European Journal of Medical Research - Deutsche AIDS ...

72 EUROPEAN JOURNAL OF MEDICAL RESEARCH
June 27, 2007
tent, generally well-tolerated, QD protease inhibitor with a
relatively low rate of ALT/AST elevations similar to comparators.
Patients with co-infection from 4 ATV clinical development
studies were analyzed.
Methods: This post-hoc analysis of studies in ARV-naïve
(BMS 034, 089) and experienced (BMS 043, 045) patients using
ATV, with/without RTV, was performed to assess the rate
of ALT, AST, total bilirubin elevations and AEs in the presence
or absence of hepatitis co-infection.
Results: 866 subjects received ATV-based regimens (214
ATV/r; 652 ATV) for a median of 48 to 95 weeks (1100 subject-years
of treatment exposure). 134 (15%) had baseline
HBV and/or HCV co-infection (Table 1).
Grade 3-4 total bilirubin elevation rates were comparable in
subjects with/without co-infection. Subjects who received
ATV/r or ATV, with/without co-infection, had similar rates of
Grade 2-4 treatment-related AEs (including jaundice and scleral
icterus) and liver-related AEs.
Conclusions: Similar to other ARVs, patients with HBV
and/or HCV co-infection had a higher rate of G3/4 ALT/AST
elevations. In contrast, G3/4 bilirubin elevations, overall AEs
and liver-related AEs, had a comparable frequency in patients
with/without co-infection, suggesting that ATV and ATV/r
are safe treatment alternatives in this population.
C.7 (Poster)
Ocular syphilis prefers different anatomical
structures in HIV–negative and -positive patients
Kunkel J. 1 , Schürmann D. 2 , Kneifel C. 3 , Zeitz M. 1 ,
Pleyer U. 4 , Krause L. 3 , Schneider T. 1
1 Charité Campus Benjamin Franklin, Med. Klinik I,
Gastroenterologie, Infektiologie, Rheumatologie, Berlin,
Germany, 2 Charité Campus Virchow Klinikum, Med. Klinik
m. S. Infektiologie, Berlin, Germany, 3 Charité Campus
Benjamin Franklin, Klinik für Augenheilkunde, Berlin,
Germany, 4 Charité Campus Virchow Klinikum, Klinik für
Augenheilkunde, Berlin, Germany
Objective: To evaluate differences in ocular syphilis between
HIV-negative and –positive patients.
Table 1 (C.7).
Table 1 (C.6).
Methods: All patients with ocular syphilis treated in our institutions
at the Charite between 1998 and 2006 were reviewed.
The diagnosis of ocular syphilis was made on the
criteria:
(1)inflammatory or noninflammatory ocular disease;
(2)serological evidence for syphilis with a positive Treponema
pallidum particle agglutination (TPPA) titer and fluorescent
treponemal antibody absorption test (FTA-Abs) result
or positive venereal disease research laboratory
(VDRL) titer;
(3)improvement following antimicrobial therapy. Major
opthalmological finding, patients´ characteristics, laboratory
features including HIV status, CSF examination and
data on treatment were collected.
Results: We identified 22 cases (37 eyes) of ocular syphilis
nine of which were HIV-positive. One patient´s HIV status
remained unknown because testing was refused, the patient
(1 eye) was therefore excluded from the study. The mean
case load was 2,75 cases/year. Presenting complaints were
generally similar, comprising loss of vision, foggy vision,
feeling of pressure and ocular pain (data not shown). 8 of 12
HIV-negative patients (67%) and 7 of 9 HIV-positive patients
(78%) had a bilateral manifestation. Optic neuritis was
most common in HIV-negative patients (6 of 12 patients/ 9 of
20 eyes), panuveitis was most common in HIV-positive patients
(4 of 9 patients/ 8 of 16 eyes). For six patients the ocular
symptoms led to the diagnosis of a previously undetected
HIV-infection. Age, CRP, TPPA and VDRL titers, CSF-cells
and -VDRL titers and intrathecal Treponema pallidum antibody
index (ITPA) were not different in the two groups. 13
of 21 patients had skin or mucosa alterations like palmoplantar
exanthema or enoral ulcerations (9 of 12 HIV-negative
and 4 of 9 HIV-positive). After treatment with iv betalactame
antibiotics for at least 10 days all patients improved except
one patient who had concommitant vitreous opacity not connected
to syphilis infection (Table 1).
Conclusions: Ocular syphilis prefers optic nerve in HIV-negative
patients and uvea in HIV-positive patients. It should be
considered in any patient with unclear ocular lesions and
screening for HIV-coinfection is essential.