Similar efficacy and tolerability of raltegravir-based antiretroviral therapy in HIV-infected patients, irrespective of age group, burden of comorbidities and concomitant medication: Real-life analysis of the German 'WIP' cohort.

Only limited efficacy and tolerability data on raltegravir (RAL) use are currently available. Study objectives were to describe the efficacy and tolerability profile of RAL-based antiretroviral therapy (ART) in routine clinical practice in Germany. The WIP study (WIP = "Wirksamkeit von Isentress unter Praxisbedingungen", Efficacy of Isentress under routine clinical conditions) was a prospective, multi-centre cohort study in Germany. Human immunodeficiency virus (HIV)-infected patients aged ≥ 18 years in whom combinational ART with RAL 400 mg BID was indicated were enrolled. The primary endpoint was virologic response (HIV-RNA <50 copies/mL; non-completion equals failure) after 48 weeks. Of 451 patients, 85.1% (n = 384) were still receiving RAL at week 48. At baseline (BL), the prevalence of concomitant diseases was higher in patients of the age group ≥50 years (94.2% vs. 75.7%) as well as concomitant medications (74.8 % vs. 55.4%). Virologic response at week 48 was 74.7% (overall), 75.0% (naïve at BL), 81.5% (suppressed at BL), 47.1% (interrupted previous treatment at BL) and 64.9% (failing at BL), without significant differences by age group. A significant correlation of achievement of HIV-RNA <50 copies/mL was seen with treatment status at BL (p = 0.004). In addition, 77.3 % of the patients with a CD4 cell count >200 cells/µL at BL achieved HIV-RNA <50 copies/mL (p = 0.029). RAL was well tolerated with 80 adverse events (AEs) in 49 patients (10.9%) and 8 serious AEs (SAEs) in 6 patients (1.3%) reported to be drug related. A total of 22 patients (4.9%) discontinued treatment due to AEs. The WIP study shows that the previously reported efficacy and safety profile of RAL can be achieved in a population with multiple comorbidities and comedications, with no major difference observed in ageing patients (≥50 years) vs. younger patients. RAL is therefore an attractive treatment option in routine medical care in Germany.

[Side effects of travel vaccinations. Data collection via telephone survey in Berlin]. / Nebenwirkungen bei Reiseimpfungen. Erhebung mittels telefonischer Befragung in Berlin.

The local and systemic side effects of some frequently administered travel vaccines were analysed in a prospective study on 3488 travelers using a standardised telephone interview procedure. The vaccines studied were yellow fever, diphtheria toxoid (d), tetanus diphtheria toxoid (Td), oral polio (OPV) and oral typhoid. Combined vaccinations studied were Td + OPV. Td + yellow fever. d + OPV and d + yellow fever. After single vaccination 30% of those inoculated reported slight local reactions. 3% had moderate local reactions and 18% complained about systemic side effects. After combined vaccinations 47% suffered from slight local reactions, 7% had moderate local reactions and 22% developed systemic side effects. Of all vaccines studied Td produced the highest frequency of local reactions. The combined vaccinations containing yellow fever vaccine were less well tolerated than the corresponding single vaccines. Systemic and local side effects were experienced more frequently by women, except in the case of diphtheria toxoid. Young travelers had more frequent and more severe side effects than older travelers after yellow fever vaccination, and after the combinations of Td + yellow fever. Td + OPV and d + yellow fever vaccinations. The side effects observed were mostly mild and none of the vaccinated travelers consulted a doctor for side effects. After travel vaccinations there are frequent, but well tolerated local and systemic side effects. Combined vaccinations are also well tolerated; their components determine the incidence of side effects.

Trichinosis: a prospective controlled study of patients ten years after acute infection.

The existence of chronic trichinosis as a disease entity is still a matter of debate. For 10 years after an outbreak of infection with Trichinella spiralis, we conducted a prospective controlled study of the patients involved. At the termination of this investigation, we undertook clinical, biochemical, serological, immunologic, neuroradiological, radiological, and psychological studies of 128 originally infected persons and 16 controls. The categories of symptoms most often documented in persons who had been infected were muscular (90%), ocular (59%), neurological (52%), and psychological (52%). Impaired muscle strength (56%), conjunctivitis (55%), and impaired coordination (32%) were the clinical manifestations most frequently encountered. Thirty-eight percent of the 128 originally infected patients still had IgG antibodies to T. spiralis after 10 years. Magnetic resonance imaging of the brain revealed no abnormalities. No calcifications of residual larvae were detected by mammography or muscle biopsy. The level of performance in psychometric tests was lower in the originally infected population than in the general population. Although patients who had had trichinosis differed significantly from controls in terms of a variety of parameters even after 10 years, we found insufficient evidence on which to conclude that chronic trichinosis exists as a distinct entity.