Publications by authors named "Christoph Stephan"

Objectives: Disseminated nontuberculous mycobacterial disease (dNTMd) remains a rare but serious complication in people living with HIV (PLWH). This study aimed to assess whether dNTMd independently contributes to delayed CD4-cell recovery following antiretroviral therapy (ART) initiation.

Methods: This retrospective 1:3 single center case-control study analyzed patient data from 2004 to 2023.

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Elderly patients with chronic diseases often use several drugs (polypharmacy). The more drugs a patient uses, the greater the risk of medication errors. To ensure a safe medication process, healthcare professionals must have a high level of medication safety competence (MSC).

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Background: Tenofovir alafenamide (TAF) was introduced in the European Union in 2015 as a novel prodrug of tenofovir showing similar efficacy in clinical trials and a more favorable safety profile than tenofovir disoproxil fumarate (TDF). The German TAFNES cohort study (2016-2019) was conducted to generate real-world evidence.

Methods: Treatment-naïve (TN) and treatment-experienced (TE) people with HIV (PWH) receiving elvitegravir/cobicistat/emtricitabine/TAF (E/C/F/TAF), rilpivirine/F/TAF (R/F/TAF) or F/TAF + 3rd agent were included.

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Virologic failure of long-acting rilpivirine/cabotegravir is rare but may result in severely limited treatment options. Known risk factors cannot predict all cases. Therapeutic drug monitoring (TDM) may help identify patients at risk, but reliable thresholds are missing.

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Objectives: To assess the safety and immunogenicity of a fourth vaccination (second booster) in individuals aged ≥75 years.

Methods: Participants were randomized to BNT162b2 (Comirnaty, 30 µg) or messenger RNA (mRNA)-1273 (Spikevax, 100 µg). The primary end point was the rate of two-fold antibody titer increase 14 days after vaccination, targeting the receptor binding domain (RBD) region of wild-type SARS-CoV-2.

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Background: The Communication and Tracing App HIV (COMTRAC-HIV) project is developing a mobile health (mHealth) app for integrated care of HIV patients in Germany. The complexity of HIV treatment and continuous care necessitates the need for tailored mHealth solutions. This qualitative study explores design solutions and a prototype to enhance the app's functionality and effectiveness.

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Objective: Interruptions in care of people with HIV (PWH) on antiretroviral therapy (ART) are associated with adverse outcomes, but most studies have relied on composite outcomes. We investigated whether mortality risk following care interruptions differed from mortality risk after first starting ART.

Design: Collaboration of 18 European and North American HIV observational cohort studies of adults with HIV starting ART between 2004 and 2019.

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Article Synopsis
  • The study examined the efficacy of dolutegravir plus rilpivirine in maintaining viral suppression in HIV patients with Lys103Asn mutations, who had not previously experienced treatment failure or resistance.
  • Conducted across 32 clinical sites in Europe, the trial involved 140 participants, dividing them into two groups: one switching to the new treatment and another continuing their existing regimen for 48 weeks.
  • Results showed a low virological failure rate, with 3.2% in the dolutegravir plus rilpivirine group compared to 2.2% in the control group, suggesting the new treatment is as effective as continuing standard therapy.
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Purpose: This study examined the characteristics, incidence and prognostic factors of the first AIDS-defining condition developed after more than one year of continuous antiretroviral therapy (ART) among people living with HIV (PLHIV).

Methods: We used data from two multicentre observational cohorts of PLHIV in Germany between 1999 and 2018. Our outcome was the first AIDS-defining event that occurred during follow-up after more than one year of continuous ART.

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Cryptococcosis is the most prevalent fungal infection of the central nervous system worldwide. We performed a retrospective multicenter cohort study to gain insights into the epidemiology of cryptococcosis in Germany. We describe the use of diagnostic tests, clinical management and patient outcome.

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Human immunodeficiency virus type 1 (HIV-1)-neutralizing antibodies (nAbs) that prevent infection are the main goal of HIV vaccine discovery. But as no nAb-eliciting vaccines are yet available, only data from HIV-1 neutralizers-persons with HIV-1 who naturally develop broad and potent nAbs-can inform about the dynamics and durability of nAb responses in humans, knowledge which is crucial for the design of future HIV-1 vaccine regimens. To address this, we assessed HIV-1-neutralizing immunoglobulin G (IgG) from 2,354 persons with HIV-1 on or off antiretroviral therapy (ART).

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  • Falciparum malaria is a serious disease mainly affecting travelers in Germany, with unclear rates of co-infection and insufficient rationale for antibiotic therapy alongside malaria treatment.
  • A study conducted on 264 malaria patients showed that 64% received antibiotics, but only 11% had significant bacterial co-infections, while severe malaria didn't correlate with higher co-infection rates.
  • The findings suggest that bacterial co-infections in malaria cases are uncommon but highlight the need for personalized risk assessments rather than a blanket approach to antibiotic use.
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In recent years, telemedicine has advanced significantly, offering new possibilities for improving healthcare and patient outcomes. This paper presents a telemedicine app for HIV patients, developed using a human-centered design approach. Designed to meet the diverse and specific needs of Pre-Exposure Prophylaxis (PrEP) users and Late Presenters (LP), the app is part of the COMTRAC-HIV Project at the University Hospital Frankfurt.

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Incidence of anal carcinoma (AC) in people living with HIV (PLWH) is increased compared to the general population. Adverse effects of chemoradiotherapy (CRT) on the immune system are associated with a significant detrimental prognosis on overall survival in patients receiving CRT for solid tumors. The aim of this study was to evaluate immunological factors, in particular the differences in recovery of CD4 and CD8 cell counts before and after CRT for AC in PLWH.

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The Communication and Tracing App HIV (COMTRAC-HIV) project aims to develop a mobile health application for integrated care of HIV patients due to the low availability of those apps in Germany. This study addressed organizational conditions and necessary app functionalities, especially for the care of late diagnosed individuals (late presenters) and those using pre-exposure prophylaxis. We followed a human-centered design approach and interviewed HIV experts in Germany to describe the context of use of the app.

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Despite cancer being a leading comorbidity amongst individuals with HIV, there are limited data assessing cancer trends across different antiretroviral therapy (ART)-eras. We calculated age-standardised cancer incidence rates (IRs) from 2006-2021 in two international cohort collaborations (D:A:D and RESPOND). Poisson regression was used to assess temporal trends, adjusted for potential confounders.

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Article Synopsis
  • - A 24-year-old patient from Cameroon came to the hospital with a foreign object in her left eye.
  • - Fluorescent microscopy was used to find moving microfilariae, confirming a diagnosis of loiasis for the first time.
  • - Even though she had high levels of microfilariae, eosinophilia (an increase in a type of white blood cell) only appeared after starting antiparasitic treatment.
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  • Patients with open pulmonary tuberculosis (opTB) can be mistakenly cleared for isolation based on sputum smear microscopy, which is less sensitive than culture testing.
  • A study analyzed data from 118 opTB patients between January 2013 and December 2017 and found that 44.8% had at least one positive culture after initial treatment despite having negative smear tests.
  • The findings suggest that de-isolating these patients after negative smears may not ensure they are infection-free, indicating a need for further research on the clinical implications of smear-negative but culture-positive cases.
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Objectives: The objective of this study was to identify the pathogen spectrum of community acquired pneumonia in people living with HIV (PLWH), and to compare it with a matched HIV negative group in order to reassess therapeutic strategies for PLWH.

Methods: Seventy-three (n = 73) PLWH (median CD4 3-6 months before CAP: 515/µl; SD 309) with community acquired pneumonia (CAP) were matched with 218 HIV-negative CAP controls in a prospective study design. Pathogen identifications used blood culture, samples from the upper and lower respiratory tract (culture and multiplex PCR) and urinary pneumococcal and legionella antigen test.

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  • Recent studies show that ongoing HCV infections are mainly transmitted through drug use and sexual behaviors, particularly among men who have sex with men (MSM), but the details of transmission and infection progression remain unclear.
  • After following 161 patients with recently acquired HCV infections over 10 years, it was found that most were male MSM, many of whom were also HIV-positive, and their main transmission risks were sexual behavior and drug use.
  • The findings indicate low spontaneous clearance rates of the infection, significant phylogenetic clustering among MSM cases, and a rise in specific HCV genotypes over time, highlighting the need for targeted interventions in high-risk groups.
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  • - Participants with HIV at high cardiovascular risk who switched to dolutegravir showed no significant difference in hypertension incidence compared to those who continued protease inhibitors over 96 weeks.
  • - Both groups experienced a small but significant increase in diastolic blood pressure during the first 48 weeks after switching to dolutegravir.
  • - Factors like existing health conditions, rather than the treatment itself, were more closely linked to the development of hypertension in the study participants.
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Background: There are conflicting data regarding baseline determinants of virological nonsuppression outcomes in persons with human immunodeficiency virus (HIV) starting antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort.

Methods: We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014-2020.

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Background: The life expectancy of people with HIV taking antiretroviral therapy (ART) has increased substantially over the past 25 years. Most previous studies of life expectancy were based on data from the first few years after starting ART, when mortality is highest. However, many people with HIV have been successfully treated with ART for many years, and up-to-date prognosis data are needed.

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