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  • Battegay, Manuel  (7)
  • Pharmazie  (7)
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  • Pharmazie  (7)
  • 1
    Online-Ressource
    Online-Ressource
    CD4 + T-Cell Count Increase in HIV-1-Infected Patients with Suppressed Viral Load Within 1 year after start of antiretroviral therapy
    SAGE Publications ; 2007
    In:  Antiviral Therapy Vol. 12, No. 6 ( 2007-08), p. 889-898
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 12, No. 6 ( 2007-08), p. 889-898
    Kurzfassung: CD4 + T-cell recovery in patients with continuous suppression of plasma HIV-1 viral load (VL) is highly variable. This study aimed to identify predictive factors for long-term CD4 + T-cell increase in treatment-naive patients starting combination antiretroviral therapy (cART). Methods Treatment-naive patients in the Swiss HIV Cohort Study reaching two VL measurements 〈 50 copies/ml 〉 3 months apart during the 1st year of cART were included ( n=1,816 patients). We studied CD4 + T-cell dynamics until the end of suppression or up to 5 years, subdivided into three periods: 1st year, years 2–3 and years 4–5 of suppression. Multiple median regression adjusted for repeated CD4 + T-cell measurements was used to study the dependence of CD4 + T-cell slopes on clinical covariates and drug classes. Results Median CD4 + T-cell increases following VL suppression were 87, 52 and 19 cells/μl per year in the three periods. In the multiple regression model, median CD4 + T-cell increases over all three periods were significantly higher for female gender, lower age, higher VL at cART start, CD4 + T-cell 〈 650 cells/μ l at start of the period and low CD4 + T-cell increase in the previous period. Patients on tenofovir showed significantly lower CD4 + T-cell increases compared with stavudine. Conclusions In our observational study, long-term CD4 + T-cell increase in drug-naive patients with suppressed VL was higher in regimens without tenofovir. The clinical relevance of these findings must be confirmed in, ideally, clinical trials or large, collaborative cohort projects but could influence treatment of older patients and those starting cART at low CD4 + T-cell levels.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350701200602
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2007
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Self-Reported Non-Adherence to Antiretroviral Therapy Repeatedly assessed by Two Questions Predicts Treatment Failure in Virologically Suppressed Patients
    SAGE Publications ; 2008
    In:  Antiviral Therapy Vol. 13, No. 1 ( 2008-01), p. 77-86
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 13, No. 1 ( 2008-01), p. 77-86
    Kurzfassung: The aim of this study was to explore the predictive value of longitudinal self-reported adherence data on viral rebound. Methods Individuals in the Swiss HIV Cohort Study on combined antiretroviral therapy (cART) with RNA 〈 50 copies/ml over the previous 3 months and who were interviewed about adherence at least once prior to 1 March 2007 were eligible. Adherence was defined in terms of missed doses of cART (0, 1, 2 or 〉 2) in the previous 28 days. Viral rebound was defined as RNA 〉 500 copies/ml. Cox regression models with time-independent and -dependent covariates were used to evaluate time to viral rebound. Results A total of 2,664 individuals and 15,530 visits were included. Across all visits, missing doses were reported as follows: 1 dose 14.7%, 2 doses 5.1%, 〉 2 doses 3.8%, taking 〈 95% of doses 4.5% and missing ≥2 consecutive doses 3.2%. In total, 308 (11.6%) patients experienced viral rebound. After controlling for confounding variables, self-reported non-adherence remained significantly associated with the rate of occurrence of viral rebound (compared with zero missed doses: 1 dose, hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.72–1.48; 2 doses, HR 2.17, 95% CI 1.46–3.25; 〉 2 doses, HR 3.66, 95% CI 2.50–5.34). Several variables significantly associated with an increased risk of viral rebound irrespective of adherence were identified: being on a protease inhibitor or triple nucleoside regimen (compared with a non-nucleoside reverse transcriptase inhibitor), 〉 5 previous cART regimens, seeing a less-experienced physician, taking co-medication, and a shorter time virally suppressed. Conclusions A simple self-report adherence questionnaire repeatedly administered provides a sensitive measure of non-adherence that predicts viral rebound.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350801300108
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2008
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    HIV in der Praxis: ein Problem, das alle angeht
    Infomed-Verlags AG ; 2005
    In:  pharma-kritik Vol. 26, No. 11 ( 2005-02-07), p. -
    Details
    In: pharma-kritik, Infomed-Verlags AG, Vol. 26, No. 11 ( 2005-02-07), p. -
    Kurzfassung: Auch in der hausärztlichen Praxis muss man an die Möglichkeit einer HIV-Infektion denken. Besonders wichtig ist es, dass beim Verdacht auf eine Primoinfektion die richtigen Tests durchgeführt werden. Bei Personen mit bekannter HIV-Infektion können Grundversorgerinnen und -versorger wesentlich dazu beitragen, dass die Behandlung konsequent und risikoarm durchgeführt wird.
    Materialart: Online-Ressource
    ISSN: 1010-5409
    URL: Article
    DOI: 10.37667/pk.2004.680
    Sprache: Unbekannt
    Verlag: Infomed-Verlags AG
    Publikationsdatum: 2005
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Lipid Profiles for Antiretroviral-Naive Patients Starting Pi- and Nnrti-Based Therapy in the Swiss HIV Cohort Study
    SAGE Publications ; 2005
    In:  Antiviral Therapy Vol. 10, No. 5 ( 2005-07), p. 585-591
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 10, No. 5 ( 2005-07), p. 585-591
    Kurzfassung: Blood lipid abnormalities in patients on highly active antiretroviral therapy (HAART) have been associated with exposure to protease inhibitors (PIs), particularly ritonavir. First therapy with a non-nucleoside reverse transcriptase inhibitor (NNRTI) leads to relatively favourable lipid profiles. We report on medium-term lipid profiles (up to 5 years) for antiretroviral-naive patients starting NNRTI- and PI-based HAART in the Swiss HIV Cohort Study. Methods Since April 2000, blood samples taken at visits scheduled every 6 months have been analysed for cholesterol and triglyceride concentrations. For 1065 antiretroviral-naive patients starting HAART after April 2000, we estimated changes in concentration over time using multivariate linear regression with adjustment for baseline covariates, use of lipid-lowering drugs and whether the sample was taken in a fasting state. Results Non-high density lipoprotein (HDL) cholesterol levels increase with increasing exposure to either PI- or NNRTI-based therapy, HDL cholesterol levels increase and triglyceride levels decrease with increasing exposure to NNRTI-based therapy, whereas triglyceride levels increase with increasing exposure to PI-based therapy. Between NNRTI-based therapies, there is a slight difference in triglyceride levels, which tend to increase with increasing exposure to efavirenz and to decrease with increasing exposure to nevirapine. Of the three common PI-based therapies, nelfinavir appears to have a relatively favourable lipid profile, with little change with increasing exposure. Of the other two PI therapies, lopinavir with ritonavir has a more favourable profile than indinavir with ritonavir, with smaller increases in both non-HDL cholesterol and triglycerides and an increase in HDL cholesterol. Increasing exposure to abacavir is associated with a decrease in the level of triglycerides. Conclusion In general, NNRTI-based therapy is associated with a more favourable lipid profile than PI-based therapy, but different PI-based therapies are associated with very different lipid profiles. Nelfinavir appears to have a relatively favourable lipid profile. Of the two boosted PI therapies, lopinavir appears to have a more favourable lipid profile than indinavir.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350501000511
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2005
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Body Fat Changes among Antiretroviral-Naive Patients on Pi- and Nnrti-Based Haart in the Swiss HIV Cohort Study
    SAGE Publications ; 2005
    In:  Antiviral Therapy Vol. 10, No. 1 ( 2005-01), p. 73-81
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 10, No. 1 ( 2005-01), p. 73-81
    Kurzfassung: Body fat changes are common in patients with HIV. For patients on protease inhibitor (PI)-based highly active antiretroviral therapy (HAART), these changes have been associated with increasing exposure to therapy in general and to stavudine in particular. Our objective is to show whether such associations are more or less likely for patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Methods We included all antiretroviral-naive patients in the Swiss HIV Cohort Study starting HAART after April 2000 who had had body weight, CD4 cell count and plasma HIV RNA measured between 6 months before and 3 months after starting HAART, and at least one assessment of body fat changes after starting HAART. At visits scheduled every 6 months, fat loss or fat gain is reported by agreement between patient and physician. We estimate the association between reported body fat changes and both time on therapy and time on stavudine, using conditional logistical regression. Results Body fat changes were reported for 85 (9%) out of 925 patients at their first assessment; a further 165 had only one assessment. Of the remaining 675 patients, body fat changes were reported for 156 patients at a rate of 13.2 changes per 100 patient-years. Body fat changes are more likely with increasing age [odds ratio (OR) 1.18 (1.00–1.38) per 10 years], with increasing BMI [OR 1.06 (1.01–1.11)] and in those with a lower baseline CD4 cell count [OR 0.91 (0.83–1.01) per 100 cells/μl]. There is only weak evidence that body fat changes are more likely with increasing time on HAART [OR 1.16 (0.93–1.46)] . After adjusting for time on HAART, fat loss is more likely with increasing stavudine use [OR 1.70 (1.34–2.15)]. There is no evidence of an association between reported fat changes and time on NNRTI therapy relative to PI therapy in those patients who used either one therapy or the other [OR 0.98 (0.56–1.63)] . Conclusion Fat loss is more likely to be reported with increasing exposure to stavudine. We find no evidence of major differences between PI and NNRTI therapy in the risk of reported body fat changes.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350501000105
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2005
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    Treatment and Prognosis of AIDS-Related Lymphoma in the Era of Highly Active Antiretroviral Therapy: Findings from the Swiss HIV Cohort Study
    SAGE Publications ; 2007
    In:  Antiviral Therapy Vol. 12, No. 6 ( 2007-08), p. 931-940
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 12, No. 6 ( 2007-08), p. 931-940
    Kurzfassung: To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma. Methods The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival. Results During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4 + T-cell count ( 〈 100 cells/μl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53–5.67] , hepatitis C seropositivity (HR 2.39 [95% CI 1.01–5.67]), the international prognostic index score (HR 1.98–3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13–5.78] ). Conclusions Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged as a predictor of death beyond the well-known international prognostic index score and CD4 + T-cell count.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350701200609
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2007
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 7
    Online-Ressource
    Online-Ressource
    Long-Term Virological Response to Multiple Sequential Regimens of Highly Active Antiretroviral Therapy for HIV Infection
    SAGE Publications ; 2004
    In:  Antiviral Therapy Vol. 9, No. 2 ( 2004-02), p. 263-274
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 9, No. 2 ( 2004-02), p. 263-274
    Kurzfassung: Information about the virological response to sequential highly active antiretroviral therapy (HAART) for HIV infection is limited. The virological response to four consecutive therapies was evaluated in the Swiss HIV Cohort. Design Retrospective analysis in an observational cohort. Methods 1140 individuals receiving uninterrupted HAART for 4.8 ±0.6 years were included. The virological response was classified as success ( 〈 400 copies/ml), low-level (LF: 400–5000 copies/ml) or high-level failure (HF: 〉 5000 copies/ml). Potential determinants of the virological response, including patient demographics, treatment history and virological response to previous HAART regimens were analysed using survival and logistic regression analyses. Results 40.1% failed virologically on the first (22.0% LF; 18.1% HF), 35.1% on the second (14.2% LF; 20.9% HF), 34.2% on the third (9.9% LF; 24.3% HF) and 32.7% on the fourth HAART regimen (9% LF; 23.7% HF). Nucleoside pre-treatment (OR: 2.34; 95% CI: 1.67–3.29) and low baseline CD4 T-cell count (OR: 0.79/100 cells rise; 95% CI: 0.72–0.88) increased the risk of HF on the first HAART. Virological failure on HAART with HIV-1 RNA levels exceeding 1000 copies/ml predicted a poor virological response to subsequent HAART regimens. A switch from a protease inhibitor- to a non-nucleoside reverse transcriptase inhibitor-containing regimen significantly reduced the risk of HF. Multiple switches of HAART did not affect the recovery of CD4 T lymphocytes. Conclusion Multiple sequential HAART regimens do not per se reduce the likelihood of long-term virological suppression and immunological recovery. However, early virological failure increases significantly the risk of subsequent unfavourable virological responses. The choice of a potent initial antiretroviral drug regimen is therefore critical. This study has been presented in part at the 10th Conference on Retroviruses & Opportunistic Infections. Boston, Mass., USA, 2003. Abstract #571.
    Materialart: Online-Ressource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.1177/135965350400900212
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2004
    ZDB Id: 2118396-X
    SSG: 15,3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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