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ABSTRACT: The skin can be an indicator of decreased immunocompetence. Dermatological markers include new and extensive seborrheic eczema, psoriasis without a family history, widespread herpes zoster in young adults, oral hairy leucoplakia and mollusca in adults. In these cases an HIV test should be offered. During the last 15 years the clinical picture of HIV has changed dramatically. Almost every year new drugs with better efficacy, lower pill burden and less side effects have been approved. Life expectancy is close to normal in western countries. In spite of better treatment options, prevention is the key to stop the worldwide epidemic. Awareness campaigns have to account for the synergies between HIV and other sexually transmitted diseases. This poses a great challenge for dermatovenereology.
Der Hautarzt 01/2012; 63(1):10-5. · 0.58 Impact Factor
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ABSTRACT: Zusammenfassung: Die dermato-venerologisch ausgerichtete Praxis ist einer der Hauptanlaufpunkte für Personen, die sich eine HIV-Infektion zugezogen haben oder dieses befürchten. Verbesserte Behandlungsmöglichkeiten haben dazu geführt, daß mehr und mehr HIV-Infizierte ärztlichen Rat und medizinische Betreuung im ambulanten Bereich suchen, weit bevor AIDS-manifestierende internistische Erkrankungen aufgetreten sind. Die vorliegende Arbeit beschreibt den Untersuchungsgang bei der ersten Begegnung und legt die Prinzipien der derzeitigen Behandlungsmöglichkeiten und Behandlungsstrategien im ambulanten Bereich dar.Summary: Dermato-Venerologists are among those primary care physicians, who are most frequently attended by HIV-infected patients and by people at risk for HIV-infection, respectively. As over the last few years improved treatment options became available, more and more HIV-infected persons do request for medical advice and care far before AIDS-defining complications have developed. This paper presents a comprehensive review of the clinical assessment and management of patients newly presenting with HIV-infection.
H& G Zeitschrift fur Hautkrankheiten 06/2008; 77(6):278 - 287.
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E Tschachler,
N Brockmeyer,
I Effendy,
H K Geiss,
S Harder,
M Hartmann,
U Jappe,
A Plettenberg, H Rasokat,
H Reimann,
P Shah,
M Stücker,
T A Wichelhaus,
H Schöfer
Journal der Deutschen Dermatologischen Gesellschaft 07/2007; 5(6):527-32. · 1.47 Impact Factor
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ABSTRACT: Interferon in a variety of topical, interlesional, and parenteral preparations has been used for condylomata acuminata (CA) in HIV negative patients. - STUDY GOALS: This open trial was initiated to determine the safety and efficacy of a new formulation of interferon, pegylated interferon-alpha2b (PEG-IFN, PegIntron in the treatment of recalcitrant CA in patients with HIV infection. -
22 HIV-1 infected patients in virologic steady state with clinically demonstrable anogenital CA were enrolled in this study (treatment group, n=12; control group, n=10). Patients in the treatment group received 80 microg PEG-IFN s.c. once a week for 24 weeks. Follow-up period was 6 month. The effects were assessed by a clinical scoring system (complete response; major response; minor response; stable disease; progression of disease). -
2 patients did not finish the study because of side effects. PEG-IFN was well accepted and completed by ten patients. Four patients revealed complete response, four patients had major response and two had minor response after PEG-IFN. In the control group, all patients showed progression of CA during the 24 weeks of this study (p < 0.001). 7/10 patients of the treatment group and 8/10 patients of the control received HAART. - While the differences of CD4 cell counts between treatment group and control group were not significant (increase of the mean CD4 cell count in the treatment group was 31.5 (75.33 without patient 1 with leucopenia under ribavirine), in the control group 69.75 CD4 cells), the HIV RNA decline in the PEG-IFN group was impressive (0.74 log subset10). Biological side effects of PEG-IFN treatment included flu-like symptoms, fatigue, local reaction, leucopenia, and increase of AST. This result makes an educated guess that PEG-IFN enhances the benefit of HAART. -
PEG-IFN is an effective and safe therapy option in HIV infected individuals with CA with concomitant positive effects on the suppression of HIV-1 replication and CD4 cell count. It might be considered as an alternative in patients that have failed to standard therapies of CA and - at the same time -could improve the benefit of HAART to a great extent. This last hypothesis needs further research.
European journal of medical research 02/2006; 11(1):27-32. · 1.13 Impact Factor
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A Kreuter,
G Reimann,
S Esser, H Rasokat,
M Hartmann,
J Swoboda,
M A Conant,
E Tschachler,
K Arasteh,
P Altmeyer,
N H Brockmeyer
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ABSTRACT: Anal intraepithelial neoplasia (AIN) is a potential precursor of invasive anal carcinoma. Introduction of highly active antiretroviral therapy (HAART) in the treatment of HIV infection substantially reduced the incidence of some diseases associated with opportunistic viral infections. However, the incidence of AIN is reported to increase and HAART seems to have only little impact on the regression or progression of AIN. Paradoxically, improvement of survival in the HAART era results in an increased risk of anal cancer. The incidence of anal carcinoma amongst homosexual men is substantially higher compared to the normal population (35/100.000). This incidence is similar to the incidence of cervical cancer before screening for CIN with cervical cytology. Recent data suggest that the incidence of AIN and anal cancer is even higher among HIV-infected individuals. Both cancer entities share biologic similarities, including the association with human papillomavirus infection (HPV). Screening for CIN with cervical cytology and early treatment has resulted in a significant decline in the incidence of cervical carcinoma. Like cervical cancer, anal carcinoma may be preventable through identification and treatment of its precursors. Future efforts should focus on a screening protocol, training of clinicians in the diagnosis and treatment of AIN and anal carcinoma, and novel approaches to treatment of these lesions. This screening protocol could help to reduce anal cancer in HIV-infection as well as save limited resources in health care system.
DMW - Deutsche Medizinische Wochenschrift 10/2003; 128(38):1957-62. · 0.53 Impact Factor
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ABSTRACT: Therapy of HIV infection has undergone significant changes since the introduction of highly-active antiretroviral therapy (HAART). Mortality and the appearance of opportunistic infections have significantly been reduced. Diseases of the skin and adjacent mucous membranes often provide the first signs for HIV infection. The spectrum of dermatologic findings related to HIV includes a variety of cutaneous and mucocutaneous disorders. The most frequent diagnoses are oral candidiasis, mollusca contagiosa, oral hairy leuokoplakia, herpes zoster and herpes simplex, seborrheic dermatitis, and Kaposi's sarcoma. Incompatibility reactions to drugs are observed on a strikingly frequent basis in HIV infection. Such severe incompatibility reactions are much more frequent in HIV patients than in the normal population. Inducers often include sulfonamides, cotrimoxazole, tuberculostatics as well as nucleoside-type reverse transcriptase inhibitors.
European journal of medical research 03/2002; 7(2):57-62. · 1.13 Impact Factor
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ABSTRACT: No data were available on the epidemiological and clinical characteristics of bacillary angiomatosis (BA) in Germany.
To determine epidemiological and clinical data on HIV-associated BA.
A chart review of all BA cases between 1990 and 1998 was performed in 23 German AIDS treatment units.
A total of 21 cases of BA was diagnosed. During this period, the participating HIV centers treated about 17,000 HIV-infected patients. As a result, a BA prevalence of 1.2 cases/1,000 patients can be assumed. 19 BA were localized in the skin; in 5 cases bones and in 4 cases the liver were involved. Out of 20 patients who received antibiotic therapy, 13 had complete remission. The median time of duration up to complete remission was 32 days (9-82). During the follow-up of the 20 patients, 7 relapses were observed.
BA is a rare HIV-associated disease with a prevalence of 1,2 cases/1,000 patients in the presented study.
Dermatology 02/2000; 201(4):326-31. · 2.05 Impact Factor
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H Schöfer,
M Imhof,
E Thoma-Greber,
N H Brockmeyer,
M Hartmann,
G Gerken,
H W Pees, H Rasokat,
H Hartmann,
I Sadri,
C Emminger,
H J Stellbrink,
R Baumgarten,
A Plettenberg
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ABSTRACT: To study syphilis in HIV infection focusing on immunocompromised patients with an atypical or aggressive clinical course of syphilis, inappropriate serological reactions or an unreliable response to therapy.
A multicentre retrospective chart review using a standardised questionnaire for all patients with active syphilis.
Thirteen dermatological and medical centres throughout Germany, all members of the German AIDS Study Group (GASG).
Clinical data of 11,368 HIV infected patients have been analysed for cases of active syphilis requiring treatment. Asymptotic patients with reactive serological parameters indicating latent syphilis without a need for treatment were excluded.
Active syphilis was reported in 151 of 11,368 HIV infected patients (1.33%, range per centre 0.3%-5.1%). Most of the 151 syphilis patients were male (93%) and belonged to the homosexual or bisexual exposure category for HIV infection (79%); another 6% were iv drug users. Among the 151 syphilis patients primary syphilis was diagnosed in 17.2%, maculopapular secondary syphilis in 29.1%, ulcerating secondary syphilis in 7.3%, neurosyphilis in 16.6% and latent seropositive syphilis without clinical symptoms but serological abnormalities indicating active syphilis in 25.2%. A history of prior treatments for syphilis was reported in 50%. At the time of syphilis diagnosis 26.5% of the patients were in CDC stage II, 33.8% in stage III and 24.5% in stage IV of HIV disease (CDC classification 1987). CD4 cell count was lowest in those with ulcerating secondary syphilis (mean 307, SD 140/microliters) and neurosyphilis (351, SD 235/ microliters). The highest CD4 count was found in patients with early primary and early secondary syphilis (444, SD 163/microliters and 470, SD 355/microliters). Inappropriate serological response to syphilis infection was found in 81 of 151 patients (54%). Remarkable findings were false negative VDRL titres (11 patients with non primary syphilis), false negative TPHA (1) or 19S-IgM-FTA-ABS-tests (16), and strongly reactive VDRL (> or = 512, 8) or TPHA titres (> or = 10 240, 47). Treatment failures were reported in at least 6 of 151 cases (4%).
Atypical clinical and serological courses of syphilis were observed in HIV infected patients. Ulcerating secondary syphilis with general symptoms ("malignant syphilis") was 60 times more frequent than in historic syphilis series. Neurosyphilis was found in one sixth of those with active syphilis. Therefore lumbar puncture should be considered a routine in coinfections with HIV and syphilis. Treatment efficacy should be monitored carefully.
Genitourinary medicine 07/1996; 72(3):176-81.
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H Schöfer,
M Imhof,
M. Meurer,
A Plettenberg,
N H Brockmeyer,
M. Hertmann,
I. Gerken,
H W Pees, H Rasokat,
H. Hertmann,
Ifna Sadri,
Johannes R. Bogner,
C Emminger,
H J Stellbrink,
R Baumgarten
