European Journal of Medical Research - Deutsche AIDS ...

June 27, 2007 EUROPEAN JOURNAL OF MEDICAL RESEARCH
85
D.16 (Vortrag)
Changes over time in risk of initial virological
failure of antiviral therapy in Austria
Sturm G. 1 , Sarcletti M. 2 , Geit M. 3 , Rieger A. 4 ,
Schmied B. 5 , Zangerle R. 2
1 Österr. HIV-Kohortenstudie, Innsbruck, Austria,
2 Medizinische Universität Innsbruck, Innsbruck, Austria,
3 AKH Linz, Linz, Austria, 4 Medizinische Universität Wien,
Wien, Austria, 5 OWS Wien, Wien, Austria
Aim of the study: Triple-combination antiviral therapy for
HIV infection has been in use for a decade, but the extent to
which treatment success has changed is uncertain. We examined
risk of initial virological failure of antiviral therapy according
to the year of starting therapy.
Method: We included subjects from 5 HIV treatment centres in
Austria who started combination antiviral therapy from 1996 to
2004. Based on the first viral load measurement from 9 to 15
months after combination antiviral therapy initiation, virological
failure was defined as a viral load of more than 400
copies/mL. We used the following 2 inclusion strategies: (1) including
all subjects, with missing VL measurement counted as
virological failure (n = 1959; strategy A); (2) including all subjects
with VL measurement (n = 1462; strategy B);
Results: From 1996 to 2002, risk of virological failure fell
from 69.2% to 31.7% for strategy A, 41.5% to 13.8% for strategy
B. Missing viral load measurement one year after initial
therapy decreased only to a small amount (27,8% and 17,9%
for the years 1996 and 2004, respectively).
Conclusions: Over a 9-year period of combination antiviral
therapy use in clinical practice, risk of initial virological failure
of treatment has decreased. These data suggest the trend is
due to improvements in combination antiviral therapy regimens
and greater effectiveness of their use. However, the rate
of patients without viral load measurement one year after initial
therapy is still unacceptably high.
D.17 (Poster)
Incidence of clinically significant renal events
among patients treated with Tenofovir (TDF) in
comparison to patients who never received TDF as
part of their ART. Results of an observational
cohort study
Schewe K. 1 , Fenske S. 2 , Weitner L. 1 , Adam A. 1 , Buhk T. 2 ,
Stellbrink H.J. 2
1 Infektionsmedizinisches Centrum Hamburg, St. Georg,
Hamburg, Germany, 2 Infektionsmedizinisches Centrum
Hamburg, Grindelpraxis, Hamburg, Germany
Objective: TDF is a highly potent NRTI used for the treatment
of HIV-infected patients. Renal toxicity may occur with
TDF use; however reported toxicity rates and severity vary
across studies. We performed a retrospective analysis of our
patient cohort to evaluate incidence of clinically significant
renal toxicity in clinical practice and underlying risk factors
Methods: Clinical and laboratory data from 1992 until Dec.
1st, 2006 are included in this analysis. Identification of patients
(pts) reaching a composite endpoint of either �
0,5mg/dl increase of serum creatinine (SCr) on a single occasion
on treatment with TDF or pts who discontinued TDF due
to renal events by screening of the data base. Comparison to
HIV-treated pts who never received TDF.
Results: Data of 1191 HIV-infected pts were analysed. Of
926 pts (69%)receiving antiretroviral therapy (ART), 492 pts
(60%) had received TDF for a mean duration of 27.4 months
(1125 patient-years (pt-yrs)), while 434 pts (40%) had never
received TDF (mean observation: 51.4 months; 1871 pt-yrs).
Pts on TDF were older (mean 46.1 vs. 43.8 yrs), had longer
duration of ART (mean 8.36 vs. 4.63 yrs), lower CD4 nadir
(207/ul vs. 302/ul) and lower current CD4 count (517/ul vs.
559/ul) than non-TDF pts.
18/492 TDF-pts experienced a 0.5 mg increase of SCr
above baseline (BL) (incidence 1.8 /100 pt-yrs) compared to
21/434 pts in the non-TDF group (incidence: 1.1/100 pt-yrs).
9 pts discontinued TDF due to renal toxicity after a median of
9 months resulting in a partial (n=5) or complete (n=4) return
of SCr to pre-TDF levels. 21 of the TDF treated patients met
the prespecified composite endpoint (incidence: 1.9 per 100
pt-yrs).11 pts continued TDF despite elevated SCr; SCr returned
to BL in 3 pts, remained elevated in 6 pts and further
increased in 2 pts. In 6/18 pts with rising SCr glucosuria was
present, proteinuria in 12/18 pts, low phosphate in 5/16 pts.
Additional risk factors were present in 16/21(76%) TDF-patients
with renal toxicity.
Conclusion: In our cohort, the incidence of clinically significant
renal toxicity was 1.9% in TDF-pts versus 1.1% in non-
TDF pts. This difference may be mainly explained by additional
renal risk factors like difference in age, duration of
HAART and lower CD4 count in the TDF group
D.18 (Poster)
HIV-positive Schwangere – muß die Sectio
wirklich immer sein?
Kästner R. 1 , Sovric M. 2 , Müller M. 1 ,
Sonnenberg-Schwan U. 3 , Gingelmaier A. 4
1 Universitätsfrauenklinik München, Psychosomatik, München,
Germany, 2 Universitätsfrauenklinik München, Geburtshilfe,
München, Germany, 3 All Around Women Special, DAIG e.V.,
München, Germany, 4 Universitätsfrauenklinik München,
Infektiologie, München, Germany
Fragestellung: Warum erhalten in Deutschland HIV-positive
Schwangere fast ausnahmslos eine Sectio?
Methodik: Psychosomatischer Ansatz, um die Leitlinien unterschiedlicher
Länder hinsichtlich ihrer Entstehung und Umsetzung
zu hinterfragen, Literaturrecherche und persönliche
Kommunikation mit Behandlern und Betroffenen in verschiedenen
Ländern
Ergebnisse: Zwischen 1999 und 2003 wurden in Deutschland
mehr als 600 HIV-positive Schwangere in spezialisierten Zentren
betreut und in 98,4% per Sectio entbunden. Demgegenüber
entbinden in benachbarten europäischen Ländern und
in den USA ca. 20 – 30 % bei Vorliegen optimaler Voraussetzungen
vaginal, ohne eine höhere Rate an vertikalen Trans-