Suchergebnisse

In recent years, an increase in acute hepatitis C (HCV) infection has been observed in human immuno‐deficiency virus (HIV)‐positive men who have sex with men (MSM). Since sexual transmission of hepatitis C does not play as significant a role in other populations, there is much speculation surrounding its transmission in HIV‐infected MSM. While injection‐drug use appears to play only a minor role, other drug use and specific sexual practices are frequently reported. The purpose of this observational study was to investigate for a correlation with other sexually transmitted diseases (STDs). Data on 133 HIV‐positive MSM with documented acute HCV infection were included in the analysis. We investigated for new or recurrent infections with Chlamydia trachomatis, Neisseria gonorrhea (direct detection of the pathogen) and Treponema pallidum (serological examination) within a time frame of 24 weeks prior to or after the acute HCV infection. The control group consisted of 1034 HIV‐positive MSM without HCV infection with a follow‐up of one year. HIV‐infected MSM with acute HCV had a higher rate of syphilis infection when compared to HIV‐positive HCV‐negative controls (73% vs. 43%). 31% of patients in the HCV group acquired a new (seroconversion) or recurrent syphilis infection (significant titre increase using the Treponema pallidum particle agglutination test=TPPA) compared to 12% of controls (p<0.05). Further, 12 cases of Neisseria gonorrhea and 6 cases of Chlamydia trachomatis infection were observed in the HCV group. Due to the lack of routine screening for these infections in the control group, a comparison could not be made. Conclusions: We report a higher prevalence of other sexually transmitted diseases in HIV‐infected MSM within 24 weeks before or after acute HCV infection. This observation however does not prove a pathophysiological connection between acute hepatitis C and other STDs. The high frequency of syphilis infections primarily affecting the ano‐genital region suggests a possible correlation.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Purpose of the studyHIV‐1‐infected patients have elevated levels of immune activation and systemic inflammatory markers which are partially strong predictors of disease progression or are associated with increased cardiovascular risk. The dependency of anti‐retroviral treatment (ART), the usage of NNRTI or PI‐based and the application of non‐nuc regimens is analysed here on the basis of a dataset (Chronic Inflammation Dependency on TREatment: CIDRE cohort) from 1500 patients in Berlin.MethodsIn a retrospective analysis we compared relative CD4+ cell counts, viral load, relative CD8+CD38+DR‐and CD3+DR+cells, concentration of high‐sensitivity C‐reactive protein (hsCRP) and interleukin‐6 (IL‐6) in therapy‐naïve or treated patients dependent on usage or non‐usage of NUCs, PI or NNRTI. Statistics were performed with R (R Core Team; 2012; R: A language and environment for statistical computing) using Wilcoxon rank sum test in two‐sided analysis.Summary of resultsAs to expect, ART‐naïve patients (n=190) had significantly higher viral loads and lower CD4+cell counts (p: both<0.05) and showed higher activation levels than treated patient (CD8+CD38+DR‐ and CD3+DR+both<0.05). But no significant difference was calculated for hsCRP or IL‐6. Nuc‐sparing regimen (n=46) did not show any distinction compared to nuc‐containing therapies (n=1249) for the analysed parameters. Significant differences were detected for PI‐regimen (n=711) with lower CD4+ cell counts and higher activation (CD8+38+DR‐, CD3+DR+) and IL‐6 (p: all<0.05) but not for hsCRP (p=0.39). The opposite was true for NNRTI‐based therapies (n=445) with higher CD4+ cell percentages and lower activation and inflammation markers (p: all<0.05) and as well no difference in hsCRP (p=0.97) compared with all other treated patients.ConclusionsThe lack of differences between therapy‐naïve patients and patients on ART for inflammation markers may be due to the relative good immunological state of the first group, which could be one of the reasons why they are not treated so far. The number of nuc‐sparing regimen is perhaps too low and too undifferentiated to find diverse inflammation states. Although the differences in activation status can be attributed to different treatment strata, there is no clear explanation for this outcome. A possible reason could be a pre‐selection bias either for NNRTI‐based or PI‐based regimens. Additional data is acquired to perform longitudinal analysis to gain further insight.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK