Causes of death in HIV-infected patients from the Cologne-Bonn cohort.

PURPOSE: Causes of death in human immunodeficiency virus (HIV)-infected subjects have changed in countries with high resources over the last several years. Acquired immunodeficiency syndrome (AIDS)-related diseases have become less prevalent, whereas deaths due to non-AIDS causes are increasing. The aim of the present study was to analyse causes of death in the Cologne-Bonn cohort. METHODS: Causes of death from the Cologne-Bonn cohort between 2004 and 2010 were systematically recorded using the CoDe algorithm (The Coding Causes of Death in HIV Project). RESULTS: In 3,165 patients followed from 2004 to 2010, 182 deaths occurred (5.7 %, 153 males, 29 females). The median age at the time of death was 47 years (range 24-85 years). The most frequent causes of death were AIDS-defining events (n = 60, 33 %), with non-Hodgkin lymphoma (NHL) (n = 29, 16 %) and infections (n = 20, 11 %) being the leading entities in this category. Non-AIDS malignancies accounted for 16 % (n = 29), non-HIV-related infections for 10 % (n = 18), cardiovascular diseases for 7 % (n = 14), suicide or accident for 4 % (n = 7) and liver diseases for 3 % (n = 5) of deaths (unknown n = 47, 26 %). Although the majority of patients (92.5 %) was on antiretroviral therapy (ART), only 50 % were virologically suppressed (HIV-RNA <50 copies/mL) and 44 % had a decreased CD4+ count (<200/µL) at their last visit before death. CONCLUSION: One-third of the causes of death in our cohort between 2004 and 2010 was AIDS-related. Since most of these deaths occur with severe immune suppression, they can possibly be prevented by the early diagnosis and treatment of HIV infection. Care providers must be aware of an increased risk for a broad range of diseases in HIV-infected patients and should apply appropriate preventive measures.

Acceptance and tolerability of an adjuvanted nH1N1 vaccine in HIV-infected patients in the Cologne-Bonn cohort.

OBJECTIVE: To evaluate the acceptance and tolerability of the nH1N1 2009 vaccine in HIV-positive individuals. METHOD: 758 patients were included in this prospective study. Different study populations were formed: The Tolerability Study Group consists of HIV-infected patients who visited three outpatient clinics (Cologne, Bonn, Freiburg) during a predefined time period. Patients were offered nH1N1 vaccination. Those accepting were administered a standard dose AS03 adjuvant nH1N1 vaccine. Questionnaires to report side effects occurring within 7 days after immunization were handed out. In a substudy conducted during the same time period, acceptance towards immunization was recorded. This Acceptance Study Group consists of all HIV-infected patients visiting the Cologne clinic. They were offered vaccination. In case of refusal, motivation was recorded. RESULTS: In the Tolerability Study Group, a total of 475 patient diaries returned in the three study centres could be evaluated, 119 of those (25%) reported no side effects. Distribution of symptoms was as follows: Pain 285/475 patients (60%), swelling 96 (20%), redness 54 (11%), fever 48/475 (10%), muscle/joint ache 173 (36%), headache 127 (27%), and fatigue 210 (44%). Association of side effects with clinical data was calculated for patients in Cologne and Bonn. Incidence of side effects was significantly associated with CDC stages A, B compared to C, and with a detectable viral load (>50 copies/mL). No correlation was noted for CD4 cell count, age, gender or ethnicity. - In the Acceptance Study Group, 538 HIV-infected patients were offered vaccination, 402 (75%) accepted, while 136 (25%) rejected. Main reasons for rejection were: Negative media coverage (35%), indecisiveness with preference to wait until a later date (23%), influenza not seen as personal threat (19%) and scepticism towards immunization in general (10%). CONCLUSION: A total of 622 HIV-infected patients were vaccinated against nH1N1-influenza in the three study centres. No severe adverse events were reported. The tolerability was in most parts comparable to general population. Acceptance rate towards influenza vaccination was high (75%). Those refusing the immunization mentioned negative media coverage as the major influence on their decision.

Results with a modified human myeloma stem cell assay.

The human tumor stem cell assay (HTSCA) introduced by Hamburger and Salmon [2] was modified in several details. It was found that a short period of treatment with deoxyribonuclease (DNase) of the material aspirated from the patients bone marrow greatly enhances the production of single cell suspensions and thereby may improve the assay. Instead of the dextran sedimentation method, we used the density gradient centrifugation method according to Bøyum [1] for the isolation of mononuclear cells from the bone marrow. Another methodical modification introduced by us is the use of the same medium for culturing the cells before plating them and in the agar after plating. Under the conditions reported here the formation of colonies was observed in 8 of 11 samples from individual myeloma patients. The average plating efficiency was 0.024% with a range of 0.009% to 0.039% showing that possibly an improvement was achieved when compared to the results obtained with the original method showing an average plating efficiency of 0.014% [2].

Extramedullary multiple myeloma. A qualitative and quantitative electron microscopic study.

A case of multiple myeloma with a mediastinal tumor and other unusual findings is described. The findings included the presence of extramedullary tumor masses at multiple sites in addition to the medullary tumor and, more interestingly, the occurrence of pleural and peritoneal effusions. The plasma cells from these effusions were analyzed using stereological morphometric methods. The plasma cells were also cultured and established as a continuous cell line and were studied using the same methods. Our results indicate that there are qualitative and quantitative morphologic differences between the pleural and peritoneal plasma cells. Comparison between plasma cells and cultured cells from the intraperitoneal exudate showed marked morphologic differences. The analysis of these differences indicated that mature plasma cells, when subjected to culture, were transformed into immature lymphoid cells.

[In vitro studies on two cell lines from patients with Hodgkin's disease (author's transl)]. / Untersuchungen in vitro an zwei Zell-Linien von Hodgkin-Patienten.

Two cell lines (Ma,Bi) were established in vitro from pleura effusions from two patients with Hodgkin's disease. After some months the monolayer line Ma spontaneously became nonadherent and proliferated in suspension. Immunological properties, enzyme activities, surface characteristics and chromosomal analyses suggested that the culture Ma is composed of lymphoid cells and macrophages. Line Bi propagated attached to the glass and had properties typical for macrophages only.