Guido Van Den Berk - Academia.edu (original) (raw)
Papers by Guido Van Den Berk
Journal of Hepatology, Apr 1, 2016
Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with me... more Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with men (MSM) and generally treated with peginterferon-alfa (pegIFN) and ribavirin (RBV) during 24 weeks. The addition of a protease inhibitor could shorten therapy without loss of efficacy. We performed an open label single arm study to investigate the efficacy and safety of a 12-week course of boceprevir, pegIFN and RBV for AHCV genotype 1 infections in 10 Dutch HIV treatment centers. Primary endpoint of the study was achievement of sustained virological response rate at week 12 (SVR12) in patients reaching a rapid viral response at week 4 (RVR4) and SVR12 in the intent to treat (ITT) entire study population was the most relevant secondary endpoint. 127 AHCV patients were screened in 16 months of which 65 AHCV genotype 1 patients were included. After spontaneous clearance in 6 patients and withdrawal before treatment initiation in 2, 57 started therapy within 26 weeks after infection. RVR4 rate was 72%. SVR12 rate was 100% in the RVR4 group. SVR12 rate in the ITT group was 86% and comparable to the SVR12 rate of 84% in 73 historical controls treated for 24 weeks with pegIFN and RBV in the same study centers. With the addition of boceprevir to pegIFN and RBV, treatment duration of AHCV genotype 1 can be reduced to 12 weeks without loss of efficacy. Given the high drug costs and limited availability of interferon-free regimens, boceprevir pegIFN and RBV can be a considered a valid treatment option for AHCV.
PubMed, Oct 1, 2011
ABSTRACT No abstract available.
Journal of Hepatology, Apr 1, 2015
Journal of Clinical Microbiology, Aug 1, 2003
We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinic... more We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinical decision making, such as in needle-stick accidents. The test was evaluated with 1,160 patients. It proved to be a simple and useful test with 99.6% specificity and 99.4% sensitivity. One patient with late-stage AIDS had a falsenegative result.
PubMed, Nov 23, 2022
Background: The non-specific symptomatology in peritoneal tuberculosis often results in a delay i... more Background: The non-specific symptomatology in peritoneal tuberculosis often results in a delay in the diagnosis. Due to clinical overlap symptoms may be confused with metastatic ovarian carcinoma. This can lead to delayed treatment, unnecessary surgical interventions and a deteriorated prognosis. Case description: A 75-year-old female of Moroccan descent was referred to the gastroenterology department with increasing ascites and weight loss. Based on the clinical picture metastatic ovarian cancer was suspected. However, repeatedly no malignant cells were found in both ascitic fluid and tissue biopsies. Peritoneal tuberculosis was considered and ovarian malignancy could not be excluded. A diagnostic laparoscopyand biopsy was considered necessary. The laparoscopic view was pathognomic for tuberculosis after which antituberculosis treatment was started with good result. Conclusion: Peritoneal tuberculosis should be included in the differential diagnosis in women from endemic areas with symptoms of abdominal pain, ascites, weight loss and/or increased CA-125. Laparoscopy should be considered if less invasive tests are inconclusive about the diagnosis.
Poster presentations, Jul 1, 2021
(a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep)... more (a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep). HCPs were less comfortable sharing sensitive information about HIV status, sexual health, behaviour and identity. Service user consent and relevance of data to sharing context were key determinants of data-sharing comfort. Conclusion Understanding the context of data-sharing in HIV care is increasingly important given the shift to remote consultations and expectations for self-management. We demonstrate the complex interplay of data types, relationship dynamics, and contexts of care provision that shape the data-sharing ecosystem in HIV care. Developing guidance on the sharing of service user and clinic-generated data in HIV care must account for these complexities.
Journal of Hepatology, 2017
Viruses
Background: In the Netherlands, unrestricted access to direct-acting antivirals (DAAs) halved the... more Background: In the Netherlands, unrestricted access to direct-acting antivirals (DAAs) halved the incidence of acute hepatitis C virus (HCV) infections among HIV-infected men who have sex with men (MSM). To develop strategies that can further reduce the spread of HCV, it is important to understand the transmission dynamics of HCV. We used phylogenetic analysis of a dense sample of MSM to provide insight into the impact of unrestricted access to DAAs on HCV transmission in the Netherlands and in Belgium. Methods: We included 89 MSM that were recently infected with HCV genotype 1a in ten Dutch and one Belgian HIV treatment centers. Sequences were generated using next gene sequencing and Sanger sequencing. Maximum likelihood phylogenetic analysis (general time reversible model) was performed on concatenated NS5A and NS5B sequences and a reference set of 389 highly similar control sequences selected from GenBank. A cluster was based on a minimum bootstrap support of 90% and a 3% genetic...
AIDS Research and Human Retroviruses
Science, 2022
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine i... more We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virul...
The Lancet HIV, 2020
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Journal of Hepatology, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
PLOS ONE, 2019
Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), pr... more Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU. Methods The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested. Results Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational prerequisites ; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2018
Background: Efavirenz is well known for its clinical cognitive side-effects. Even asymptomatic pa... more Background: Efavirenz is well known for its clinical cognitive side-effects. Even asymptomatic patients who switch for other reasons than neurocognitive complaints have reported a subjective improvement in cognitive functioning after discontinuing Efavirenz. The aim of this study was to assess the effect on cognition of switching Atripla (TDF/FTC/EFV) to Eviplera (TDF/FTC/RPV), hypothesizing an improvement when discontinuing Efavirenz. Setting: a randomized controlled design with a highly comparable comparator drug was used to minimize bias and to differentiate drug-versus learning effects. An extensive sensitive neuropsychological assessment (NPA) was used to detect subtle changes. Methods: virologically suppressed, cognitively asymptomatic male HIV-infected patients on Atripla were included and randomized (2:1) to switch to Eviplera (switch group) or continue on Atripla (control group) for 12 weeks. At baseline and week 12, patients underwent an extensive NPA. Results: 14 control and 34 switch subjects completed the study. There were no differences at baseline. Group-analysis demonstrated a significantly better improvement for the switch group on the domains attention (p=0.041) and speed of information processing (p=0.014). Normative comparison analyses showed that 5 out of the 34 patients who switched (15%) improved on NPA-score as compared to the control group. Interestingly, subjective improvement after discontinuing Efavirenz made 74% of the switch group chose for a regime without Efavirenz after study completion. Conclusion: switching from Atripla to Eviplera resulted in objective cognitive improvement on group level in cognitively asymptomatic patients. Discrepancies in
Quality of Life Research, 2019
Purpose We selected and evaluated a comprehensive set of themes that encompass health-related qua... more Purpose We selected and evaluated a comprehensive set of themes that encompass health-related quality of life (HRQOL) among HIV patients, which enables clinicians to tailor care to individual needs, follow changes over time and quantify returns on health care investments and interventions. Methods HIV patients (N = 250) of two Dutch HIV clinics were invited to complete an online survey comprised of a set of (adaptations of) validated questionnaires measuring eight themes, including general health (SF-12), stigma (short stigma scale), social support (SSL12-I), self-esteem (SISE), sexuality problems, anxiety and depression (HADS), sleeping difficulties (SCL90-Sleep) and perceived side-effects. Results Findings from 170 (response rate 68%) patients (Male = 159, 94.1%) showed that questionnaires had high internal consistency, and most themes significantly correlated (r's .21 to − .69, p < .05) in the expected directions. Exploring cutoff scores shows that a significant proportion of patients score outside of the desired range on single themes (between 16.0 and 73.1%), and many patients on multiple themes simultaneously (8.9% on 5 or more themes). Regression analysis showed that social support, self-esteem and sexuality problems were associated with general health (R = .48, R 2 = .23, F(4,145) = 10.57, p < .001); adding anxiety and depression, sleeping difficulties and perceived side-effects explained 51.2% of the variance in total (R = .72, ∆R 2 = .29, F(3, 142) = 27.82, p < .001). Conclusions We succeeded in developing a questionnaire that comprehensively assesses HRQOL. HRQOL of the majority of Dutch HIV patients could be improved. The themes strongly influenced each other, therefore insights into any of the themes could inform interventions to improve HRQOL, and increase attention to these themes in routine consultations between patients and health care professionals.
OBJECTIVE: To investigate the incidence of dose adjustments, delays and discontinuation of chemot... more OBJECTIVE: To investigate the incidence of dose adjustments, delays and discontinuation of chemotherapy and the incidence of antineoplastic drug related toxicity in patients treated for lymphoma combined with cART, as well as differences between patients with PI-based and NNRTI-based cART. DESIGN AND METHODS: A retrospective observational cohort study was conducted among HIV-infected adult patients with cART who have been diagnosed with lymphoma and treated with cyclophosphamide, doxorubicin and/or vinca alkoloids, which interact with CYP3A4. Toxic events were identified and classified as renal, hepatic or bone marrow toxicity. Time of administration and dosage of antineoplastic drugs were collected to determine dose adjustments, delay and discontinuation of the chemotherapy and the clinical outcome of chemotherapy was registered. RESULTS: 50 HIV-positive patients were included of which 22 patients used PI-based and 21 NNRTI-based cART. HIV-positive patients with cART had more toxicity than HIV-negative patients. No significant differences in toxicity were observed between patients with PI-based and NNRTI-based cART, apart from a trend that patients with PI-based cART suffered more severe or life-threatening bone marrow toxicity. Patients with PI-based cART applied significantly earlier dose reduction and treatment delay than with NNRTI-based cART. No significant differences in clinical outcome of the chemotherapy were found between PI-based and NNRTI-based cART, but cART achieved less complete remission compared to HIV-negative patients. CONCLUSION: Patients with PI-based cART applied earlier dose adjustments and delays due to toxicity than patients with NNRTI-based cART. A prospective study should enhance the knowledge of the clinical pharmacology of the drug-drug interaction between antineoplastic and antiretroviral agents.
International Journal of Clinical Pharmacy, Jun 12, 2018
Background The combination of combined active antiretroviral therapy (cART) with chemotherapy in ... more Background The combination of combined active antiretroviral therapy (cART) with chemotherapy in the treatment of lymphoma in human immunodeficiency virus (HIV)-positive patients has improved the overall survival of these patients. However, drug-drug interactions between antineoplastic agents and the antiretroviral agents non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) can occur by influencing the activity of the CYP3A4 enzyme. So far, little is known about the clinical relevance of this interaction: the effect on the efficacy and toxicity of the chemotherapy. Also, there is no general consensus which cART is preferable in combination with antineoplastic drugs. Objective To compare PI-based with NNRTI-based cART on the efficacy and toxicity of chemotherapy in lymphoma patients. Setting The Onze Lieve Vrouwe Gasthuis, located in Amsterdam, The Netherlands. Method A retrospective observational cohort study including all patients with HIV and lymphoma over a 10-year period. Clinical outcome (response to chemotherapy and survival) and toxicity of chemotherapy (renal, hepatic and bone marrow toxicity as well as dose reduction, treatment delay and discontinuation) was compared in patients with PI based and NNRTI-based cART. Main outcome measure: Response to chemotherapy and survival. Results Patients using PI-based cART (n = 22) had a significantly lower 1 year survival compared to NNRTI-based cART (n = 21). No significant differences were observed in reaching complete remission after chemotherapy. No overall significant differences in toxicity and discontinuation of the chemotherapy were observed. However, there was a trend towards more severe bone-marrow toxicity in patients with PI-based cART. In addition, patients with PI-based cART received earlier dose-reduction and treatment delay, indicating increased toxicity in PI-treated patients. Conclusion This retrospective study shows that PI-based cART is inferior in combination with chemotherapy to NNRTI-based cART: a lower 1 year survival is observed and dose-reduction and treatment delay occur earlier, possibly based on an earlier onset of toxicity. Keywords cART • Chemotherapy • Drug-drug interactions • HIV • Lymphoma Impacts on practice • When combining chemotherapy for lymphoma with antiretroviral therapy for HIV, non PI-based drug regimens are preferred. • Combining PI-based cART with chemotherapy for lymphoma results in a lower 1-year survival rate when compared to NNRTI-based cART combinations.
Sexually Transmitted Diseases
Introduction: As the incidence of hepatitis C virus (HCV) infections remains high among human imm... more Introduction: As the incidence of hepatitis C virus (HCV) infections remains high among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) an HCV testing strategy was introduced at the sexually transmitted infections (STI) clinic in Amsterdam in 2017. We aimed to evaluate this HCV testing strategy. Methods: The HIV-positive MSM and transgender women (TGW) were eligible for HCV testing (anti-HCVand HCV ribonucleic acid) at the STI clinic if they did not visit their HIV clinician in the 3 months before the consultation and had not been tested for HCVat the STI clinic in the previous 6 months. All eligible individuals were administered the 6 questions on risk behavior of the HCV-MSM observational study of acute infection with hepatitis C (MOSAIC) risk score; a risk score of 2 or greater made a person eligible for testing.
Journal of Hepatology, Apr 1, 2016
Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with me... more Acute hepatitis C virus infections (AHCV) are prevalent among HIV positive men having sex with men (MSM) and generally treated with peginterferon-alfa (pegIFN) and ribavirin (RBV) during 24 weeks. The addition of a protease inhibitor could shorten therapy without loss of efficacy. We performed an open label single arm study to investigate the efficacy and safety of a 12-week course of boceprevir, pegIFN and RBV for AHCV genotype 1 infections in 10 Dutch HIV treatment centers. Primary endpoint of the study was achievement of sustained virological response rate at week 12 (SVR12) in patients reaching a rapid viral response at week 4 (RVR4) and SVR12 in the intent to treat (ITT) entire study population was the most relevant secondary endpoint. 127 AHCV patients were screened in 16 months of which 65 AHCV genotype 1 patients were included. After spontaneous clearance in 6 patients and withdrawal before treatment initiation in 2, 57 started therapy within 26 weeks after infection. RVR4 rate was 72%. SVR12 rate was 100% in the RVR4 group. SVR12 rate in the ITT group was 86% and comparable to the SVR12 rate of 84% in 73 historical controls treated for 24 weeks with pegIFN and RBV in the same study centers. With the addition of boceprevir to pegIFN and RBV, treatment duration of AHCV genotype 1 can be reduced to 12 weeks without loss of efficacy. Given the high drug costs and limited availability of interferon-free regimens, boceprevir pegIFN and RBV can be a considered a valid treatment option for AHCV.
PubMed, Oct 1, 2011
ABSTRACT No abstract available.
Journal of Hepatology, Apr 1, 2015
Journal of Clinical Microbiology, Aug 1, 2003
We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinic... more We evaluated the reliability of a rapid human immunodeficiency virus type 1 test for quick clinical decision making, such as in needle-stick accidents. The test was evaluated with 1,160 patients. It proved to be a simple and useful test with 99.6% specificity and 99.4% sensitivity. One patient with late-stage AIDS had a falsenegative result.
PubMed, Nov 23, 2022
Background: The non-specific symptomatology in peritoneal tuberculosis often results in a delay i... more Background: The non-specific symptomatology in peritoneal tuberculosis often results in a delay in the diagnosis. Due to clinical overlap symptoms may be confused with metastatic ovarian carcinoma. This can lead to delayed treatment, unnecessary surgical interventions and a deteriorated prognosis. Case description: A 75-year-old female of Moroccan descent was referred to the gastroenterology department with increasing ascites and weight loss. Based on the clinical picture metastatic ovarian cancer was suspected. However, repeatedly no malignant cells were found in both ascitic fluid and tissue biopsies. Peritoneal tuberculosis was considered and ovarian malignancy could not be excluded. A diagnostic laparoscopyand biopsy was considered necessary. The laparoscopic view was pathognomic for tuberculosis after which antituberculosis treatment was started with good result. Conclusion: Peritoneal tuberculosis should be included in the differential diagnosis in women from endemic areas with symptoms of abdominal pain, ascites, weight loss and/or increased CA-125. Laparoscopy should be considered if less invasive tests are inconclusive about the diagnosis.
Poster presentations, Jul 1, 2021
(a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep)... more (a) demographic data (e.g. age) and (b) non-sensitive data related to general health (e.g. sleep). HCPs were less comfortable sharing sensitive information about HIV status, sexual health, behaviour and identity. Service user consent and relevance of data to sharing context were key determinants of data-sharing comfort. Conclusion Understanding the context of data-sharing in HIV care is increasingly important given the shift to remote consultations and expectations for self-management. We demonstrate the complex interplay of data types, relationship dynamics, and contexts of care provision that shape the data-sharing ecosystem in HIV care. Developing guidance on the sharing of service user and clinic-generated data in HIV care must account for these complexities.
Journal of Hepatology, 2017
Viruses
Background: In the Netherlands, unrestricted access to direct-acting antivirals (DAAs) halved the... more Background: In the Netherlands, unrestricted access to direct-acting antivirals (DAAs) halved the incidence of acute hepatitis C virus (HCV) infections among HIV-infected men who have sex with men (MSM). To develop strategies that can further reduce the spread of HCV, it is important to understand the transmission dynamics of HCV. We used phylogenetic analysis of a dense sample of MSM to provide insight into the impact of unrestricted access to DAAs on HCV transmission in the Netherlands and in Belgium. Methods: We included 89 MSM that were recently infected with HCV genotype 1a in ten Dutch and one Belgian HIV treatment centers. Sequences were generated using next gene sequencing and Sanger sequencing. Maximum likelihood phylogenetic analysis (general time reversible model) was performed on concatenated NS5A and NS5B sequences and a reference set of 389 highly similar control sequences selected from GenBank. A cluster was based on a minimum bootstrap support of 90% and a 3% genetic...
AIDS Research and Human Retroviruses
Science, 2022
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine i... more We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log 10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV—CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences—is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virul...
The Lancet HIV, 2020
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Journal of Hepatology, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
PLOS ONE, 2019
Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), pr... more Objective Medical Psychiatry Units (MPUs), also known as Complexity Intervention Units (CIUs), provide care for complex patients suffering from both psychiatric and physical disorders. Because there is no consensus on the indications for admission to an MPU, daily practice and effectiveness research are hampered. This study therefore used a concept mapping approach to investigate which organizational and medical factors determine the decision to admit a patient to an MPU. Methods The first step of the concept mapping approach was to create a list of factors determining MPU admission from literature. Secondly, clinical experts sorted and ranked these factors. The sorted and ranked data were then analyzed, and a draft conceptual framework was created. A final conceptual MPU admission framework was then drawn during an expert consensus meeting and recommendations for implementation were suggested. Results Thirteen clinical experts defined 90 factors from literature, which were sorted and ranked by 40 experts from 21 Dutch hospitals. This concept mapping approach resulted in a five-cluster solution for an MPU admission framework based on: 1. Staff competencies and organizational prerequisites ; 2. Patient context; 3. Patient characteristics; 4. Medical needs and capabilities; and 5. Psychiatric symptoms and behavioral problems. Furthermore, three inclusion and two exclusion criteria were formulated to help the clinicians decide whether or not to admit patients to an MPU. These criteria can be implemented in daily practice.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2018
Background: Efavirenz is well known for its clinical cognitive side-effects. Even asymptomatic pa... more Background: Efavirenz is well known for its clinical cognitive side-effects. Even asymptomatic patients who switch for other reasons than neurocognitive complaints have reported a subjective improvement in cognitive functioning after discontinuing Efavirenz. The aim of this study was to assess the effect on cognition of switching Atripla (TDF/FTC/EFV) to Eviplera (TDF/FTC/RPV), hypothesizing an improvement when discontinuing Efavirenz. Setting: a randomized controlled design with a highly comparable comparator drug was used to minimize bias and to differentiate drug-versus learning effects. An extensive sensitive neuropsychological assessment (NPA) was used to detect subtle changes. Methods: virologically suppressed, cognitively asymptomatic male HIV-infected patients on Atripla were included and randomized (2:1) to switch to Eviplera (switch group) or continue on Atripla (control group) for 12 weeks. At baseline and week 12, patients underwent an extensive NPA. Results: 14 control and 34 switch subjects completed the study. There were no differences at baseline. Group-analysis demonstrated a significantly better improvement for the switch group on the domains attention (p=0.041) and speed of information processing (p=0.014). Normative comparison analyses showed that 5 out of the 34 patients who switched (15%) improved on NPA-score as compared to the control group. Interestingly, subjective improvement after discontinuing Efavirenz made 74% of the switch group chose for a regime without Efavirenz after study completion. Conclusion: switching from Atripla to Eviplera resulted in objective cognitive improvement on group level in cognitively asymptomatic patients. Discrepancies in
Quality of Life Research, 2019
Purpose We selected and evaluated a comprehensive set of themes that encompass health-related qua... more Purpose We selected and evaluated a comprehensive set of themes that encompass health-related quality of life (HRQOL) among HIV patients, which enables clinicians to tailor care to individual needs, follow changes over time and quantify returns on health care investments and interventions. Methods HIV patients (N = 250) of two Dutch HIV clinics were invited to complete an online survey comprised of a set of (adaptations of) validated questionnaires measuring eight themes, including general health (SF-12), stigma (short stigma scale), social support (SSL12-I), self-esteem (SISE), sexuality problems, anxiety and depression (HADS), sleeping difficulties (SCL90-Sleep) and perceived side-effects. Results Findings from 170 (response rate 68%) patients (Male = 159, 94.1%) showed that questionnaires had high internal consistency, and most themes significantly correlated (r's .21 to − .69, p < .05) in the expected directions. Exploring cutoff scores shows that a significant proportion of patients score outside of the desired range on single themes (between 16.0 and 73.1%), and many patients on multiple themes simultaneously (8.9% on 5 or more themes). Regression analysis showed that social support, self-esteem and sexuality problems were associated with general health (R = .48, R 2 = .23, F(4,145) = 10.57, p < .001); adding anxiety and depression, sleeping difficulties and perceived side-effects explained 51.2% of the variance in total (R = .72, ∆R 2 = .29, F(3, 142) = 27.82, p < .001). Conclusions We succeeded in developing a questionnaire that comprehensively assesses HRQOL. HRQOL of the majority of Dutch HIV patients could be improved. The themes strongly influenced each other, therefore insights into any of the themes could inform interventions to improve HRQOL, and increase attention to these themes in routine consultations between patients and health care professionals.
OBJECTIVE: To investigate the incidence of dose adjustments, delays and discontinuation of chemot... more OBJECTIVE: To investigate the incidence of dose adjustments, delays and discontinuation of chemotherapy and the incidence of antineoplastic drug related toxicity in patients treated for lymphoma combined with cART, as well as differences between patients with PI-based and NNRTI-based cART. DESIGN AND METHODS: A retrospective observational cohort study was conducted among HIV-infected adult patients with cART who have been diagnosed with lymphoma and treated with cyclophosphamide, doxorubicin and/or vinca alkoloids, which interact with CYP3A4. Toxic events were identified and classified as renal, hepatic or bone marrow toxicity. Time of administration and dosage of antineoplastic drugs were collected to determine dose adjustments, delay and discontinuation of the chemotherapy and the clinical outcome of chemotherapy was registered. RESULTS: 50 HIV-positive patients were included of which 22 patients used PI-based and 21 NNRTI-based cART. HIV-positive patients with cART had more toxicity than HIV-negative patients. No significant differences in toxicity were observed between patients with PI-based and NNRTI-based cART, apart from a trend that patients with PI-based cART suffered more severe or life-threatening bone marrow toxicity. Patients with PI-based cART applied significantly earlier dose reduction and treatment delay than with NNRTI-based cART. No significant differences in clinical outcome of the chemotherapy were found between PI-based and NNRTI-based cART, but cART achieved less complete remission compared to HIV-negative patients. CONCLUSION: Patients with PI-based cART applied earlier dose adjustments and delays due to toxicity than patients with NNRTI-based cART. A prospective study should enhance the knowledge of the clinical pharmacology of the drug-drug interaction between antineoplastic and antiretroviral agents.
International Journal of Clinical Pharmacy, Jun 12, 2018
Background The combination of combined active antiretroviral therapy (cART) with chemotherapy in ... more Background The combination of combined active antiretroviral therapy (cART) with chemotherapy in the treatment of lymphoma in human immunodeficiency virus (HIV)-positive patients has improved the overall survival of these patients. However, drug-drug interactions between antineoplastic agents and the antiretroviral agents non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) can occur by influencing the activity of the CYP3A4 enzyme. So far, little is known about the clinical relevance of this interaction: the effect on the efficacy and toxicity of the chemotherapy. Also, there is no general consensus which cART is preferable in combination with antineoplastic drugs. Objective To compare PI-based with NNRTI-based cART on the efficacy and toxicity of chemotherapy in lymphoma patients. Setting The Onze Lieve Vrouwe Gasthuis, located in Amsterdam, The Netherlands. Method A retrospective observational cohort study including all patients with HIV and lymphoma over a 10-year period. Clinical outcome (response to chemotherapy and survival) and toxicity of chemotherapy (renal, hepatic and bone marrow toxicity as well as dose reduction, treatment delay and discontinuation) was compared in patients with PI based and NNRTI-based cART. Main outcome measure: Response to chemotherapy and survival. Results Patients using PI-based cART (n = 22) had a significantly lower 1 year survival compared to NNRTI-based cART (n = 21). No significant differences were observed in reaching complete remission after chemotherapy. No overall significant differences in toxicity and discontinuation of the chemotherapy were observed. However, there was a trend towards more severe bone-marrow toxicity in patients with PI-based cART. In addition, patients with PI-based cART received earlier dose-reduction and treatment delay, indicating increased toxicity in PI-treated patients. Conclusion This retrospective study shows that PI-based cART is inferior in combination with chemotherapy to NNRTI-based cART: a lower 1 year survival is observed and dose-reduction and treatment delay occur earlier, possibly based on an earlier onset of toxicity. Keywords cART • Chemotherapy • Drug-drug interactions • HIV • Lymphoma Impacts on practice • When combining chemotherapy for lymphoma with antiretroviral therapy for HIV, non PI-based drug regimens are preferred. • Combining PI-based cART with chemotherapy for lymphoma results in a lower 1-year survival rate when compared to NNRTI-based cART combinations.
Sexually Transmitted Diseases
Introduction: As the incidence of hepatitis C virus (HCV) infections remains high among human imm... more Introduction: As the incidence of hepatitis C virus (HCV) infections remains high among human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) an HCV testing strategy was introduced at the sexually transmitted infections (STI) clinic in Amsterdam in 2017. We aimed to evaluate this HCV testing strategy. Methods: The HIV-positive MSM and transgender women (TGW) were eligible for HCV testing (anti-HCVand HCV ribonucleic acid) at the STI clinic if they did not visit their HIV clinician in the 3 months before the consultation and had not been tested for HCVat the STI clinic in the previous 6 months. All eligible individuals were administered the 6 questions on risk behavior of the HCV-MSM observational study of acute infection with hepatitis C (MOSAIC) risk score; a risk score of 2 or greater made a person eligible for testing.