IAS 2007 - Adverse Effects of Antiretroviral Therapy

Adverse Effects of Antiretroviral Therapy

WEAB3

Type:

Oral abstract session

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Venue:

Parkside Auditorium

Time:

14:30 - 16:00, Wednesday, 25.07.2007

Code:

WEAB3

Co-Chairs:

Andrew Carr, Australia
Peter Reiss, Netherlands

Presentations in this session:
14:30
WEAB301
Abstract
Powerpoint (210 KB) Significant increases in cardiovascular diseases and diabetes as causes of death in HIV-infected individuals in the HAART era in Brazil: a population based analysis
Presented by Antonio Guilherme Fonseca Pacheco, Brazil
Fonseca Pacheco A.G.¹, Tuboi S.², Faulhaber J.C.², Harrison L.³, Schechter M.⁴
¹FIOCRUZ, DEMQS, Rio de Janeiro, Brazil, ²UFRJ, Projeto Praça Onze, Rio de Janeiro, Brazil, ³University of Pittsburgh, Infectious Diseases Epidemiology Research Unit, Pittsburgh, United States, ⁴UFRJ, AIDS Research Laboratory, Rio de Janeiro, Brazil

14:45
WEAB302
Abstract Control of HIV viral replication is associated with rapid improvement in endothelial function sustained over twenty-four weeks: A5152s, a substudy of A5142
Presented by Francesca Torriani, United States
Torriani F.¹, Komarow L.², Cotter B.³, Murphy R.⁴, Fichtenbaum C.⁵, Currier J.⁶, Dube M.⁷, Squires K.⁸, Gerschenson M.⁹, Mitchell C.¹⁰, Stein J.¹⁰
¹University of California San Diego, Medicine, San Diego, United States, ²SDAC/Harvard School of Public Health, School of Public Health, Boston, United States, ³University of California San Diego, Cardiovascular Medicine, San Diego, United States, ⁴Northwestern University, Medicine, Chicago, United States, ⁵University of Cincinnati, Medicine, Cincinnati, United States, ⁶University of California Los Angeles, Medicine, Los Angeles, United States, ⁷Indiana University, Medicine, Indianapolis, United States, ⁸University of Southern California, Medicine, Los Angeles, United States, ⁹University of Hawaii, Medicine, Honolulu, United States, ¹⁰University of Wisconsin, Cardiovascular Medicine, Madison, United States

15:00
WEAB303
Abstract
Powerpoint (377 KB) Dietary intervention when starting HAART prevents the increase in lipids independently of drug regimen: a randomized trial
Presented by Eduardo Sprinz, Brazil
Lazzaretti R.¹, Pinto-Ribeiro J.¹, Kummer R.¹, Polanczyk C.¹, Sprinz E.²
¹Hospital de Clinicas, Serviço de Cardiologia, Porto Alegre, Brazil, ²Hospital de Clinicas, Serviço de Medicina Interna, Porto Alegre, Brazil

15:15
WEAB304
Abstract Tubular amino acid reabsorption and urinary proteome analysis in HIV patients treated with antiretroviral therapy
Presented by Georg Behrens, Germany
Behrens G.¹, Wittke S.², Luecke T.³, Das A.³, Moebius U.¹, Gurjanov A.¹, Mischak H.², Schmidt R.E.¹, Competence Network HIV/AIDS
¹Hannover Medical School, Clinical Immunology, Hannover, Germany, ²Mosaiques Diagnostics, Hannover, Germany, ³Hannover Medical School, Department for Paediatric Kidney and Liver Diseases and Metabolic Disorders, Hannover, Germany

15:30
WEAB305
Abstract
Powerpoint (238 KB) High sensitivity of HLA-B*5701 in Whites and Blacks in immunologically-confirmed cases of abacavir hypersensitivity (ABC HSR)
Presented by Elizabeth Phillips, Australia
Saag M.¹, Balu R.², Brachman P.³, Brothers C.², Stancil B.², Mosteller M.², Wannamaker P.², Sutherland-Phillips D.², Phillips E.⁴, Mallal S.⁴, Shaefer M.²
¹University of Alabama, Center for AIDS Research, Birmingham, AL, United States, ²GlaxoSmithKline, Infectious Disease Medicine Development Center, Research Triangle Park, NC, United States, ³Emory University, Atlanta, GA, United States, ⁴Royal Perth Hospital and Murdoch University, Perth, Australia

15:45
WEAB3LB
Abstract Abacavir hypersensitivity in HLA-B57-positive individuals with HIV infection is dependent upon the conventional MHC-I Ag presentation pathway
Presented by James McCluskey
McCluskey J.¹, Chessman D.¹, Lethborg T.¹, Kostenko L.¹, Purcell A.W.², Kjer-Nielsen L.¹, Mifsud N.A.¹, Tait B.D.³, Holdsworth R.³, Almeida C.-A.⁴, Nolan D.⁴, Mallal S.⁴, Bharadwaj M.¹, Rossjohn J.⁵
¹University of Melbourne, Department of Microbiology and Immunology, Melbourne, Australia, ²University of Melbourne, Department of Biochemistry and Molecular Biology, Melbourne, Australia, ³Australian Red Cross Blood Bank, Victorian Transplantation and Immunogenetics Service, Melbourne, Australia, ⁴Royal Perth Hospital, Centre for Clinical Immunology and Biomedical Statistics, Perth, Australia, ⁵Monash University, The Protein Crystallography Unit, Department of Biochemistry and Molecular Biology, Melbourne, Australia

Audio files:

audio file - high quality (mp3 format, 46.2 MB)
audio file - low quality (mp3 format, 23.2 MB)

Rapporteur report

Track B: Clinical Research, Treatment and Care report by Nick Paton

Dr Fonseca Pacheco presented an analysis of mortality from Brazil based on death certificate data that showed a change in the spectrum of causes of death in HIV, with more cardiovascular disease and other non-AIDS diseases increasing over time.

Francesca Torriani from UCSD presented the results of ACTG 5152s. This was a sub-study of ACTG 5142 in which ART naïve patients were randomized to EFV and 2NRTIs, or LPV/r and 2NRTIs, or LPV/r and EFV (the idea being PI sparing, NNRTI sparing and NRTI-sparing regimens). The NRTIs were not randomized. The duration of the sub-study was 24 weeks and endothelial function was measured by the standard technique of flow-mediated dilatation (FMD). The study found significantly improved endothelial function in all three treatment arms, with no significant difference between the three drug regimens. There were no correlations between the change in FMD and changes in other metabolic variables, and the control of HIV replication was the only variable that was associated with improved endothelial function.

Eduardo Sprinz from Porto Allegre, Brazil presented a study designed to test whether dietary intervention at the time of starting ART could avoid the increases in lipids when starting ART. 90 patients starting ART (mostly AZT + 3TC + EFV) were randomized to control or to an intervention arm consisting of nutritional counseling from a dietitian every 3 months with the intent of lowering cholesterol. The dietary intervention group has less self-reported energy intake and less fat intake and less cholesterol intake. There was a significant increase in triglycerides in the control group whereas this showed a decrease from baseline in the intervention group (P<0.001). LDL cholesterol increased in the control arm, and showed no change in the dietary intervention arm. HDL increased similarly in the two groups. Thus nutritional intervention is effective in preventing changes in lipid profile of HIV positive individuals who start HAART.

G Behrens presented some complicated data obtained using the technique of capillary electrophoresis coupled to mass spectrometry to identify abnormal urinary peptide patterns. The method has been validated in detecting a variety of renal diseases. The aim of this study was to evaluate urinary proteome analysis in patients receiving different types of ART. Four groups of patients were studied. The first group had elevated creatinine on TDF and was found to have a high proportion of patients with an abnormal urinary peptide pattern. The second group had normal creatinine on TDF, and they also had a high proportion with abnormal peptide profile. For patients not on TDF or naïve to ART, there were very few with an abnormal peptide profile. This method may be potentially useful way of identifying people with early nephrotoxicity on ART.

Following on from the PREDICT study presented earlier in the afternoon in the late-breaker session, E Phillips presented the results from the SHAPE study designed to test whether HLA-B*5701 could predict abacavir hypersensitivity in non-white patients. This was a case-control study of patients with clinically suspected ABC hypersensitivity and controls from other GSK studies that had tolerated ABC for at least 12 weeks. Of those who had confirmed ABC hypersensitivity confirmed by patch testing, 100% of patients were HLA positive irrespective of race. When the diagnosis was based on clinical manifestations only, the sensitivity was lower in black than in white patients. The implications for screening in black patients are that if you screen 100 patients you would get 98 HLA negative who would go on to be treated in safety. Of the 2 who would be HLA positive and who would not therefore receive ABC, only 1 of these would go on to have a hypersensitivity reaction. So you would be unnecessarily excluding 1 patient from treatment. The results of the SHAPE study are consistent with PREDICT, indicating that the results are generalisable across racial groups.

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