European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
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following a list of resistance associated mutations proposed
by Bennet et al. (13th CROI; 2006). This algorithm classifies
mutations as resistance relevant, which meet the following
criteria: Mutations should be associated with HIV drug resistance
and selected by ART, non-polymorph and applicable
to all subtypes. Results of both methods were compared.
Non-B subtypes were additionally analysed with NCBI subtype
tool.
Results: The following subtypes were determined: B (212;
80%), A (6; 2.3%), D (12; 4.5%), C (4; 1.5%), G (2; 0.8%), K
(1; 0.4%), CRF02_AG (10; 3.8%), CRF01_AE (10; 3.8%),
CRF05_DF (2; 0.8%), CRF06_CPX (2; 0.8%), CRF08 (1;
0.4%), PR:F/RT:B (2; 0.8%) and 14BG (1; 0.4%)(Table1).
Conclusion: In this study the prevalence of primary resistance
in Germany is 10.2% (Stanford) or 8.7% (Bennett). The
results of the two different algorithms differ slightly, due to
the fact that Stanford db regards other additional secondary
mutations and thus found more isolates with PI mutations
than Bennett. Most resistance mutations were found against
NRTIs and least against PIs. 2% of all patients have resistance
mutations against more than one drug-class. The analysis of
HIV-Subtype becomes more important in Germany, since
every fifth patient is infected with HIV non-B subtype.
A.4 (Poster)
Establishing large-scale cohorts in Africa to
prepare for HIV vaccine efficacy trials
Price M. 1 , Kamali A. 2 , Karita E. 3 , Anzala O. 4 ,
Mwangome M. 5 , Sanders E. 6 , Bekker L. 7 , Gilmour J. 8 ,
Fast P. 8 , Amornkul P. 9 , Stevens G. 8 , Imambao M. 10 ,
Kenkewa W. 10 , Middlekoop K. 7 , Ruzagira E. 2 ,
Kayitenkore K. 11 , Vwalika C. 10 , Lakhi S. 10 , Mutua G. 4 ,
Byabagambi J. 2 , Kebba A. 2
1 International Aids Vaccine Initiative, R&D, San Mateo,
United States of America, 2 Med Res Council/Uganda Virus
Res Inst, Masaka and Entebbe, Entebbe, Uganda, 3 Rwanda
Zambia HIV Res Group, Kigali and Lusaka, Lusaka, Zambia,
4 Kenya Aids Vaccine Initiative, Nairobi, Kenya, 5 Kenya
Medical Research Institute, Kifili, Kenya, 6 Oxford University,
Oxford, United Kingdom, 7 Univ of Cape Town, Desmond
Tutu HIV Ctr, Cape Town, South Africa, 8 International Aids
Vaccine Initiative, New York, United States of America,
9 International Aids Vaccine Initiative, Nairobi, Kenya,
10 Rwanda Zambia HIV Res Group, Kigali and Lusaka, Kigali,
Rwanda, 11 Rwanda Zambia HIV Res Group, Kigali and
Lusaka, Kifili, Rwanda
Objectives: To develop cohorts and collect data on HIV-related
risk behaviors, HIV incidence, cohort recruitment and
retention for future HIV vaccine efficacy trials.
Methods: Since 2004, eight sites in east and southern Africa
have developed clinical, laboratory, and counseling capacity
to prepare for large-scale HIV vaccine trials in collaboration
with IAVI. After providing informed consent, adult, HIV-negative
potential trial volunteers are recruited, receive HIV voluntary
counseling and testing, and are followed quarterly. Demographic
and risk behavior data are collected through structured
questionnaires; specimens are collected for HIV-testing.
Table1. 4 two-class resistances and 1
triple-class resistance were found.
Volunteers who become HIV-infected are followed to collect
viral and immunopathogenesis information on early HIV infection.
All sites operate according to good clinical and laboratory
practices.
Results: As of January 2007, 5,615 at-risk volunteers are enrolled:
2,783 (50%) HIV-discordant couples, 1184 (21%) rural
residents in high HIV-prevalence area, 178 (3%) men who
have sex with men (MSM), and 1,196 (21%) other at-risk participants.
With over 8,500 person-years of observation (PY),
HIV incidence in sites with more than 100 PY ranged from
1.0 to 11.3 cases/100 PY. Despite shorter duration of followup,
MSM have the highest incidence, 8.2 cases/100PY. Over
160 volunteers with a documented duration of HIV-infection
of less than 385 days are being followed.
Conclusions: Eight sites in sub-Saharan Africa have successfully
engendered research facilities capable of recruiting thousands
of potential volunteers for vaccine clinical trials. The
lessons learned from this work will guide the development of
upcoming efficacy trials.
A.5 (Vortrag)
Entwicklung von Morbidität und Mortalität in der
Frankfurter Kohorte
Stephan C. 1 , Khaykin P. 1 , Staszewski S. 1 , Klauke S. 2 ,
Gute P. 3 , Helm E.B. 1
1 HIVCENTER, Klinikum der Johann Wolfgang Goethe-
Universität, Frankfurt, Germany, 2 IFS Praxis Stresemannallee,
Frankfurt, Germany, 3 HIV Schwerpunkt-Praxis
Friedensstrasse, Frankfurt, Germany
Ziel: Identifikation von Trends in der HIV-Epidemiologie anhand
einer Kohorte.
Methodik: Analyse von Morbiditätsfaktoren und Mortalität
bei 9000 HIV-infizierten Patienten der Frankfurter Kohorte ab
1982.
Ergebnis: Bis Ende des Jahres 2006 waren im untersuchten
Kollektiv rund 2900 Patienten an AIDS erkrankt. Insgesamt
sind bis Ende 2006 ca. 1900 gestorben, 320 vor Erreichen des
Stadiums AIDS. Seit 1996 wird ein kontinuierlicher Rückgang
der AIDS-Inzidenz in der Kohortenpopulation beobachtet.
Der Anteil der Frauen beträgt in den letzten Jahren nahezu
unverändert 20-25%. Die Zahl der Erstvorstellung i.v.-Drogenabhängiger
Patienten hat seit dem Jahr 2000 deutlich
abgenommen, nicht aber der Anteil an den AIDS-Patienten
des Gesamtkollektivs. Der Anteil der Migranten aus Endemiegebieten
an den HIV-Infizierten hat seit Mitte der
1990er Jahre zugenommen, heute hat jeder vierte Patient der
Frankfurter Kohorte einen Migrationshintergrund. Unter den
AIDS-definierenden Erkrankungen sind klassische Diagnosen
wie PCP und Kaposi-Sarkom seltener geworden, während
maligne Lymphome und Tuberkulose zunehmen. Unter den
Todesursachen sind die AIDS-definierenden Erkrankungen
seltener; zunehmend werden kardiovaskuläre und onkologische
Erkrankungen beobachtet; dem zahlenmäßigen Rückgang
der i.v.-Drogenabhängigen unter den AIDS-Patienten folgend,
nimmt auch die Todesursache Leberzirrhose in den letzten
beiden Jahren wieder ab.