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This Project Has Been Supported with Unrestriced Grants from Abbvie Gilead Sciences HEXAL Janssen-Cilag MSD Viiv Healthcare By This project has been supported with unrestriced grants from AbbVie Gilead Sciences HEXAL Janssen-Cilag MSD ViiV Healthcare By Marcus Altfeld, Hamburg/Boston (USA) Achim Barmeyer, Dortmund Georg Behrens, Hannover Dirk Berzow, Hamburg Christoph Boesecke, Bonn Patrick Braun, Aachen Thomas Buhk, Hamburg Rob Camp, Barcelona (Spain/USA) Rika Draenert, Munich Christian Eggers, Linz (Austria) Stefan Esser, Essen Gerd Fätkenheuer, Cologne Gunar Günther, Windhoek (Namibia) Thomas Harrer, Erlangen Christian Herzmann, Borstel Christian Hoffmann, Hamburg Heinz-August Horst, Kiel Martin Hower, Dortmund Christoph Lange, Borstel Thore Lorenzen, Hamburg Tim Niehues, Krefeld Christian Noah, Hamburg Ramona Pauli, Munich Ansgar Rieke, Koblenz Jürgen Kurt Rockstroh, Bonn Thorsten Rosenkranz, Hamburg Bernhard Schaaf, Dortmund Ulrike Sonnenberg-Schwan, Munich Christoph D. Spinner, Munich Thomas Splettstoesser (Figures), Berlin Matthias Stoll, Hannover Hendrik Streeck, Essen/Boston (USA) Jan Thoden, Freiburg Markus Unnewehr, Dortmund Mechthild Vocks-Hauck, Berlin Jan-Christian Wasmuth, Bonn Michael Weigel, Schweinfurt Thomas Weitzel, Santiago (Chile) Eva Wolf, Munich HIV 2015/16 www.hivbook.com Edited by Christian Hoffmann and Jürgen K. Rockstroh Medizin Fokus Verlag IV Christian Hoffmann, M.D., Ph.D. ICH Stadtmitte (Infektionsmedizinisches Centrum Hamburg) Glockengiesserwall 1 20095 Hamburg, Germany Phone: + 49 40 2800 4200 Fax: + 49 40 2800 42020 [email protected] Jürgen K. Rockstroh, M.D., Ph.D. Department of Medicine I University of Bonn Sigmund-Freud-Strasse 25 53105 Bonn, Germany Phone: + 49 228 287 6558 Fax: + 49 228 287 5034 [email protected] HIV Medicine is an ever-changing field. The editors and authors of HIV 2015/16 have made every effort to provide information that is accurate and complete as of the date of publication. However, in view of the rapid changes occurring in HIV medical science, HIV prevention and policy, as well as the possibility of human error, this site may contain technical inaccuracies, typographical or other errors. Readers are advised to check the product information currently provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the trea- ting physician who relies on experience and knowledge about the patient to deter- mine dosages and the best treatment for the patient. The information contained herein is provided "as is" and without warranty of any kind. The contributors to this site, including the editors and the Medizin Fokus Verlag, disclaim responsibility for any errors or omissions or for results obtained from the use of information contai- ned herein. © 2015 by Medizin Fokus Verlag, Hamburg Cover, Print-Production: SchrödersAgentur, www.schroedersagentur.de Graphic-Design: Tobias Emskoetter, Hamburg ISBN: 978-3-941727-17-5 V Preface 2015/2016 The goal remains the same – to make a textbook that is easily readable and can be used in the daily practice of HIV treatment. As in previous years, all the chapters of HIV 2015/2016 have been thoroughly revised. Again, special emphasis was put on actuality. This is underlined by the fact that in the antiretroviral therapy chapter alone, more than 100 are dated in the years 2013 and 2014. Previous issues of the progenitor “HIV Medicine” were available in several langua- ges, such as Spanish, Romanian, Portuguese, Vietnamese and Persian. We are very proud that a Russian issue could be published in 2015. Under certain conditions, the editors and the authors of this book may agree to remove the copyright on HIV 2015/2016 for all languages except English and German. You could therefore translate the content of this book into any language and publish it under your own name, without paying a license fee. HIV 2015/2016 is also freely available on the Internet (www.hivbook.com), because we firmly believe that this is the way medical textbooks should be handled in the 21st century. Research, knowledge, and expertise in the field of HIV can be shared and accessible to those who are dedicated to the treatment and care of individuals affected by HIV. Christian Hoffmann, Jürgen K. Rockstroh Hamburg, Bonn – September 2015 We would like to thank all the authors and all the people who helped us generously to realise this project, especially Laura Belkien, Nicole Bentrup, Matthias Berg, Ines Bohn, Daniel D. Breitenstein, Christian Dedek, Fiona Diekhoff, Beate Doebrich, Sabine Dransfeld, Tobias Emskoetter, Thomas Fischer, Annette Haberl, Iren Güler, Georg Haerter, Stefan Hansen, Sebastian Hindermann, Mareike Humpf, Johannes Jongen, Rainer A. Jordan, Brigitte Jung, Fabian Kalb, Anja Keimes, Claudia Kröger, Giao Le, Christoph Mayr, Marc Oette, Daniela Otto, Christian Perro, Britta Ranneberg, Michael Sabranski, Sven Schellberg, Carl Knud Schewe, Christiane Schlüter-Bracker, Gerald Schröder, Armin Schuster, Maxie Sinner, Victor Stanislevskiy, Hans-Jürgen Stellbrink, Jutta Thannheimer, and Martin Vogel. VI Christian Hoffmann (CH) and Juergen Rockstroh (JR) would like to thank the follo- wing colleagues for providing clinical pictures: Thomas Buhk, Hamburg (TB) Christian Eggers, Linz (CE) Stefan Esser, Essen (SE) Christoph Gerigk, Hamburg (CG) Georg Haerter, Ulm (GH) Stefan Hansen, Hamburg (SH) Johannes Jongen, Kiel (JJ) Rainer A. Jordan, Cologne (RJ) Christoph Lange, Borstel (CL) Marc Oette, Cologne (MO) Michael Sabranski, Hamburg (MS) Carl-Knud Schewe, Hamburg (KS) Hans-Juergen Stellbrink (HJS) Jan Thoden, Freiburg (JT) Clinical Images Credits 1: 1 JR, 2 MO, 3 CH 17: 1a+b CH, 2 MS, 3 HJS, 4+5 MO 2: 1 MO, 2 JR, 3 MO 18: 1-6 CH 3: 1+2 CH, 3+4 HJS 19: 1+2 CH, 3+4 CG, 5 CH 4: 1-3 CH 20: 1+2 CH, 3 SH, 4+5 CH 5: 1 JR, 2-6 MO 21: 1-3 CH, 4 MO, 5 JR 6: 1+2 CH, 3+4 MO 22: 1+2 CH, 3 HJS 7: 1 CH, 2 SU, 3+4 CH 23: 1 CH, 2 HJS, 3+4 CH 8: 1a HJS, 1b CH, 2 JR, 3 MO 24: 1 JR, 2 HJS, 3 CH, 4 TB, 5 SH 9: 1+2 CL, 3 JR 25: 1 CH, 2 JJ, 3 MO, 4-6 CH 10: 1 HJS, 2 CH, 3 SU 26: 1-4 CH, 5 KS 11: 1-3 MO 27: 1 MO, 2 HJS, 3+4 RJ, 5 MO 12: 1 JR, 2 SU, 3+4 MO 28: 1-5 RJ 13: 1+2 CH, 3 HJS, 4 CE 29: 1 SE, 2 MO, 3-4 SE, 5 JJ 14: 1-5 CH 30: 1-2 JJ, 3+4 MO 15: 1 CH, 2 HJS, 3 MO, 4+5 GH 31: 1-3 JJ, 4+5 CH 16: 1+2 CH, 3 JT, 4 CH, 5+6 HJS 32: 1-4 JJ VII Assistant Editor Rob Camp (Barcelona, Spain) Contributors Marcus Altfeld, MD, PhD Patrick Braun Heinrich-Pette-Institute PZB Aachen Virus Immunology Research Unit Blondelstrasse 9 Martinistrasse 52 D-52062 Aachen D-20251 Hamburg Phone +49 241 470970 Phone +49 48051-0 Fax +49 241-408652 [email protected] [email protected] Thomas Buhk, MD Achim Barmeyer, MD ICH Grindel Klinikum Dortmund gGmbH Grindelallee 35 Beurhausstrasse 40 D-20146 Hamburg D-44137 Dortmund Phone +49 40 41 32 420 Phone +49 231 95321 761 [email protected] Fax +49 231 95321 500 [email protected] Rob Camp Phone +34 93 218 6400 [email protected] Georg Behrens, MD, PhD Klinische Immunologie Rika Draenert, MD, PhD Zentrum Innere Medizin der Hospital of the University of Munich Medizinischen Hochschule Campus Innenstadt Carl-Neuberg-Strasse 1 Medizinische Klinik und Poliklinik IV D-30625 Hannover Pettenkoferstrasse 8a Phone +49 511 532 5393 D-80336 München Fax +49 511 532 9067 Phone +49 89 4400-53573 [email protected] Dirk Berzow, MD Schäferkampsallee 56-58 Christian Eggers, MD, PhD D-20357 Hamburg Abteilung für Neurologie Phone +49 40 404711 Krankenhaus der Barmherzigen Brüder Fax +49 40 40195671 Seilerstätte 2 [email protected] A-4021 Linz Phone +43 732 7897 25305 [email protected] Christoph Boesecke, MD Department of Medicine I Stefan Esser, MD University of Bonn Department of Dermatology Sigmund-Freud-Strasse 25 University of Essen D-53105 Bonn Hufelandstrasse 55 Phone +49 228 287 6558 D-45122 Essen Fax +49 228 287 5034 Phone +49 201-723-3878 [email protected] [email protected] VIII Contributors Gerd Fätkenheuer, MD, PhD Thore Lorenzen, MD Department of Internal Medicine ifi Institute University of Cologne Lohmühlenstrasse 5 Joseph-Stelzmann-Strasse 9 D-20099 Hamburg D-50924 Köln Phone +49 40 181885 3780 [email protected] Fax +49 40 181885 3788 [email protected] Gunar Günther, MD, MPH, DTM&H Katutura State Hospital; Tim Niehues, MD, PhD University of Namibia, School of Medicine Immunodeficiency and Pediatric Windhoek, Namibia Rheumatology Centre Phone +264 81 756 47 21 Helios Klinikum Krefeld [email protected] Lutherplatz 40 Thomas Harrer, MD, PhD D-47805 Krefeld Department of Internal Medicine III Phone +49 2151 32 2301 Universitätsklinikum Erlangen Fax +49 2151 32 2334 Krankenhausstrasse 12 [email protected] D-91054 Erlangen Phone +49 9131 854 3004 Christian Noah, MD Fax +49 9131 853 4749 Labor Lademannbogen [email protected] Lademannbogen 61-63 D-22339 Hamburg Christian Herzmann, MD Phone +49 40 53805-706 Clinical Infectious Diseases, Medical Clinic, [email protected] Research Center Borstel Parkallee 35 Ramona Pauli, M.D. D-23845 Borstel Äerztezentrum Isartor Phone + 49 4537 188 0 Isartorplatz 6 [email protected] D-80331 München Heinz-August Horst, MD, PhD Phone +49 89 229216 University of Kiel, UKSH Fax +49 89 229217 II. Medical Department [email protected] Chemnitzstrasse 33 D-24116 Kiel Ansgar Rieke, MD Phone +49 431-1697-1207 Klinikum Kemperhof Koblenz II. Med. Klinik Martin Hower Immunologische Ambulanz Medizinische Klinik Nord Koblenzer Strasse 115-155 Klinikum Dortmund GmbH D-56065 Koblenz Hövelstrasse 8 (Gebäude Gesundheitsamt) Phone +49 261 499 2691 D-44137 Dortmund Fax +49 261 499 2690 Phone +49 231 95320 700 (Fax -702) [email protected] [email protected] Christoph Lange, MD, PhD Thorsten Rosenkranz, MD Clinical Infectious Diseases, Medical Clinic, Neurologische Abteilung Research Center Borstel Asklepios Klinik St.
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