European Journal of Medical Research - Deutsche AIDS ...

More documents

Recommendations

Info

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH 67 increase. However, factors such as tolerance, pill count and drug-resistance determine the use of AR-drugs. Determination and specification of (ART)-strategies in HIV treating centres between 1996 and 2006. Methods: Analysis of high-grade ART data from 21 ClinSurv centers. Daily R were generated using documented start and stop dates for each drug. Ongoing R were censored at the last known clinical event or the end of the observation period. The analysis is focused on the main class-regimens (MR) representing at least 1% of entire R-time. Results: The assessment of daily ART was based on 15.2 mill. S-days or 4.6 mill. R-days, respectively. Overall 3,757 patients have been treated with 30 S in six S-classes. The number of quarterly used S increased from 11 to 24 over time. 12 MR from the over-all 87 class-R were representing 83% of R-time. Mono-class NRTI-R had an over-all share of 9%, whereof 2- NUC-R held 46% of R-time in 1996 and lost rapidly impact. 3- NUC-combinations achieved in 2003 9% and decreased to 4% in 2006. All MR contained at least two NRTI except boosted double-PI-R having 3% in 2006. In the study period the use of DDI, DDC and D4T decreased from 43% to 6%, whereas the use of “new” NRTI as TDF and FTC increased by 23% in the last five years. The frequency of PI containing R decreased since 1998 from 60% to 27% in 2003 and currently increased up to 35%. The frequency of NNRTI containing R increased to a stable rate of 44% over the last six years. At the end of study 57% of boosted PI-R were based on LPV and 16% on ATV, whereas in 1999 IDV or SQV were the predominant S. Conclusions: ART-strategies documented in ClinSurv changed lasting. With the appearance of TDF and FTC “older” NUC lost a quarter of impact. Over the years PI-containing R were replaced by NNRTI-containing R. Since 2004 the influence of PI-R reincreased. The former were dominated at the end of the study period by boosted LPV. ClinSurv ART documentation offers a daily detailed contemporary image of antiretroviral treatment in Germany. B.38 (Poster) Prevalence and characteristics of HIV-2 infection in Germany Schwarze-Zander C. 1 , Skoetz N. 2 , Kupfer B. 3 , Stellbrink H.J. 4 , Schmidt R.E. 5 , Karwat M. 6 , Jäger H. 7 , Brockmeyer N.H. 8 , Rockstroh J.K. 1 , for the Competence Network for HIV/AIDS 1 University of Bonn, Department of Medicine I, Bonn, Germany, 2 Coordinating Centre for clinical trials, Cologne, Germany, 3 University of Bonn, Institute for Medical Microbiology, Immunology, and Parasitology, Bonn, Germany, 4 Private Practice, Hamburg, Germany, 5 Hannover Medical School, Dept. of Clinical Immmunology, Hannover, Germany, 6 Private Practice, Munich, Germany, 7 MUC Research, Munich, Germany, 8 Ruhr-University Bochum, Department of Dermatology, Bochum, Germany Background: While infection with HIV-2 is predominantly found in West Africa, HIV-2 infections are rare elsewhere. It is known that clinical course and clinical picture of HIV-1 and HIV-2 infection differ. Little is known about HIV-2 infection in Germany. Therefore we investigated prevalence and clinical characteristics of HIV-2 infection in Germany. Methods: Since 2002 13995 HIV positive patients have been enrolled in the Competence Network for HIV/AIDS. Clinical data (CD4 cell count, CDC stage) of these patients were collected every 6 months. Results: HIV-2 infection was detected in 29/13995 (0.2%) of HIV infected subjects. In these individuals no co-infection with HIV-1 was found. Interestingly, only 8/29 (28%) were of african origin. 85% of HIV-1 infected subjects were men, while only 65% of HIV-2 infected subjects were male. MSM was found as risk factor of HIV-2 transmission in 14/29 (48%). No difference in CD4 cell count was found between HIV-2 and HIV-1 infected patients (489.9 vs 498.9, respectively). Distribution of the clinical CDC stage in HIV-2 and HIV-1 was: A = 69% vs. 35%, B = 18% vs. 38%, C = 14% vs. 27%, respectively. Conclusions: HIV-2 infection is not common in Germany. Interestingly, risk of HIV-2 infection is not restricted to people from high prevalence countries. Despite comparable CD4 cell counts AIDS is less frequent in HIV-2 infection in cohort participants. B.39 (Poster) Reasons for hospital admission in HIV patients 5 and 10 years after the introduction of highly active antiretroviral therapy Blaas S. 1 , Salzberger B. 1 1 Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin I, Regensburg, Germany Objective: The introduction of HAART in 1996 has greatly influenced the clinical course and the outcome of patients infected with HIV. HAART has reduced hospital admissions in the first years. Whether the admission rate now is further declining is not clear. Therefore we analysed all hospital admissions during the years 2001 and 2006 from our in- and outpatient hospital cohort. Methods: All inpatient admissions of our department with a diagnosis including the term “HIV” or “AIDS” during the years 2001 and 2006 were retrieved through our electronic database. Baseline characteristics, reasons for hospital admission, diagnoses and outcome were analysed. Results: There was an increase from 22 to 39 hospital admissions of HIV patients from 2001 to 2006. HIV was newly diagnosed in 3 out of 19 in 2001 and in 9 out of 32 pts. in 2006. The majority of patients had advanced HIV disease. Only 3 out of 9 (2001) and 7 out of 11 (2006) patients receiving HAART had a viral load below 50 copies/ml. In only 4 out of 13 (2001) and 3 out of 21 (2006) patients not on HAART, antiretroviral therapy was not indicated, when restrictive criteria (CDC stage B/C or CD4 count < 200/�l) were applied. Nonadherence and newly diagnosed HIV-infection were the most common reasons for not taking HAART. Opportunistic infections were the most common cause of hospital admission. For both tuberculosis and pneumocystis jirovecii pneumonia there was an increase from 1 to 5 cases from 2001 to 2006. There were 4 cases of non-AIDS-defining malignant disease in 2006 but none in 2001. There were two cases of HAART related diarrhea and one immune reconstitution syndrome in 2006, but no hospital admission due to HAART side effects in 2001. In both years, two patients died in hospital. Conclusions: Opportunistic and other infections as well as direct manifestations of HIV are still the most common reasons for hospital admission 10 years after the introduction of HAART. Admitted patients had a low rate of virologic suppression in both periods. Nonadherence and previously unknown HIV infection were the most common causes for no or insufficient HAART. Additionally a rise in non-AIDS-defin-
68 EUROPEAN JOURNAL OF MEDICAL RESEARCH June 27, 2007 ing malignant disease was observed. These trends should be examined in a larger cohort. B.40 (Poster) Incidence of gastritis in patients presenting before and after 1996 and the role of ART. A retrospective analysis of the AVK cohort Traeder C.E. 1 , Kowol S. 1 , Masuhr A. 1 , Arastéh K. 1 , Kompetenznetz HIV/AIDS Deutschland 1 Vivantes Auguste-Viktoria-Klinikum Berlin, Infektiologie, Berlin, Germany HIV patients have been treated in the Vivantes Auguste-Viktoria-Klinikum (AVK) Berlin since 1985. The total number of episodes of treatment amounts to 15228 until the end of 2006, with 5368 different patients and a constant number of 750-850 patients/years. Gastritis is a constant problem in patients presenting with HIV infection. The reason for this is not clear and the role of HAART is discussed controversially. Methods: We compared the number of gastritis found in endoscopic examinations and correlated these results to the HIV therapy taken by the investigated patients. The analysis was done by a retrospective analysis of the electronic data base of the department of infectiology. Data were analysed for the years 1994- 1996 (853 gastroscopies) and the years 2004 – 2006 (1159 gastroscopies). Gastritis, which in this presentation is not being differentiated into gastritis a, b or c, was diagnosed endoscopically or histopathologically. Recurrent patients were counted. Results: 1994 – 1996: 853 gastroscopies, gastritis 327/38.3% (included 71 patients with CMV gastritis). These 327 patients could be divided in the group with NRTI (42, 12,8%) and the group without NRTI (285, 87,2%). None of the patients got PI or NNRTI, study medication not detected. 2004 – 2006: 1159 gastroscopies, gastritis 422/36.4% (included 36 patients with CMV gastritis). These 422 patients could be divided in the group of combination therapy with NNRTI or PI (249, 59.0%) and without combination therapy (173, 41.0%). ART in the years 2004 – 2006: 2764 stays, 1549 (56.0%) on HAART, 1215 (44.0%) without HAART. 1549 Patients on HAART divided in NNRTI group (459, 29.6 %) and PI group (1090, 70.4%). NNRTI versus PI combination and gastritis: total number of gastritis and HAART: 249, use of NNRTI 76, 30.5%, use of PI 161, 64.6 %, use of NNRTI and PI 12, 4.8%. Discussion: We did not observe an increase in gastritis since 1996. The percentage of 38% in the first period is comparable with 36% of the second period. The use of HAART in the second period is much higher (60% versus 12%) and reflects the availability of combination therapy. There is no difference between NNRTI or PI combination therapy (compared use of NNRTI or PI / all patients with use of NNRTI or PI / gastritis patients). B.41 (Vortrag) Die Primäre HIV-Infektion: Grundlagen, Diagnostik und Behandlung Jessen H. 1 1 Gemeinschaftspraxis Jessen/Jessen/Stein, Berlin, Germany Die Primäre HIV-Infektion (PHI) wird definiert als der Zeitraum zwischen dem Eintritt des Virus in die lokalen Zielzellen und dem Abschluss der Serokonversion. Es ist schwierig, dieses akute Stadium der HIV-Infektion zu erkennen – und dennoch ist eine frühe Diagnose von großer Bedeutung: Es gibt zunehmend Anzeichen dafür, dass eine während dieser Phase einsetzende Behandlung den Verlauf der Krankheit ändern und in virologischer, immunologischer und klinischer Hinsicht von Vorteil sein kann. Auch wenn uns nur wenige Ergebnisse von kontrollierten Studien zur Verfügung stehen, ist der potentielle Nutzen einer Behandlung von PHI doch dem bekannten Risiko von Nebenwirkungen bei Langzeitbehandlung und der Resistenzentwicklung gegenüberzustellen. Eine frühest mögliche Identifizierung eines Patienten mit PHI ist darüber hinaus wichtig, um eine deutlich einfachere Übertragung von HIV-1 in dieser Phase mit sehr hoher Virämie zu verhindern. B.42 (Vortrag) 6 year-outcome in 20 HIV-1 positive children treated with 2 nucleoside reverse transcriptase inhibitors + Nelfinavir as first line protease inhibitor Hien S. 1 , Buchholz B. 1 , Beichert M. 2 , Duerken M. 1 , Schaible T. 1 1 Universitätskinderklinik Mannheim, Mannheim, Germany, 2 Universitätsfrauenklinik Mannheim, Mannheim, Germany Purpose: Because only few data about long term outcome of HIV-1-infected children treated with Nelfinavir (NFV) as first line protease inhibitor (PI) exist, a retrospective analysis of antiviral activity and safety in these children was performed. Methods: 20 PI-naive children, who were treated with 2 nucleoside reverse transcriptase inhibitors (NRTI) + NFV between Oct 1997 – Jan 2007 were analysed. According to CDC-classification 7 children were classified as stage A1-2, 6 as B1-2, 3 as B3 and 4 as C3 at start of NFV. 10 had a HIV- 1 viral load (VL) 1Mio. copies/ml. All children received NFV as whole, halved or crushed tablets (dissolved in water) in a dosage of initially 3x 30mg/kg and after 1999 of 2x 60- 65mg/kg. Results: In the table the proportions of patients with HIV1- VL less than 400 copies/ml by on-treatment - versus intent-totreat analysis are shown (Table 1). Table 1
Page 1 and 2:
European Journal of Medical Researc
Page 3 and 4:
Instructions to Authors 1. The Euro
Page 6 and 7:
June 27, 2007 EUROPEAN JOURNAL OF M
Page 8 and 9:
Page 10 and 11:
Page 12 and 13:
Page 14 and 15:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25: June 27, 2007 EUROPEAN JOURNAL OF M
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
show all

European Journal of Medical Research - Deutsche AIDS ...

Create successful ePaper yourself

Delete template?

Save as template?