1
|
Uhrmacher M, Skaletz-Rorowski A, Nambiar S, Schmidt AJ, Ahaus P, Serova K, Mordhorst I, Kayser A, Wach J, Tiemann C, Münstermann D, Brockmeyer NH, Potthoff A. HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic: Results from a prospective observational study in Germany. Front Public Health 2022; 10:930208. [PMID: 36091531 PMCID: PMC9449641 DOI: 10.3389/fpubh.2022.930208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023] Open
Abstract
Aims Since 2017, HIV pre-exposure prophylaxis (PrEP) care has been provided through an intersectoral collaboration at WIR (Walk-in-Ruhr, Center for Sexual Health and Medicine, Bochum, Germany). The aim of this study was to establish possible impact of COVID-restrictions on the sexual behavior of PrEP users in North Rhine-Westphalia. Methods The current PrEP study collected data of individuals using PrEP, their sexual behavior and sexually transmitted infections (STIs) before (each quarter of year 2018) and during the COVID-19 pandemic (each quarter of year 2020). Results During the first lockdown in Germany from mid-March until May 2020, PrEP-care appointments at WIR were postponed or canceled. Almost a third of PrEP users had discontinued their PrEP intake in the 2nd quarter of 2020 due to alteration of their sexual behavior. The number of sexual partners decreased from a median of 14 partners in the previous 6 months in 1st quarter of 2020, to 7 partners in 4th quarter of 2020. Despite such a significant reduction in partner number during the pandemic in comparison to the pre-pandemic period, a steady rate of STIs was observed among PrEP users in 2020. Conclusion The SARS-CoV-2-pandemic has impacted PrEP-using MSM in North Rhine-Westphalia with respect to their PrEP intake regimen and sexual behavior in 2020. Our study revealed a steady rate of STI among PrEP users even during the pandemic, thus highlighting the importance of ensuring appropriate HIV/STI prevention services in times of crisis.
Collapse
Affiliation(s)
- M. Uhrmacher
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Skaletz-Rorowski
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S. Nambiar
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. J. Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom,Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P. Ahaus
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - K. Serova
- Institute of Educational Research, Ruhr Universität Bochum, Bochum, Germany
| | - I. Mordhorst
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Kayser
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Aidshilfe Bochum e.V. (Aids-Service Organization Bochum), Bochum, Germany
| | - J. Wach
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Local Health Department Bochum, Bochum, Germany
| | - C. Tiemann
- Laboratory Krone, Bad Salzuflen, Germany
| | | | - N. H. Brockmeyer
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Potthoff
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany,*Correspondence: A. Potthoff
| |
Collapse
|
2
|
Brauckmann V, Nambiar S, Potthoff A, Höxtermann S, Wach J, Kayser A, Tiemann C, Schuppe AK, Brockmeyer NH, Skaletz-Rorowski A. Influence of dietary supplementation of short-chain fatty acid sodium propionate in people living with HIV (PLHIV). J Eur Acad Dermatol Venereol 2022; 36:881-889. [PMID: 35176190 DOI: 10.1111/jdv.18006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 07/18/2021] [Revised: 12/08/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-AIDS associated chronic diseases in HIV+ patients have been on the rise since the advent of antiretroviral therapy. Especially cardiovascular diseases and disruption in the gastrointestinal tract have limited health-related quality of life (QoL). Several of those complications have been associated with chronic systemic inflammation. Short chain fatty-acids (SCFA), with propionate as one of the major compounds, have been described as an important link between gut microbiota and the immune system, defining the pro- and the anti-inflammatory milieu through direct and indirect regulation of T-cell homeostasis. The effects of dietary supplementation of sodium propionate (SP) in people living with HIV (PLHIV) have not yet been investigated prior to this study. OBJECTIVES To investigate the impact of SP uptake among PLHIV and its relevance to improve QoL, the study aimed to investigate metabolic, immunological, microbiome and patient-reported QoL related changes post SP-supplementation with follow up. METHODS: A prospective, non-randomized, controlled, monocentric interventional study was conducted in WIR, Center for Sexual Health and Medicine, in Bochum, Germany. 32 HIV+ patients with unaltered ART-regimen in the last three months were included. Participants were given SP for a duration of 12 weeks in the form of daily oral supplementation and were additionally followed-up for another 12 weeks. RESULTS The supplementation of SP was well tolerated. We found an improvement in lipid profiles and long-term blood glucose levels. A decrease in pro-inflammatory cytokines and a depletion of effector T-Cells was observed. Regulatory T-Cells and IL-10 decreased. Furthermore, changes in taxonomic composition of the microbiome during follow-up were observed and improvement of items of self-reported life-quality assessment. CONCLUSION: Taken together, the beneficial impact of SP in PLHIV reflects its potential in improving metabolic parameters and modulating pro-inflammatory immune responses. Thus possibly reducing the risk of cardiovascular disorders and facilitating long-term improvement of the gut flora.
Collapse
Affiliation(s)
- Vesta Brauckmann
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S Nambiar
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A Potthoff
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S Höxtermann
- Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - J Wach
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Public Health Department Bochum, Bochum, Germany
| | - A Kayser
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Aidshilfe Bochum (Aids Service Organization Bochum) e.V, Bochum, Germany
| | - C Tiemann
- MVZ Laboratory Krone, Molecular Diagnostics, Bad Salzuflen, Germany
| | - A K Schuppe
- MVZ Laboratory Krone, Molecular Diagnostics, Bad Salzuflen, Germany
| | - N H Brockmeyer
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A Skaletz-Rorowski
- WIR-Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| |
Collapse
|
3
|
Kreuter A, Silling S, Potthoff A, Oellig F, Michalowitz AL, Wieland U. Human papillomavirus type 67 in cutaneous squamous cell dysplasia and carcinoma. J Eur Acad Dermatol Venereol 2021; 35:e807-e809. [PMID: 34242420 DOI: 10.1111/jdv.17496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A Kreuter
- Department of Dermatology, Venerology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - S Silling
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Faculty of Medicine and University Hospital Cologne, Koeln, Germany
| | - A Potthoff
- Walk in Ruhr, Center for Sexual Health, St. Elisabeth-Hospital, Department of Dermatology, Ruhr University Bochum, Bochum, Germany
| | - F Oellig
- Institute of Pathology, Mülheim an der Ruhr, Mülheim, Germany
| | - A L Michalowitz
- Department of Dermatology, Venerology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - U Wieland
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Faculty of Medicine and University Hospital Cologne, Koeln, Germany
| |
Collapse
|
4
|
Schulz CA, Mavarani L, Reinsch N, Albayrak-Rena S, Potthoff A, Brockmeyer N, Hower M, Erbel R, Jöckel KH, Schmidt B, Esser S. Prediction of future cardiovascular events by Framingham, SCORE and asCVD risk scores is less accurate in HIV-positive individuals from the HIV-HEART Study compared with the general population. HIV Med 2021; 22:732-741. [PMID: 34028959 DOI: 10.1111/hiv.13124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/17/2020] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score-specific differences in risk prediction. METHODS HIV-positive outpatients from the HIV-HEART (HIVH) study (n = 567) were compared with participants from the population-based Heinz Nixdorf Recall (HNR) study (n ~ 4440) both recruited from the German Ruhr area. During a follow-up time of around 5 years, the associations between the FRS and incident CVD and peripheral artery disease (CVD_pAD), SCORE and coronary heart disease (CHD), and asCVD and incident CVD were examined using logistic regression. Score performances were assessed by comparing the areas under the curve (AUCs). RESULTS The mean ages were 52.9 ± 6.7 and 59.1 ± 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age- and sex-adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62). CONCLUSIONS Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population.
Collapse
Affiliation(s)
- C-A Schulz
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - L Mavarani
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - N Reinsch
- Department of Cardiology, Alfried-Krupp Hospital, Essen, Germany.,Department of Cardiology, University Witten/Herdecke, Witten, Germany
| | - S Albayrak-Rena
- HPSTD Outpatient-Clinic, Department of Dermatology and Venereology, Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Potthoff
- WIR-Walk In Ruhr, Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - N Brockmeyer
- WIR-Walk In Ruhr, Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - M Hower
- Department of Pneumology, Infectious Diseases and Internal Medicine, Klinikum Dortmund, Dortmund, Germany
| | - R Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - S Esser
- HPSTD Outpatient-Clinic, Department of Dermatology and Venereology, Institute for Translational HIV Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
5
|
Schöfer H, Enders M, Esser S, Feiterna-Sperling C, Hagedorn HJ, Magistro G, Mayr C, Münstermann D, Hahn K, Jansen K, Klein M, Krause W, Maschke M, Ochsendorf FR, Osowski S, Petry KU, Potthoff A, Rieg S, Sing A, Stücker M, Weberschock T, Werner RN, Brockmeyer NH. [Diagnosis and treatment of syphilis : Update of the S2k guidelines 2020 of the German STI Society (DSTIG) in cooperation with the following specialist societies: DAIG, dagnä, DDG, DGA, DGGG, DGHM, DGI, DGN, DGPI, DGU, RKI]. Hautarzt 2021; 71:969-999. [PMID: 32940778 DOI: 10.1007/s00105-020-04672-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Schöfer
- Helios Dr. Horst Schmidt Kliniken, Deutsche Klinik für Diagnostik, Aukamm-Allee 33, 65191, Wiesbaden, Deutschland.
| | - M Enders
- Labor Prof. Gisela Enders & Kollegen MVZ Stuttgart, Stuttgart, Deutschland
| | - S Esser
- Leiter der HIV/STD-Ambulanz, Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen, Deutschland
| | - C Feiterna-Sperling
- Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - G Magistro
- Urologische Klinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Mayr
- Facharzt für Innere Medizin/Infektiologie, Hausärztliche Betreuung, Zentrum für Infektiologie Berlin, Prenzlauer Berg (ZIBP), MVZ, Berlin, Deutschland
| | | | - K Hahn
- Klinik für Neurologie, Universitätsmedizin Charité, Campus Charité Mitte, Berlin, Deutschland
| | - K Jansen
- Abteilung für Infektionsepidemiologie, Fachgebiet für HIV/AIDS und andere sexuell oder durch Blut übertragbare Infektionen, Robert Koch-Institut, Berlin, Deutschland
| | - M Klein
- Abteilung: Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Deutschland
| | - W Krause
- Hautklinik der Philipps-Universität, Marburg, Deutschland
| | - M Maschke
- Abteilung: Neurologie, Neurophysiologie und neurologische Frührehabilitation, MVZ der Barmherzigen Brüder Trier, Sektion Neurologie, Psychiatrie, Trier, Deutschland
| | - F R Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie (KDVA), Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - S Osowski
- Klinik f. Dermatologie, Venerologie und Allergologie (KDVA) und Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - K U Petry
- Frauenklinik, Klinikum der Stadt Wolfsburg, Wolfsburg, Deutschland
| | - A Potthoff
- WIR "Walk In Ruhr" im St. Elisabeth-Hospital, Bochum, Deutschland
| | - S Rieg
- Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Sing
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Oberschleißheim, Deutschland
| | - M Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - T Weberschock
- Klinik f. Dermatologie, Venerologie und Allergologie (KDVA) und Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - R N Werner
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - N H Brockmeyer
- WIR "Walk In Ruhr" im St. Elisabeth-Hospital, Bochum, Deutschland
| |
Collapse
|
6
|
Skaletz-Rorowski A, Potthoff A, Nambiar S, Wach J, Kayser A, Kasper A, Brockmeyer NH. Sexual behaviour, STI knowledge and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) prevalence in an asymptomatic cohort in Ruhr-area, Germany: PreYoungGo study. J Eur Acad Dermatol Venereol 2020; 35:241-246. [PMID: 32881091 DOI: 10.1111/jdv.16913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 07/28/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time. METHODS In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented. RESULTS Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h. CONCLUSION Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.
Collapse
Affiliation(s)
- A Skaletz-Rorowski
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A Potthoff
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S Nambiar
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - J Wach
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Public Health Department Bochum, Bochum, Germany
| | - A Kayser
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Aids Service Organization Bochum e. V., Bochum, Germany
| | - A Kasper
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - N H Brockmeyer
- Walk In Ruhr (WIR), Center for Sexual Health and Medicine, Bochum, Germany.,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| |
Collapse
|
7
|
Abstract
Benign liver tumors form a heterogeneous group. The most frequent forms include simple cysts, hemangiomas, focal nodular hyperplasia and hepatocellular adenomas. They are often incidentally detected during routine sonography. The diagnosis of a liver tumor not uncommonly causes anxiety and insecurity in those affected, which is why a rapid and reliable diagnostic procedure should be carried out. Because some tumors, particularly hepatocellular adenomas, are of prognostic relevance due to the potential risk of malignant transformation, a correct classification should always be strived for. The type and extent of diagnostic clarification depend on the clinical and patient-related risk factors. This article describes the most important benign space-occupying lesions. The etiology, clinical manifestations and diagnostics as well as possible necessary treatment measures are presented.
Collapse
Affiliation(s)
- R J de Knegt
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Niederlande
| | - A Potthoff
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - T Wirth
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| |
Collapse
|
8
|
Abstract
Liver tumors are often incidentally found during ultrasound examinations. The decision on further diagnostic imaging depends on the clinical context and the appearance in B mode ultrasound. This review highlights the role of grey scale and contrast-enhanced ultrasound (CEUS) and summarizes the ultrasonographic key features of the most common benign and malignant liver tumors. Conventional grey scale ultrasound is recommended in several guidelines for screening and follow-up of liver tumors in certain risk populations but its ability to characterize liver tumors is limited in most cases. The CEUS has an excellent tolerability and enables liver tumor characterization with a high sensitivity and specificity. The diagnostic value of CEUS is comparable to magnetic resonance imaging. In the case of unclear lesions, inconclusive findings by different imaging methods or if molecular targeted treatment is pursued, ultrasound-guided biopsy is often mandatory. Ultrasound is a rapidly and ubiquitously available method for the detection of liver tumors and CEUS is the only imaging method that enables real-time examination of all contrast phases in the liver. It should therefore be used as the first line imaging method for liver tumor characterization.
Collapse
Affiliation(s)
- C Höner Zu Siederdissen
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - A Potthoff
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| |
Collapse
|
9
|
Abstract
CLINICAL ISSUE Biliary diseases require fast and rational use of diagnostic tests by both gastroenterologists and radiologists. STANDARD TREATMENT Standard diagnostic workup includes transabdominal ultrasound, endoscopic retrograde cholangiography (ERC), endoscopic ultrasound, direct cholangioscopy, magnetic resonance cholangiopancreatography (MRI/MRCP), and computed tomography (CT). TREATMENT INNOVATIONS Modular cholangioscopy is a novel diagnostic method. DIAGNOSTIC WORK-UP The goal of diagnostic examinations is the determination of the location of obstructions and differentiation of benign from malignant lesions. ACHIEVEMENTS Transabdominal ultrasound is risk-free and can show the gallbladder in great detail providing high diagnostic accuracy in most conditions. Endoscopic ultrasound, ERC and/or cholangioscopy are powerful tools to investigate the large bile ducts but are associated with inherent procedural risks. PRACTICAL RECOMMENDATIONS Gall bladder diseases can often be diagnosed with transabdominal ultrasound alone. Bile duct disease often requires the use of endoscopic ultrasound, ERC and/or cholangioscopy.
Collapse
Affiliation(s)
- Thomas von Hahn
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. .,Klinik für Gastroenterologie und Interventionelle Endoskopie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - K I Ringe
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - A Potthoff
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
10
|
Abstract
BACKGROUND Kaposi's sarcoma (KS) represents the most common AIDS-defining neoplasm. Only very few studies regarding the course and treatment of human immunodeficiency virus (HIV)-associated KS have been carried out in Germany. OBJECTIVE In this study the course of HIV-associated KS was observed in patients from the cohort database of the competence network for HIV/AIDS. MATERIAL AND METHODS Data from HIV-associated KS patients from 9 German core centers from 1987 to 2011 were retrospectively collected. Kaplan-Meier curves for the recurrence and survival probability were calculated. RESULTS In 222 patients KS was diagnosed at a median age of 38.5 ± 10.1 years. Men were almost exclusively affected (97.7%). The HIV viral load at the time of diagnosis was in 7.4% <50 copies/ml. Of the patients 55.5% developed KS with a CD4 cell count of <200 cells/μl and 9.5% with >500 cells/μl. In 68 patients KS therapy consisted exclusively of the optimization or initiation of antiretroviral therapy (ART). In addition, 71 patients were treated with pegylated liposomal doxorubicin. During the median follow-up period of 8.9 ± 4.9 years, 80.2% of the patients were free of KS recurrence. Survival rates after 5 and 10 years were 96.8% and 91.3%, respectively. CONCLUSION Even with a good immune status HIV-associated KS occurred. An effective ART was the most important mainstay of therapy. With appropriate therapy, HIV-positive patients with KS showed a good survival rate.
Collapse
Affiliation(s)
- R-E Klingenberg
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
| | - S Esser
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - N H Brockmeyer
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - C Michalik
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
- Zentrum für klinische Studien, Köln, Deutschland
| | - A Skaletz-Rorowski
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - A Potthoff
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland.
| |
Collapse
|
11
|
Attia D, Bantel H, Lenzen H, Manns MP, Gebel MJ, Potthoff A. Liver stiffness measurement using acoustic radiation force impulse elastography in overweight and obese patients. Aliment Pharmacol Ther 2016; 44:366-79. [PMID: 27363528 DOI: 10.1111/apt.13710] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 02/12/2016] [Revised: 02/28/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity and overweight are global health problems. AIM To evaluate the diagnostic accuracy of liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) elastography in overweight and obese patients for staging liver fibrosis. METHODS Ninety-seven patients (mean age: 50 years, 50% male) with body mass index (BMI) ≥25 kg/m(2) (mean BMI: 31 kg/m(2) ) were prospectively enrolled. All patients underwent ARFI elastography and liver biopsy. In 87/97 patients, transient elastography (TE) was performed (M- and XL-probes). Patients were divided into two groups respectively: overweight: BMI <30 kg/m(2) (n = 61); and obese: BMI ≥30 kg/m(2) (n = 26). RESULTS Acoustic radiation force impulse elastography correlated with liver fibrosis in overweight (r = 0.84, P < 0.0001) and obese patients (r = 0.85, P < 0.0001), while no correlation was observed with steatosis, steatohepatitis and BMI. Area under the curve detecting liver cirrhosis for ARFI and TE were 0.97 in overweight and 0.94 and 0.92 in obese patients. In both groups, the failure rate was lower for ARFI than TE. ARFI of liver segment 8 showed a lower discordance than TE in both groups (overweight: 3% vs. 12%, P = 0.002; obese: 8% vs. 27%, P = 0.034). Steatosis and steatohepatitis were neither predictors of discordance nor of performance in LSM by ARFI or TE in both groups. CONCLUSIONS In overweight and obese patients, acoustic radiation force impulse can diagnose liver cirrhosis and significant fibrosis with high diagnostic accuracy. Liver stiffness measurement using the XL-probe reduces the influence of BMI, steatosis and steatohepatitis. The failure and discordance rates were lower for acoustic radiation force impulse than transient elastography in both patients groups.
Collapse
Affiliation(s)
- D Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - H Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M J Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
12
|
Kuhn E, Potthoff A, Dirks H, Borgmann R, Esser S, Scherbaum N, Brockmeyer NH, Skaletz-Rorowski A. Viral load strategy: impact on risk behaviour and serocommunication of men who have sex with men in specialized care. J Eur Acad Dermatol Venereol 2016; 30:1561-6. [PMID: 27393373 DOI: 10.1111/jdv.13672] [Citation(s) in RCA: 3] [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] [Received: 11/08/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incidence and prevalence of HIV are continuously high in German men, who have sex with men (MSM). Different transmission risk minimizing strategies have been observed. The viral load strategy rates patients unlikely to be sexually infectious if their viral load under effective therapy is stably suppressed during 6 months and no other sexually transmitted infections are present. OBJECTIVES We aim to objectify the current popularity of the viral load strategy, the adherence to basic conditions and its impact on risk behaviour and serocommunication. Until now, no data on a German sample of HIV-positive MSM in regular specialized outpatient care are available. METHODS Cross-sectional study with group comparisons between user group and non-user-group of the viral load strategy. Self-report questionnaires were conducted with 269 sexually active German HIV+MSM under effective treatment in specialized outpatient care. Structured interviews gathered additional information about approach to and realization of definite action levels concerning sexual risk behaviour and transmission risk minimizing strategies. RESULTS Twenty-seven of 269 participants (10%) affirmed knowledge of having an undetectable viral load and stated this to be criteria for unprotected sexual behaviour. This subgroup reported more unprotected insertive (P = 0.018) and receptive anal intercourse (P = 0.042), more anonymous sex partners (P = 0.008) and less consistent safer sex. Analysing serocommunication, less addressing HIV/AIDS in general (P = 0.043) and less disclosing to sex partners (P = 0.023) was found, especially in anonymous settings. Differentiating serocommunication characteristics, a focus on seroguessing was depicted. CONCLUSIONS The user group of the viral load strategy is small. But a less frequent, more reactive and assumptive serocommunication leads to an imprecise information exchange paired with higher frequency of risky behaviour, especially in anonymous settings, where frank serocommunication is often avoided. The targeted group of the viral load strategy diverges greatly from the user group.
Collapse
Affiliation(s)
- E Kuhn
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany
| | - A Potthoff
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
| | - H Dirks
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - R Borgmann
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - S Esser
- Department of Dermatology and Venerology, University Hospital Duisburg-Essen, Essen, Germany
| | - N Scherbaum
- Department of Addiction Medicine and Addictive Behaviour, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | - N H Brockmeyer
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
| | - A Skaletz-Rorowski
- Department of Dermatology, Venerology and Allergology, Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.,Competence Network for HIV/AIDS, Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
13
|
Dietrich CF, Chiorean L, Potthoff A, Ignee A, Cui X, Sparchez Z. Percutaneous sclerotherapy of liver and renal cysts, comments on the EFSUMB guidelines. Z Gastroenterol 2016; 54:155-66. [PMID: 26854836 DOI: 10.1055/s-0041-106594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cystic lesions in the liver and kidneys are common incidental findings. They are generally benign and require no treatment. They can appear sporadically or as part of a syndrome, and are characterised by their anechoic structure and posterior enhancement in ultrasound imaging. Increased size, haemorrhage or infection of a cyst can lead to development of symptoms. Along with surgical options and laparoscopic cyst fenestration, ultrasound-guided sclerotherapy of symptomatic cysts represents an effective and safe minimally invasive treatment option.
Collapse
Affiliation(s)
- C F Dietrich
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - L Chiorean
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - A Potthoff
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, Hannover, Germany
| | - A Ignee
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - X Cui
- Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Germany
| | - Z Sparchez
- Gastroenterology, University of Medicine and Pharmacy "Iuliu Hatieganu", Institute for Gastroenterology and Hepatology "O.Fodor", Cluj-Napoca, Romania
| |
Collapse
|
14
|
Fuchs W, Wieland U, Skaletz-Rorowski A, Brockmeyer N, Swoboda J, Kreuter A, Michalik C, Potthoff A. The male ScreenING Study: prevalence of HPV-related genital and anal lesions in an urban cohort of HIV-positive men in Germany. J Eur Acad Dermatol Venereol 2016; 30:995-1001. [DOI: 10.1111/jdv.13539] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/19/2015] [Indexed: 02/01/2023]
Affiliation(s)
- W. Fuchs
- Department of Dermatology, Venereology and Allergology; Center for Sexual Health and Medicine; Ruhr-University Bochum; Bochum Germany
| | - U. Wieland
- National Reference Center for Papilloma- and Polyomaviruses; Institute of Virology; Uniklinik Köln; University of Cologne; Koeln Germany
| | - A. Skaletz-Rorowski
- Competence Network for HIV/AIDS (KompNet HIV/AIDS); Ruhr-University Bochum; Bochum Germany
| | - N.H. Brockmeyer
- Department of Dermatology, Venereology and Allergology; Center for Sexual Health and Medicine; Ruhr-University Bochum; Bochum Germany
| | | | - A. Kreuter
- Department of Dermatology, Venereology and Allergology; Center for Sexual Health and Medicine; Ruhr-University Bochum; Bochum Germany
| | - C. Michalik
- Competence Network for HIV/AIDS (KompNet HIV/AIDS); Ruhr-University Bochum; Bochum Germany
- Clinical Trial Centre (ZKS); University of Cologne; Cologne Germany
| | - A. Potthoff
- Department of Dermatology, Venereology and Allergology; Center for Sexual Health and Medicine; Ruhr-University Bochum; Bochum Germany
| | | |
Collapse
|
15
|
Fuchs W, Kreuter A, Hellmich M, Potthoff A, Swoboda J, Brockmeyer NH, Wieland U. Asymptomatic anal sexually transmitted infections in HIV-positive men attending anal cancer screening. Br J Dermatol 2016; 174:831-8. [PMID: 26577338 DOI: 10.1111/bjd.14288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND HIV-positive men who have sex with men (HIV+MSM) have an increased risk for anal dysplasia and for sexually transmitted infections (STIs). OBJECTIVES We determined the positivity rates of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Mycoplasma genitalium (MG) and syphilis in HIV+MSM participating in an anal cancer screening programme. METHODS In total, 852 intra-anal swabs were collected from 503 HIV+MSM between 2012 and 2014. Anal cytology and polymerase chain reaction assays for human papillomavirus (HPV), CT, NG and MG detection were performed. The syphilis status was determined serologically. Risk factors for STIs were explored by multiple logistic regression analysis. RESULTS In total 20·7% (104 of 503) of the patients had an STI other than HPV within the study period. The most common was CT, found in 10·9%, followed by NG (8·9%) and MG (4·2%). Early syphilis was detected in 4·6% and past syphilis in 44·5% of the HIV+MSM. Eighteen patients (3·6%) had more than one STI episode, and 90·6% of the 127 cases of STIs were asymptomatic. Age, anal HPV infection, abnormal anal cytology and previous syphilis were risk factors for STI. CONCLUSIONS Anal STIs are frequent and mostly asymptomatic in HIV+MSM participating in anal cancer screening. STI screening should be incorporated into anal cancer screening programmes for HIV+MSM.
Collapse
Affiliation(s)
- W Fuchs
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - A Kreuter
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Straße 62, 50924, Köln, Germany
| | - A Potthoff
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - J Swoboda
- Institute of Cytology, Koblenzer Straße 121-123, 53177, Bonn, Germany
| | - N H Brockmeyer
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - U Wieland
- National Reference Center for Papilloma- and Polyomaviruses, Institute of Virology, Uniklinik Köln, University of Cologne, Fuerst-Pueckler-Straße 56, 50935, Köln, Germany
| |
Collapse
|
16
|
Lauermann J, Potthoff A, Mc Cavert M, Marquardt S, Vaske B, Rosenthal H, von Hahn T, Wacker F, Meyer BC, Rodt T. Erratum to: Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device. Cardiovasc Intervent Radiol 2015; 39:635-6. [PMID: 26662291 DOI: 10.1007/s00270-015-1262-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J Lauermann
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M Mc Cavert
- Department of Diagnostic and Interventional Radiology, Beaumont Hospital, Dublin, Ireland
| | - S Marquardt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B Vaske
- Institute of Biometry, Hannover Medical School, Hannover, Germany
| | - H Rosenthal
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - T von Hahn
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Rodt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| |
Collapse
|
17
|
Attia D, Schoenemeier B, Rodt T, Negm AA, Lenzen H, Lankisch TO, Manns M, Gebel M, Potthoff A. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med 2015; 36:603-610. [PMID: 26565516 DOI: 10.1055/s-0041-107971] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate-in comparison to HVPG-the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging. MATERIALS AND METHODS A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10-< 12 mmHg and HVPG ≥ 12 mmHg. RESULTS LSM, SSM were significantly higher in patients with HVPG ≥ 10 - < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 - < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate -analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003). CONCLUSION LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.
Collapse
Affiliation(s)
- D Attia
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - B Schoenemeier
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T Rodt
- Hannover Medical School, Diagnostic and Interventional Radiology, Hannover, Germany
| | - A A Negm
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T O Lankisch
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Manns
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Gebel
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| |
Collapse
|
18
|
Busch J, Meißner T, Potthoff A, Bleyl S, Georgi A, Mackenzie K, Trabitzsch R, Werban U, Oswald SE. A field investigation on transport of carbon-supported nanoscale zero-valent iron (nZVI) in groundwater. J Contam Hydrol 2015; 181:59-68. [PMID: 25864966 DOI: 10.1016/j.jconhyd.2015.03.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/11/2015] [Accepted: 03/22/2015] [Indexed: 05/20/2023]
Abstract
The application of nanoscale zero-valent iron (nZVI) for subsurface remediation of groundwater contaminants is a promising new technology, which can be understood as alternative to the permeable reactive barrier technique using granular iron. Dechlorination of organic contaminants by zero-valent iron seems promising. Currently, one limitation to widespread deployment is the fast agglomeration and sedimentation of nZVI in colloidal suspensions, even more so when in soils and sediments, which limits the applicability for the treatment of sources and plumes of contamination. Colloid-supported nZVI shows promising characteristics to overcome these limitations. Mobility of Carbo-Iron Colloids (CIC) - a newly developed composite material based on finely ground activated carbon as a carrier for nZVI - was tested in a field application: In this study, a horizontal dipole flow field was established between two wells separated by 5.3m in a confined, natural aquifer. The injection/extraction rate was 500L/h. Approximately 1.2kg of CIC was suspended with the polyanionic stabilizer carboxymethyl cellulose. The suspension was introduced into the aquifer at the injection well. Breakthrough of CIC was observed visually and based on total particle and iron concentrations detected in samples from the extraction well. Filtration of water samples revealed a particle breakthrough of about 12% of the amount introduced. This demonstrates high mobility of CIC particles and we suggest that nZVI carried on CIC can be used for contaminant plume remediation by in-situ formation of reactive barriers.
Collapse
Affiliation(s)
- J Busch
- Institute of Earth and Environmental Science, University of Potsdam, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany.
| | - T Meißner
- Fraunhofer IKTS, Winterbergstraße 28, 01277 Dresden, Germany.
| | - A Potthoff
- Fraunhofer IKTS, Winterbergstraße 28, 01277 Dresden, Germany.
| | - S Bleyl
- Helmholtz Centre for Environmental Research, Permoserstraße 15, 04318 Leipzig, Germany.
| | - A Georgi
- Helmholtz Centre for Environmental Research, Permoserstraße 15, 04318 Leipzig, Germany.
| | - K Mackenzie
- Helmholtz Centre for Environmental Research, Permoserstraße 15, 04318 Leipzig, Germany.
| | - R Trabitzsch
- Helmholtz Centre for Environmental Research, Permoserstraße 15, 04318 Leipzig, Germany.
| | - U Werban
- Helmholtz Centre for Environmental Research, Permoserstraße 15, 04318 Leipzig, Germany.
| | - S E Oswald
- Institute of Earth and Environmental Science, University of Potsdam, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany.
| |
Collapse
|
19
|
Lauermann J, Potthoff A, Mc Cavert M, Marquardt S, Vaske B, Rosenthal H, von Hahn T, Wacker F, Meyer BC, Rodt T. Comparison of Technical and Clinical Outcome of Transjugular Portosystemic Shunt Placement Between a Bare Metal Stent and a PTFE-Stentgraft Device. Cardiovasc Intervent Radiol 2015; 39:547-56. [DOI: 10.1007/s00270-015-1209-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/29/2015] [Indexed: 02/07/2023]
|
20
|
Soudah B, Schirakowski A, Gebel M, Potthoff A, Braubach P, Schlue J, Krech T, Dämmrich ME, Kreipe HH, Abbas M. Overview and evaluation of the value of fine needle aspiration cytology in determining the histogenesis of liver nodules: 14 years of experience at Hannover Medical School. Oncol Rep 2014; 33:81-7. [PMID: 25333302 DOI: 10.3892/or.2014.3554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/20/2014] [Indexed: 01/09/2023] Open
Abstract
Fine needle aspiration (FNA) is a sensitive and specific method (95%), often helpful in characterizing suspected liver lesions. It is appropriate to distinguish between primary and secondary liver neoplasia. Moreover, in most cases, the use of cell block preparations of small specimens allows immunocytochemical evaluation to determine the nature of the primary tumour. In a retrospective study at Hannover Medical School (MHH) from 1998 to 2012 (14 years), 4,136 sonographically guided FNAs were performed. The patients provided consent and the study protocol was approved by the local ethics committee. There were 39.6% malignant and 57.5% benign lesions in the liver, while 2.8% of the cases were undetermined. FNA was non-representative in 1.1% of the cases. The diagnostic utility of highly differentiated hepatocellular carcinoma (HCC; G1) remains difficult; cell bridges with cell atypia are pathognomonic for diagnosis. Ancillary techniques and immunocytochemical investigations will increase the sensitivity and specificity, particularly by using the cell block technique.
Collapse
Affiliation(s)
- B Soudah
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - A Schirakowski
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - M Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, D-30625 Hannover, Germany
| | - A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, D-30625 Hannover, Germany
| | - P Braubach
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - J Schlue
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - T Krech
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - M E Dämmrich
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - H H Kreipe
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| | - M Abbas
- Institute of Pathology, Hannover Medical School, D-30625 Hannover, Germany
| |
Collapse
|
21
|
Nußbaum T, Bellmunt-Zschäpe A, Potthoff A, Brockmeyer N, Kreuter A. Lymphogranuloma venereum – Eine in Vergessenheit geratene Geschlechtskrankheit. Akt Dermatol 2014. [DOI: 10.1055/s-0034-1365474] [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] [Indexed: 10/25/2022]
Affiliation(s)
- T. Nußbaum
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik, Oberhausen
| | | | - A. Potthoff
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr Universität Bochum
| | - N. Brockmeyer
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef Hospital, Ruhr Universität Bochum
| | - A. Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik, Oberhausen
| |
Collapse
|
22
|
Rodt T, Lauermann J, Hasdemir D, Potthoff A, Marquardt S, Falck CV, Rosenthal H, Wacker F, Meyer B. TIPS bei Patienten mit portaler Hypertension aufgrund von Leberzirrhose: Vergleich von initialem technischen Outcome und Langzeitoffenheitsraten zwischen Stent und PTFE-Stentgraft. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373100] [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: 10/25/2022]
|
23
|
Thoden J, Potthoff A, Bogner JR, Brockmeyer NH, Esser S, Grabmeier-Pfistershammer K, Haas B, Hahn K, Härter G, Hartmann M, Herzmann C, Hutterer J, Jordan AR, Lange C, Mauss S, Meyer-Olson D, Mosthaf F, Oette M, Reuter S, Rieger A, Rosenkranz T, Ruhnke M, Schaaf B, Schwarze S, Stellbrink HJ, Stocker H, Stoehr A, Stoll M, Träder C, Vogel M, Wagner D, Wyen C, Hoffmann C. Therapy and prophylaxis of opportunistic infections in HIV-infected patients: a guideline by the German and Austrian AIDS societies (DAIG/ÖAG) (AWMF 055/066). Infection 2013; 41 Suppl 2:S91-115. [PMID: 24037688 PMCID: PMC3776256 DOI: 10.1007/s15010-013-0504-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/28/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There was a growing need for practical guidelines for the most common OIs in Germany and Austria under consideration of the local epidemiological conditions. MATERIALS AND METHODS The German and Austrian AIDS societies developed these guidelines between March 2010 and November 2011. A structured Medline research was performed for 12 diseases, namely Immune reconstitution inflammatory syndrome, Pneumocystis jiroveci pneumonia, cerebral toxoplasmosis, cytomegalovirus manifestations, candidiasis, herpes simplex virus infections, varizella zoster virus infections, progressive multifocal leucencephalopathy, cryptosporidiosis, cryptococcosis, nontuberculosis mycobacteria infections and tuberculosis. Due to the lack of evidence by randomized controlled trials, part of the guidelines reflects expert opinions. The German version was accepted by the German and Austrian AIDS Societies and was previously published by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF; German Association of the Scientific Medical Societies). CONCLUSION The review presented here is a translation of a short version of the German-Austrian Guidelines of opportunistic infections in HIV patients. These guidelines are well-accepted in a clinical setting in both Germany and Austria. They lead to a similar treatment of a heterogeneous group of patients in these countries.
Collapse
Affiliation(s)
- J Thoden
- Private Practice Dr. C. Scholz and Dr. J. Thoden, Bertoldstrasse 8, 79098, Freiburg, Germany,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Abebe S, Adem A, Brockmeyer NH, Potthoff A, Coenenberg J, Bekele E, Skaletz-Rorowski A, Adama Y. P2.175 Incidence and Predictors of AIDS Related Opportunistic Illnesses After Initiation of HAART: Results from a Retrospective Single Centred Cohort Study, Ayder Referral Hospital, Mekelle University, Ethiopia. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0439] [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: 11/03/2022]
|
25
|
Jin YH, Potthoff A, Xu J, Yu WJ, Liu K, Weng NC, Brockmeyer NH, Wu NP. Evaluation of mental status HIV-infected patients: implications for treatment. Curr HIV Res 2012; 10:546-51. [PMID: 22716106 DOI: 10.2174/157016212802429857] [Citation(s) in RCA: 5] [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] [Received: 03/21/2012] [Revised: 06/05/2012] [Accepted: 06/13/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of the study was to explore factors that may influence mental health status of HIV-infected patients, and to figure out a method that could effectively classify the patients by evaluating the severity of their mental health problems. METHODS Eighty-five patients were recruited and divided into two groups: the low risk group (LRG, n = 38) and the high risk group (HRG, n = 47). All patients finished Symptom Check-List 90 Revised (SCL-90-R) which is a multidimensional questionnaire designed to screen for a broad range of psychological problems. RESULTS SCL-90-R scores of HRG were significantly higher than those of the general population and did not differ from those of psychosomatic outpatients. Scores of LRG were significantly lower than those of psychosomatic outpatients and did not differ from those of the general population in most subscales. HIV-infected men having sex with men and unemployed patients had much higher incidence of mental health problems. CONCLUSION Besides undistinguishable group psychotherapy, we call for a clinical screening by psychological questionnaires at the first step, and then at-risk or high-risk patients should be given corresponding and individualized treatments. More attention and health care should be given to HIV-infected men who have sex with men and unemployed patients.
Collapse
Affiliation(s)
- Y H Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Rifai K, Hadem J, Wiegand J, Potthoff A, Pischke S, Klempnauer J, Strassburg C, Wedemeyer H, Manns MP, Tillmann HL. Gender differences in patient receiving liver transplantation for viral hepatitis. Z Gastroenterol 2012; 50:760-5. [PMID: 22895904 DOI: 10.1055/s-0031-1281631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The course of viral hepatitis shows wide interindividual differences, ranging from asymptomatic disease to liver failure. Only limited data on gender differences in patients undergoing liver transplantation (OLT) exist. We studied the gender distribution in patients who underwent liver transplantation for viral hepatitis. METHODS A retrospective analysis was performed on a cohort of 368 patients who underwent OLT for viral hepatitis-associated acute or chronic liver failure. In 96 of them, additional hepatocellular carcinoma (HCC) was present at transplantation. Gender ratios of the different hepatitis virus infections and in relation to HCC were evaluated. RESULTS Significantly more males than females underwent OLT for chronic HBV. In contrast, patients after OLT for fulminant HBV were more frequently females. In patients transplanted for chronic HCV or HDV, no significant gender differences were found. However, men presented more frequently with HCC in both groups of chronic liver disease. CONCLUSIONS There was a gender difference in HBV infection with more women developing fulminant hepatic failure in acute HBV while more men progressed to end-stage liver disease in chronic HBV. The role of gender in chronic HCV and HDV infection was less pronounced, except for a male predominance among patients with HCC.
Collapse
Affiliation(s)
- K Rifai
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Lind A, Reinsch N, Neuhaus K, Esser S, Brockmeyer NH, Potthoff A, Pankuweit S, Erbel R, Maisch B, Neumann T. Pericardial effusion of HIV-infected patients ? Results of a prospective multicenter cohort study in the era of antiretroviral therapy. Eur J Med Res 2012; 16:480-3. [PMID: 22027640 PMCID: PMC3351804 DOI: 10.1186/2047-783x-16-11-480] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients with human immunodeficiency virus (HIV) infection have an increased risk of cardiovascular diseases. Previous publications described pericardial effusion as one of the most common HlV-associated cardiac affiliations. The aim of the current study was to investigate if pericardial effusion still has a relevant meaning of HIV-infected patients in the era of antiretroviral therapy. Methods The HIV-HEART (HIV-infection and HEART disease) study is a cardiology driven, prospective and multicenter cohort study. Outpatients with a known HIV-infection were recruited during a 20 month period in a consecutive manner from September 2004 to May 2006. The study comprehends classic parameters of HIV-infection, comprising CD4-cell count (cluster of differentiation) and virus load, as well as non-invasive tests of cardiac diseases, including a thorough transthoracic echocardiography. Results 802 HIV-infected patients (female: 16.6%) with a mean age of 44.2 ± 10.3 years, were included. Duration of HIV-infection since initial diagnosis was 7.6 ± 5.8 years. Of all participants, 85.2% received antiretroviral therapy. Virus load was detectable in 34.4% and CD4 - cell count was in 12.4% less than 200 cells/μL. Pericardial effusions were present in only two patients of the analysed population. None of the participants had signs of a relevant cardiovascular impairment by pericardial effusion. Conclusions Our results demonstrate that the era of antiretroviral therapy goes along with low rates of pericardial effusions in HIV-infected outpatients. Our findings are in contrast to the results of publications, performed before the common use of antiretroviral therapy.
Collapse
Affiliation(s)
- Alexander Lind
- West German Heart Center, Department of Cardiology, University of Duisburg/Essen, Essen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Shou C, Weng N, Jin Y, Feng L, Jin C, Hoextermann S, Potthoff A, Skaletz-Rorowski A, Brockmeyer NH, Wu N. Study of T cell subsets and IL-7 protein expression in HIV-1-infected patients after 7 years HAART. Eur J Med Res 2012; 16:473-9. [PMID: 22027639 PMCID: PMC3351803 DOI: 10.1186/2047-783x-16-11-473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To study the changes in T cell subsets and IL-7 in HIV-1-infected patients after seven years of highly active antiretroviral therapy (HAART). Methods Seventy-five individuals were included in this study (25 with effective HAART, 18 with ineffective HAART, 17 untreated HIV+ patients, and 15 volunteers in the HIV negative control group). The counts of CD4+, CD8+, CD8/CD38+, and CD8/HLADR+ T cells as well as the IL-7 protein expression was measured at 5 time points during a period of seven years in patients starting HAART (baseline) and in the HIV negative control group. The expression of CD127 on CD3+ T cells was measured by flow cytometry at a single time point (after 7 years) in patients with HAART and was compared with untreated HIV+ patients and the HIV negative control group. Results At baseline CD4+ T cell counts of HIV-1-infected patients were lower than that in the control group (p < 0.01), whereas the CD8+, CD8/HLADR+ and CD8/CD38+ T cell counts were higher than those in the control group (p <0.01). After seven years of effective HAART, the CD4+ T cell counts had increased and the CD8+ T cell count had decreased, although not to the normal levels (p < 0.05). Both the CD8/HLADR+ and CD8/CD38+ T cell counts had gradually approached those of the control group (p > 0.05). In the ineffective HAART group, the CD8/CD38+ T cell count had not decreased significantly, and CD8/HLADR+ T cell count gradually decreased. Before treatment, IL-7 serum levels of patients were significantly higher than that in the control group (p < 0.01). After seven years of effective HAART, IL-7 levels had gradually decreased, but were still higher than in the control group (p < 0.01). The CD127 expression on CD3+ CD8+ T cells in effective HAART patients was higher than in untreated HIV+ patients (p < 0.05), but was lower than that in the control group (p < 0.05). CD127 expression on CD3+ CD4+ T cells was not significantly different among the control group, untreated HIV+ patients and effective HAART group. Conclusion After seven years of effective HAART, the quantity and capacity of T cell subsets and IL-7 in HIV-1-infected patients had been partially restored, and the abnormal immune activation has significantly diminished.
Collapse
Affiliation(s)
- C Shou
- Zhejiang University, School of Medicine, Hangzhou, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Dirks H, Esser S, Borgmann R, Wolter M, Fischer E, Potthoff A, Jablonka R, Schadendorf D, Brockmeyer N, Scherbaum N. Substance use and sexual risk behaviour among HIV-positive men who have sex with men in specialized out-patient clinics. HIV Med 2012; 13:533-40. [PMID: 22435363 DOI: 10.1111/j.1468-1293.2012.01005.x] [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: 02/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Unprotected sexual intercourse between men who have sex with men (MSM) is the most common route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV-infected MSM in specialized care. METHODS In a German sample of 445 HIV-infected MSM treated in specialized out-patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self-report questionnaires and a structured interview. RESULTS Recreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts. Substance use in the context of sexual activity significantly increased sexual risk behaviour. CONCLUSIONS Substance use, especially in the context of sexual activity, should be taken into account when developing new prevention and intervention programmes aimed at reducing sexual risk behaviour in HIV-infected MSM currently in specialized care.
Collapse
Affiliation(s)
- H Dirks
- Addiction Research Group at the Department of Psychiatry and Psychotherapy, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Potthoff A, Rasokat H, Brockmeyer NH. [HIV infection]. Hautarzt 2012; 63:10-5. [PMID: 22212157 DOI: 10.1007/s00105-011-2195-9] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The skin can be an indicator of decreased immunocompetence. Dermatological markers include new and extensive seborrheic eczema, psoriasis without a family history, widespread herpes zoster in young adults, oral hairy leucoplakia and mollusca in adults. In these cases an HIV test should be offered. During the last 15 years the clinical picture of HIV has changed dramatically. Almost every year new drugs with better efficacy, lower pill burden and less side effects have been approved. Life expectancy is close to normal in western countries. In spite of better treatment options, prevention is the key to stop the worldwide epidemic. Awareness campaigns have to account for the synergies between HIV and other sexually transmitted diseases. This poses a great challenge for dermatovenereology.
Collapse
Affiliation(s)
- A Potthoff
- Interdisziplinäre Immunologische Ambulanz , St. Josef Hospital Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
| | | | | |
Collapse
|
32
|
Rifai K, Cornberg J, Bahr M, Mederacke I, Potthoff A, Wedemeyer H, Manns M, Gebel M. ARFI elastography of the spleen is inferior to liver elastography for the detection of portal hypertension. Ultraschall Med 2011; 32 Suppl 2:E24-E30. [PMID: 22194051 DOI: 10.1055/s-0031-1281771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To date, the use of transient elastography has been limited to the liver. Acoustic radiation force impulse imaging (ARFI) is a new technology offering elastography of different tissues. Here, we present initial spleen elastography data and evaluate its influencing factors, especially portal hypertension. MATERIALS AND METHODS Elastography of the spleen and liver using the ARFI method was performed in 30 patients with portal hypertension, 70 patients with chronic liver disease without portal hypertension and 25 healthy controls. RESULTS ARFI elastography of the spleen was feasible in 99% of patients and valid in 78%. The mean propagation velocity inside the spleen was 2.95 ± 0.60 m/sec, thus much higher than in the normal liver (< 1.10 m/sec). Spleen stiffness was higher in the patients with portal hypertension (p < 0.008) but did not correlate to spleen size. Spleen stiffness increased with patient age and liver stiffness (both p < 0.0001) as confirmed by multivariate analysis (R2 = 0.19, p < 0.01). In ROC analysis, spleen elastography was inferior to liver elastography for the detection of portal hypertension (area under the curve 0.68 vs. 0.90). CONCLUSION The new ARFI method allows accurate elastography of the spleen. The stiffness of the normal spleen is much higher than that of the normal liver and increases with age. However, spleen elastography is inferior to liver elastography for the detection of portal hypertension.
Collapse
Affiliation(s)
- K Rifai
- Gastroenterology and Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Tang LL, Jin CZ, Wu LJ, Brockmeyer NH, Potthoff A, Wu NP. The Impact of Highly Active Antiretroviral Treatment on the Blood Profiles of Patients with Acquired Immune Deficiency Syndrome. J Int Med Res 2011; 39:1520-8. [PMID: 21986156 DOI: 10.1177/147323001103900442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study retrospectively investigated the short- and long-term impact of highly active antiretroviral treatment (HAART) on the blood profiles of patients with acquired immune deficiency syndrome (AIDS), and their relationship with disease progression. CD4+ T-cell count was measured by flow cytometry, plasma viral load of human immunodeficiency virus (HIV) RNA was detected by reverse transcription—polymerase chain reaction, and blood profile was determined by an automated analyser. CD4+ T-cell count, total lymphocyte count (TLC) and haemoglobin concentration improved gradually in patients with AIDS after the initiation of HAART. Long-term effective HAART significantly increased CD4+ T-cell counts TLC and haemoglobin concentrations, and reduced viral load to undetectable levels. An increase in haemoglobin was positively correlated with an increase in CD4+ T-cells. These findings suggest that TLC is a valuable tool for determining the initiation of HAART, and that the haemoglobin concentration could be an additional indicator for long-term monitoring of HAART in resource-limited settings.
Collapse
Affiliation(s)
- LL Tang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - CZ Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - LJ Wu
- Department of Nursing, School of Medicine, Taizhou College, Taizhou, China
| | - NH Brockmeyer
- Department of Dermatology, Allergy and STDs, Ruhr University Bochum, Bochum, Germany
| | - A Potthoff
- Department of Dermatology, Allergy and STDs, Ruhr University Bochum, Bochum, Germany
| | - NP Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
34
|
Potthoff A, Brockmeyer N. HIV-Infektion. Akt Dermatol 2011. [DOI: 10.1055/s-0030-1256212] [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: 10/18/2022]
|
35
|
Frey UH, Fritz A, Rotterdam S, Schmid KW, Potthoff A, Altmeyer P, Siffert W, Brockmeyer NH. GNAS1 T393C polymorphism and disease progression in patients with malignant melanoma. Eur J Med Res 2011; 15:422-7. [PMID: 21156401 PMCID: PMC3352186 DOI: 10.1186/2047-783x-15-10-422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Once metastasized, despite a variety of therapeutic options, the prognosis of patients with malignant melanoma (MM) is still poor. Therefore, the search for reliable markers to identify patients with high risk of disease progression is of high clinical importance. We have recently shown that TT genotypes of the single-nucleotide polymorphism (SNP) T393C in the gene GNAS1 are significantly associated with better outcome in a variety of carcinomas. Patients In the present study we assessed whether the T393C SNP is also related to the clinical course in MM. 328 patients with MM were retrospectively genotyped and genotypes were correlated with clinical outcome. Results While the allele frequency in the MM group (fC 0.52) did not significantly differ from that of healthy blood donors, the T393C SNP was associated with tumor progression of MM. Carriers of the C-allele showed a significantly more severe tumor progression as estimated from the time period to develop metastasis (HR 2.2, 95% CI 1.1-3.2, p = 0.017). Proportions of 5-year metastasis-free intervals were 87.1% for TT genotypes and 66.0% for C-allele carriers. Moreover, multivariable Cox regression analysis including tumor stage and melanoma subtype proved the T393C polymorphism to be an independent factor for metastasis (p = 0.012). Conclusions In summary, the GNAS1 T393C SNP represents a genetic host factor for predicting tumor progression also in patients with MM; genotyping of this SNP may contribute to better define patients who could benefit from an early individualized therapy.
Collapse
Affiliation(s)
- U H Frey
- Institut für Pharmakogenetik, Universität Duisburg-Essen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Banasch M, Frank J, Serova K, Knyhala K, Kollar S, Potthoff A, Brockmeyer NH, Goetze O. Impact of antiretroviral treatment on (13) C-methionine metabolism as a marker of hepatic mitochondrial function: a longitudinal study. HIV Med 2011; 12:40-5. [PMID: 20500232 DOI: 10.1111/j.1468-1293.2010.00847.x] [Citation(s) in RCA: 7] [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: 01/06/2023]
Abstract
OBJECTIVES Uncontrolled viral replication and antiretroviral treatment (ART) may independently contribute to hepatic mitochondrial toxicity. The present study was designed to explore the longitudinal effects of treatment modifications on hepatic mitochondrial function by means of noninvasive (13) C-methionine breath test (MeBT) diagnostics. METHODS A total of 113 HIV-infected patients underwent two consecutive MeBTs over an interval of 11.8±3.5 months. Forty-nine patients remained on stable ART or no therapy; 28 participants switched ART; 27 patients (re)initiated ART, and nine individuals underwent a structured treatment interruption (STI) of ART between MeBTs 1 and 2. Breath test results were expressed as cumulative percentage dose of (13) CO(2) recovered after 1.5 h test time (cPDR(1.5h) ). RESULTS Initiation of ART in treatment-naïve individuals and patients on STI was associated with a significant improvement of hepatic mitochondrial function (P<0.05). Cessation of ART or a prolonged delay in initiating therapy in treatment-naïve patients in turn led to a significant decline of (13) C-exhalation compared with baseline (P<0.05). A marked increase in (13) C-exhalation was observed in individuals who switched from stavudine or ddI to tenofovir or abacavir (+170%; P<0.001), while no differences between MeBTs 1 and 2 were found in individuals on ART who had remained on stable regimens or in those who changed a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) component. CONCLUSION The present data suggest that hepatic mitochondrial function in HIV disease is a dynamic process with a high regenerative capacity and highlight the pathogenic relevance of HIV replication. Our findings suggest that modern ART per se does not negatively impact hepatic mitochondrial function.
Collapse
Affiliation(s)
- M Banasch
- Department of Internal Medicine, St Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Mederacke I, Meier M, Luth JB, Schmidt-Gurtler H, Raupach R, Horn-Wichmann R, Wursthorn K, Potthoff A, Colucci G, Manns MP, Wedemeyer H, Tillmann HL. Different kinetics of HBV and HCV during haemodialysis and absence of seronegative viral hepatitis in patients with end-stage renal disease. Nephrol Dial Transplant 2011; 26:2648-56. [DOI: 10.1093/ndt/gfq757] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
38
|
Richel O, Wieland U, de Vries HJC, Brockmeyer NH, van Noesel C, Potthoff A, Prins JM, Kreuter A. Topical 5-fluorouracil treatment of anal intraepithelial neoplasia in human immunodeficiency virus-positive men. Br J Dermatol 2010; 163:1301-7. [PMID: 20716208 DOI: 10.1111/j.1365-2133.2010.09982.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-induced potential precursor lesion of anal cancer, is frequent among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). So far, only a few prospective studies have been performed on the topical treatment of AIN, especially at the intra-anal location. OBJECTIVES To evaluate the efficacy and safety of self-administered topical 5-fluorouracil (5-FU) treatment of AIN in HIV-positive MSM. METHODS High-resolution anoscopy (HRA) was performed and patients with AIN (grade 1-3) were treated with 5-FU twice weekly for a total of 16 weeks. HRA-guided lesional biopsies were repeated after 5-FU treatment for histopathological evaluation. Lesional swabs were obtained before and after treatment for HPV typing and HPV-DNA load determination of the high-risk types HPV16, 18, 31 and 33. Responding patients returned 6 months after treatment for follow-up. RESULTS A total of 46 patients with AIN were included in this open prospective pilot study; 76% had multifocal disease and 74% had high-grade lesions (AIN 2 or 3). In an intention-to-treat analysis, 26 of 46 patients (57%) responded to 5-FU treatment. Eighteen patients (39%) had a complete clearance of AIN and eight patients (17%) had a partial response. Seventeen patients (37%) did not respond (unchanged grade of AIN in 16 patients and progression from low- to high-grade AIN in one patient). 5-FU treatment led to a significant decrease of HPV16-DNA load and cumulative high-risk HPV-DNA load in both responding and nonresponding patients. Thirty-nine patients (85%) experienced side-effects during therapy, but only two discontinued 5-FU treatment. One patient was lost to follow-up. Six months later, 50% of the complete responders had a recurrence. CONCLUSIONS A substantial proportion of HIV-positive MSM with AIN completely cleared their lesions with topical 5-FU treatment. In those with partial response, pretreatment with topical 5-FU might facilitate subsequent ablative therapy.
Collapse
Affiliation(s)
- O Richel
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Pischke S, Potthoff A, Hauröder B, Schlué J, Manns M, Cornberg M, Wedemeyer H. Hepatitis E: Eine Infektionskrankheit erlebt einen Bedeutungswechsel. Dtsch Med Wochenschr 2010; 135:1129-33. [DOI: 10.1055/s-0030-1255136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Potthoff A, Berg T, Wedemeyer H. Late hepatitis B virus relapse in patients co-infected with hepatitis B virus and hepatitis C virus after antiviral treatment with pegylated interferon-a2b and ribavirin. Scand J Gastroenterol 2010; 44:1487-90. [PMID: 19900055 DOI: 10.3109/00365520903329585] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [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: 02/04/2023]
Abstract
HBV DNA and HCV RNA viremia levels may fluctuate over time in HBV-HCV-coinfected patients. Long-term follow-up data of more than 6 months after PEG-IFNa + ribavirin treatment of HBV/HCV co-infection are lacking. We here report that HBV may reactivate, even after a period of years, in HBV- and HCV-co-infected patients if HCV is cleared by antiviral therapy. In contrast, a sustained response concerning HCV is durable. We recommend long-term monitoring of HBV/HCV-co-infected patients after IFN a-based therapies.
Collapse
Affiliation(s)
- A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | |
Collapse
|
41
|
Kreuter A, Potthoff A, Brockmeyer NH, Gambichler T, Swoboda J, Stücker M, Schmitt M, Pfister H, Wieland U. Anal carcinoma in human immunodeficiency virus-positive men: results of a prospective study from Germany. Br J Dermatol 2010; 162:1269-77. [PMID: 20184584 DOI: 10.1111/j.1365-2133.2010.09712.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anal intraepithelial neoplasia (AIN), a human papillomavirus (HPV)-associated potential precursor lesion of anal cancer, is frequent among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). There is a paucity of data published on the progression of high-grade AIN to invasive cancer as well as on clinical and virological characteristics comparing anal margin and anal canal carcinoma. OBJECTIVES To search for anal carcinoma and AIN in a large series of HIV-positive MSM, to assess treatment response of anal carcinoma, and to analyse lesional HPV spectrum of anal cancers. METHODS Detection of anal carcinoma and AIN was performed using cytology, high-resolution anoscopy, and histology in case of abnormal findings. Additionally, HPV analyses for 36 high- and low-risk α-HPV types were performed in patients with anal carcinoma. RESULTS In total, 446 German HIV-positive MSM were examined within an observation period of 5 years and 10 months. Of these, 116 (26·0%) patients had normal findings, 163 (36·5%) had low-grade AIN, 156 (35·0%) had high-grade AIN, and 11 (2·5%) had anal carcinoma as evidenced by the highest grade of cytology/histology. Five patients with anal cancer, who had refused treatment of their precancerous lesions, had progressed from high-grade AIN to invasive cancer within a median time of 8·6 months. All anal cancers carried high-risk α-HPV types. All five squamous cell carcinomas (SCCs) of the anal canal were HPV16 positive. In contrast, only one of the four anal margin SCCs were HPV16 positive (HPV31, HPV33 and HPV33 + HPV68 were found in the other three anal margin SCCs). HPV59 was found in two adenocarcinomas, one of which additionally carried HPV33. In contrast to the cancer biopsies, a broad spectrum of surface high- and low-risk HPV types was found in anal swabs of the patients. Surgical excision resulted in long-term disease control of all anal margin carcinomas, whereas combined chemoradiotherapy in carcinomas of the anal canal was associated with high recurrence rates, high toxicity, and high mortality. CONCLUSIONS Anal carcinoma and AIN are frequent in HIV-positive men, even in patients participating in anal cancer prevention programmes. High-grade dysplasia in these patients can progress to invasive cancer within a short period of time. Anal margin carcinoma and anal canal carcinoma differ substantially in their lesional HPV spectrum, prognosis and treatment response.
Collapse
Affiliation(s)
- A Kreuter
- Department of Dermatology, Ruhr University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Deterding K, Grüner N, Wiegand J, Buggisch P, Galle P, Spengler U, Hinrichsen H, Berg T, Cornberg M, Potthoff A, Diepolder H, Feyerabend S, Jung MC, Manns MP, Wedemeyer H. Präsidentenposter: Early versus delayed treatment of acute hepatitis C: The German HEP-NET acute HCV-III study – a randomized controlled trial. Z Gastroenterol 2009. [DOI: 10.1055/s-0029-1241337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
43
|
Potthoff A, Rifai K, Wedemeyer H, Deterding K, Manns M, Strassburg C. Successful treatment of fulminant hepatitis B during pregnancy. Z Gastroenterol 2009; 47:667-70. [PMID: 19606409 DOI: 10.1055/s-0028-1109148] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We here report the use of lamivudine 100 mg daily in a young pregnant woman (24th week of gestation) with fulminant hepatic failure due to acute HBV infection. After initiation of oral lamivudine (100 mg/d), ALT levels rapidly decreased from 5046 U/L to normal values within five weeks. HBe seroconversion occured three weeks after treatment start, followed by HBs seroconversion within less than six months. A preterm female baby was delivered at gestational week 29 (weight 1000 gr) (five weeks after start of lamivudine). The infant received simultaneous active and passive HBV immunisation within 12 hours after delivery. The neonatal check-up revealed meconium ileus which was successfully treated by surgery. At last presentation 241 days after initiation of treatment, both mother and infant showed stable HBs-seroconversion (anti-HBs 169 IU/mL and > 1000 IU/L, respectively). Therefore, lamivudine therapy was withdrawn. This case suggests that oral nucleos(t)ides may be safely used in pregnant patients with fulminant hepatitis B potentially preventing liver transplantation and interruption of pregnancy.
Collapse
Affiliation(s)
- A Potthoff
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, Medizinische Hochschule, Carl-Neuberg Str. 1, 30171 Hannover
| | | | | | | | | | | |
Collapse
|
44
|
Deterding K, Wiegand J, Grüner N, Hahn A, Jäckel E, Jung MC, Buggisch P, Galle P, Berg T, Hinrichsen H, Potthoff A, Zeuzem S, Cornberg M, Manns M, Wedemeyer H. The German Hep-Net acute hepatitis C cohort: impact of viral and host factors on the initial presentation of acute hepatitis C virus infection. Z Gastroenterol 2009; 47:531-40. [PMID: 19533544 DOI: 10.1055/s-0028-1109149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The impacts of viral load, genotype, age, sex and BMI on the clinical course of acute hepatitis C are poorly defined. Here we studied 259 patients with acute HCV infection recruited in the German Hep-Net data base between 1998 and 2008. Antiviral treatment with interferon alpha was initiated in 171 patients (66 %) within 4 months after the diagnosis of acute hepatitis C. RESULTS In this cohort (i) the mode of infection was associated with age as iv-drug users were significantly younger than non-iv-drug users while the proportion of patients who acquired HCV by medical procedures increased with age; (ii) patients younger than 30 years were more often infected with genotype 3 (26 % versus 8 % for patients older than 50 years; p = 0.03); (iii) 51 % of patients were icteric and 28 % presented with a 30-fold elevation of liver enzymes, however, no fulminant hepatic failure occurred; (iv) HCV genotype was not associated with disease severity and time to onset of symptoms; (v) low HCV viremia was associated with lower serum AST levels and a longer time from exposure to onset of symptoms; (vi) disease severity was independent from the mode of infection, age, sex and body mass index (BMI). CONCLUSIONS In this large cohort of patients admitted for antiviral therapy, acute hepatitis C took a rather mild course of disease in the majority of patients. Disease severity was not associated with HCV genotype, viral load, age, sex and BMI.
Collapse
Affiliation(s)
- K Deterding
- Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str.1 30625 Hannover
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Potthoff A, Schwannecke S, Nabi G, Hoffmann D, Grunwald T, Wildner O, Brockmeyer N, Überla K, Tenbusch M. Immunogenicity and efficacy of intradermal tattoo immunization with adenoviral vector vaccines. Vaccine 2009; 27:2768-74. [DOI: 10.1016/j.vaccine.2009.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 02/24/2009] [Accepted: 03/02/2009] [Indexed: 12/17/2022]
|
46
|
Kremer H, Sonnenberg-Schwan U, Arendt G, Brockmeyer NH, Potthoff A, Ulmer A, Graefe K, Lorenzen T, Starke W, Walker UA. HIV or HIV-therapy? Causal attributions of symptoms and their impact on treatment decisions among women and men with HIV. Eur J Med Res 2009; 14:139-46. [PMID: 19380286 PMCID: PMC3401004 DOI: 10.1186/2047-783x-14-4-139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 03/04/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Among people with HIV, we examined symptom attribution to HIV or HIV-therapy, awareness of potential side effects and discontinuation of treatment, as well as sex/gender differences. METHODS HIV-patients (N=168, 46% female) completed a comprehensive symptom checklist (attributing each endorsed symptom to HIV, HIV-therapy, or other causes), reported reasons for treatment discontinuations and potential ART-related laboratory abnormalities. RESULTS Main symptom areas were fatigue/sleep/energy, depression/mood, lipodystrophy, and gastrointestinal, dermatological, and neurological problems. Top HIV-attributed symptoms were lack of stamina/energy in both genders, night sweats, depression, mood swings in women; and fatigue, lethargy, difficulties concentrating in men. Women attributed symptoms less frequently to HIV than men, particularly fatigue (p<.01). Top treatment-attributed symptoms were lipodystrophy and gastrointestinal problems in both genders. Symptom attribution to HIV-therapy did not differ between genders. Over the past six months, 22% switched/interrupted ART due to side effects. In women, side effect-related treatment decisions were more complex, involving more side effects and substances. Remarkably, women took predominantly protease inhibitor-sparing regimens (p=.05). Both genders reported only 15% of potential ART-related laboratory abnormalities but more than 50% had laboratory abnormalities. Notably, women had fewer elevated renal parameters (p<.01). CONCLUSIONS Men may attribute symptoms more often to HIV and maintain a treatment-regimen despite side effects, whereas women may be more prudent in avoiding treatment side effects. Lacking awareness of laboratory abnormalities in both genders potentially indicates gaps in physician-patient communication. Gender differences in causal attributions of symptoms/side effects may influence treatment decisions.
Collapse
Affiliation(s)
- H Kremer
- All Around Women Special, German AIDS Society, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Kreuter A, Skrygan M, Gambichler T, Brockmeyer NH, Stücker M, Herzler C, Potthoff A, Altmeyer P, Pfister H, Wieland U. Human papillomavirus-associated induction of human beta-defensins in anal intraepithelial neoplasia. Br J Dermatol 2009; 160:1197-205. [PMID: 19298269 DOI: 10.1111/j.1365-2133.2009.09090.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antimicrobial peptides and proteins (AMPs) are widely distributed effector molecules of the innate immune system with well-known antibacterial activity. However, there is a paucity of information regarding antiviral effects of AMPs. OBJECTIVES The present study was performed to analyse expression of AMPs in human papillomavirus (HPV)-associated anal skin lesions of human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), a special high-risk group for persistent HPV infections and anal dysplasia. METHODS Skin lesions were analysed for the presence of LL-37, RNase 7, and human beta-defensin (hBD)-1, hBD-2 and hBD-3. Moreover, HPV typing and HPV DNA load determination for HPV types 6, 11, 16, 18, 31 and 33 were performed to evaluate possible correlations between expression of AMPs and lesional HPV types. RESULTS Skin biopsies of 45 HIV-positive MSM with anal intraepithelial neoplasia (AIN), anal condylomata acuminata or unaffected anal mucosa, as well as condylomata acuminata of eight HIV-negative MSM, were analysed for AMP mRNA expression. Additionally, immunohistochemical analysis for hBD-2 and hBD-3 was performed in a total of 45 samples. hBD-2 and hBD-3 gene and protein expression was significantly increased in both AIN and condyloma, whereas LL-37, RNase 7 and hBD-1 gene expression did not differ significantly from unaffected anal mucosa. AMP expression correlated neither with the number of HPV types nor with the high-risk and low-risk HPV DNA loads of the quantified types. No significant differences in AMP expression were observed in condylomata of HIV-positive and HIV-negative MSM. CONCLUSIONS hBD-2 and hBD-3 expression was shown to be significantly upregulated in HPV-associated anal skin lesions of both HIV-positive and HIV-negative MSM. Their biological significance in the innate immunity against these lesions needs further research.
Collapse
Affiliation(s)
- A Kreuter
- Department of Dermatology and Allergology, Ruhr-University Bochum, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Banasch M, Knyhala K, Kollar S, Serova K, Potthoff A, Schlottmann R, Schmidt WE, Brockmeyer NH, Goetze O. Disease- and treatment-related predictors of hepatic mitochondrial dysfunction in chronic HIV infection assessed by non-invasive (13)C-methionine breath test diagnostic. Eur J Med Res 2008; 13:401-408. [PMID: 18948231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES An increasing proportion of deaths among human immunodeficiency virus (HIV)-infected persons are due to hepatic complications. Hepatitis coinfection, antiretroviral treatment and co-occurrence of metabolic risk factors contribute to hepatic mitochondrial damage manifesting in hepatic steatosis and steatohepatitis. The aim was to assess disease- and treatment-related predictors on hepatic mitochondrial dysfunction in HIV infection by means of a new (13)C-methionine breath test (MeBT). PATIENTS AND METHODS 148 HIV positive individuals with and without antiretroviral treatment (ART) [44 therapy-naives; 89 patients on combination ART and 15 patients on structured treatment interruption (STI)] and 20 HIV-negative controls were studied prospectively by MeBT. RESULTS A decay of (13)C-methionine metabolism, expressed as cumulated percentage dose recovered over 1.5h (cPDR(1.5h)), in the subgroups of treatment-naives and patients on STI compared to controls was detected (cPDR(1.5h): 3.4 +/- 1.3% and 4.0 +/- 2.4% vs. 6.3 +/- 1.2%; p<0.01). Multivariate analyses including metabolic, treatment- and disease-related variables showed that antiretroviral treatment with stavudine, didanosine or zalcitabine and treatment-naivety were best predictors of a reduced MeBT result (cPDR(1.5h)) (beta = -0.56 and -0.50, p<0.05). CD4 count had only a minor association (beta = 0.15, p<0.05). No other variable including disease and treatment duration was associated with MeBT outcome. These factors explained 39% of the variance of MeBT results (p<0.05). CONCLUSIONS Therapy naivety and treatment with d-drugs were the best predictors of poor MeBT outcome. MeBT may be proposed as a feasible, noninvasive diagnostic instrument for clinical assessment of hepatic mitochondrial function and early detection of drug-induced mitochondriotoxity in chronic HIV infection.
Collapse
Affiliation(s)
- M Banasch
- Department of Internal Medicine, St Josef-Hospital, University of Bochum, Bochum, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Potthoff A, Nebelung M, Bräunig R. Online-Analytik zur Charakterisierung von Nanopartikeln in hohen Konzentrationen. CHEM-ING-TECH 2008. [DOI: 10.1002/cite.200750799] [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: 11/07/2022]
|
50
|
Bechara FG, Sand M, Potthoff A, Altmeyer P, Brockmeyer NH. HIV-associated facial lipoatrophy--review of current therapy options. Eur J Med Res 2008; 13:93-99. [PMID: 18499554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy for HIV-infected patients. Long-term complications of both HIV-infection and antiretroviral agents are therefore of increasing concern. Facial lipoatrophy (FLA) is a stigmatizing complication associated with sever social impact and a reduced quality of life for the patient. - We aimed to review the treatment options of HIV-associated FLA. The current treatments available for treating FLA are limited and can be classified in three main categories: I. Medial therapy, II. Injectables with different duration of effect, and III. Surgical treatment options. Medical therapy can provide a small benefit but improvement is, at best, slow and partial. Injectables can yield marked results but are costly, time consuming and may be associated with complications such as granuloma formation. Surgical options such as augmentation with specially designed silicone implants may be of benefit for severe cases of FLA, however, they are associated with higher surgical complications and do not account for the dynamic process of FLA. - To summarize, until today no ideal strategies for treatment of HIV-associated FLA are available, and new therapies are strongly required. heart disease.
Collapse
Affiliation(s)
- Falk Georges Bechara
- Department of Dermatology and Allergology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstr. 56, 44791 Bochum, Germany.
| | | | | | | | | |
Collapse
|