Einleitung: Daten HCV-monoinfizierter Patienten (Pts) zeigen einen anhaltenden Therapieerfolg bei bis zu 98% der Pts wenn eine Interferon (IFN) Mono-Therapie während der akuten Phase der HCV-Infektion initiiert wurde. Unklar ist, ob auch bei HIV+ Patienten eine IFN-Therapie einen vergleichbaren Therapieerfolg erreicht.

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

Studies on hepatitis C virus (HCV) monoinfected patients suggest high sustained treatment response rates of up to 98% when interferon monotherapy is administered during the acute phase of HCV-infection. To clarify whether early treatment of acute hepatitis C is similarly efficient in human immunodeficiency virus (HIV) positive patients, we conducted a retrospective survey of HIV-positive patients with acute HCV infection. Eleven HIV-positive patients who had been treated with interferon or interferon/ribavirin were identified at eight HIV-specialty outpatient clinics. The patients had been treated over a median 25 weeks with standard interferon (two patients), pegylated interferon (four patients) and pegylated interferon in combination with ribavirin (five patients). A post-treatment response (negative serum HCV-RNA at the end of treatment) was seen in 10 of 11 patients and HCV-RNA remained undetectable 24 weeks after the end of treatment in all the 10 responders. Alanine aminotransferase (ALT) normalized in eight patients while two virological responders and one nonresponder showed persistent mild ALT elevations. In conclusion, early treatment of acute hepatitis C seems to achieve high sustained virological treatment response rates also in patients with HIV-infection.

Three HIV-infected patients with chronic hepatitis B (genotype A) were switched to adefovir therapy after unsuccessful lamivudine treatment. Surprisingly, adefovir therapy failed, although none of the virus isolates displayed mutations known to be associated with adefovir resistance (A181V, N236T). In two isolates we identified hepatitis B virus DNA polymerase mutation L217R, in one case we found multiple frameshifts in the same region. In all cases adefovir was replaced by tenofovir, resulting in a significant drop in the viral load.

Vascular thromboembolism (VTE) complicating cytomegalovirus (CMV) primary infection is increasingly reported in immunocompetent adults. No guideline is, however, currently available for the management of these infections and particularly for the antiviral therapy indication.We performed a literature review of VTE complicating CMV primary infection in immunocompetent adults using PubMed.Sixty-nine case patients of VTE complicating CMV primary infection were reported. The main sites of venous thrombosis were the splanchnic veins (30 patients) or those of the lower limbs (18 patients). One-third of patients presented with pulmonary embolism (25 patients). Forty-nine patients (76%) had at least one VTE risk factor, inherited or acquired thrombophilia for 37 patients (58%), and another risk factor for 27 patients (42%). Only 11 patients received an antiviral therapy. A positive outcome was observed in all patients.We suggest that antiviral therapy should be considered for patients presenting with severe VTE, VTE with a negative outcome despite anticoagulation, severe organ involvement, or for patients managed in the intensive care unit.Les cas de primo-infections à cytomégalovirus (CMV) compliquées d'un accident thromboembolique chez des adultes immunocompétents sont de plus en plus fréquents. Cependant, il n'existe pas de recommandation de prise en charge de ces infections, notamment concernant l'indication d'un traitement antiviral.Une revue systématique de la littérature décrivant les cas d'accident thromboembolique compliquant une primo-infection à CMV chez des adultes immunocompétents a été effectuée sur PubMed.Soixante-neuf cas d'accident thromboembolique compliquant une primo-infection à CMV ont été rapportés. Les thromboses touchaient principalement les veines abdominales (30 cas) ou celles des membres inférieurs (18 cas). Une embolie pulmonaire survenait chez un tiers des patients (25 cas). Quarante-neuf patients (76 %) avaient au moins un facteur de risque thromboembolique, thrombophilie acquise ou constitutionnelle chez 37 patients (58 %) et autre facteur de risque chez 27 patients (42 %). Onze patients seulement ont reçu un traitement antiviral. L'évolution a été favorable chez tous les patients.Nous proposons de réserver le traitement antiviral aux cas d'accident thromboembolique sévère, d'accident thromboembolique d'évolution défavorable sous anticoagulation, ou aux cas de primo-infection avec atteinte viscérale sévère ou pris en charge en réanimation.

Viral suppression rates <50 cop/ml were similar in the intent to treat and per protocol analysis (figure 2). A total of 22 (4%), 35 (7%), and 50 (10%) patients discontinued the initial regimen at or before month 6, 12, and 18, respectively. No difference in the rate of discontinuation was detected between recipients of EFV and PI-containing regimens. Compared to PI regimens, EFV-based treatment was associated with a significantly higher likelihood of continued viral suppression at month 12 and 18 (table 3). In the multivariate logistic regression, virological success at month 12 and 18 was best predicted by use of EFV in the initial regimen (OR 2.14, 95% CI 1.06- 4.32, p=0.03 and OR 2.32, 95% CI 1.10-4.92, p=0.03). Results of a Cox proportional hazards model analyzing risk factors for virological failure (1. analysis) and discontinuation of initial regimen (2. analysis) are shown in table 4.