Flying Publisher www.HIVMedicine.com HIV Medicine 2006 Hoffmann - Rockstroh - Kamps By Dirk Albrecht, Borstel Marcus Altfeld, Boston Philip Aries, Hamburg Georg Behrens, Hannover U. Fritz Bredeek, Tucson Thomas Buhk, Hamburg Laura Dickinson, Liverpool Christian Eggers, Linz Gerd Fätkenheuer, Cologne Georg Friese, Gießen Ardeschir Ghofrani, Gießen Carole Gilling-Smith, London Katrin Graefe, Hamburg Christian Hoffmann, Hamburg Bernd Sebastian Kamps, Paris Peter Krings, Essen Christoph Lange, Borstel Thore Lorenzen, Hamburg Hermione Lyall, London Grace A. McComsey, Cleveland Leonie Meemken, Hamburg Oliver Mittermeier, Hamburg Fiona Mulcahy, Dublin Till Neumann, Essen Tim Niehues, Düsseldorf Falk Ochsendorf, Frankfurt Mario Ostrowski, Toronto Wolfgang Preiser, Tygerberg Ansgar Rieke, Koblenz Jürgen Rockstroh, Bonn Thorsten Rosenkranz, Hamburg Andrea Rubbert, Cologne Dana A. Sachs, Ann Arbor Bernhard Schaaf, Lübeck Christiane Schieferstein, Frankfurt Reinhold E. Schmidt, Hannover Helmut Schöfer, Frankfurt Ulrike Sonnenberg-Schwan, Munich Mirko Steinmüller, Gießen Matthias Stoll, Hannover Susanne Tabrizian, Hamburg Zahra Toossi, Cleveland Mechthild Vocks-Hauck, Berlin Bruce D. Walker, Boston Ulrich A. Walker, Freiburg Jan-Christian Wasmuth, Bonn Michael Weigel, Mannheim Thomas Weitzel, Berlin Eva Wolf, Munich HIV Medicine 2006 www.HIVMedicine.com Edited by Christian Hoffmann Jürgen K. Rockstroh Bernd Sebastian Kamps Flying Publisher 4 Editors Christian Hoffmann, M.D., Ph.D. ifi, St. Georg Hospital Lohmühlenstrasse 5 D – 20099 Hamburg Tel: + 49 40 181885 3780 Fax: + 49 40 181885 3788 www.HIVMedicine.com www.InfluenzaReport.com Jürgen K. Rockstroh, M.D., Ph.D. Department of Medicine I University of Bonn Sigmund-Freud-Str. 25 D – 53105 Bonn Phone: + 49 228 287 6558 Fax: + 49 228 287 5034 email: Juergen.Rockstroh@ukb.uni-bonn.de Bernd Sebastian Kamps, M.D. FlyingPublisher.com InfluenzaReport.com Amedeo.com Paris HIV Medicine is an ever-changing field. The editors and authors of HIV Medicine 2006 have made every effort to provide information that is accurate and complete as of the date of publication. However, in view of the rapid changes occurring in medical science, HIV prevention and policy, as well as the possibility of human error, this site may contain technical inaccuracies, typographical or other errors. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the treating physician who relies on experience and knowledge about the patient to determine dosages and the best treatment for the patient. The information contained herein is provided "as is" and without warranty of any kind. The contributors to this site, including the editors and Flying Publisher, disclaim responsibility for any errors or omissions or for results obtained from the use of information contained herein. © 2006 by Flying Publisher – Paris, Cagliari, Wuppertal Proofreading: Emma Raderschadt, M.D. Cover: Attilio Baghino, www.a4w.it ISBN: 3-924774-50-1 – ISBN-13: 978-3-924774-50-9 Printed by Druckhaus Süd GmbH & Co. KG, D-50968 Cologne, Tel. + 49 221 387238 Email: info@druckhaus-sued.de 5 Preface 2006 As in previous years, all chapters of the 14 th edition have been thoroughly revised, and new chapters have been added (HIV and Renal Disease, Sexual Dysfunction in HIV/AIDS). Again, the book is freely available on the Internet. That is the way, we firmly believe, that medical textbooks should be handled in the 21 st century. HIV Medicine is now available in Spanish, German, Russian, and Portuguese (www.hivmedicine.com/textbook/lang.htm), and we expect translations into further languages. This is clearly a challenge for the future, and the authors of HIV Medicine are ready to take the challenge. As a matter of fact, the 2007 edition is already under way. The philosophy which governs the publication of HIV Medicine 2006 has been published at www.freemedicalinformation.com. Christian Hoffmann Jürgen K. Rockstroh Bernd Sebastian Kamps Hamburg, Bonn, Paris – August 2006 6 Preface 2003 Hardly any field of medicine has ever undergone a similar stormy development to that of the therapy of HIV infection. Little more than 10 years passed, between the discovery of the pathogen and the first effective treatment! However, there is also hardly a field that is subjected to so many fast- and short-lived trends. What today seems to be statute, is tomorrow often already surpassed. Nevertheless, therapeutical freedom must not be confused with freedom of choice. This book presents the medical knowledge that is actual today: from December 2002 to January 2003. Because HIV medicine changes so fast, HIV Medicine 2003 will be updated every year. Additional chapters about opportunistic infections, malignancies and hepatitis are freely available at our Web site www.HIVMedicine.com. Under certain conditions, the editors and the authors of this book might agree to remove the copyright on HIV Medicine for all languages except English and German. You could therefore translate the content of HIV Medicine 2003 into any language and publish it under your own name – without paying a license fee. For more details, please see http://hivmedicine.com/textbook/cr.htm. Christian Hoffmann and Bernd Sebastian Kamps Hamburg/Kiel and Paris/Cagliari, January 2003 7 Assistant Editor Nyasha Bakare, M.D. Johns Hopkins School of Public Health 615 N Wolfe St Baltimore, MD 21205 nbakare@jhsph.edu Contributors Dirk Albrecht Medizinische Klinik Forschungszentrum Borstel Parkallee 1-40 23845 Borstel Phone: + 49 4537-188 312 Fax: + 49 4537-188 313 dalbrecht@fz-borstel.de Marcus Altfeld, M.D., Ph.D. Partners AIDS Research Center Massachusetts General Hospital Bldg. 149, 13th Street, 5th floor Charlestown, MA 02129 USA Phone: + 1 617 724 2461 Fax: + 1 617 724 8586 MAltfeld@partners.org Sven Philip Aries, M.D. Max Brauer Allee 45 D – 22765 Hamburg Phone: + 49 40 3903534 Fax: + 49 40 3903948 Dr.Aries@web.de Georg Behrens, M.D., Ph.D. Klinische Immunologie Zentrum Innere Medizin der Medizinischen Hochschule Carl-Neuberg-Straße 1 D – 30625 Hannover Phone: + 49 511 532 5393 Fax: + 49 511 532 9067 U. Fritz Bredeek, M.D. Assistant Clinical Professor Dept. of Infectious Diseases Olive View Medical Center University of California Los Angeles Phone: + 1 520 628-8287 Fax: + 1 520 628-8749 fritz@doctor.com Thomas Buhk, M.D. Grindelpraxis Hamburg Grindelallee 35 D – 20146 Hamburg Phone: + 49 40 41 32 420 buhk@grindelpraxis.de Laura Dickinson, BSc Liverpool HIV Pharmacology Group University of Liverpool Block H, First Floor 70 Pembroke Place GB – Liverpool, L69 3GF Phone: + 44 151 794 5565 Fax: + 44 151 794 5656 Laurad@liverpool.ac.uk 8 Contributors Christian Eggers, M.D., Ph.D. Abteilung für Neurologie Krankenhaus der Barmherzigen Brüder Seilerstätte 2 A – 4021 Linz Phone: + 43 732 7897 25305 Fax: + 43 732 7897 25399 Christian.Eggers@bblinz.at Gerd Fätkenheuer, M.D., Ph.D. Klinik I für Innere Medizin Universitätsklinikum Köln Joseph-Stelzmann-Str. 9 D – 50924 Köln Phone: + 49 221 478 4886 Fax: + 49 221 478 3424 g.faetkenheuer@uni-koeln.de Georg Friese, M.D. University Hospital Giessen Department of Internal Medicine Infectious Diseases Klinikstr. 36 D – 35392 Giessen Phone: + 49 641 99 42674 Fax: + 49 641 99 42679 Ardeschir Ghofrani, M.D. University Hospital Giessen Department of Internal Medicine Pulmonology/Intensive Care Medicine Klinikstrasse 36 D – 35392 Giessen Phone: + 49 641 99 42 421 Fax: + 49 641 99 42 419 Carole Gilling-Smith, M.A., FRCOG, Ph.D. Assisted Conception Unit Chelsea & Westminster Hospital 369 Fulham Road GB – London SW10 9NH Phone: + 41 20 8746 8922 Fax: + 41-20 8746 8921 e-mail: cgs@chelwest.nhs.uk Katrin Graefe, M.D. ifi Institute, Haus K Lohmühlenstrasse 5 D – 20099 Hamburg Phone: + 49 40 181885 3780 Fax: + 49 40 181885 3788 graefe@ifi-infektiologie.de Stephen Korsman, M.D. Medizinische Virologie Tygerberg NHLS / Stellenbosch University PO Box 19063, Tygerberg 7505 South Africa Phone: + 27 21 938 9347 Fax: + 27 21 938 9361 snjk@sun.ac.za Peter Krings Klinik für Kardiologie Westdeutsches Herzzentrum Essen Universitätsklinikum Essen Hufelandstr. 55, 45122 Essen Phone: + 49 201 723 4878 Fax.: + 49 201 723 5488 Email: peter.krings@uk-essen.de Christoph Lange, M.D., Ph.D. Medizinische Klinik des Forschungszentrums Borstel Parkallee 35 D – 23845 Borstel Phone: + 49 4537 188 0 Fax: + 49 4537 188 313 clange@fz-borstel.de Thore Lorenzen, M.D. ifi Institute Lohmühlenstrasse 5 D – 20099 Hamburg Phone: + 49 40 181885 3780 Fax: + 49 40 181885 3788 lorenzen@ifi-infektiologie.de Contributors 9 Hermione Lyall The Family Clinic and Imperial College St Mary's Hospital, Praed Street GB – London W2 1NY United Kingdom Hermione.Lyall@St-Marys.nhs.uk Christoph Mayr, M.D. MVZ Ärzteforum Seestrasse Gemeinschaftspraxis HIV/AIDS und Hepatitiden, Hämatologie und Onkologie Seestrasse 64 13347 Berlin Tel: + 49 30 455095 0 Fax: + 49 30 455095 25 Grace A. McComsey, M.D. Division of Pediatric infectious Diseases and Rheumatology Case Western Reserve University Cleveland, Ohio Phone: + 1 216 844 2460 Fax: + 1 216 832 4312 mccomsey.grace@clevelandactu. org Leonie Meemken ifi Institute Lohmühlenstrasse 5 D – 20099 Hamburg Phone.: + 49 40 181885 3796 meemken@ifi-infektiologie.de Oliver Mittermeier, M.D. Department of Psychiatry and Psychotherapy Asklepios Westklinikum Hamburg Suurheid 20 D – 22559 Hamburg O.Mittermeier@t-online.de Fiona Mulcahy, M.D., FRCPI Department of Genito Urinary Medicine & Infectious Diseases St James's Hospital James's Street EI – Dublin 8 Phone: + 353 1 4162590 Fax: + 353 1 4103416 fmulcahy@stjames.ie Till Neumann, M.D. Universitätsklinikum Essen Klinik für Kardiologie Westdeutsches Herzzentrum Essen Zentrum für Innere Medizin Hufelandstr. 55 D – 45122 Essen Phone: + 49 201 723 4878 Fax: + 49 201 723 5401 till.neumann@uni-essen.de Tim Niehues, M.D., Ph.D. Zentrum für Kinder- und Jugendmedizin Klinik für Kinder-Onkologie, –Hämatologie und –Immunologie Ambulanz für Pädiatrische Immunologie und Rheumatologie Heinrich Heine Universität Moorenstr. 5 D – 40225 Düsseldorf Phone: + 49 211 811 7647 Fax: + 49 211 811 6539 niehues@uni-duesseldorf.de Falk Ochsendorf, M.D., Ph.D. Zentrum der Dermatologie und Venerologie Klinikum der J.W. Goethe- Universität Theodor-Stern-Kai 7 D – 60590 Frankfurt am Main Phone: + 49 69 6301 6819 Ochsendorf@em.uni-frankfurt.de 10 Contributors Mario Ostrowski, M.D. Clinical Sciences Division University of Toronto Medical Sciences Building, Rm 6271 1 King's College Circle Toronto, ON M5S 1A8 Canada Phone: + 1 416 946 5805 FAX: + 1 416 978 8765 E-mail: m.ostrowski@utoronto.ca Ansgar Rieke, M.D. Klinikum Kemperhof Koblenz II. Med. Klinik Immunologische Ambulanz Koblenzer Str. 115-155 56065 Koblenz Tel: + 49 261 499 2691 Fax: + 49 261 499 2690 ansgar.rieke@kemperhof.de Wolfgang Preiser, M.D., Ph.D. University of Stellenbosch Discipline of Medical Virology Tygerberg Campus PO Box 19063, Tygerberg 7505, South Africa Phone: + 27 21 938 9353, -4 Fax: + 27 21 938 9361 preiser@sun.ac.za Thorsten Rosenkranz, M.D. Neurologische Abteilung Allgemeines Krankenhaus St. Georg Lohmühlenstraße 5 D – 20099 Hamburg Phone: + 49 40 181885 2241 Fax: + 49 40 181885 2971 TRosenkranz@t-online.de Andrea Rubbert, M.D., Ph.D. Medizinische Klinik I Universitätsklinik Köln Joseph-Stelzmann Str 9 D – 50924 Köln Germany Phone: + 49 221 478 5623 Fax: + 49 221 478 6459 Dana L. Sachs, M.D. University of Michigan Department of Dermatology 1910 Taubman Center 1500 E. Medical Center Drive Ann Arbor, Michigan 48109 USA Phone: + 1 734 936 4081 dsachs@med.umich.edu Bernhard Schaaf, M.D. Universitätsklinikum Schleswig- Holstein Campus Lübeck Medizinische Klinik III Pneumologie/Infektiologie Ratzeburger Allee 160 23538 Lübeck Tel: + 49 451 500 2344 Fax: + 49 451 500 6558 schaaf@uni-luebeck.de Christiane Schieferstein, M.D. Medizinische Klinik II Uniklinikum Frankfurt Theodor-Stern-Kai 7 D – 60590 Frankfurt am Main Phone: + 49 69 6301 0 schieferstein@wildmail.com [...]... Lancet 19 86, 2 :11 1 3-5 http://amedeo.com/lit.php?id=2877269 61 Moore RD, Chaisson RE Natural history of HIV infection in the era of combination antiretroviral therapy AIDS 19 99, 13 : 19 3 3-4 2 http://amedeo.com/lit.php?id =10 513 653 62 Murphy DA, Mitchell R, Vermund SH, Futterman D Factors associated with HIV testing among HIVpositive and HIV- negative high-risk adolescents: the REACH Study Pediatrics 2002, 11 0:... Investigation of potential HIV transmission to the patients of an HIV- infected surgeon JAMA 19 93, 269: 17 9 5 -1 8 01 http://amedeo.com/lit.php?id=8459 510 78 Spira R, Lepage P, Msellati P, et al Natural history of HIV type 1 infection in children: a five-year prospective study in Rwanda Mother-to-Child HIV- 1 Transmission Study Group Pediatrics 19 99, 10 4: e56 http://amedeo.com/lit.php?id =10 545582 79 Stewart GJ,... http://amedeo.com/lit.php?id=33367 81 11 Centers for Disease Control (19 81c) Follow-up on Kaposi's sarcoma and Pneumocystis pneumonia MMWR Morb Mortal Wkly Rep 19 81, 30: 40 9 -1 0 12 Centers for Disease Control (19 81b) Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men New York City and California MMWR Morb Mortal Wkly Rep 19 81, 30: 30 5-8 13 Centers for Disease Control (19 81a) Pneumocystis pneumonia... normally seen during acute HIV- 1 infection (in our own studies on average 13 x 10 6 copies HIV- 1 RNA/ml with a range of 0.25 – 95.5 x 10 6 copies HIV- 1 RNA/ml) Repetition of the assay for HIV- 1 RNA from the same sample with the same test led to a negative result in all false positive cases Measurement of HIV- 1 RNA from duplicate samples therefore results in a sensitivity of 10 0 % with 10 0 % specificity In contrast,... 7 61 270 3384 Fax: + 49 7 61 270 3384 or -3 306 ulrich.walker@klinikum.unifreiburg.de Jan-Christian Wasmuth, M.D Department of Medicine I University of Bonn Sigmund-Freud-Str 25 D – 5 310 5 Bonn Phone: + 49 228 287 6558 Fax: + 49 228 287 5034 j-c.wasmuth@uni-bonn.de Michael Weigel, M.D., Ph.D Frauenklinik im Klinikum Mannheim Theodor-Kutzer-Ufer 1- 3 D – 6 816 7 Mannheim Phone: + 49 6 213 83 2286 Fax: + 49 6 21. .. Lancet 19 83, 1: 11 8 7-9 1 http://amedeo.com/lit.php?id= 613 3990 3 Armbruster C, Kriwanek S, Vorbach H Gender-specific differences in the natural history, clinical features, and socioeconomic status of HIV- infected patients: experience of a treatment centre in Vienna Wien Klin Wochenschr 2000, 11 2: 75 4-6 0 http://amedeo.com/lit.php?id =11 042904 4 Barre-Sinoussi F, Chermann JC, Rey F, et al Isolation of a T-lymphotropic... AIDS 7.2 8,700 6,500 0.7 2,700 1, 300 0.9 740 17 0 0.6 0 .1 550 380 18 0 11 0 0.2 18 0 16 0 0.7 1. 6 12 0 80 50 70 0.3 60 30 0.5 20 10 Total 40,300,000 1. 1 13 ,530 * Adapted from WHO: AIDS Epidemic Update 2005, http:/ /hiv. net/link.php?id=227 8,580 Conclusion 29 Conclusion HIV cannot be transmitted as easily as the influenza virus Compared to other viral diseases, the prevention of HIV infection is therefore easier... Dtsch Med Wochenschr 19 85, 11 0: 14 8 3-7 http://amedeo.com/lit.php?id=38754 71 83 Wormser GP, Bittker S, Forseter G, et al Absence of infectious HIV type 1 in "natural" eccrine sweat J Infect Dis 19 92, 16 5: 15 5-8 http://amedeo.com/lit.php?id =13 45794 84 Ziegler JB, Cooper DA, Johnson RO, Gold J Postnatal transmission of AIDS-associated retrovirus from mother to infant Lancet 19 85, 1: 89 6-8 http://amedeo.com/lit.php?id=2858746... have the ability to elimi- 34 Acute HIV- 1 Infection nate HIV- 1- infected cells directly by MHC class I-restricted cytolysis or indirectly by producing cytokines, chemokines or other soluble factors, thus curtailing the generation of new viral progeny (Yang 19 97) The biological relevance of HIV- 1specific cytotoxic T cells (CTL) in acute HIV- 1 infection was highlighted in recent in-vivo studies demonstrating... approach Nat Med 2002, 8: 64 9-5 0 48 Harris C, Small CB, Klein RS, et al Immunodeficiency in female sexual partners of men with the AIDS N Engl J Med 19 83, 308: 11 8 1- 4 http://amedeo.com/lit.php?id=62 211 92 49 Hubert JB, Burgard M, Dussaix E, et al Natural history of serum HIV- 1 RNA levels in 330 patients with a known date of infection AIDS 2000, 14 : 12 3-3 1 http://amedeo.com/lit.php?id =10 708282 50 Jean SS, Pape . Baghino, www.a4w.it ISBN: 3-9 2477 4-5 0 -1 – ISBN -1 3 : 97 8-3 -9 2477 4-5 0-9 Printed by Druckhaus Süd GmbH & Co. KG, D-50968 Cologne, Tel. + 49 2 21 387238 Email: info@druckhaus-sued.de 5 Preface 2006 As. 49 211 811 7647 Fax: + 49 211 811 6539 niehues@uni-duesseldorf.de Falk Ochsendorf, M.D., Ph.D. Zentrum der Dermatologie und Venerologie Klinikum der J.W. Goethe- Universität Theodor-Stern-Kai. to HIV testing 57 References 58 4. Pathogenesis of HIV- 1 Infection 61 1. The structure of HIV- 1 62 2. The HIV replication cycle 66 3. HIV and the immune system 74 References 82 5. ART 2006 89 1.