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People living nowadays with HIV and AIDS may be treated effectively regarding virus replication and immunology. However, non-AIDS-defining cancer is of growing relevance due to high incidence and unfavorable outcome. The aim of this review is to summarize current knowledge on gastrointestinal (GI) carcinoma. Although literature on GI cancer is rare, an increased incidence of esophageal, gastric, pancreatic, hepatocellular, and colorectal carcinoma has been demonstrated. However, there are only few reports on therapy strategies and outcome, so that, despite increased occurrence of many GI carcinomas, only little is known about individualized treatment options and outcome in HIV-positive patients. More efforts have to be undertaken to close this gap. [ABSTRACT FROM AUTHOR]

Anal carcinoma shows an increasing incidence in people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in whom it is also much more common compared to the HIV-negative population. Human papillomavirus infection is the etiological basis of malignant development in the anal epithelium. Therefore, adequate diagnosis and treatment of the precursor lesions (anal intraepithelial neoplasia) is of clinical importance. In cases with preserved immune function, anal cancer can be treated according to guidelines issued for HIV-negative patients. This review summarizes the current knowledge regarding anal malignancies in HIV-positive patients. [ABSTRACT FROM AUTHOR]

Background: Resistance analysis from viral RNA is restricted to detectable viral load. Therefore, analysis from proviral DNA could help in cases with low-level or suppressed viremia. Methods: Viral plasma RNA and the corresponding cellular proviral DNA of 78 EDTA samples from 48 therapy-naïve (TN) and 30 therapy-experienced (TE) HIV-1-infected patients were isolated and analyzed for their resistance profiles in the protease and reverse transcriptase genes. Results: Overall, 175 drug-resistance mutations (DRMs) were detected in 25/30 TE (83.3%) and 5/48 TN (10.4%) samples. The TE patients displayed a mean number of 6.68 DRMs in RNA and 5.20 in DNA. In the TN patients, a mean of 0.8 DRMs was found in RNA and 1.0 in DNA; 75% of the DRMs were detected in RNA and DNA simultaneously. In the TE samples, 76% of the DRMs were detected simultaneously in RNA and DNA, 23% exclusively in RNA and 1% in DNA only. The TN samples revealed a significantly higher frequency of DRMs in DNA than in RNA. Conclusions: Proviral DNA resistance testing provides additional resistance information for TN patients. It is also a reliable alternative for TE patients with unsuccessful RNA testing and can provide valuable information when no records are available. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Older HIV patients are defined as aged 50 years and older. This group is a growing population in developed countries. In order to improve care for older HIV patients, we intended to gain insight into the specific features of transmission, epidemiology, immunology and antiretroviral treatment (ART) of this population. Patients and Methods: All patients from the RESINA cohort were analyzed, comprising 2,085 individuals at the beginning of 2010. RESINA is an ongoing study analyzing epidemiological and immunological data, resistance patterns and therapeutic data in treatment-naive HIV-positive patients from North Rhine-Westphalia, Germany. Patients are included in the RESINA cohort at the time of the intended start of ART. For statistical evaluation, we used χ2 and Mann-Whitney U tests. Results: A total of 14.6% of patients in our cohort was above 50 years. Men were significantly more prevalent among older patients (86.8 vs. 78.6%; p < 0.001). The proportion of older patients was significantly higher in the heterosexual group (30%) as compared to bisexual (20%), homosexual (13%) and intravenous drug user (4%) modes of transmission (p < 0.001). When comparing ethnic groups, older patients were most often found among Caucasians (17 vs. 4% in other groups, p < 0.001). No significant difference for transmitted drug resistance patterns was found. The proportion of older patients with CDC stage A was significantly lower than with stages B or C (10 vs. 21 vs. 21%, p < 0.001). In older patients, changes of ART regimes were more frequent (p = 0.015) and the median CD4 cell count at the start of treatment was lower (176 vs. 200/μl, p = 0.017). After 72 weeks of ART, the relative increase of CD4 cells was significantly lower in older as compared to younger patients (200 vs. 231/μl, p = 0.017). Conclusions: Our results provide insight into the epidemiology of HIV in the elderly. In our cohort, the typical older patient was a Caucasian male who had acquired HIV through heterosexual contact. The prognosis in older patients is worsened as a result of several unfavorable circumstances, such as delayed start of ART, more frequent treatment changes and diminished immune reconstitution. As a consequence, better strategies for more frequent HIV testing in patients at risk for HIV are needed, and ART should be offered to older patients at earlier time points and higher CD4 cell counts. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: Transmitted HIV drug resistance may impair treatment efficacy of combination antiretroviral therapy (ART). This study describes the epidemiology of transmitted resistance in chronically infected patients. Methods: In a prospective multicenter trial in Nordrhein-Westfalen, Germany, transmitted drug resistance was determined by genotypic resistance testing in patients on initiation of first-line ART. Results: From 2001 to 2009, 2,078 patients were enrolled in the study. 79.9% were male, 81.2% were Caucasians, and a homosexual transmission mode was found in 51.3%. Of these patients, 41.5% were at the stage of AIDS, median CD4 cell count was 230/μl, and median viral load was 64.466 copies/ml. Transmitted drug resistance mutations were seen in 9.2% (95% CI, 7.9-10.4). Resistance in the nucleoside reverse transcriptase inhibitor class was found in 5.8% (4.8-6.8), in the nonnucleoside reverse transcriptase inhibitor class in 2.8% (2.1-3.6), and in the protease inhibitor class in 2.7% (2.0-3.4). After a continuous increase to a level above 10% in the years 2006 and 2007, a decline of drug resistance prevalence followed in 2008 and 2009. Conclusions: Transmitted HIV drug resistance was found in around 10% of chronically infected patients in Germany who started their ART. We showed a moderate decline of the prevalence of mutant virus strains in recent years. Further surveillance of this phenomenon is mandatory. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Highly active antiretroviral therapy (HAART) has been shown to be effective in many recent trials. However, there is limited data on time trends of HAART efficacy after treatment change. Methods: Data from different European cohorts were compiled within the EuResist Project. The efficacy of HAART defined by suppression of viral replication at 24 weeks after therapy switch was analyzed considering previous treatment modifications from 1999 to 2008. Results: Altogether, 12,323 treatment change episodes in 7,342 patients were included in the analysis. In 1999, HAART after treatment switch was effective in 38.0% of the patients who had previously undergone 1-5 therapies. This figure rose to 85.0% in 2008. In patients with more than 5 previous therapies, efficacy rose from 23.9 to 76.2% in the same time period. In patients with detectable viral load at therapy switch, the efficacy rose from 23.3 to 66.7% with 1-5 previous treatments and from 14.4 to 55.6% with more than 5 previous treatments. Conclusion: The results of this large cohort show that the outcome of HAART switch has improved considerably over the last years. This result was particularly observed in the context after viral rebound. Thus, changing HAART is no longer associated with a high risk of treatment failure. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]