European Journal of Medical Research - Deutsche AIDS ...

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June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 65 B.32 (Vortrag) Clinical correlates and consequences of discordant immuno-/virological response in patients initiating HAART at severe immunodeficiency Kreuzberg C. 1 , Lüchters G. 2 , Hertling S. 3 , Degen O. 3 , van Lunzen J. 3 1 Universitätsklinikum Hamburg Eppendorf, Medizinische Klinik I/Ambulanzzentrum Infektiologie, Hamburg, Germany, 2 Universität Bonn, Bonn, Germany, 3Universitätsklinikum Hamburg Eppendorf, Ambulanzzentrum Infektiologie, Hamburg, Germany Background: Discordant immuno-/virological response has been described in HIV infected patients following initiation of HAART. However, the clinical consequences of such discordant response remain to be elucidated especially in patients starting HAART in advanced stages of immunodeficiency. Methods: A cohort of 39 HAART naive patients with severe immunodeficiency (CD4 counts before start of HAART < 100 cells/�l) but adequate antiviral treatment response (sustained virological suppression 200 cells/�l on two subsequent occasions) after 1 and 2 years of HAART versus those with discordant response (suppressed viral load but no rise in CD4 > 200 cells/�l). Results: At initiation of HAART 30/39 (76,9%) of the patients had at least one AIDS defining diagnosis. One third of the patients (12/39) developed a rise in CD4 count to > 200 cells/�l in the first year of therapy. There was no difference in mean initial CD4 counts and viral load (49 versus 28 CD4 cells/�l and 5,5 versus 5,6 log HIV RNA copies/ml) in patients with or without immunreconstitution after year one. Five patients (12,8%) experienced at least one AIDS defining event during the first year of HAART, 4(80 %) of the events occurred in the discordant group. The overall incidence rate was higher (5/148 versus 1/71,5 person years) in this group. In the second year of HAART 26 (66,7%) reached CD4 counts above 200 cells/�l. Again mean CD4 counts and viral loads at initiation of HAART (39 versus 25; 5,6 versus 5,2log) did not differ clinically significantly. Interestingly the overall incidence of AIDS defining events in long-term discordant patients was even lower (0/ 72,5 versus 6/146 person years). Conclusion: Severely immunocompromised patients with discordant immuno-/virological response are at special risk to develop disease progression in the first year after initiating HAART but not thereafter. Long term inadequate rise in CD4 count does not seem to have clinical relevance in patients with sustained viral suppression. B.33 (Poster) CD4 cell count at initiation of HAART over time - An approach by using German ClinSurv multicenter cohort data Kollan C. 1 , Kühne A.1, Hamouda O. 1 , for the ClinSurv Study Group 1 Robert Koch Institut, Infektionsepidemiologie, Berlin, Germany Objectives: Since introducing HAART the “philosophy” when to initiate therapy changed several times. The “hit early” era was followed by the paradigm to start late which meant at CD4 levels £200. The optimal time point to begin ART is still uncertain. This study aims to highlight the actual clinical reality in Germany in the past 10 years. Comparsion of CD4-counts at ART onset in 21 HIV treatment centres between 1997 and 2006. Methods: Analysis of CD4 counts at start of first-line ART by period of clinical observation. CD4 values closest to startdate were chosen in a range of 30 days before and 10 days after initial treatment. Patients where stratified into: (a) having been observed >45 days before ART and (b) £45 days of observation. CD4 counts were compared by the Kruskall-Wallis test. Results: 1.552 patients were eligible, 578 for (a) and 974 for (b). The trend over time of median CD4 counts for both groups show a parallel course with a peak in the year 1998, 438 and 224 for (a) and (b) and a minimum in 2000, 93 and 221 for (a) and (b) respectively. The overall median is 171 and group medians are 252 (a) and 105 (b) (p
66 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 tained and min 3 NRTI were chosen for next treatment cycle according to the results. We compared CD4+ T-cell count and VL developing in each cycle with BL values. Results: We included 30 pt (1/30 female; 29/30 male). 12/30 were excluded for various reasons: new treatment options, protocol violation etc.. 17 patients completed week 48 and were analyzed. Mean CD4-T-cellcount was 160/�l (R: 10- 580/�l), mean VL was 4,99 log (R: 2,4 – 5,88 log) at BL. The time-on-NRTI/PI-cycle- ratio was 1,84. Due to permissive VL elevation we could see a mean VL reduction in each cycle: C1: -0,64 log (R: + 1,71 to – 4,18log), C2: -0,51log (R: +0,74 to – 1,72log), C3:-0,64log (R:+0,67 to -1,69log), C4: -0,78log (R:+ 0,42 to -2,67log), C5: -0,82log (R: +0,01 to -3.04log) compared to the VL at the end of the prior cycle. Conclusion: We could see a significant decline within each cycle attributed to a rest activity of the drug combinations. In 8/17 patients we could see a mild to moderate increase of CD4 T-cell within the cycles. Therefore we consider this strategy as a further option in the mosaic of deep salvage therapy. B.35 (Poster) Frequency and reasons for ARV switch in heavily pretreated patients in a 24 months observation period. Results of the Radata-cohort Lorenzen T. 1 , Staszewski S. 2 , Faetkenheuer G. 3 , Bogner J.R. 4 , van Lunzen J. 5 , Mutz A. 6 , Gute P. 7 , Arbter P. 8 , Bähr D. 1 , Stoehr A. 1 , Hoffmann C. 1 , Plettenberg A. 1 , for the Radata-studygroup 1 ifi-Institut für interdisziplinäre Medizin, Hamburg, Germany, 2 Universität Frankfurt, HIV-Center, Frankfurt, Germany, 3 Klinikum der Universität zu Köln, Klinik I für Innere Medizin, Köln, Germany, 4 Medizinische Poliklinik, Klinikum der Universität München Innenstadt, Infektionsambulanz, München, Germany, 5 Universitätsklinikum Hamburg- Eppendorf, Ambulanzzentrum Infektiologie, Hamburg, Germany, 6 Klinikum Osnabrück, Infektionsambulanz, Osnabrück, Germany, 7HIV-Schwerpunktpraxis, Frankfurt, Germany, 8 Praxis für Allgemeinmedizin, Krefeld, Germany Objective: Radata is an internet-based system which provides planning of antiretroviral therapy (ART), according to resistance analysis, adherence questionnaire, therapeutic drug monitoring and external expert advice. Methods: Of 637 patients included in the radata database, 224 patients with a follow up of at least 24 months were selected and were analysed according to frequency and reasons for switches of ART. All patients were put on a new ART at the time of enrolment. Results: Within the 24 months period of follow-up, 317 ART switches in 146/224 patients (1.4 switches per patient, range 0-7) were observed. The main reason for switch was therapeutical failure (n = 180, 50.4 %). Within this subgroup, elevated viral load was the main reason in 117, CD4-T-cell decline in 17 and clinical progression in 7 cases. For 39 cases, the detailed reason for switch due to therapeutical failure was not stated by treating physician. Besides therapeutical failure, switches due to drug related side effects were noted in 75 cases (21.0 %). In 27 cases (7.6 %) simplification of regimen was the primary reason for therapeutic change, 25 cases (7.0 %) were switched due to inadequate adherence of patients and for 13 cases (3.6 %) study related conditions (protocol requirement) were responsible. In 12 cases (3.4 %), comorbidities such as acute illnesses or newly diagnosed gravidity led to the switch. In 6 cases (1.7 %) physicians assumed unfavourable drug interactions. In 19 cases (5.3 %) physicians did not state a specific reason for change of therapy. Conclusions: Despite intensive pre-treatment of the patients, only half of the therapy switches over a period of 24 months in this cohort were due to therapeutic failure. Other predominant reasons were side effects, treatment simplification and inadequate patient adherence. B.36 (Vortrag) Sexually transmitted infections in men having sex with men with primary HIV infection Lenz J.C.C. 1 , Jessen H. 1 , Jessen A.B. 1 1 Praxis Jessen/Jessen/Stein, Berlin, Germany Objective: In the very early stage of HIV infection high levels of HI virus are measured. Also at this stage individuals with HIV are often not aware of their infection. Both may contribute to the high proportions of HIV transmission in this phase. Sexually transmitted infections (STI) are known to increase both the risk to acquire HIV as well as to transmit HIV to sex partners. Co-infections of HIV and STI in patients with primary HIV infection (PHI) may represent an individual risk factor that facilitated acquiring the new HIV infection as well as a risk factor to transmit HIV to other sex partners. In this study we want identify the rate of STI in patients with primary HIV infection. Methods: We performed a retrospective analysis of all men having sex with men (MSM) with PHI in the years 2005 and 2006 in the database of a single center (Praxis Jessen, Berlin) an HIV and STI practice. PHI was defined as presence of HIV (measured by PCR) and three or less HIV specific bands in the western blot. For these patients the charts were reviewed for clinical signs and laboratory test (Syphilis, Gonorrhea, Chlamydia, Hepatitis B and C) results indicative of symptomatic STI. Results: We identified 22 individuals with PHI. In 4 (18%) active infection with syphilis, chlamydia or gonorrhea was found. In two other possibly sexually transmitted diseases were present (campylobacter, unspecific urethritis). Over all 1/3 of the patients with PHI had infections that are possibly sexually transmitted. Conclusions: The presence of STI in about 1/3 of patients with PHI in this center may represent an individual risk that led to the HIV infection. It may also indicate that HIV and STI have been acquired at the same time. This finding leads us to conclude that screening for STI should be performed in PHI. The identification and subsequent treatment of STI will not only prevent negative consequences of STI, but also may help to reduce the additional risk for onward transmission of HIV caused by an active STI. B.37 (Poster) Antiretroviral (AR) treatment (ART) in the German ClinSurv multicenter cohort - An overview of HAART in Germany over the last ten years Kollan C. 1 , Kühne A. 1 , Hamouda O. 1 , for the ClinSurv Study Group 1 Robert Koch Institut, Infektionsepidemiologie, Berlin, Germany Objective: With the available number of different AR-substances (S) the number of drugs (ARV) and AR-regimen (R)
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