[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

7525 KamDo medicine containina PANAX rINSENG in
treatment of hemophiliacs infected with HIV.
Masao Hada*, H.Fukue*, S.Ikematsu*, M.Fujimaki*
T.Hattori**, K.Takatsuki**
*Clinical Pathology, Tokyo Medical College, Tokyo
**Internal Medicine, Kumamoto University, Kumamoto
Objective. Two kinds of Kamno medicine (Sho-saiko-to;SST,
Ninjin-to;NT) were administered to hemoohiliacs infected
with HIV in an attempt to improve their immunoabnormalities, because serious side effects had not been reported
and an oral administration is possible.
Methods. Four asymptomatic carriers(AC) were treated with
SST, and NT was administered to three AC and one with
AIDS-related comolex(ARC). Single and dual color analysis
of lymphocyte suboopulations were aDnlied for the observation in above eight cases for six months.
Results. Increases of absolute numbers of lymohocytes were
observed in five patients; 10% in SST grouo and 32% in NT
group. Mean persentages of increases of CD4-bearinq cells
of SST and NT groups were 3% and 32%, respectively. Increases of absolute numbers of natural killer cells(Leu7-CDi6
+) in both SST(41%) and NT(43%) groups. Improvements of
clinical conditions without any side effect were also
observed. Increase of body weight(over 3kg) were found in
two cases, and in one case headache and persistent slicht
fever was disappeared.
Conclusion. SST and NT are extracts from several herbs
containing PANAX GINSENG, but pharmacological actions on
HIV-infected patients are unclear yet. The facts of this
pilot study strongly suggest that esoecially NT miqht be
a mixture of immunomodifing and anti-viral comnonents
which is supported by the existence 6f the homology
between the Doetide T and carrot extensin.

7526 MEGESTROL ACETATE AND THE TREATMENT OF HIVRELATED CACHEXIA. J. Von Roenn, R. Murphy,
S. Weitzman. Northwestern University, Chicago, IL, USA.
Cachexia is a frequent problem in persons infected
with the human immunodeficiency virus (HIV) and portends
a poor prognosis. Weight loss leads to patient concern
and debility. Furthermore, the well-recognized interaction between nutritional status and immunity may be of
importance in persons with HIV infection. Megestrol
acetate (M.A.), an agent used for the treatment of metastatic breast cancer, has, as a side effect, appetite
stimulation and weight gain. We have treated 10 HIV
positive men with M.A. 80mg orally four times a day. All
patients lost 10% or more of their pre-illness body
weight at the time of initiation of therapy (average
weight loss per patient - 25 lbs). Eight men carried a
diagnosis of AIDS on the basis of opportunistic infection, one on the basis of Kaposi's sarcoma. One patient
had weight loss as his primary manifestation of HIV
infection. Seven patients were receiving AZT at the time
of initiation of M.A. The patients have been on therapy
from 2 to 13 weeks. All patients have gained weight with
an average weight gain of 13 lbs (range 2 to 24 lbs) at a
rate of 1-2 lbs per week. Two patients have returned to
their pre-illness body weight. Six patients reported
marked improvement in their sense of well-being. No
patient has developed peripheral edema. Four patients
have died, 3 from recurrent episodes of pneumocystis
carinii pneumonia, 1 from progressive neurologic disease.
All patients tolerated the drug well and reported
improvement in appetite while on therapy. The appetite
improvement and weight gain is encouraging but the true
effectiveness of M.A. for HIV-related cachexia and its
effect on quality of life cannot be assessed without a
placebo controlled trial. This trial will open in 1988.

Notes:

7527
Total Parenteral Nutrition (TPN) in Patients With AIDS
(PWA). A. Pomp, M.D.; A. E. Fisher, M.D.; M. D. Caldwell, M.D.,
Ph.D.; M. Winkler, M.S.; L. Varella, M.S.; J. Albina, M.D. Rhode
Island Hospital and Brown University, Providence, RI. U.S.A.
Objective. To determine the safety and efficacy of TPN in PWA with
malnutrition and gut failure.
Methods. Malnutrition was defined by weight loss greater than 20%
of usual body weight and/or a serum albumin <3.0 g/dl. Gut failure
was defined by diarrhea, malabsorption and inability to feed enterally.
TPN was provided via percutaneously placed subclavian catheters and
delivered, on the average, 1.0 g protein and 33 Kcal/kg/day (20% of
non-protein calories as IV fat emulsion).
Results. 8 male patients (mean age 36.5 years) averaged 26 days of
in-hospital TPN (mean non-AIDS TPN 15.5 days), 3 patients
progressed to home TPN (mean duration 2.6 months). An episode of
catheter-related sepsis (S. aureus) occurred in one hospitalized patient,
and responded rapidly to antibiotics and catheter removal. There were
no episodes of sepsis during home-TPN. One patient developed
severe hypertriglyceridemia during IV fat emulsion infusion. Positive
N balance was only obtained in 2 of the 6 patients in whom it was
measured. Retinol binding protein (RBP) concentration was normal in
3 patients prior to TPN and improved in 4 other patients during
therapy. Prealbumin (PA) was within normal limits in 5 patients and
improved in 2 other patients. Pre-TPN serum selenium levels were
normal in all patients and serum zinc was normal in all but 1 patient.
Conclusion. TPN can be delivered safely to PWA and gut failure both
in the hospital and at home. The provision of adequate protein/calorie
intake resulted in improvement or maintenance of RBP and PA
concentrations. However, most patients remained in negative N
balance, reflecting a severe catabolic course. Home-TPN is a valid
alternative to hospitalization in PWA and gut failure.

7528 Clinical versus post mortem findings
in patients with HIV-infectWn
U.Kronawitter,F.-D. Goebel,Ch.Zietz,W.Zoller
M.Eder +Medizinische Poliklinik,Pathologisches
Institut,University of Munich, West Germany
Without effective therapy of HIV-infection, the
prognosis of the patients often depends on early
diagnosis of opportunistic infections or tumors.
To find out which of those are frequently not
detected intra vitam, we compared our clinical
findings with the results of the autopsy in 29
homosexual men aged 24-68 years (mean 38 years).
Out of 25 patients (86%) with finally confirmed
opportunistic infections, 13 (52%) had a simultaneous infection with 2 agents, 2 patients (8%)
even with 4. The most frequent infectious agent
was cytomegalovirus (13 cases; 45%), of which only 6 cases (46%) were diagnosed clinically. In
all 4 patients with involvement of the eyes at
least 2 other organs were afflicted. So this
seems to be an indicator for generalized and advanced CMV-infection. The results concerning
other infections and tumors: Kaposi's sarcoma
(totally 11 cases, 11 diagnosed intra vitam),
Pneumocystis carinii pneumonia (8/6), Mycobacterium avium complex (7/5), toxoplasmosis (6/5),
Non-Hodgkin-lymphoma (3/2) cryptosporidiosis
(2/2), herpes simplex (2/1), aspergillus (1/0),
cryptococcosis (1/10),Mycobacterium tuberculosis
(1/1), other neoplasms (1/1).
Compared to other opportunistic infections the
incidence of CMV-infection appears to be underestimated clinically. CMV-disease might be obscured by other overwhelming infections.

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