed. This is the first report on an interaction
between ritonavir-boosted fosamprenavir and
tacrolimus. As the numbers of HIV-infected patients with solid
organ transplantation will rise clinicians must be increasingly
aware of potential drug interactions with PI and immunosuppressants
such as tacrolimus.
D.70 (Poster)
Low dose Prednisolone helps to delay HAART
initiation
Ulmer A. 1 , Müller M. 1 , Stützer H. 2 , Frietsch B. 1
1 Praxis Ulmer Frietsch Müller, Stuttgart, Germany,
2 University of Cologne, IMSIE - Institute of Medical
Statistics, Köln, Germany
Objective: HAART is the best and almost the only established
treatment option for HIV infected individuals. But it is
expensive and complicated, leading to limited access in developing
countries with dramatic consequences, connected with
side effects and potential resistances. An important issue is to
find additional or alternative therapeutic options and to increase
the independence of HAART. The study groups of Andrieu
and ourselves have already published a CD4-stabilizing
effect of Prednisolone. The number of patients and the time of