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Pradier A, Mamez AC, Stephan C, Giannotti F, Masouridi-Levrat S, Wang S, Morin S, Neofytos D, Vu DL, Melotti A, Arm I, Eberhardt CS, Tamburini J, Kaiser L, Chalandon Y, Simonetta F. T Cell Receptor Sequencing Reveals Reduced Clonal Breadth of T Cell Responses against SARS-CoV-2 after Natural Infection and Vaccination in Allogeneic Hematopoietic Stem Cell Transplant Recipients. Ann Oncol 2022; 33:1333-1335. [PMID: 36116692 PMCID: PMC9477612 DOI: 10.1016/j.annonc.2022.09.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- A Pradier
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - A C Mamez
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - C Stephan
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - F Giannotti
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - S Masouridi-Levrat
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - S Wang
- Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - S Morin
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - D Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - D L Vu
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - A Melotti
- Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - I Arm
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C S Eberhardt
- Center for Vaccinology, University Hospitals of Geneva Division of General Pediatrics, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J Tamburini
- Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - L Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospitals of Geneva & Faculty of Medicine, University of Geneva, Geneva, Switzerland; Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Y Chalandon
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - F Simonetta
- Division of Hematology, Department of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Translational Research Centre in Onco-Haematology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Stephan C. [35/m-Unprotected sexual contact : Preparation for the medical specialist examination: part 136]. Internist (Berl) 2021; 63:207-212. [PMID: 34550400 DOI: 10.1007/s00108-021-01149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- C Stephan
- Medizinische Klinik 2, Schwerpunkt Infektiologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, Haus 33 C, 60590, Frankfurt am Main, Deutschland.
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Arendt C, De Leuw P, Haberl A, Kann G, Wolf T, Stephan C, Schuettfort G, Arcari L, Vasquez M, Albrecht M, Escher F, Vogl T, Zeiher A, Nagel E, Puntmann V. Outcomes of cardiovascular magnetic resonance imaging in people living with HIV. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
People living with human immunodeficiency virus (HIV, PLWH) are at increased risk of cardiovascular disease (CVD). HIV infection and accelerated traditional risk factors due to highly-active antiretroviral therapy (HAART) are proposed mechanisms for increased rate of heart failure (HF). The pathophysiological drivers of myocardial dysfunction and worse cardiovascular outcome in HIV remain poorly understood.
Purpose
To examine prognostic relationships of cardiac imaging measures with cardiovascular outcome in PLWH on HAART.
Methods
This is a prospective observational longitudinal study using cardiac magnetic resonance (CMR) imaging in consecutive PLHWH on long-term HAART who were screened for underlying CVD and followed up clinically for adjudicated adverse cardiovascular events (cardiovascular mortality, non-fatal acute coronary syndrome, an appropriate device discharge, or a documented HF hospitalization). Imaging protocol included routine assessment of cardiac volumes and function, scar by late gadolinium enhancement, myocardial perfusion and native T1 /T2 mapping. Time-to-event analysis was performed from the index CMR exam to the first single event per patient Systematic risk scores for CVD (Framingham risk score (FRS), Data Collection on Adverse effects of anti-HIV Drugs score, D:A:D and MAGGIC integer score) were calculated using original online calculators.
Results
156 participants (males 62%, 50 [42-57] years of age) were included. 24 events were observed (4 HF deaths, 1 sudden cardiac death, 2 non-fatal acute myocardial infarction, 1 appropriate device discharge and 16 HF hospitalizations) during a median follow-up of 13 [9-19] months. Patients with events had higher native T1 (ms, 1149 [1115-1163] ms vs. 1110 [1075-1138] ms), native T2 (ms, 40 [38-41] vs. 37 [36-39]), LV mass index (g/m², 65 [49-77] vs. 57 [49-64]) p < 0.05 for all). In multivariable analyses, native T1 was independently predictive of adverse events (ChiSq 15.9, p < 0.001, native T1 (10 ms) hazard ratio (95% confidence interval) 1.20 (1.08-1.33), p = 0.001), followed by a model that also included LV mass (ChiSq 17.1, p < 0.001). Traditional cardiovascular risk scores were not predictive of the adverse events.
Conclusions
Native myocardial T1 and LV mass by CMR, as opposed to traditional cardiovascular risk scores, predict cardiovascular outcome in PLWH, together reflecting the pathological myocardial remodeling of myocardial fibrosis and inflammation that potentially explain higher rates of HF in PLWH as compared to the non-infected population. These findings may inform personalized approaches to screening and early intervention to reduce the burden of HF.
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Affiliation(s)
- C Arendt
- Goethe University Hospital, Frankfurt, Germany
| | - P De Leuw
- Infektiologikum, Frankfurt am Main, Germany
| | - A Haberl
- Goethe University Hospital, Frankfurt, Germany
| | - G Kann
- Infektiologikum, Frankfurt am Main, Germany
| | - T Wolf
- Goethe University Hospital, Frankfurt, Germany
| | - C Stephan
- Goethe University Hospital, Frankfurt, Germany
| | | | - L Arcari
- Sapienza University of Rome, Rome, Italy
| | - M Vasquez
- Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - M Albrecht
- Goethe University Hospital, Frankfurt, Germany
| | - F Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - T Vogl
- Goethe University Hospital, Frankfurt, Germany
| | - A Zeiher
- Goethe University Hospital, Frankfurt, Germany
| | - E Nagel
- Goethe University Hospital, Frankfurt, Germany
| | - V Puntmann
- Goethe University Hospital, Frankfurt, Germany
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5
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Ankert J, Rößler S, Stephan C, Schleenvoigt BT. [HIV infection in the intensive care unit]. Med Klin Intensivmed Notfmed 2020; 117:91-99. [PMID: 33211118 DOI: 10.1007/s00063-020-00757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
Around 88,000 people in Germany live with an HIV (human immunodeficiency virus) infection. The proportion of those over 50 is around 30% and it has now become more likely that an older HIV-positive patient with other pre-existing illnesses will have to be treated in an intensive care unit (ICU) for a reason not directly associated with HIV than a person with a new HIV diagnosis for acquired immune deficiency syndrome (AIDS). Nevertheless, one third of patients with a new HIV diagnosis already have an advanced immune deficiency. Neurological or respiratory symptoms that require intensive medical care must be expected in these patients. The present article aims to raise awareness of these clinical pictures and the necessary differential diagnostics, and to provide the reader with an overview of the most important opportunistic infections and their treatment. In addition, the main focus of this article is on the possibilities of antiretroviral therapy in intensive care patients and provides the clinician with an overview of the start of treatment, the selection of suitable substances, and their dosage in the ICU.
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Affiliation(s)
- J Ankert
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - S Rößler
- Arztpraxis Rößler, Arztpraxis Rößler, Leipziger Straße 53, Zwickau, 08058, Deutschland
| | - C Stephan
- HIVCENTER, Zentrum der Inneren Medizin/Medizinische Klinik II, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, Frankfurt am Main, 60590, Deutschland
| | - B T Schleenvoigt
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Mohamed A, Henderson Y, Chen Y, Stephan C, Cote G, Cabanillas M, Zafereo M, Sandulache V, Lai S. PD-0065: Utilizing a high-throughput approach to identify effective agents for aggressive thyroid cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Arendt C, De Leuw P, Haberl A, Stephan C, Vasquez M, Arcari L, Zhou H, Zainal H, Albrecht M, Vogl T, Zeiher A, Nagel E, Puntmann V. In-depth phenotyping of cardiac diseases by MRI in HIV-positive people reveals diverse and independent forms of myocardial involvement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
It is increasingly recognised that non-ischaemic and ischaemic myocardial involvement represent important drivers of cardiac diseases in people living with HIV (PLWH). Non-invasive measurements with cardiac magnetic resonance (CMR) directly inform on the type of myocardial damage.
Purpose
To screen for the prevalence and type of cardiovascular disease (CVD) in PLWH using stress CMR in a cohort with highly active antiretroviral therapy (HAART).
Methods
This prospective cross-sectional study enrolled consecutive PLWH undergoing standardised evaluation for CVD using imaging. All participants underwent a standardised CMR protocol in a 3 Tesla scanner for function and volumes (cine), stress perfusion (regadenosone), scar (late gadolinium enhancement (LGE)), diffuse fibrosis (native T1-mapping) and oedema (native T2-mapping). Blood samples were additionally collected prior to CMR.
Results
141 participants were identified (n=32 in category C/AIDS). 16 patients had previously documented (n=23) myocardial diseases: myocarditis, n=1 non-obstructive coronary artery disease (CAD), n=8 myocardial infarction, n=3 congestive heart failure, n=3, and arrhythmia, n=8. Mean value for hs-cTnT, CRP and NT-proBNP was 9±18ng/l, 0.3±0.6mg/l and 104±229ng/l. 14 subjects had impaired LV-EF (<50%) and 35 presented borderline LV-EF (50–55%). Myocardial LGE was present in 28 patients: non-ischemic pattern, n=16, ischemic pattern, n=11, and both patterns, n=1. Two patients had relevant inducible ischaemia, whereas a pattern of microvascular disease (MVD) was found in 26 patients. 72 subjects had diffuse fibrosis and 25 had active inflammation. Elevated native T1/T2 was significantly associated with low (<350/μl), current, and initial CD4-count (χ2=5.317, p=0.021; χ2=3.841, p=0.050), just as with category C/AIDS (χ2=4.949, p=0.026). Native T2 showed a significant correlation with initial CD4-count (r=−0.252, p=0.008) and current NT-proBNP (r=0.190, p=0.030), but not with other laboratory values.
Conclusions
CMR in PLWH reveal high prevalence of cardiac involvement, which is predominantly non-ischaemic inflammatory in origin. MVD is a major presentation compared to relevant ischaemia due to epicardial CAD. Individual cardiovascular risk assessment in PLWH using CMR may bear a potential for personalised treatment.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Centre for Cardiovascular Research (DZHK)
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Affiliation(s)
- C Arendt
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P De Leuw
- Infektiologikum, Frankfurt am Main, Germany
| | - A Haberl
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Stephan
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M Vasquez
- Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - L Arcari
- Sapienza University of Rome, Rome, Italy
| | - H Zhou
- Central South University, Changsha, China
| | - H Zainal
- Universiti Teknologi MARA, Sg. Buloh, Malaysia
| | - M Albrecht
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T Vogl
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Zeiher
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - E Nagel
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - V Puntmann
- University Hospital Frankfurt, Frankfurt am Main, Germany
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Arendt C, De Leuw P, Haberl A, Stephan C, Vasquez M, Arcari L, Zhou H, Zainal H, Albrecht M, Vogl T, Zeiher A, Nagel E, Puntmann V. Myocardial fibrosis and inflammation are predictors of heart failure outcomes in people living with HIV. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
People living with HIV (PLWH) have higher prevalence of heart failure (HF), which cannot be fully related to traditional cardiovascular disease (CVD) risk factor< or coronary artery disease. Tissue characterisation by cardiac magnetic resonance (CMR), such as with T1 and T2 mapping, is a unique diagnostic approach to provide non-invasive insights into the underlying myocardial pathophysiology.
Purpose
To examine prognostic associations of CMR measures, conventional and modified CVD risk scores with HF outcome in PLWH on long-term highly active antiretroviral therapy (HAART).
Methods
Consecutive PLWH underwent prospectively standardized evaluation of HF using CMR, risk scores and blood markers. CMR protocol included T1 and T2 mapping, perfusion and scar imaging. MAGGIC, Framingham and D:A:D risk scores were collected. Primary HF endpoint was defined as hospitalization or mortality due to HF, and time-to-even analysis from the index CMR to the first event per patient was performed.
Results
141 PLWH (61% males, 48.0 [40.1–54.6] years, CD4 count 655 [411–909] cells/μl) were included. 16 HF events were observed (12 hospitalizations and 4 deaths) during a median follow-up of 13 [9–16] months. Baseline myocardial native T1, T2, left ventricular volumes and troponin were significant univariate predictors of the HF endpoint. The only signifcant (p<0.001) independent predictor in the multivariate analysis was myocardial native T1 (T1 ≥4 SD, HR (95% CI): 5.0 [1.8–13.4]). Conventional and modified CVD risk scores showed no prognostic association with HF outcomes.
Conclusions
Our results show that presence and severity of myocardial inflammation and predominantly diffuse fibrosis detected by T2 and T1 mapping strongly relates to HF events in contrast to conventional and traditional CVD risk scores.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Centre for Cardiovascular Research (DZHK)
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Affiliation(s)
- C Arendt
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P De Leuw
- Infektiologikum, Frankfurt am Main, Germany
| | - A Haberl
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - C Stephan
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M Vasquez
- Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - L Arcari
- Sapienza University of Rome, Rome, Italy
| | - H Zhou
- Central South University, Changsha, China
| | - H Zainal
- Universiti Teknologi MARA, Sg. Buloh, Malaysia
| | - M Albrecht
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - T Vogl
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Zeiher
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - E Nagel
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - V Puntmann
- University Hospital Frankfurt, Frankfurt am Main, Germany
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Schuettfort G, Boekenkamp L, Cabello A, Cotter AG, De Leuw P, Doctor J, Górgolas M, Hamzah L, Herrmann E, Kann G, Khaykin P, Mallon PW, Mena A, Del Palacio Tamarit M, Sabin CA, Stephan C, Wolf T, Haberl AE. Antiretroviral treatment outcomes among late HIV presenters initiating treatment with integrase inhibitors or protease inhibitors. HIV Med 2020; 22:47-53. [PMID: 33047484 DOI: 10.1111/hiv.12962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the efficacy and safety of first-line antiretroviral therapy (ART) with integrase inhibitor (INI) or protease inhibitor (PI)-based regimens in patients with low CD4 cell counts and/or an AIDS-defining disease. METHODS We conducted a retrospective, multicentre analysis to investigate discontinuation proportions and virological response in patients with CD4 cell counts < 200 cells/µL and/or AIDS-defining disease when starting first-line ART. Proportions of those discontinuing ART were compared using univariate analysis. Virological response was analysed using the Food & Drug Administration (FDA) snapshot analysis (HIV-1 RNA < 50 HIV-1 RNA copies/mL at week 48). RESULTS Two hundred and eighteen late presenters were included in the study: 13.8% were women and 23.8% were of non-European ethnicity, and the mean baseline CD4 count was 91 cells/µL (standard deviation 112 cells/µL). A total of 131 late presenters started on INI- and 87 on PI-based treatment. It was found that 86.1% of patients treated with INIs and 81.1% of patients treated with PIs had a viral load < 50 copies/mL at week 48; proportions of discontinuation because of adverse events were 6.1% in the INI group and 11.5% in the PI group. No significant differences in discontinuation proportions were observed at week 12 or 48 between INI- and PI-based regimens (P = 0.76 and 0.52, respectively). Virological response was equally good in those receiving INIs and those receiving PIs (86.1% vs. 81.1%, respectively; P = 0.36). CONCLUSIONS In a European cohort of late presenters starting first-line INI or PI-based ART regimens, there were no significant differences in discontinuation proportions or virological response at week 48.
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Affiliation(s)
- G Schuettfort
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - L Boekenkamp
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - A Cabello
- Infectious Diseases Outpatient Clinic, Hospital Fundación Jiménez Díaz, University Autónoma of Madrid, Madrid, Spain
| | - A G Cotter
- Department of Infectious Diseases, HIV Molecular Research Group, University College Dublin (UCD) School of Medicine, Mater Misericordae University Hospital, Dublin, Ireland
| | - P De Leuw
- Infektiologikum Frankfurt, Frankfurt, Germany
| | - J Doctor
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Górgolas
- Infectious Diseases Outpatient Clinic, Hospital Fundación Jiménez Díaz, University Autónoma of Madrid, Madrid, Spain
| | - L Hamzah
- St George's Hospital NHS Foundation Trust, London, UK
| | - E Herrmann
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - G Kann
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - P Khaykin
- MainFacharzt Frankfurt, Frankfurt, Germany
| | - P W Mallon
- Department of Infectious Diseases, HIV Molecular Research Group, University College Dublin (UCD) School of Medicine, Mater Misericordae University Hospital, Dublin, Ireland
| | - A Mena
- Department of Infectious Diseases, A Coruña University Hospital, A Coruña, Spain
| | - M Del Palacio Tamarit
- Infectious Diseases Outpatient Clinic, Hospital Fundación Jiménez Díaz, University Autónoma of Madrid, Madrid, Spain
| | - C A Sabin
- University College London, London, UK
| | - C Stephan
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - T Wolf
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - A E Haberl
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
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Schüttfort G, Philipp K, de Leuw P, Herrmann E, Kann G, Khaykin P, Stephan C, Wolf T, Haberl A. Sex and Gender Differences in Rilpivirine based ART - Data from the HIVCENTER Frankfurt. Curr HIV Res 2020; 17:368-374. [PMID: 31686639 DOI: 10.2174/1570162x17666191104112557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE While Rilpivirine has shown high overall response rates in treatment-naïve patients without sex and gender specific differences in clinical trials, Sex and gender specific data in treatment experienced patients receiving rilpivirine are still limited. We conducted a 48 week efficacy and safety analysis in naïve and treatment experienced men and women using retrospective data from the HIVCENTER Frankfurt. MATERIALS AND METHODS In this retrospective observational study data of all patients who received a rilpivirine based regimen at the HIVCENTER between March 2011 and December 2015 were analyzed. Primary endpoint was the proportion of patients with any discontinuation until week 48. Virologic response rates (FDA snapshot analysis; HIV-1 RNA <50 copies/mL) were assessed at week 48. RESULTS 194 patients (34% female) were included in the analysis. 74% were treatment-experienced and 26% naïve, respectively. Discontinuations were observed in 31 (15.9%) patients. Regarding sex differences, the proportion of discontinuations was significantly higher in women than in men (24.2% vs. 11.7%; p=0.024; ODDS-Ratio = 2.41; CI 1.12 - 5.18). Virologic failure occurred in 8 PLWHIV (4.1%). CONCLUSION While virologic overall response rates to rilpivirine based ART were high for both treatment-experienced and -naïve patients the proportion of discontinuations was significantly higher in women (24.2% vs. 11.7%; p = 0.024; ODDS-Ratio = 2.41; CI 1.12 - 5.18). Although the total number of patients with virologic failure was low (4.1%), the higher rate of ART discontinuations in female patients receiving RPV require close monitoring in the first months of treatment addressing special needs of women living with HIV.
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Affiliation(s)
- G Schüttfort
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - K Philipp
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - P de Leuw
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - E Herrmann
- Department of Biostatistics and Mathematical Modelling, Frankfurt, Germany
| | - G Kann
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | | | - C Stephan
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - T Wolf
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - A Haberl
- HIVCENTER, Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
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11
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Mocroft A, Neesgard B, Zangerle R, Rieger A, Castagna A, Spagnuolo V, Antinori A, Lampe FC, Youle M, Vehreschild JJ, Mussini C, Borghi V, Begovac J, Duvivier C, Gunthard HF, Rauch A, Tiraboschi J, Chkhartishvili N, Bolokadze N, Wit F, Wasmuth JC, De Wit S, Necsoi C, Pradier C, Svedhem V, Stephan C, Petoumenos K, Garges H, Rogatto F, Peters L, Ryom L. Treatment outcomes of integrase inhibitors, boosted protease inhibitors and nonnucleoside reverse transcriptase inhibitors in antiretroviral-naïve persons starting treatment. HIV Med 2020; 21:599-606. [PMID: 32588958 DOI: 10.1111/hiv.12888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Although outcomes of antiretroviral therapy (ART) have been evaluated in randomized controlled trials, experiences from subpopulations defined by age, CD4 count or viral load (VL) in heterogeneous real-world settings are limited. METHODS The study design was an international multicohort collaboration. Logistic regression was used to compare virological and immunological outcomes at 12 ± 3 months after starting ART with an integrase strand transfer inhibitor (INSTI), contemporary nonnucleoside reverse transcriptase inhibitor (NNRTI) or boosted protease inhibitor (PI/b) with two nucleos(t)ides after 1 January 2012. The composite treatment outcome (cTO) defined success as VL < 200 HIV-1 RNA copies/mL with no regimen change and no AIDS/death events. Immunological success was defined as a CD4 count > 750 cells/μL or a 33% increase where the baseline CD4 count was ≥ 500 cells/μL. Poisson regression compared clinical failures (AIDS/death ≥ 14 days after starting ART). Interactions between ART class and age, CD4 count, and VL were determined for each endpoint. RESULTS Of 5198 ART-naïve persons in the International Cohort Consortium of Infectious Diseases (RESPOND), 45.4% started INSTIs, 26.0% PI/b and 28.7% NNRTIs; 880 (17.4%) were aged > 50 years, 2539 (49.4%) had CD4 counts < 350 cells/μL and 1891 (36.8%) had VL > 100 000 copies/mL. Differences in virological and immunological success and clinical failure among ART classes were similar across age groups (≤ 40, 40-50 and > 50 years), CD4 count categories (≤ 350 vs. > 350 cells/μL) and VL categories at ART initiation (≤ 100 000 vs. > 100 000 copies/mL), with all investigated interactions being nonsignificant (P > 0.05). CONCLUSIONS Differences among ART classes in virological, immunological and clinical outcomes in ART-naïve participants were consistent irrespective of age, immune suppression or VL at ART initiation. While confounding by indication cannot be excluded, this provides reassuring evidence that such subpopulations will equally benefit from contemporary ART.
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Affiliation(s)
- A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - B Neesgard
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Zangerle
- Medical University of Innsbruck, Innsbruch, Austria
| | - A Rieger
- Medical University of Vienna, Vienna, Austria
| | - A Castagna
- Vita-Salute San Raffaele University, Milano, Italy
| | - V Spagnuolo
- Vita-Salute San Raffaele University, Milano, Italy
| | - A Antinori
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - F C Lampe
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - M Youle
- Royal Free Hospital, London, UK
| | | | | | - V Borghi
- University of Modena, Modena, Italy
| | - J Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - C Duvivier
- Necker University Hospital, Department of Infectious and Tropical Diseases, Paris, France
| | - H F Gunthard
- University of Zurich, Zurich, Switzerland.,University Hospital of Zurich, Zurich, Switzerland
| | - A Rauch
- University Hospital Berne, Bern, Switzerland
| | - J Tiraboschi
- PISCIS Cohort Study, Bellvitge Hospital, Barcelona, Spain
| | | | - N Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - F Wit
- Stichting HIV Monitoring (SHM), Amsterdam, the Netherlands
| | | | - S De Wit
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Necsoi
- Infectious Disease Research Centre, Brussels, Belgium
| | - C Pradier
- Côte d'Azur University and University Hospital Center, Nice, France
| | - V Svedhem
- Karolinska University Hospital, Stockholm, Sweden
| | - C Stephan
- Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany
| | | | | | - F Rogatto
- Gilead Sciences, Foster City, CA, USA
| | - L Peters
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Ryom
- Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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12
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Stephan C, Kurban M, Khalil S, Bitar F, El-Rassi I, Assy J. Viral-associated trichodysplasia spinulosa in a paediatric cardiac transplant recipient. Clin Exp Dermatol 2019; 45:244-246. [PMID: 31219640 DOI: 10.1111/ced.14017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- C Stephan
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - M Kurban
- Department of Dermatology, American University of Beirut, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - S Khalil
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - F Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - I El-Rassi
- Department of Surgery, American University of Beirut, Lebanon
| | - J Assy
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
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13
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Krznaric I, Bickel M, Carganico A, De Leuw P, Haberl A, Knecht G, Koegl C, Lauscher P, Schüttfort G, Stephan C, Wolf E, Wolf T. Similar long-term efficacy of dual therapy containing raltegravir and a boosted protease inhibitor versus standard triple therapies in pretreated HIV-1-infected patients in a retrospective, real-life cohort of 14 years. HIV Med 2018; 19:662-667. [PMID: 29971922 DOI: 10.1111/hiv.12636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Raltegravir is used in many antiretroviral combinations, but its use in treatment-experienced patients without knowledge of baseline resistance is discussed controversially as a number of comparative studies have shown a higher rate of virological failure. However, it has been used frequently for the management of treatment failure, as it was the first integrase inhibitor to become available, and thus offered new options for patients with multiple resistance. The strategic use of raltegravir in this setting is examined in this study. METHODS In order to examine the efficacy of raltegravir in second and later lines of antiretroviral combinations, data for 740 patients from three clinical cohorts were analysed with a focus on the combinations that were used. These were stratified into the combination of two nonnucleoside reverse transcriptase inhibitors and raltegravir (2NRTIs + RAL), the combination of a boosted protease inhibitor and raltegravir (bPI + RAL), and other raltegravir-containing combinations. RESULTS The overall rate of virological suppression to < 50 HIV-1 RNA copies/mL was 69.5%. Although the baseline rate of virological suppression was higher for 2NRTIs + RAL than for the other strata, the outcomes were similar for all three groups at weeks 24, 48, 72 and 96. CONCLUSIONS These data indicate that, in a real-life setting, raltegravir can be used with a high virological success rate in treatment-experienced patients, and that the different combinations analysed (2NRTIs + RAL, bPI + RAL and others) show comparable rates of virological suppression.
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Affiliation(s)
- I Krznaric
- Centre for Infectious Diseases, Berlin, Germany
| | - M Bickel
- Infektiologikum (Centre for Infectious Diseases) Frankfurt, Frankfurt, Germany
| | - A Carganico
- Centre for Infectious Diseases, Berlin, Germany
| | - P De Leuw
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - A Haberl
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - G Knecht
- Infektiologikum (Centre for Infectious Diseases) Frankfurt, Frankfurt, Germany
| | - C Koegl
- MUC Research, Munich, Germany
| | | | - G Schüttfort
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - C Stephan
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
| | - E Wolf
- MUC Research, Munich, Germany
| | - T Wolf
- Infectious Diseases Division, Department of Internal Medicine II, HIV Center, University Hospital Frankfurt, Frankfurt, Germany
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14
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Abstract
INTRODUCTION The hepatitis C virus (HCV) has affected an estimated of 80 million individuals worldwide and is a strain on public health. Around 25-30% of patients in Europe and the US who are infected with HIV are coinfected with HCV. Prior to 2013, treatment modalities containing an NS3/4A protease inhibitor in combination with pegylated interferon and ribavirin improved sustained virological response (SVR) rates. However, rates of severe side effects were high. Nowadays, oral direct-acting antiviral (DAA) combination therapy offers excellent treatment efficacy, safety and tolerability. AREAS COVERED This review focuses on the current literature and clinical evidence and their impact regarding NS3/4A protease inhibitors. The pitfalls encountered in treating HIV- and HBV-coinfected patients are also discussed. EXPERT OPINION In the era of DAA treatment, third-generation pan-genotypic NS3/4A protease inhibitors (mainly glecaprevir and voxilaprevir) show high antiviral activity and a genetic resistance barrier with cure rates of over 95% when combined with an NS5A inhibitor, irrespective of baseline resistance associated variants (RASs) being present. These new key components of DAA combination therapy are impressive options to eradicate HCV in the so-called difficult-to-treat population (e.g. compensated cirrhosis, end-stage renal disease and patients who failed previous DAA treatment).
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Affiliation(s)
- P de Leuw
- a Medical Clinic II, Infectious Diseases Unit , Goethe-University Hospital Frankfurt , Frankfurt am Main , Germany
| | - C Stephan
- a Medical Clinic II, Infectious Diseases Unit , Goethe-University Hospital Frankfurt , Frankfurt am Main , Germany
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15
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Merrifield RC, Stephan C, Lead JR. Quantification of Au Nanoparticle Biouptake and Distribution to Freshwater Algae Using Single Cell - ICP-MS. Environ Sci Technol 2018; 52:2271-2277. [PMID: 29400052 DOI: 10.1021/acs.est.7b04968] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Quantifying metal and nanoparticle (NP) biouptake and distribution on an individual cellular basis has previously been impossible, given available techniques which provide qualitative data that are laborious to acquire and prone to artifacts. Quantifying metal and metal NP uptake and loss processes in environmental organisms will lead to mechanistic understanding of biouptake and improved understanding of potential hazards and risks of metals and NPs. In this work, we present a new technique, single cell inductively coupled plasma mass spectrometry (SC-ICP-MS), which allows quantification of metal concentrations on an individual cell basis down to the attogram (ag) per cell level. We present data validating the novel method, along with the mass of metal per cell. Finally, we use SC-ICP-MS, with ancillary cell counting methods, to quantify the biouptake and strong sorption and distribution of both dissolved Au and Au NPs in a freshwater alga (Cyptomonas ovate). The data suggests differences between dissolved and NP uptake and loss. In the case of NPs, there was a dose and time dependent uptake, but individual cellular variations; at the highest realistic exposure conditions used in this study up to 40-50% of cells contained NPs, while 50-60% of cells did not.
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Affiliation(s)
- R C Merrifield
- Centre for Environmental Nanoscience and Risk, University South Carolina , Columbia, South Carolina 29208, United States
| | - C Stephan
- PerkinElmer , Woodbridge, Ontario L4L 8H1, Canada
| | - J R Lead
- Centre for Environmental Nanoscience and Risk, University South Carolina , Columbia, South Carolina 29208, United States
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16
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Dupont E, Otuka N, Cabellos O, Aberle O, Aerts G, Altstadt S, Alvarez H, Alvarez-Velarde F, Andriamonje S, Andrzejewski J, Audouin L, Bacak M, Badurek G, Balibrea J, Barbagallo M, Barros S, Baumann P, Bécares V, Bečvář F, Beinrucker C, Belloni F, Berthier B, Berthoumieux E, Billowes J, Boccone V, Bosnar D, Brown A, Brugger M, Caamaño M, Calviani M, Calviño F, Cano-Ott D, Capote R, Cardella R, Carrapiço C, Casanovas A, Castelluccio D, Cennini P, Cerutti F, Chen Y, Chiaveri E, Chin M, Colonna N, Cortés G, Cortés-Giraldo M, Cosentino L, Couture A, Cox J, Damone L, David S, Deo K, Diakaki M, Dillmann I, Domingo-Pardo C, Dressler R, Dridi W, Duran I, Eleftheriadis C, Embid-Segura M, Fernández-Domínguez B, Ferrant L, Ferrari A, Ferreira P, Finocchiaro P, Fraval K, Frost R, Fujii K, Furman W, Ganesan S, Garcia A, Gawlik A, Gheorghe I, Gilardoni S, Giubrone G, Glodariu T, Göbel K, Gomez-Hornillos M, Goncalves I, Gonzalez-Romero E, Goverdovski A, Gramegna F, Griesmayer E, Guerrero C, Gunsing F, Gurusamy P, Haight R, Harada H, Heftrich T, Heil M, Heinitz S, Hernández-Prieto A, Heyse J, Igashira M, Isaev S, Jenkins D, Jericha E, Kadi Y, Kaeppeler F, Kalamara A, Karadimos D, Karamanis D, Katabuchi T, Kavrigin P, Kerveno M, Ketlerov V, Khryachkov V, Kimura A, Kivel N, Kokkoris M, Konovalov V, Krtička M, Kroll J, Kurtulgil D, Lampoudis C, Langer C, Leal-Cidoncha E, Lederer C, Leeb H, Naour CL, Lerendegui-Marco J, Leong L, Licata M, Meo SL, Lonsdale S, Losito R, Lozano M, Macina D, Manousos A, Marganiec J, Martinez T, Marrone S, Masi A, Massimi C, Mastinu P, Mastromarco M, Matteucci F, Maugeri E, Mazzone A, Mendoza E, Mengoni A, Milazzo P, Mingrone F, Mirea M, Mondelaers W, Montesano S, Moreau C, Mosconi M, Musumarra A, Negret A, Nolte R, O’Brien S, Oprea A, Palomo-Pinto F, Pancin J, Paradela C, Patronis N, Pavlik A, Pavlopoulos P, Perkowski J, Perrot L, Pigni M, Plag R, Plompen A, Plukis L, Poch A, Porras I, Praena J, Pretel C, Quesada J, Radeck D, Rajeev K, Rauscher T, Reifarth R, Riego A, Robles M, Roman F, Rout P, Rudolf G, Rubbia C, Rullhusen P, Ryan J, Sabaté-Gilarte M, Salgado J, Santos C, Sarchiapone L, Sarmento R, Saxena A, Schillebeeckx P, Schmidt S, Schumann D, Sedyshev P, Smith A, Sosnin N, Stamatopoulos A, Stephan C, Suryanarayana S, Tagliente G, Tain J, Tarifeño-Saldivia A, Tarrío D, Tassan-Got L, Tavora L, Terlizzi R, Tsinganis A, Valenta S, Vannini G, Variale V, Vaz P, Ventura A, Versaci R, Vermeulen M, Villamarin D, Vicente M, Vlachoudis V, Vlastou R, Voss F, Wallner A, Walter S, Ware T, Warren S, Weigand M, Weiß C, Wolf C, Wiesher M, Wisshak K, Woods P, Wright T, Žugec P. Dissemination of data measured at the CERN n_TOF facility. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201714607002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Schuettfort G, de Leuw P, Haberl A, Stephan C, Nguyen M. Implementation of Pharmacists to an Interdisciplinary Care Provider Team for People Living With HIV—6 Month Interims Analysis. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Judd A, Lodwick R, Noguera-Julian A, Gibb DM, Butler K, Costagliola D, Sabin C, van Sighem A, Ledergerber B, Torti C, Mocroft A, Podzamczer D, Dorrucci M, De Wit S, Obel N, Dabis F, Cozzi-Lepri A, García F, Brockmeyer NH, Warszawski J, Gonzalez-Tome MI, Mussini C, Touloumi G, Zangerle R, Ghosn J, Castagna A, Fätkenheuer G, Stephan C, Meyer L, Campbell MA, Chene G, Phillips A. Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe. HIV Med 2016; 18:171-180. [PMID: 27625109 PMCID: PMC5298034 DOI: 10.1111/hiv.12411] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 01/12/2023]
Abstract
Objectives The aim of the study was to determine the time to, and risk factors for, triple‐class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. Methods We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15–29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV‐1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. Results The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4–111) vs. 8 (IQR 2–38) weeks, respectively], and highest in perinatally infected participants aged 10–14 years [49 (IQR 9–267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0−12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9−5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10–14 years when starting ART (27.7%; 95% CI 13.2−42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10–14 years, African origin, pre‐ART AIDS, NNRTI‐based initial regimens, higher pre‐ART viral load and lower pre‐ART CD4. Conclusions The results suggest a beneficial effect of starting ART before adolescence, and starting young people on boosted PIs, to maximize treatment response during this transitional stage of development.
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Affiliation(s)
- A Judd
- MRC Clinical Trials Unit, University College London, London, UK
| | - R Lodwick
- Department of Infection and Population Health, University College London, London, UK
| | - A Noguera-Julian
- Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública Ciberesp, Barcelona, Spain
| | - D M Gibb
- MRC Clinical Trials Unit, University College London, London, UK
| | - K Butler
- Department of Infectious Diseases and Immunology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - D Costagliola
- INSERM, UPMC Univ Paris 06, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Sorbonne Universités, Paris, France
| | - C Sabin
- Department of Infection and Population Health, University College London, London, UK
| | - A van Sighem
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, Zurich, Switzerland
| | - C Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy
| | - A Mocroft
- Department of Infection and Population Health, University College London, London, UK
| | - D Podzamczer
- HIV and STD Unit, Infectious Disease Service, Hospital Universitari de Bellvitge. L'Hospitalet, Barcelona, Spain
| | - M Dorrucci
- Istituto Superiore di Sanità, Rome, Italy
| | - S De Wit
- Département of Infectious Diseases, Centre Hospitalier Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - N Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - F Dabis
- INSERM U1219 - Centre Inserm Bordeaux Population Health, Université de Bordeaux, Bordeaux, France.,ISPED, Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - A Cozzi-Lepri
- Department of Infection and Population Health, University College London, London, UK
| | - F García
- Clinical Microbiology Department, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - N H Brockmeyer
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, St. Josef Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - J Warszawski
- INSERM CESP U1018, AP-HP Public Health Department, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre Paris, France
| | - M I Gonzalez-Tome
- HIV and Paeds Infectious Diseases Department, Hospital 12 de Octubre, Madrid, Spain
| | - C Mussini
- Infectious Diseases Clinics, University Hospital, Modena, Italy
| | - G Touloumi
- Department Hygiene, Epidemiology & Medical Statistics, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - R Zangerle
- Medical University Innsbruck, Innsbruck, Austria
| | - J Ghosn
- EA 7327, Faculté de Médecine site Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,APHP, Unité Fonctionnelle de Thérapeutique en Immuno-Infectiologie, Hôpitaux Universitaires Paris Centre site Hôtel Dieu, Paris, France
| | - A Castagna
- San Raffaele Scientific Institute, Vita-SaLute University, Milan, Italy
| | - G Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Stephan
- Second Medical Department, Infectious Diseases Unit, Goethe-University Hospital, Frankfurt, Germany
| | - L Meyer
- INSERM CESP U1018, Université Paris-Sud, Université Paris-Saclay, Paris, France.,AP-HP Public Health Department, Le Kremlin-Bicêtre, Paris, France
| | - M A Campbell
- Centre for Health and Infectious Disease Research, University of Copenhagen, Copenhagen, Denmark
| | - G Chene
- INSERM U1219 - Centre Inserm Bordeaux Population Health, Université de Bordeaux, Bordeaux, France.,ISPED, Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Pole de sante publique, Service d'information medicale, Bordeaux, France
| | - A Phillips
- Department of Infection and Population Health, University College London, London, UK
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Stephan C, Carlebach A, Rottmann C, Haberl A, Dauer B, von Hentig N, Kurowski M, Staszewski S. Dose reduction effective in alleviating symptoms of saquinavir toxicity. Int J STD AIDS 2016; 18:81-4. [PMID: 17331276 DOI: 10.1258/095646207779949763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gastrointestinal intolerance is a limitation of boosted saquinavir antiretroviral treatment. We present three HIV-infected individuals whose severe toxicity symptoms started directly after initiation of a standard dose saquinavir hard-gel capsule-containing regimen (saquinavir/ritonavir 1000/100 mg). All patients underwent immediate 12 h pharmacokinetic (PK) assessment and showed extraordinarily high saquinavir plasma exposure. All three patients did not recover until the saquinavir exposure was decreased. This pilot case study anticipates a new concept of 'direct PK'-guided individual dose interventions under close viral load monitoring. Two major reasons for symptomatic saquinavir overexposure were defined: impaired liver function in a chronic hepatitis C virus co-infected individual at normal liver performance parameters and a delayed cytochrome p450 enzyme autoinduction. Overexposure seems to be an independent intolerance factor. Although delayed autoinduction is not well established as a reason for adverse events in saquinavir therapy, this observation may be confirmed in the near future by increased use.
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Affiliation(s)
- C Stephan
- Medical HIV Treatment and Research Unit, Hospital of the Johann Wolfgang Goethe University, Department of Internal Medicine II, Frankfurt, Germany.
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20
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Fätkenheuer G, Jessen H, Stoehr A, Jung N, Jessen AB, Kümmerle T, Berger M, Bogner JR, Spinner CD, Stephan C, Degen O, Vogelmann R, Spornraft-Ragaller P, Schnaitmann E, Jensen B, Ulmer A, Kittner JM, Härter G, Malfertheiner P, Rockstroh J, Knecht G, Scholten S, Harrer T, Kern WV, Salzberger B, Schürmann D, Ranneberg B. PEPDar: A randomized prospective noninferiority study of ritonavir-boosted darunavir for HIV post-exposure prophylaxis. HIV Med 2016; 17:453-9. [PMID: 27166295 DOI: 10.1111/hiv.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES PEPDar compared the tolerability and safety of ritonavir-boosted darunavir (DRV/r)-based post-exposure prophylaxis (PEP) with the tolerability and safety of standard of care (SOC). The primary endpoint was the early discontinuation rate among the per-protocol population. METHODS PEPDar was an open-label, randomized, multicentre, prospective, noninferiority safety study. Subjects were stratified by type of event (occupational vs. nonoccupational, i.e. sexual) and were randomized to receive DRV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) or SOC PEP. Twenty-two private or university HIV clinics in Germany participated. Subjects were ≥ 18 years old and had documented or potential HIV exposure and indication for HIV PEP. They initiated PEP not later than 72 h after the event and were HIV negative. RESULTS A total of 324 subjects were screened, the per-protocol population was 305, and 273 subjects completed the study. One hundred and fifty-five subjects received DRV/r-based PEP and 150 subjects received ritonavir-boosted lopinavir (LPV/r)-based PEP for 28-30 days; 298 subjects also received tenofovir/emtricitabine. The early discontinuation rate in the DRV/r arm was 6.5% compared with 10.0% in the SOC arm (P = 0.243). Adverse drug reactions (ADRs) were reported in 68% of DRV/r subjects and 75% of SOC subjects (P = 0.169). Fewer DRV/r subjects (16.1%) had at least one grade 2 or 3 ADR compared with SOC subjects (29.3%) (P = 0.006). All grades of diarrhoea, nausea, and sleep disorders were significantly less frequent with DRV/r, while headache was significantly more frequent. No HIV seroconversion was reported during follow-up. CONCLUSIONS Noninferiority of DRV/r to SOC was demonstrated. DRV/r should be included as a standard component of recommended regimens in PEP guidelines.
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Affiliation(s)
- G Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany
| | - H Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - A Stoehr
- ifi - Institute for Interdisciplinary Medicine, Study Centre St. Georg, Hamburg, Germany
| | - N Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A B Jessen
- Praxis Jessen2 + Kollegen, Berlin, Germany
| | - T Kümmerle
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - M Berger
- Immunology Outpatient Clinic, Vivantes Auguste Viktoria Hospital, Berlin, Germany
| | - J R Bogner
- Section Infectcious Diseases, Med IV, University Hospital of Munich, Munich, Germany
| | - C D Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - C Stephan
- Department of Medicine, Center for Internal Medicine, J. W. Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - O Degen
- Outpatient Infectious Diseases Unit, University Center Hamburg Eppendorf, Hamburg, Germany
| | - R Vogelmann
- Department of Internal Medicine, Medical Clinic II, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | | | - B Jensen
- Department of Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Ulmer
- Group Practice Ulmer/Frietsch/Müller/Roll, Stuttgart, Germany
| | - J M Kittner
- Medical Clinic and Outpatient Clinic I, University Hospital Mainz, Mainz, Germany
| | - G Härter
- Clinic for Internal Medizin III, Ulm University Medical Center, Ulm, Germany
| | - P Malfertheiner
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Magdeburg, Magdeburg, Germany
| | - J Rockstroh
- Internal Medicine I, Gastroenterology, Infectious Diseases, University Hospital Bonn, Bonn, Germany
| | - G Knecht
- Internal Medicine Specialist Center Stresemannallee, Frankfurt am Main, Germany
| | - S Scholten
- Practice Hohenstaufenring, Cologne, Germany
| | - T Harrer
- Department of Medicine 3, University Medicine Erlangen, Erlangen, Germany
| | - W V Kern
- Division of Infectious Diseases, University Hospital, Freiburg, Germany
| | - B Salzberger
- Department Internal Medicine I, University Regensburg, Regensburg, Germany
| | - D Schürmann
- Division of Infectiology and Pneumonology, Medical Department, Charité-University Medicine Berlin, Berlin, Germany
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Diakaki M, Audouin L, Berthoumieux E, Calviani M, Colonna N, Dupont E, Duran I, Gunsing F, Leal-Cidoncha E, Le Naour C, Leong L, Mastromarco M, Paradela C, Tarrio D, Tassan-Got L, Aerts G, Altstadt S, Alvarez H, Alvarez-Velarde F, Andriamonje S, Andrzejewski J, Badurek G, Barbagallo M, Baumann P, Becares V, Becvar F, Belloni F, Berthier B, Billowes J, Boccone V, Bosnar D, Brugger M, Calvino F, Cano-Ott D, Capote R, Carrapiço C, Cennini P, Cerutti F, Chiaveri E, Chin M, Cortes G, Cortes-Giraldo M, Cosentino L, Couture A, Cox J, David S, Dillmann I, Domingo-Pardo C, Dressler R, Dridi W, Eleftheriadis C, Embid-Segura M, Ferrant L, Ferrari A, Finocchiaro P, Fraval K, Fujii K, Furman W, Ganesan S, Garcia A, Giubrone G, Gomez-Hornillos M, Goncalves I, Gonzalez-Romero E, Goverdovski A, Gramegna F, Griesmayer E, Guerrero C, Gurusamy P, Haight R, Heil M, Heinitz S, Igashira M, Isaev S, Jenkins D, Jericha E, Kadi Y, Kaeppeler F, Karadimos D, Karamanis D, Kerveno M, Ketlerov V, Kivel N, Kokkoris M, Konovalov V, Krticka M, Kroll J, Lampoudis C, Langer C, Lederer C, Leeb H, Lo Meo S, Losito R, Lozano M, Manousos A, Marganiec J, Martinez T, Marrone S, Massimi C, Mastinu P, Mendoza E, Mengoni A, Milazzo P, Mingrone F, Mirea M, Mondelaers W, Moreau C, Mosconi M, Musumarra A, O’Brien S, Pancin J, Patronis N, Pavlik A, Pavlopoulos P, Perkowski J, Perrot L, Pigni M, Plag R, Plompen A, Plukis L, Poch A, Pretel C, Praena J, Quesada J, Rauscher T, Reifarth R, Riego A, Roman F, Rudolf G, Rubbia C, Rullhusen P, Salgado J, Santos C, Sarchiapone L, Sarmento R, Saxena A, Schillebeeckx P, Schmidt S, Schumann D, Stephan C, Tagliente G, Tain J, Tavora L, Terlizzi R, Tsinganis A, Valenta S, Vannini G, Variale V, Vaz P, Ventura A, Versaci R, Vermeulen M, Villamarin D, Vincente M, Vlachoudis V, Vlastou R, Voss F, Wallner A, Walter S, Ware T, Weigand M, Weiß C, Wiesher M, Wisshak K, Wright T, Zugec P. Towards the high-accuracy determination of the238U fission cross section at the threshold region at CERN – n_TOF. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201611102002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Paradela C, Duran I, Tassan-Got L, Audouin L, Berthier B, Isaev S, Le Naour C, Stephan C, Tarrío D, Abbondanno U, Aerts G, Álvarez-Pol H, Álvarez-Velarde F, Andriamonje S, Andrzejewski J, Badurek G, Baumann P, Becvar F, Berthoumieux E, Calviño F, Calviani M, Cano-Ott D, Capote R, Carrapiço C, Cennini P, Chepel V, Chiaveri E, Colonna N, Cortes G, Couture A, Cox J, Dahlfors M, David S, Dillmann I, Domingo-Pardo C, Dridi W, Eleftheriadis C, Embid-Segura M, Ferrant L, Ferrari A, Ferreira-Marques R, Fujii K, Furman W, Gonçalves I, Gonzalez-Romero E, Goverdovski A, Gramegna F, Guerrero C, Gunsing F, Haight R, Heil M, Igashira M, Jericha E, Kadi Y, Kaeppeler F, Karadimos D, Kerveno M, Ketlerov V, Koehler P, Konovalov V, Krticka M, Lampoudis C, Lederer C, Leeb H, Lindote A, Lukic S, Marganiec J, Martinez T, Marrone S, Massimi C, Mastinu P, Mengoni A, Milazzo P, Moreau C, Mosconi M, Pancin SJ, Pavlik A, Pavlopoulos P, Perrot L, Plag R, Plompen A, Plukis A, Poch A, Pretel C, Praena J, Quesada J, Rauscher T, Reifarth R, Rubbia C, Rudolf G, Rullhusen P, Salgado J, Santos C, Sarchiapone L, Savvidis I, Tagliente G, Tain J, Tavora L, Terlizzi R, Vaz P, Ventura A, Villamarin D, Vincente M, Vlachoudis V, Vlastou R, Voss F, Walter S, Weiss C, Wiesher M, Wisshak K. High accuracy235U(n,f) data in the resonance energy region. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201611102003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Masouridi-Levrat S, Simonetta F, Beauverd Y, Tsopra O, Tirefort Y, Stephan C, Levrat E, Ansari M, Verholen F, Roosnek E, Passweg JR, Chalandon Y. Excellent outcome with a high proportion of mixed chimerism in patients with severe aplastic anemia treated with partially T-cell-depleted peripheral hematopoietic stem cell transplants. Bone Marrow Transplant 2016; 51:860-2. [DOI: 10.1038/bmt.2015.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Baker JV, Engen NW, Huppler Hullsiek K, Stephan C, Jain MK, Munderi P, Pett S, Duprez D. Assessment of arterial elasticity among HIV-positive participants with high CD4 cell counts: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:109-18. [PMID: 25711329 DOI: 10.1111/hiv.12239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Both HIV infection and antiretroviral therapy (ART) may increase cardiovascular disease (CVD) risk. Assessments of vascular function and structure can be used to study the pathogenesis and progression of CVD, including the effects of ART and other interventions. The objective of this report is to understand methods to assess vascular (dys)function and report our experience in the Arterial Elasticity Substudy in the Strategic Timing of AntiRetroviral Treatment (START) trial. METHODS We review literature and analyze baseline data from the Arterial Elasticity Substudy, which estimated vascular (dys)function through analysis of the diastolic blood pressure (BP) waveform. Linear regression was used to study cross-sectional associations between baseline clinical factors and small or large arterial elasticity. RESULTS Arterial elasticity measurement was chosen for its improved measurement reproducibility over other methodologies and the potential of small arterial elasticity to predict clinical risk. Analysis of baseline data demonstrates that small artery elasticity is impaired (lower) with older age and differs by race and between geographical regions. No HIV-specific factors studied remained significantly associated with arterial elasticity in multivariate models. CONCLUSIONS Longitudinal analyses in this substudy will provide essential randomized data with which to study the effects of early ART initiation on the progression of vascular disease among a diverse global population. When combined with future biomarker analyses and clinical outcomes in START, these findings will expand our understanding of the pathogenesis of HIV-related CVD.
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Affiliation(s)
- J V Baker
- Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
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25
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Jaeckle M, Khaykin P, Haberl A, De Leuw P, Schüttfort G, Stephan C, Wolf T. Efficacy of raltegravir-containing regimens in antiretroviral-naïve and -experienced individuals in routine clinical practice. Int J STD AIDS 2015; 27:1170-1179. [PMID: 26429890 DOI: 10.1177/0956462415610678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/16/2015] [Indexed: 11/15/2022]
Abstract
Raltegravir is one of the standard antiretroviral therapy (ART) options in treatment-experienced and -naïve patients. However, efficacy data from clinical practice are scarce. Therefore, the efficacy of raltegravir-containing ART in clinical practice was investigated retrospectively. In all, 295 treatment-naïve and -experienced patients were analysed using two different cut-offs for virological failure (200 or 50 copies/ml). The response at week 24 and onwards was evaluated as a 'time to loss of virological response' analysis and estimated as a survival function. Additionally, dual therapy regimens (raltegravir plus boosted protease inhibitor) were compared to standard combinations in experienced patients performing a snapshot analysis at weeks 24 and 48, as well as a time to loss of virological response analysis. A total of 86.2% of the 64 treatment-naïve patients maintained virological suppression using a cut-off of 200 copies/ml (c/ml), while 67.7% maintained virological suppression with a 50 copies/ml cut-off from week 24 until the end of observation. Among the 231 treatment-experienced patients, 84.8% maintained virological suppression from week 24 onwards using a cut-off of 200 copies/ml; and 71.0% using 50 copies/ml, respectively. In the subgroup snapshot analysis at week 24, 98.3% (86.7% using a cut-off of 50 copies/ml) and at week 48, 93.3% (80.0%) of patients responded to dual therapy. Patients who were receiving a standard background therapy responded in 88.3% (81.3%) at week 24 and in 86.0% (80.7%) at week 48. Differences were not significant. This study shows again the overall long-term efficacy of raltegravir-based ART and furthermore gives reference for a comparable efficacy of dual and standard nucleos(t)ide reverse transcriptase inhibitor-backbone regimens in experienced patients on raltegravir over a period of 48 weeks in a real-life cohort where patients with severe comorbidities were included.
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Affiliation(s)
- M Jaeckle
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - P Khaykin
- MainFachArzt, Specialist Practice for Infectious Diseases and Primary Care, Frankfurt, Germany
| | - A Haberl
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - P De Leuw
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - G Schüttfort
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - C Stephan
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - T Wolf
- HIV Center, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
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Abstract
Prostate-specific antigen (PSA) has revolutionized the management of prostate cancer (PCa) within the last 3 decades. This widely used tumour marker strongly correlates with the risk of harbouring a PCa but it lacks specificity. Therefore there is an urgent need for new biomarkers especially to detect clinically significant and aggressive PCa. Of all PSA-based markers, only the FDA-approved prostate health index phi shows improved specificity over percent free (%fPSA) and total PSA. Other serum kallikreins or sarcosine in serum or urine show more ambiguous data. In urine, the FDA-approved prostate cancer gene 3 (PCA3) has also proven its utility in the detection and management of early PCa with advantages as compared with PSA and %fPSA. However, some aspects of its correlation with aggressiveness and the low sensitivity at very high values have to be re-examined. The detection of alterations of the androgen regulated TMPRSS2 and ETS transcription factor genes in tissue of ~50% of all PCa patients was a milestone in PCa research. But only the combination of the urinary assays for TMPRSS2:ERG gene fusion and PCA3 (both use the same platform) show the expected improved accuracy for PCa detection. Comparisons of phi and PCA3, the best available PCa biomarkers so far, show an equal performance of both parameters.
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Affiliation(s)
- C. Stephan
- Klinik für Urologie, Charité – Universitätsmedizin Berlin
| | - K. Jung
- Klinik für Urologie, Charité – Universitätsmedizin Berlin
| | - K. Miller
- Klinik für Urologie, Charité – Universitätsmedizin Berlin
| | - B. Ralla
- Klinik für Urologie, Charité – Universitätsmedizin Berlin
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Abstract
Occupational transmission of HIV among healthcare personnel is rare but has repeatedly been published in the literature. Early initiation of postexposure HIV prophylaxis (HIV-PEP) is crucial to prevent virus transmission. For this reason the need for HIV-PEP has to be evaluated immediately and if necessary, started as soon as possible. This article presents an early intervention program in a university hospital which enables healthcare personnel immediate 24/7/365 access to a HIV-PEP prophylaxis kit following occupational HIV exposure.
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Affiliation(s)
- S Wicker
- Betriebsärztlicher Dienst, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland,
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Maxeiner A, Stephan C, Fischer T, Durmus T, Kilic E, Asbach P, Haas M, Günzel K, Neymeyer J, Miller K, Cash H. [Real-time MRI/US fusion-guided biopsy in biopsy-naïve and pre-biopsied patients with suspicion for prostate cancer]. Aktuelle Urol 2015; 46:34-8. [PMID: 25519051 DOI: 10.1055/s-0034-1395563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI)/ultrasound (US) fusion-guided biopsy detects more prostate cancer (PCa) than transrectal US (TRUS)-guided biopsy in patients with an indication for prostate re-biopsy. The aim of this study was a) to compare the detection rates of MRI/US fusion-guided biopsy with conventional TRUS in a double centre cohort and b) to investigate the influence of the number of pre-biopsies on the PCa detection rate. MATERIAL AND METHODS In the period from January 2012 to July 2014, 310 consecutive patients gave written informed consent and underwent 3 Tesla MRI scans of the prostate. All patients had at least one PCa suspicious lesion in the MRI and were biopsied by MRI/US fusion followed by a conventional 10-core biopsy of the prostate. Detection rates based on technique, Gleason score and number of pre-biopsies were calculated. RESULTS The overall detection rate of the study was 51% (158 patients). Among these 158 patients a histopathological Gleason score of 6 was detected in 60 patients (38%), a Gleason score of 7 in 54 patients (34%) and a Gleason score≥8 in 44 patients (28%). MRI/US fusion-guided biopsy detected 110 (69.7%) of the overall detected 158 PCa. TRUS-guided biopsy detected a higher rate of Gleason score 6 (54%) and a lower rate of Gleason score≥8 (15%) lesions in comparison to 38% Gleason 6 and 28% Gleason≥8 in the MRI/US fusion-guided biopsy, respectively. Furthermore, a lower Gleason score was observed in patients with more than one pre-biopsy. The detection rate in biopsy-naïve patients undergoing MRI/US fusion was 75% (40 patients) among 75% detected Gleason score≥7. CONCLUSION MRI/US fusion-guided biopsy detected more PCa and also more clinically significant cancer than conventional TRUS. In our cohort patients with more than one pre-biopsy showed lower Gleason scores. The included patients with an initial MRI/US fusion-guided biopsy should be further investigated.
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Affiliation(s)
- A. Maxeiner
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - C. Stephan
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Fischer
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Durmus
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - E. Kilic
- Klinik für Pathologie, Charité – Universitätsmedizin Berlin, CCM, Berlin
| | - P. Asbach
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - M. Haas
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - K. Günzel
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - J. Neymeyer
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - K. Miller
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - H. Cash
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
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Cohen T, Widdows D, Stephan C, Zinner R, Kim J, Rindflesch T, Davies P. Predicting high-throughput screening results with scalable literature-based discovery methods. CPT Pharmacometrics Syst Pharmacol 2014; 3:e140. [PMID: 25295575 PMCID: PMC4474167 DOI: 10.1038/psp.2014.37] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/20/2014] [Indexed: 11/10/2022]
Abstract
The identification of new therapeutic uses for existing agents has been proposed as a means to mitigate the escalating cost of drug development. A common approach to such repurposing involves screening libraries of agents for activities against cell lines. In silico methods using knowledge from the biomedical literature have been proposed to constrain the costs of screening by identifying agents that are likely to be effective a priori. However, results obtained with these methods are seldom evaluated empirically. Conversely, screening experiments have been criticized for their inability to reveal the biological basis of their results. In this paper, we evaluate the ability of a scalable literature-based approach, discovery-by-analogy, to identify a small number of active agents within a large library screened for activity against prostate cancer cells. The methods used permit retrieval of the knowledge used to infer their predictions, providing a plausible biological basis for predicted activity.
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Affiliation(s)
- T Cohen
- University of Texas School of Biomedical Informatics at Houston, Houston, Texas, USA
| | - D Widdows
- Microsoft Bing, Redmond, Washington, USA
| | - C Stephan
- Center for Translational Cancer Research, Texas A&M Health Sciences Center, Institute of Biosciences and Technology, Houston, Texas, USA
| | - R Zinner
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J Kim
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - T Rindflesch
- National Library of Medicine, Bethesda, Maryland, USA
| | - P Davies
- Center for Translational Cancer Research, Texas A&M Health Sciences Center, Institute of Biosciences and Technology, Houston, Texas, USA
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Wolf T, Fuß B, Khaykin P, Berger A, Knecht G, Gute P, Brodt HR, Goepel S, Bickel M, Stuermer M, Stephan C. Improved virological and immunological efficacy of resistance-guided switch in antiretroviral therapy: a Frankfurt HIV cohort analysis. Med Microbiol Immunol 2014; 203:409-14. [PMID: 25148909 DOI: 10.1007/s00430-014-0350-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/29/2014] [Indexed: 12/15/2022]
Abstract
To evaluate the treatment outcome of antiretroviral therapy, depending on the use and utility of a concept of resistance-guided switch, patients from the Frankfurt HIV cohort have been followed for 24 weeks. If available, prior resistance data have been evaluated and patients were grouped into their expected viral response. The data of 354 patients were thus analysed, taking into account the genotypic sensitivity score of the administered medication (> or ≤2). When looking at the proportion of patients who achieved a viral load of <50/ml, the response rates differed significantly better for patients with a favourable resistance scoring as compared to an unfavourable one (71.9 % as compared to 56.0 %, p = 0.008). Interestingly, patients with a favourable resistance score also showed a better immunological response, as measured by median CD4 cell count of 391/µl [interquartal range (IQR) 250-530/µl] against 287/µl (IQR 174-449/µl) and a larger total increase of 141/µl against 38/µl. A significant virological and immunological benefit could be demonstrated for patients of a cohort with resistance-guided antiretroviral therapy adjustments.
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Affiliation(s)
- T Wolf
- Infectious Diseases Unit at Medical Department No. 2, HIVCENTER, Hospital of the Johann Wolfgang Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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de Groot J, Thomas C, Piao Y, Nguyen N, Drewry D, Zuercher B, Verhaak R, Stephan C, Sulman EP, Lang F, Yung A. HIGH-THROUGHPUT SCREENING OF GLIOMA STEM CELL LINES FOR DRUG STRUCTURE- AND GENOTYPE-CORRELATED SENSITIVITY TO A PANEL OF TYROSINE KINASE INHIBITORS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou208.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Maxeiner A, Fischer T, Stephan C, Cash H, Slowinski T, Kilic E, Durmus T. [Real-time MRI/US fusion-guided biopsy improves detection rates of prostate cancer in pre-biopsied patients]. Aktuelle Urol 2014; 45:197-203. [PMID: 24902069 DOI: 10.1055/s-0034-1375682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND According to the guidelines of the European Association of Urology (EAU) on prostate cancer (PCa) in 2013, patients with increasing prostate-specific antigen (PSA) levels, suspicious digital rectal examination (DRE) or high-grade prostatic intraepithelial neoplasia after negative prostate biopsy (PB) should undergo a repeat biopsy. Low cancer detection rates in the repeat biopsy illuminate the dilemma of the international gold standard of transrectal ultrasound (TRUS) guided PB in the detection of PCa. Our study evaluated the combination of TRUS and prostate magnetic resonance imaging (MRI) and its reported high sensitivities and high specificities by using real-time MRI/US fusion-guided biopsy. The detection of clinically significant PCa was investigated. MATERIAL AND METHODS 128 consecutive patients in the period of January 2012 to August 2013 were included. All patients had at least one TRUS-guided biopsy with negative findings and the clinical indication for a systematic re-biopsy. Prior to the MRI/US fusion all patients underwent a 3 Tesla prostate MRI without endorectal coil. The MRI data were uploaded to a modern US system. The B-mode, power-mode, elastography and CEUS imaging were used to classify the suspicious lesions from the MRI on a scale of 0-3 and a US sum score was calculated. The lesion was consecutively biopsied by real-time MRI/US fusion followed by a systematic 10 core biopsy. RESULTS Among 128 patients 51 PCa could be detected (39.8%). From these 51 PCa cases, clinically significant PCa was detected by MRI/US fusion-guided biopsy as follows: Gleason score >7 in 9 of 10 patients; Gleason score=7 in 14 of 20 patients and Gleason score <7 in 13 of 21 patients. A positive correlation was shown between the US sum score and the associated PI-RADS score in 65 patients in whom lesions were classified by PI-RADS. A positive correlation was further shown between the US sum score and the Gleason score of all suspicious and biopsied lesions. MRI/US fusion and TRUS-guided biopsy combined, detected 30 of 51 PCa; 6 of 51 PCa were detected by MRI/US fusion alone and 15 of 51 PCa by conventional TRUS-guided biopsy alone. CONCLUSION Real-time MR/US fusion increases detection rates of PCa in patients undergoing repeat biopsy. Especially, clinically significant PCa with a Gleason score ≥ 7 were almost exclusively detected by MR/US fusion-guided biopsy.
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Affiliation(s)
- A. Maxeiner
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Fischer
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
| | - C. Stephan
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - H. Cash
- Klinik für Urologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Slowinski
- Klinik für Nephrologie, Charité – Universitätsmedizin Berlin, Berlin
| | - E. Kilic
- Klinik für Pathologie, Charité – Universitätsmedizin Berlin, Berlin
| | - T. Durmus
- Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Berlin
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Wicker S, Walcher F, Wutzler S, Stephan C, Marzi I. Best practice for needlestick injuries. Eur J Trauma Emerg Surg 2014; 40:151-8. [PMID: 26815895 DOI: 10.1007/s00068-014-0376-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/09/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE Needlestick injuries (NSIs) are a significant health hazard. Occupational transmission of bloodborne pathogens among healthcare workers (HCWs) is rare but has been repeatedly reported in the literature. METHODS In October 2010, new regulations were introduced for medical aftercare of HCWs following NSIs at the University Hospital Frankfurt. In June 2013, a university hospital-wide early intervention program was introduced that gives HCWs immediate 24/7/365 access to an HIV postexposure prophylaxis kit after confirmed or probable occupational HIV exposure. RESULTS Interdisciplinary collaboration between the attending surgeon and occupational health as well as infectious disease specialists facilitates optimal postexposure medical treatment of HCWs who suffer NSIs. Complete reporting of NSIs is a prerequisite for achieving optimal treatment of the affected HCWs. CONCLUSION An NSI is an emergency and needs to be evaluated immediately and, if necessary, treated as soon as possible. A standardized algorithm for initial diagnostic and treatment has proven to be helpful.
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Affiliation(s)
- S Wicker
- Occupational Health Service, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - F Walcher
- Department of Trauma, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - S Wutzler
- Department of Trauma, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - C Stephan
- Department of Medicine II, Infectiology, HIV Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - I Marzi
- Department of Trauma, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Himmelreich H, Sarrazin CM, Stephan C, Rabenau HF, Marzi I, Wicker S. [Early diagnosis of hepatitis C transmission after needlestick injury]. Unfallchirurg 2014; 116:650-2. [PMID: 22955297 DOI: 10.1007/s00113-012-2261-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Occupational transmission of hepatitis C (HCV) is rare but has been repeatedly described in the published literature. Early diagnosis and therapy of acute hepatitis C is associated with an excellent chance of permanent HCV elimination. The majority of chronic HCV infections, however, lead to a slowly progressive hepatitis with associated morbidity and risk of liver cirrhosis. For this reason the need for antiviral therapy has to be evaluated immediately.
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Affiliation(s)
- H Himmelreich
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Wolf T, Kiderlen T, Atta J, Stephan C, Kann G, Brodt HR, Brandts C. Successful treatment of AIDS-associated, primary CNS lymphoma with rituximab- and methotrexate-based chemotherapy and autologous stem cell transplantation. Infection 2014; 42:445-7. [PMID: 24442720 DOI: 10.1007/s15010-013-0579-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- T Wolf
- Department of Medicine II-Infectious Diseases, HIV Center, Hospital of the J. W. Goethe University, Theodor Stern Kai 7, 60596, Frankfurt, Germany,
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Geretti AM, Conibear T, Hill A, Johnson JA, Tambuyzer L, Thys K, Vingerhoets J, Van Delft Y, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvivier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Alvarez CM, Quero JH, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Sensitive testing of plasma HIV-1 RNA and Sanger sequencing of cellular HIV-1 DNA for the detection of drug resistance prior to starting first-line antiretroviral therapy with etravirine or efavirenz. J Antimicrob Chemother 2013; 69:1090-7. [DOI: 10.1093/jac/dkt474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aaberg-Jessen C, Fogh L, Halle B, Jensen V, Brunner N, Kristensen BW, Abe T, Momii Y, Watanabe J, Morisaki I, Natsume A, Wakabayashi T, Fujiki M, Aldaz B, Fabius AWM, Silber J, Harinath G, Chan TA, Huse JT, Anai S, Hide T, Nakamura H, Makino K, Yano S, Kuratsu JI, Balyasnikova IV, Prasol MS, Kanoija DK, Aboody KS, Lesniak MS, Barone T, Burkhart C, Purmal A, Gudkov A, Gurova K, Plunkett R, Barton K, Misuraca K, Cordero F, Dobrikova E, Min H, Gromeier M, Kirsch D, Becher O, Pont LB, Kloezeman J, van den Bent M, Kanaar R, Kremer A, Swagemakers S, French P, Dirven C, Lamfers M, Leenstra S, Pont LB, Balvers R, Kloezeman J, Kleijn A, Lawler S, Leenstra S, Dirven C, Lamfers M, Gong X, Andres A, Hanson J, Delashaw J, Bota D, Chen CC, Yao NW, Chuang WJ, Chang C, Chen PY, Huang CY, Wei KC, Cheng Y, Dai Q, Morshed R, Han Y, Auffinger B, Wainwright D, Zhang L, Tobias A, Rincon E, Thaci B, Ahmed A, He C, Lesniak M, Choi YA, Pandya H, Gibo DM, Fokt I, Priebe W, Debinski W, Chornenkyy Y, Agnihotri S, Buczkowicz P, Rakopoulos P, Morrison A, Barszczyk M, Becher O, Hawkins C, Chung S, Decollogne S, Luk P, Shen H, Ha W, Day B, Stringer B, Hogg P, Dilda P, McDonald K, Moore S, Hayden-Gephart M, Bergen J, Su Y, Rayburn H, Edwards M, Scott M, Cochran J, Das A, Varma AK, Wallace GC, Dixon-Mah YN, Vandergrift WA, Giglio P, Ray SK, Patel SJ, Banik NL, Dasgupta T, Olow A, Yang X, Mueller S, Prados M, James CD, Haas-Kogan D, Dave ND, Desai PB, Gudelsky GA, Chow LML, LaSance K, Qi X, Driscoll J, Driscoll J, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovic RD, McMahon J, Powers JP, Jaen JC, Schall TJ, Eroglu Z, Portnow J, Sacramento A, Garcia E, Raubitschek A, Synold T, Esaki S, Rabkin S, Martuza R, Wakimoto H, Ferluga S, Tome CL, Debinski W, Forde HE, Netland IA, Sleire L, Skeie B, Enger PO, Goplen D, Giladi M, Tichon A, Schneiderman R, Porat Y, Munster M, Dishon M, Weinberg U, Kirson E, Wasserman Y, Palti Y, Giladi M, Porat Y, Schneiderman R, Munster M, Weinberg U, Kirson E, Palti Y, Gramatzki D, Staudinger M, Frei K, Peipp M, Weller M, Grasso C, Liu L, Becher O, Berlow N, Davis L, Fouladi M, Gajjar A, Hawkins C, Huang E, Hulleman E, Hutt M, Keller C, Li XN, Meltzer P, Quezado M, Quist M, Raabe E, Spellman P, Truffaux N, van Vurden D, Wang N, Warren K, Pal R, Grill J, Monje M, Green AL, Ramkissoon S, McCauley D, Jones K, Perry JA, Ramkissoon L, Maire C, Shacham S, Ligon KL, Kung AL, Zielinska-Chomej K, Grozman V, Tu J, Viktorsson K, Lewensohn R, Gupta S, Mladek A, Bakken K, Carlson B, Boakye-Agyeman F, Kizilbash S, Schroeder M, Reid J, Sarkaria J, Hadaczek P, Ozawa T, Soroceanu L, Yoshida Y, Matlaf L, Singer E, Fiallos E, James CD, Cobbs CS, Hashizume R, Tom M, Ihara Y, Ozawa T, Santos R, Torre JDL, Lepe E, Waldman T, Prados M, James D, Hashizume R, Ihara Y, Huang X, Yu-Jen L, Tom M, Mueller S, Gupta N, Solomon D, Waldman T, Zhang Z, James D, Hayashi T, Adachi K, Nagahisa S, Hasegawa M, Hirose Y, Gephart MH, Moore S, Bergen J, Su YS, Rayburn H, Scott M, Cochran J, Hingtgen S, Kasmieh R, Nesterenko I, Figueiredo JL, Dash R, Sarkar D, Fisher P, Shah K, Horne E, Diaz P, Stella N, Huang C, Yang H, Wei K, Huang T, Hlavaty J, Ostertag D, Espinoza FL, Martin B, Petznek H, Rodriguez-Aguirre M, Ibanez C, Kasahara N, Gunzburg W, Gruber H, Pertschuk D, Jolly D, Robbins J, Hurwitz B, Yoo JY, Bolyard C, Yu JG, Wojton J, Zhang J, Bailey Z, Eaves D, Cripe T, Old M, Kaur B, Serwer L, Yoshida Y, Le Moan N, Santos R, Ng S, Butowski N, Krtolica A, Ozawa T, Cary SPL, James CD, Johns T, Greenall S, Donoghue J, Adams T, Karpel-Massler G, Westhoff MA, Kast RE, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Karpel-Massler G, Kast RE, Westhoff MA, Merkur N, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Kievit F, Stephen Z, Wang K, Kolstoe D, Silber J, Ellenbogen R, Zhang M, Kitange G, Schroeder M, Sarkaria J, Kleijn A, Haefner E, Leenstra S, Dirven C, Lamfers M, Knubel K, Pernu BM, Sufit A, Pierce AM, Nelson SK, Keating AK, Jensen SS, Kristensen BW, Lachowicz J, Demeule M, Regina A, Tripathy S, Curry JC, Nguyen T, Castaigne JP, Le Moan N, Serwer L, Yoshida Y, Ng S, Davis T, Santos R, Davis A, Tanaka K, Keating T, Getz J, Kapp GT, Romero JM, Ozawa T, James CD, Krtolica A, Cary SPL, Lee S, Ramisetti S, Slagle-Webb B, Sharma A, Connor J, Lee WS, Maire C, Kluk M, Aster JC, Ligon K, Sun S, Lee D, Ho ASW, Pu JKS, Zhang ZQ, Lee NP, Day PJR, Leung GKK, Liu Z, Liu X, Madhankumar AB, Miller P, Webb B, Connor JR, Yang QX, Lobo M, Green S, Schabel M, Gillespie Y, Woltjer R, Pike M, Lu YJ, Torre JDL, Waldman T, Prados M, Ozawa T, James D, Luchman HA, Stechishin O, Nguyen S, Cairncross JG, Weiss S, Lun X, Wells JC, Hao X, Zhang J, Grinshtein N, Kaplan D, Luchman A, Weiss S, Cairncross JG, Senger D, Robbins S, Madhankumar A, Slagle-Webb B, Rizk E, Payne R, Park A, Pang M, Harbaugh K, Connor J, Wilisch-Neumann A, Pachow D, Kirches E, Mawrin C, McDonell S, Liang J, Piao Y, Nguyen N, Yung A, Verhaak R, Sulman E, Stephan C, Lang F, de Groot J, Mizobuchi Y, Okazaki T, Kageji T, Kuwayama K, Kitazato KT, Mure H, Hara K, Morigaki R, Matsuzaki K, Nakajima K, Nagahiro S, Kumala S, Heravi M, Devic S, Muanza T, Nelson SK, Knubel KH, Pernu BM, Pierce AM, Keating AK, Neuwelt A, Nguyen T, Wu YJ, Donson A, Vibhakar R, Venkatamaran S, Amani V, Neuwelt E, Rapkin L, Foreman N, Ibrahim F, New P, Cui K, Zhao H, Chow D, Stephen W, Nozue-Okada K, Nagane M, McDonald KL, Ogawa D, Chiocca E, Godlewski J, Ozawa T, Yoshida Y, Santos R, James D, Pang M, Liu X, Madhankumar AB, Slagle-Webb B, Patel A, Miller P, Connor J, Pasupuleti N, Gorin F, Valenzuela A, Leon L, Carraway K, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Phillips A, Boghaert E, Vaidya K, Ansell P, Shalinsky D, Zhang Y, Voorbach M, Mudd S, Holen K, Humerickhouse R, Reilly E, Huang T, Parab S, Diago O, Espinoza FL, Martin B, Ibanez C, Kasahara N, Gruber H, Pertschuk D, Jolly D, Robbins J, Ryken T, Agarwal S, Al-Keilani M, Alqudah M, Sibenaller Z, Assemolt M, Sai K, Li WY, Li WP, Chen ZP, Saito R, Sonoda Y, Kanamori M, Yamashita Y, Kumabe T, Tominaga T, Sarkar G, Curran G, Jenkins R, Scharnweber R, Kato Y, Lin J, Everson R, Soto H, Kruse C, Kasahara N, Liau L, Prins R, Semenkow S, Chu Q, Eberhart C, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Serwer L, Kapp GT, Le Moan N, Yoshida Y, Romero JM, Ng S, Davis A, Ozawa T, Krtolica A, James CD, Cary SPL, Shai R, Pismenyuk T, Moshe I, Fisher T, Freedman S, Simon A, Amariglio N, Rechavi G, Toren A, Yalon M, Shen H, Decollogne S, Dilda P, Chung S, Luk P, Hogg P, McDonald K, Shimazu Y, Kurozumi K, Ichikawa T, Fujii K, Onishi M, Ishida J, Oka T, Watanabe M, Nasu Y, Kumon H, Date I, Sirianni RW, McCall RL, Spoor J, van der Kaaij M, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Stephen Z, Veiseh O, Kievit F, Fang C, Leung M, Ellenbogen R, Silber J, Zhang M, Strohbehn G, Atsina KK, Patel T, Piepmeier J, Zhou J, Saltzman WM, Takahashi M, Valdes G, Inagaki A, Kamijima S, Hiraoka K, Micewicz E, McBride WH, Iwamoto KS, Gruber HE, Robbins JM, Jolly DJ, Kasahara N, Warren K, McCully C, Bacher J, Thomas T, Murphy R, Steffen-Smith E, McAllister R, Pastakia D, Widemann B, Wei K, Yang H, Huang C, Chen P, Hua M, Liu H, Woolf EC, Abdelwahab MG, Fenton KE, Liu Q, Turner G, Preul MC, Scheck AC, Yoshida Y, Ozawa T, Butowski N, Shen W, Brown D, Pedersen H, James D, Zhang J, Hariono S, Yao TW, Sidhu A, Hashizume R, James CD, Weiss WA, Nicolaides TP, Olusanya T. EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2013; 15:iii37-iii61. [PMCID: PMC3823891 DOI: 10.1093/neuonc/not176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Lin S, Zhang J, Giri U, Stephan C, Sobieski M, Nguyen N, Davies P, Komaki R, Yoo S, Heymach J. High Throughput Clonogenic Survival Screen Identifies Novel Radiation Sensitizers for K-ras Mutant Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stephan C, León W. Finding of nevirapine extended release tablet remnants in stools does not threaten the success of combination antiretroviral therapy. HIV Med 2013; 15:124-8. [DOI: 10.1111/hiv.12090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C Stephan
- Infectious Diseases Unit-HIV Center; Medical Department 2; Johann Wolfgang Goethe University Hospital; Frankfurt Germany
| | - W León
- Clinical Development/Medical Affairs; Boehringer Ingelheim Pharmaceuticals, Inc.; Ridgefield CT USA
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Bickel M, Khaykin P, Stephan C, Schmidt K, Buettner M, Amann K, Lutz T, Gute P, Haberl A, Geiger H, Brodt HR, Jung O. Acute kidney injury caused by tenofovir disoproxil fumarate and diclofenac co-administration. HIV Med 2013; 14:633-8. [PMID: 23980564 DOI: 10.1111/hiv.12072] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The renal elimination of tenofovir (TFV) may be subject to renal drug-drug interactions that may increase the risk of kidney injury. Case reports indicated that diclofenac might increase TFV-associated nephrotoxicity via a drug-drug interaction, leading to an increased intracellular TFV concentration in proximal tubular cells. METHODS A retrospective analysis of data for all patients from the Frankfurt HIV Cohort (FHC) who had diclofenac prescriptions between January 2008 and June 2012 was carried out. RESULTS Among 89 patients with diclofenac use, 61 patients (68.5%) were treated with tenofovir disoproxil fumarate (TDF) and 28 patients (31.5%) were treated with TDF-sparing combination antiretroviral therapy (cART). Thirteen patients (14.6%) developed acute kidney injury (AKI) shortly after initiating diclofenac treatment. AKI occurred exclusively in TDF-treated patients, although all had previously stable renal function. All cases were accompanied by new onset of at least two parameters indicating proximal tubular damage, such as normoglycaemic-glucosuria and hypophosphataemia. TFV-associated nephrotoxicity was demonstrated by renal biopsy in four cases. Additionally, 11.5% of patients on TDF treatment developed new-onset proximal tubular damage, while having a preserved glomerular filtration rate. In contrast, diclofenac did not affect renal function in patients with TDF-sparing cART, as only one case of isolated hypophataemia was observed in these patients. In univariate analysis, risk factors for AKI were TDF-containing cART (P = 0.0076) and pre-existing hypophosphataemia (P = 0.0086). CONCLUSIONS Drug-drug interaction caused by diclofenac could exacerbate TFV-associated nephrotoxicity. Diclofenac should be used with caution in patients on TDF therapy, especially in those with hypophosphataemia. Our findings need to be confirmed in larger studies.
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Affiliation(s)
- M Bickel
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany
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Durmus T, Stephan C, Grigoryev M, Diederichs G, Saleh M, Slowinski T, Maxeiner A, Thomas A, Fischer T. [Detection of prostate cancer by real-time MR/ultrasound fusion-guided biopsy: 3T MRI and state of the art sonography]. ROFO-FORTSCHR RONTG 2013; 185:428-33. [PMID: 23420313 DOI: 10.1055/s-0032-1330704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Multiparametric MRI of the prostate is a noninvasive diagnostic method with high sensitivity and specificity for prostate cancer. The aim of this study is to evaluate whether prostate cancer detection rates of transrectal ultrasound (TRUS)-guided biopsy may be improved by an image fusion of state-of-the-art ultrasound (CEUS, elastography) and MR (T2w, DWI) imaging. MATERIALS AND METHODS 32 consecutive patients with a history of elevated PSA levels and at least one negative TRUS-guided biopsy with clinical indication for a systematic re-biopsy underwent multiparametric 3 T MRI without endorectal coil. MR data (T2w) were uploaded to a modern sonography system and image fusion was performed in real-time mode during biopsy. B-mode, Doppler, elastography and CEUS imaging were applied to characterize suspicious lesions detected by MRI. Targeted biopsies were performed in MR/US fusion mode followed by a systematic standard TRUS-guided biopsy. Detection rates for both methods were calculated and compared using the Chi²-test. RESULTS Patient age was not significantly different in patients with and without histologically confirmed prostate cancer (65.2 ± 8.0 and 64.1 ± 7.3 age [p = 0.93]). The PSA value was significantly higher in patients with prostate cancer (15.5 ± 9.3 ng/ml) compared to patients without cancer (PSA 10.4 ± 9.6 ng/ml; p = 0.02). The proportion of histologically confirmed cancers in the study group (n = 32) of the MR/US fusion biopsy (11/12; 34.4 %) was significantly higher (p = 0.01) in comparison to the TRUS systematic biopsy (6/12; 18.8 %). CONCLUSION Real-time MR/US image fusion may enhance cancer detection rates of TRUS-guided biopsies and should therefore be studied in further larger studies.
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Affiliation(s)
- T Durmus
- Institut für Radiologie, Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
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Stephan C, Hill A, Sawyer W, van Delft Y, Moecklinghoff C. Impact of baseline HIV-1 RNA levels on initial highly active antiretroviral therapy outcome: a meta-analysis of 12,370 patients in 21 clinical trials*. HIV Med 2012; 14:284-92. [PMID: 23171153 DOI: 10.1111/hiv.12004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individual randomized trials of first-line antiretroviral treatment do not consistently show an association between higher baseline HIV-1 RNA and lower efficacy. METHODS A MEDLINE search identified 21 HIV clinical trials with published analyses of antiretroviral efficacy by baseline HIV-1 RNA, using a standardized efficacy endpoint of HIV-1 RNA suppression <50 copies/mL at week 48. RESULTS Among 21 clinical trials identified, eight evaluated only nonnucleoside reverse transcriptase inhibitor (NNRTI)-based combinations, eight evaluated only protease inhibitor-based regimens and five compared different treatment classes. Ten of the trials included tenofovir (TDF)/emtricitabine (FTC) as only nucleoside reverse transcriptase inhibitor (NRTI) backbone, in addition but not restricted to abacavir (ABC)/lamivudine (3TC) (n = 7), zidovudine (ZDV)/3TC (n = 4) and stavudine (d4T)/3TC (n = 1). Across trials, the mean percentage of patients achieving HIV-1 RNA < 50 copies/mL at week 48 was 81.5% (5322 of 6814) for patients with baseline HIV-1 RNA < 100 000, vs. 72.6% (3949 of 5556) for patients with HIV-1 RNA > 100 000 copies/mL. In the meta-analysis, the absolute difference in efficacy between low and high HIV-1 RNA subgroups was 7.4% [95% confidence interval (CI) 5.9-8.9%; P < 0.001]. This difference was consistent in trials of NNRTI-based treatments (difference = 6.9%; 95% CI 4.3-9.6%), protease inhibitor-based treatments (difference = 8.4%; 95% CI 6.0-10.8%) and integrase or chemokine (C-C motif) receptor 5 (CCR5)-based treatments (difference = 6.0%; 95% CI 2.1-9.9%) and for trials using TDF/FTC (difference = 8.4%; 95% CI 6.0-10.8%); there was no evidence for heterogeneity of this difference between trials (Cochran's Q test; not significant). CONCLUSIONS In this meta-analysis of 21 first-line clinical trials, rates of HIV-1 RNA suppression at week 48 were significantly lower for patients w ith baseline HIV-1 RNA > 100 000 copies/mL (P < 0.001). This difference in efficacy was consistent across trials of different treatment classes and NRTI backbones.
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Affiliation(s)
- C Stephan
- Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
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Wolf T, Goetsch U, Oremek G, Bickel M, Khaykin P, Haberl A, Bellinger O, Gottschalk R, Brodt HR, Stephan C. Tuberculosis skin test, but not interferon-γ-releasing assays is affected by BCG vaccination in HIV patients. J Infect 2012; 66:376-80. [PMID: 23159357 DOI: 10.1016/j.jinf.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/26/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Of this study was to compare the results of tuberculin skin test (TST) with two interferon-γ releasing-assays (IGRA) in a cohort of HIV positive patients, to analyze impact of prior Bacille-Calmette-Guérin (BCG)-vaccination. METHODS Prospective cross sectional study, enrolling only asymptomatic adult HIV infected outpatients from a large German University hospital clinic. All participants were simultaneously tested for latent tuberculosis infection (LTBI) by QuantiFERON-TB Gold, T-SPOT.TB and TST. Only individuals with available definite results (positive/negative, indeterminates excluded) from all three test systems and recalling BCG-vaccination status by interview questionnaire were evaluated. RESULTS From 286 study participants, 133 were evaluable; BCG-vaccination history was positive for 18 individuals, and negative for 115. The proportion of individuals with a positive TST was significantly higher for vaccinated (n = 6, 33.3%) than for unvaccinated individuals (n = 13, 11.3%, p = 0.013). There were no significant differences in the proportion of patients with CDC stage C, origin from a TB endemic country or in the CD4 count between the two groups. CONCLUSION TST but not IGRAs interfered significantly with prior BCG vaccination in a cohort of HIV infected individuals from a low prevalence TB country. Therefore IGRA should preferentially be used for LTBI-testing in BCG-vaccinated adult HIV-patients.
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Affiliation(s)
- T Wolf
- Department of Medicine II, Infectious Diseases Unit, Johann Wolfgang Goethe-University Hospital, Theodor Stern Kai 7, 60590 Frankfurt, Germany
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Bickel M, Marben W, Betz C, Khaykin P, Stephan C, Gute P, Haberl A, Knecht G, Wolf T, Brodt HR, Geiger H, Herrmann E, Jung O. End-stage renal disease and dialysis in HIV-positive patients: observations from a long-term cohort study with a follow-up of 22 years. HIV Med 2012; 14:127-35. [PMID: 22994610 DOI: 10.1111/j.1468-1293.2012.01045.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Renal disease is a common and serious complication in HIV-infected patients. METHODS A retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease (ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy (HAART)], 1997-2003 (early HAART) and 2004-2010 (late HAART). RESULTS Data for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years (PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk (RR) 5.1; 95% confidence interval (CI) 2.3-10.3; P < 0.0001], injecting drug use (IDU) (RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus (HCV) coinfection (RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up (PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 (RR 0.72; P = 0.52), but significantly from period 1 to 3 (RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality (RR 9.9; 95% CI 6.3-14.5; P < 0.0001). CONCLUSION As a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD.
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Affiliation(s)
- M Bickel
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany.
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Goehler H, Kowald A, Turewicz M, Stephan C, Meyer HE, Lueking A, Schottstedt V, Woitalla D, Hoffmann R, Gold R, Saft C. F08 The autoimmune profile of Huntington's disease patients: a pilot study. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303524.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Scherb T, Kimber SAJ, Stephan C, Henry PF, Schumacher G, Escolastico S, Serra JM. Proton conduction in geometrically frustrated lanthanum tungstate. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312096535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Többens DM, Tovar M, Stephan C, Henry PF. E9 upgraded: the fine-resolution neutron powder diffractometer at BER II. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312097401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fatkenheuer G, Duvivier C, Rieger A, Durant J, Rey D, Schmidt W, Hill A, van Delft Y, Marks S, Rieger A, Vetter N, Greil R, Pedersen C, Storgaard M, Morlat P, Katlama C, Durant J, Cotte L, Duvvier C, Rey D, Esser S, Stellbrink C, Schmidt W, Stoll M, Stephan C, Fatkenheuer G, Stoehr A, Rockstroh J, Banhegyi D, Itzchak L, Shahar E, Maayan S, Turner D, Lazzarin A, Antinori A, Carosi G, Minoli L, di Perri G, Filice G, Andreoni M, Duiculescu D, Rugina S, Erscoiu S, Streinu A, Pronin A, Pokrovsky V, Gruzdev B, Yakovlev A, Voronin E, Clotet B, Gatell J, Arribas J, Podzamczer D, Domingo P, Miralles Alvarez C, Hernandez Quero J, Furrer H, Feher J, Johnson M, Fox J, Nelson M, Fisher M, Orkin C. Lipid profiles for etravirine versus efavirenz in treatment-naive patients in the randomized, double-blind SENSE trial. J Antimicrob Chemother 2011; 67:685-90. [DOI: 10.1093/jac/dkr533] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abou-Ras D, Caballero R, Fischer CH, Kaufmann CA, Lauermann I, Mainz R, Mönig H, Schöpke A, Stephan C, Streeck C, Schorr S, Eicke A, Döbeli M, Gade B, Hinrichs J, Nunney T, Dijkstra H, Hoffmann V, Klemm D, Efimova V, Bergmaier A, Dollinger G, Wirth T, Unger W, Rockett AA, Perez-Rodriguez A, Alvarez-Garcia J, Izquierdo-Roca V, Schmid T, Choi PP, Müller M, Bertram F, Christen J, Khatri H, Collins RW, Marsillac S, Kötschau I. Comprehensive comparison of various techniques for the analysis of elemental distributions in thin films. Microsc Microanal 2011; 17:728-751. [PMID: 21906418 DOI: 10.1017/s1431927611000523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The present work shows results on elemental distribution analyses in Cu(In,Ga)Se2 thin films for solar cells performed by use of wavelength-dispersive and energy-dispersive X-ray spectrometry (EDX) in a scanning electron microscope, EDX in a transmission electron microscope, X-ray photoelectron, angle-dependent soft X-ray emission, secondary ion-mass (SIMS), time-of-flight SIMS, sputtered neutral mass, glow-discharge optical emission and glow-discharge mass, Auger electron, and Rutherford backscattering spectrometry, by use of scanning Auger electron microscopy, Raman depth profiling, and Raman mapping, as well as by use of elastic recoil detection analysis, grazing-incidence X-ray and electron backscatter diffraction, and grazing-incidence X-ray fluorescence analysis. The Cu(In,Ga)Se2 thin films used for the present comparison were produced during the same identical deposition run and exhibit thicknesses of about 2 μm. The analysis techniques were compared with respect to their spatial and depth resolutions, measuring speeds, availabilities, and detection limits.
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Affiliation(s)
- D Abou-Ras
- Helmholtz-Zentrum Berlin für Materialien und Energie, Hahn-Meitner-Platz 1, 14109 Berlin, Germany.
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Stephan C, Schorr S, Scherb T. The cation distribution in off-stoichiometric CuInSe 2and CuGaSe 2. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311097637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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