Suchergebnisse

IntroductionSince the introduction of highly active antiretroviral therapy (HAART) [1] and later on the availability of anti‐CD20 monoclonal antibody treatment [2], the therapeutic options as well as the prognosis of AIDS related lymphoma (ARL) have been improved. There is however no uniform agreement on how to treat patients who do not achieve a partial remission, who experience a relapse or who have very aggressive subtypes. Autologous hematopoietic stem cell transplantation (ASCT) has become an option for those patients. We retrospectively examined ARL patients to elucidate the feasibility of high‐dose chemotherapy and autologous stem cell transplantation.Patients and methodsData of seven male and one female HIV+ patients with ARL was collected and informed consent was obtained. Age, HIV disease characteristics (CD4 count, HIV‐RNA‐PCR, ART) and transplantation‐related details (histopathology, myeloablative therapy, neutrophil engraftment and NCI‐CTCAE during/after transplantation as well as follow up and survival) were obtained from the patients' medical records.ResultsEight patients were treated with the intent of ASCT. The median age was at 64 years. Four patients had experienced prior AIDS. The median CD4 NADIR was at 157/µl, the median CD4 count at diagnosis of lymphoma at 81/µl. Five patients were receiving combination antiretroviral therapy (cART) at the time of lymphoma diagnosis, four of which had achieved a viral load of less than 50/µl. Two patients have died, due to (Nr. 8) a transplant‐related complication (non‐infectious leukoencephalophathy). The other patient died of an unknown reason (351 days after transplantation). The median survival is at 345 days to date. The time until engraftment was well at 11 days. Grade 3/4 haematological toxicity was present in all patients. Five out of three patients developed infectious complications, but there were no infection‐related deaths. One patients (Nr. 4) developed a Kaposi Sarcoma reactivation that necessitated further chemotherapy.ConclusionsASCT is feasible in high risk ARL with good engraftment. Toxicity was substantial and studies are needed to define which patients have an unduly high risk of toxicity.

IntroductionDepression is a co‐morbidity of clinical significance in HIV‐positive patients with an estimated prevalence of more than 20%. Sex and gender‐related differences in depression are well described in HIV‐negative populations, demonstrating that more women are being affected. So far little is known about frequency and characteristics of depression in HIV‐positive men and women.Materials and MethodsPrimary objective of our prospective epidemiological study was the evaluation of the Beck score for depression in male and female patients of the Frankfurt HIV Cohort. The Beck Depression Inventory (BDI‐II) is a self‐report symptom inventory made up of 21 questions, each with 4 possible answers, correlating with a certain point value. Interpretation: score 14–19: mild depression; score 20–28: moderate depression; score ≥29: severe depression. Secondary objectives of the analysis were factors that might possibly influence the disposition for depression in HIV‐positive patients, e.g. age, antiretroviral treatment history, co‐morbidities and socioeconomic status.ResultsBetween January and October 2013, 348 patients were enrolled in the study, 161 women and 187 men of the Frankfurt HIV Cohort, who had a routine appointment at the HIV‐Center of the University Clinic Frankfurt. The mean age of all study participants was 45 years (range 22–80). The majority of patients were on antiretroviral therapy (91%) at study entrance. The median BDI‐II score in all patients was 8 (0–49); in female patients 10 (0–42), in male patients 6 (0–49), respectively (Table 1). Significant more women than men showed a score for moderate depression (p=0.006). Factors associated with a BDI‐II score ≥20 in women were older age (>45 years), living alone, unemployment and the number of prior changes in antiretroviral therapy.ConclusionsDepression in people living with HIV shows sex and gender‐related differences that might also influence antiretroviral treatment strategies. HIV specialists should be aware of these gender‐specific aspects and consider routine screening for depression especially in female patients of older age or those with multiple therapy changes in history.

IntroductionHIV infection is accompanied by a variety of neurological disorders. Depression of cell‐mediated immunity is followed by the development of central nervous system opportunistic infections/tumours, and frequently by the occurrence of the AIDS dementia complex (ADC). However, the pathophysiology of the emergence of neuro‐AIDS is still unknown. Despite the development of cognitive impairments, the early diagnosis, objectification and quantification of the existence and extent of this impairment during infection are difficult to recognize in each individual case. To support the early diagnosis of ADC, there is a need for additional, non‐invasive diagnostic methods. In this study, it is of interest to answer the clinically relevant question of whether magnetic resonance spectroscopy can detect changes in the cerebral metabolism of asymptomatic HIV‐positive patients and is possibly suitable for the early diagnosis and prevention of HIV encephalopathy.MethodsA group of 13 asymptomatic, HIV‐positive patients with combined antiretroviral therapy (cART) and 13 healthy controls were examined with 2D 1H‐MRS and 3D 31P‐MRS at 3T. The patients were treated with cART for at least 12 months. Changes in the absolute concentrations of phosphorylated metabolites (ATP), N‐acetyl‐aspartate, creatine, myo‐Isonitol, glutamate/glutamine and choline‐containing compounds were compared with that of control subjects.ResultsAsymptomatic HIV‐positive patients had significantly lower N‐acetyl‐aspartate in the white matter in a frontal and parietal target region. The other evaluated metabolites in the 1H MRS showed no significant difference between the HIV‐positive patients and healthy controls. The 31P‐MRS detected significant elevated values regarding the choline‐containing compounds PEth, GPE and PCho.ConclusionsThis spectroscopic study revealed a significantly lower N‐acetyl‐aspartate in the white matter in a frontal and parietal cerebral target region in asymptomatic, HIV‐positive patients as an early sign of neuronal disintegration. The 31P‐MRS detected significant elevated values regarding the choline‐containing compounds PEth, GPE and PCho as an early sign of gliosis. Furthermore we could show that with the use of 1H‐MRS and 31P‐MRS cerebral metabolites can be reliably detected and measured in HIV‐positive patients. The 1H‐MRS and 31P‐MRS is therefore suited as a diagnostic tool for early cerebral metabolic changes in HIV‐positive patients.

Zusammenfassung
Hintergrund Über die qualitative Bedeutung der testenden Zentren
im Gesundheitswesen ist wenig bekannt, gleichzeitig stellen die Late-Presenter
eine immer noch große Gruppe bei den HIV-Erstdiagnosen.
Ziel der Arbeit Analyse des Einflusses von Testzentren und -grund auf die
Prävalenz von HIV-Erstdiagnosen und Late-Presentation, exemplarisch
für das Jahr 2014.
Material und Methoden In einer Querschnittsstudie wurden zu allen im
Netzwerk HIV-Regional Behandelten mit Erstdiagnose HIV im Jahr 2014
retrospektiv, pseudonymisiert und dezentral klinische und demographische
Patienten-Charakteristika inklusive Angaben HIV-Test gesammelt und zentral
statistisch ausgewertet.
Ergebnisse 971 Individuen mit Erstdiagnose HIV aus 31 spezialisierten
Versorgungszentren in ganz Deutschland (15 Kliniken, 16 Praxen)
repräsentieren einen Anteil von 27,5% aller
HIV-Erstdiagnosemeldungen des Robert-Koch-Instituts für 2014, mit
ähnlichen Ergebnissen für CD4-Zellzahl und
HIV-Übertragungsrisiko. Häufigster Testort war das Krankenhaus
(34,8%), gefolgt vom Hausarzt (19,6%) und Facharzt
(16,1%). Wurde die Erstdiagnose in der Klinik gestellt, dann waren die
Betroffenen im Mittel älter als ambulant getestete (42 vs. 37 Jahre,
p=0,001), außerdem fand sich eine höhere HI-Viruslast
(585 vs. 270 Tsd. Kopien/mL, p<0,001) und niedrigere
CD4-Zellzahl (265 vs. 414/µL, p<0,001). Bei
208/971 HIV-positiv getesteten fand sich mindestens eine
AIDS-definierende Erkrankung, am häufigsten die Pneumocystis-Pneumonie
(43,8%), Candidiasis (36,5%) und Kaposi-Sarkom (10,6%).
Im regionalen Vergleich fand sich bei ostdeutschen Erstdiagnostizierten ein
jüngeres Lebensalter, eine höhere HIV-RNA und häufiger
das Vollbild AIDS.
Schlussfolgerung Die HIV-Regional-Analyse zum Jahr 2014 erlaubt
exemplarisch einen tieferen Einblick in die HIV-Erstdiagnosen am Vorabend der
Einführung wichtiger Präventionsmaßnahmen in
Deutschland, z. B. HIV-Heimtests und die
Prä-Expositionsprophylaxe. Diese repräsentative Stichprobe
unterstreicht die Bedeutung spezialisierter Kliniken für die
HIV-Versorgungsstruktur, besonders für Ostdeutschland und allgemein
für die Einbindung sogenannter Late-Presenter ins Gesundheitswesen.