Ambulatory care for HIV-infected patients: differences in outcomes between hospital-based units and private practices: analysis of the RESINA cohort
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- 作者：Mark Oette (1)
Stefan Reuter (2)
Rolf Kaiser (3)
Bj?rn Jensen (4)
Thomas Lengauer (5)
Gerd F?tkenheuer (3)
Heribert Knechten (6)
Martin Hower (7)
Abdurrahman Sagir (4)
Herbert Pfister (3)
Dieter H?ussinger (4) - 关键词：HAART ; Therapy na?ve ; Transmitted drug resistance ; Treatment setting
- 刊名：European Journal of Medical Research
- 出版年：2013
- 出版时间：December 2013
- 年：2013
- 卷：18
- 期：1
- 全文大小：180 KB
- 参考文献：1. Robert Koch Institute Berlin: Robert Koch Institute: HIV/AIDS in Deutschland - Eckdaten der Sch?tzung; 2013. []
2. Bhaskaran K, Hamouda O, Sannes M, Boufassa F, Johnson AM, Lambert PC, Porter K, CASCADE Collaboration: Changes in the risk of death after HIV seroconversion compared with mortality in the general population. / JAMA 2008, 300:51-9. dx.doi.org/10.1001/jama.300.1.51" target="_blank" title="It opens in new window">CrossRef
3. Lennox JL, Dejesus E, Berger DS, Lazzarin A, Pollard RB, RamalhoMadruga JV, Zhao J, Wan H, Gilbert CL, Teppler H, Rodgers AJ, Barnard RJ, Miller MD, Dinubile MJ, Nguyen BY, Leavitt R, Sklar P, STARTMRK Investigators: Raltegravir versus Efavirenz regimens in treatment-naive HIV-1-infected patients: 96-week efficacy, durability, subgroup, safety, and metabolic analyses. / J Acquir Immune Defic Syndr 2010, 55:39-8. dx.doi.org/10.1097/QAI.0b013e3181da1287" target="_blank" title="It opens in new window">CrossRef
4. Pursuing Later Treatment Option II (PLATO II) Project Team; Observational HIV Epidemiological Research Europe (COHERE) Group: Trends in virological and clinical outcomes in individuals with HIV-1 infection and virological failure of drugs from three antiretroviral drug classes: a cohort study. / Lancet Infect Dis 2012, 12:119-27. dx.doi.org/10.1016/S1473-3099(11)70248-1" target="_blank" title="It opens in new window">CrossRef
5. Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, Gatell JM, Günthard HF, Hammer SM, Hirsch MS, Jacobsen DM, Reiss P, Richman DD, Volberding PA, Yeni P, Schooley RT, International AIDS Society-USA: Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. / JAMA 2010, 304:321-33. dx.doi.org/10.1001/jama.2010.1004" target="_blank" title="It opens in new window">CrossRef
6. Leisegang R, Maartens G, Hislop M, Sargent J, Darkoh E, Cleary S: A novel Markov model projecting costs and outcomes of providing antiretroviral therapy to public patients in private practices versus public clinics in south Africa. / PLoS One 2013, 8:e53570. dx.doi.org/10.1371/journal.pone.0053570" target="_blank" title="It opens in new window">CrossRef
7. N?stlinger C, Page J, Jaccard R, Somaini B, Weber R: Structures of co-operation between an HIV-outpatient clinic and private care physicians. / Gesundheitswesen 2003, 65:90-5. dx.doi.org/10.1055/s-2003-37693" target="_blank" title="It opens in new window">CrossRef
8. Oette M, Reuter S, Kaiser R, Lengauer T, F?tkenheuer G, Knechten H, Hower M, Pfister H, H?ussinger D, RESINA Study group: Epidemiology of transmitted drug resistance in chronically HIV-infected patients in Germany: the RESINA Study 2001-009. / Intervirology 2012, 55:154-59. dx.doi.org/10.1159/000332015" target="_blank" title="It opens in new window">CrossRef
9. Beerenwinkel N, D?umer M, Oette M, Korn K, Hoffmann D, Kaiser R, Lengauer T, Selbig J, Walter H: Geno2pheno: estimating phenotypic drug resistance from HIV-1 genotypes. / Nucleic Acids Res 2003, 31:3850-855. dx.doi.org/10.1093/nar/gkg575" target="_blank" title="It opens in new window">CrossRef
10. Oette M, Kaiser R, D?umer M, Akbari D, F?tkenheuer G, Rockstroh JK, Stechel J, Rieke A, Mauss S, Schmal?er D, G?bels K, Vogt C, Wettstein M, H?ussinger D: Primary drug resistance in HIV-positive patients on initiation of first-line antiretroviral therapy in Germany. / Eur J Med Res 2004, 9:273-78.
11. Bennett DE, Camacho RJ, Otelea D, Kuritzkes DR, Fleury H, Kiuchi M, Heneine W, Kantor R, Jordan MR, Schapiro JM, Vandamme AM, Sandstrom P, Boucher CA, van de Vijver D, Rhee SY, Liu TF, Pillay D, Shafer RW: Drug resistance mutations for surveillance of transmitted HIV-1 drug-resistance: 2009 update. / PLoS One 2009, 4:e4724. dx.doi.org/10.1371/journal.pone.0004724" target="_blank" title="It opens in new window">CrossRef
12. Jansen K, Brockmeyer NH, Hahn M, Kaul I, Fenske S, Rausch M, Kuhlmann B, Ulmer A, Lauenroth-Mai E, Harrer T, Hower M, Skaletz-Rorowski A, Michalik C: Competence network for HIV/AIDS. Epidemiological composition, clinical and treatment characteristics of the patient cohort of the German Competence Network for HIV/AIDS. / Eur J Med Res 2009, 14:415-25.
13. Oette M, Kaiser R, D?umer M, Petch R, F?tkenheuer G, Carls H, Rockstroh JK, Schmal?er D, Stechel J, Feldt T, Pfister H, H?ussinger D, the RESINA Study Team: Primary HIV drug-resistance and efficacy of first-line antiretroviral therapy guided by resistance testing. / J Acquir Immune Defic Syndr 2006, 41:573-81. dx.doi.org/10.1097/01.qai.0000214805.52723.c1" target="_blank" title="It opens in new window">CrossRef - 作者单位：Mark Oette (1)
Stefan Reuter (2)
Rolf Kaiser (3)
Bj?rn Jensen (4)
Thomas Lengauer (5)
Gerd F?tkenheuer (3)
Heribert Knechten (6)
Martin Hower (7)
Abdurrahman Sagir (4)
Herbert Pfister (3)
Dieter H?ussinger (4)
1. Clinic for General Medicine, Gastroenterology, and Infectious Diseases Augustinerinnen Hospital, Jakobstrasse 27-31, Koln, 50678, Germany
2. Klinikum Leverkusen, Leverkusen, Germany
3. University of Cologne, Cologne, Germany
4. University Clinic Düsseldorf, Düsseldorf, Germany
5. Max Planck Institute for Informatics, Saarbrücken, Germany
6. Private Practice Blondelstrasse, Aachen, Germany
7. Klinikum Dortmund, Dortmund, Germany - ISSN：2047-783X
文摘
Background The efficacy of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is influenced by factors such as potency of applied drugs, adherence of the patient, and resistance-associated mutations. Up to now, there is insufficient data on the impact of the therapeutic setting. Methods Since 2001, the prospective multicenter RESINA study has examined the epidemiology of transmitted HIV drug resistance in Nordrhein-Westfalen, the largest federal state of Germany by population. Characteristics of patients treated in hospital-based outpatient units were compared to those of patients treated in medical practices. Longitudinal data of all participants are being followed in a cohort study. Results Overall, 1,591 patients were enrolled between 2001 and 2009 with follow-up until the end of 2010. Of these, 1,099 cases were treated in hospital-based units and 492 in private practices. Significant differences were found with respect to baseline characteristics. A higher rate of patients with advanced disease and non-European nationality were cared for in hospital units. Patients in medical practices were predominantly Caucasian men who have sex with men (MSM) harboring HIV-1 subtype B, with lower CDC stage and higher CD4 cell count. Median viral load was 68,828 c/mL in hospital-based units and 100,000 c/mL in private practices (P--.041). Only median age and rate of transmitted drug resistance were not significantly different. After 48?weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (P--.12). A similar result was seen after 96?weeks (P--.54). Although the baseline CD4 cell count was different (189.5/μL in hospital units and 246.5/μL in private practices, P <0.001), a consistent and almost identical increase was determined in both groups. Conclusions The RESINA study covers a large HIV-infected patient cohort cared for in specialized facilities in Germany. Despite significant differences of patients-baseline characteristics in hospital-based units compared to medical practices, we could not find significant differences in treatment outcome up to 2?years after the initiation of HAART.