Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track B: Clinical Science

Mo.B.1216 - Mo.B.1221

Conclusions: our data confirm the litterature reports of incidence of bacteremia in ARC
(I 7 %o/y) and AIDS (30-310%~/y), according to the stage reached by the lIHIVinfection. Also
the incidence of principal bacterial agents is similar except for a lower incidence of
Streptococcus pneumornie in our bacteremlas.The acute physiolot cr. I,,rc i tae evaluation
of sepsis and citokines in AIDS Pts were in the lower medium of cl,tred in common S and did not differ significantly from HIV-control group, butii!h a ii sze of the study
does not permit to draw conclusions on a presuptive lower pr(it a,l i r! unnologic
response in andvanced HIV infection.
F.M. Gritti Div. Malattie Infettive, Osp. Maggiore L.go B.Nigrinsoli:.:,,. Italy
Mo.B.1216
BACTERIAL PNEUMONIA IN HIV-INFECTED PATIENTS: CLINICAL AND
EPIDEMIOLOGICAL STUDY.
Baril L, Astagneau P Mengual X, Nguyen J, Caumes E, Bricaire F, IK,in C.;k 'tie Salpetrirdre
Hospital, Paris, France.
To determine the clinical and microbiological features of bacterial perlm.r,rnrii (BP), all HIVinfected patients who consecutively presented clinical and radiologrii iP i i)ur service
from January to July 1994 underwent a protected specimen bru usi, cfiberoptic bronchoscopy, blood cultures and serum collection for laboratory dianosii.,mong 263 patients
who were admitted during the study, 33 (12.5%) had BR including five.th two consecutive
episodes (mean age: 37.4 ~ 9. 1 years; mean CD4 count: 15 micr uL ine: 0 602)).Twentyeight patients recovered under appropriate therapy No fatal out come.vias related to the
BPThirty-three episodes were documented by microbiologyThirty- seven pathogens were
isolated: S. pneumoniae (n=1 6), H. influenzae (n=6), P aerugino, 5(n =6), F. oIi (n-=4), K.
pneumroniae (n- I), M. catarrhalis (n= 1 ), S. aureus (n= 1 ), E. faecium (n i). and Clhamydiae
sp. (n=- I).The overall rate of S. pneumoniae strains with decreased sensitivity to penicillin
was 75% (0. 1 MIC I g/mL: n= 10 and MIC I g/mL: n-=2).When Ihe 3 hospitalized patients
with BP were compared with 80 HIV infected hospitalized patients,without BR the risk factors for BP were history of sinusitis within the last month before idission ( OR, 3.2;
95%CI, I. I-9. 1; p-=0.03) and bronchitis or BP within the last six onth (R, 3. I; 95%CI,
I.1-8.3; p-0.02). Since BP are often due to bacteria with lower susceptiiblity to antibiotics,
empiric antibiotic therapy merit further revisions in HIV patients.
L. Baril, Dkpartement des Maladies Infectieuses Hfpital PitiB-Salpetrie e. 4/ Rd de I'H6pital
750 I 3 Paris, France.Tel: (33) 142 I 601 11 Fax: (33) I 44240450
Mo.B.1217
SALMONELLA GROUP D PAROTITIS IN AN HIV INFECTED INDIVIDUAL
Hatcher Jeffrey, Schranz, Jennifenr. Department of Medicine, Divis ion of Infectious Diseases,
SUNY Stony Brook, Stony Brook,New York, US.
We describe a 44 year old HIV infected male; CD4 lymphocyte count 540 cells/mrm3, with
bilateral parotid lymphoepithelial hyperplasia.The parotid gland I yperplasia intermittently
required fine needle aspiration with prompt resolution of swellin,nd pain [his patient
developed acute onset of fever (I04~ F), rigors, increasing parotid distension wKith erythema
and induration of the left parotid gland. No fluctuant mass, intric-rK, i ei ythema/purulent discharge or palpable salivary duct stones were palpated. Bilateral poster iichain adenopathy,
xerostomia and keratoconiuctivitis sicca were noted on examirnatin.
Parenteral ticarcillin/clavulonate was started for presumptive bacterial paroatitis. CAT scan
demonstrated bilateral parotid enlargement, multiple complex cystic ma.rses with an
enhancing rim and extensive lymphadenopathy. The concern of a parotid abscess prompted
fine needle aspiration.The gram stain revealed few WBC's, many PBC and no organisms.
Culture isolated Samonella group D sensitive to ampicillin.The patient received two weeks
of combined parenteral and oral therapy with recurrence of symptoms with in one week of
completion.
Benign lymphoepithelial cystic disease is a well known complicatiori l HIV infection.
Histologically the lesions appear as cysts lined by stratified squa rous epithelium with multipie aggregations of lymphoid follicles composing the walls.The glandular iparenchyma is
often preserved. Bacterial superinfection is uncommon in this populatiion with the most frequently isolated organisms Strphylococcus aureus and Streptocor specie's. Review of literature describes one case report of pneumococcal parotitis in an AIDS palient and one of
Salmonello enteritidis parotitis in a leukemic patient.
Bilateral parotid enlargement is a common physical finding in HIV ine ted individuals. One
must be aware that bacterial seeding can complicate benign lymphoepithelial cysts resulting
in suppurative parotitis. Once this occurs, chronic antimicrobial siuppres ive therapy may be
required to prevent recurrence.
Jeffrey Hatcher, Dept. of Medicine, Division of Infectious Diseases, INY S toiny Brook, Stony
Brook, New York 11794 Phone (5 I 6) 444- I 660
Mo.B. 1218
CMV RETINITIS TREATMENT IN AIDS PATIENTS IN ARGENTINA
Perez Hector, Puente 5, Mestre C, Casir6 A. Cahn P-Hospital Fernrndez. Buenos Aires,
Argentina
Objective: To study effect of treatment on CMV retinitis (CMV R) in A.ID' patients in
Argentina.
Methods: We studied I 22 AIDS cases who met diagnostic cnteri, ir CM MV-fR (I 1.6%), 109
were followed for at least I month, while the other I3 pts discon-tinud controis after diag
nosis. Gancyclovir (GCV) was the initial choice for treatment, loscarne (FOS) was used in
leukopenic pts at entry Comparison between treated (TR) and not ticerd (NT), and GCV
vs FOS was performed.Visual outcomes and survival status were cenred is of 15/12195.
Kruskal-Wallis, chi-square, Kaplan-Meier and log rank test were used foK sactIstcs
Results: A total 09 pts. were followed during 732 pts./rronth. (Mean K. +/ 4-.7). CMV R
was bilateral at entry in 41.3%, lesions were located in zone I of ihe re inr n I % and in
zones 2 and/or 3 plus I in 52.8%.Treatment was given to 88 pts 80.)0 68 ( (76.9%), 20
F (23%). Median survival in TR pts was 8 mo. and 3 mo. in N-. Media civival with GCV: 8,
FOS: 7 mo. Adjusted monthly mortality was of 9.8 +/-1.25% (R), 1.3% r/ 4.2% (NT)
p<0.0049); 9.4+/-1.35% (GCV), I 1.8 +/-3.4% (FOS) p:0.2 I. In 88 pts. vsi,K acuity was studied in the last 30 days before death or last control: Bilateral blindness ippeied in 35 cases:
24/75TR (32%); 11/13 NT (84.6%) p<0.001 I, Odds ratio:l 1.7; [G(tK19/58 (32.8%);
FOS:5/17 (29.4%), NS]. Fifty-three pts. remained with vision better t[ii 2t1/200. [TR 51/75

(68%); NT 2/13 (15.4%) p<0.00I I; GCV 39/58 (67.2%), FOS 12/17 (70.6%) p=0.97. Switch
to the other drug was necessary in 17 cases: From GCV to FOS: 14/70 (20%); from FOS to
GCV: 3/21 (14.2%) p=0.22.
Conclusions: Treatment of CMV-R improves survival and preservation of visual function. No
significant differces were seen between GCV and FOS neither in survival and visual outcome nor in need to switch to the alternative drug.
Hector Perez, Gasc6n 79 (I 181) Buenos Aires, Argentina. Phone (54 I) 98 1-1828
Fax [phone]
Mo.B. 1219
EARLY DETECTION OF CMV RETINITIS RELAPSE IN HIV PATIENTS AND
ANTIVIRAL MONITORING BY CMV ANTIGENEMIA, DNA HYBRIDIZATION AND
DNA PCR ON SERA.
Riss eanMarc, Zandotti C, Petit N, Moreau J, Dhiver C, Gastaut JA, Bourgeade A. CHU
Timone, Marseille, France.
Objective: To determine virological markers of Cytonrregolovirus (CMV) retinitis relapse and
virological markers for antiviral monitoring in HIV patients under anti CMV therapy
Methods: Fifteen HIV patients have been followed from 3 to 9 months after diagnosis of
CMV retinitis. All were on maintenance therapy with intravenous foscarnet or ganciclovir A
follow up including ophtalmological evaluation with fundus photograph, determination of
CMV quantitative pp65 leukocytic antigenemia (ArgeneFrance), CMV DNA polymerase
chain reaction (PCR) on sera (as described by Brytting et al, 1I992) and quantitative CMV
DNA detection (Hybrid Capture CMV DNA, Murex, UK) was carried out bimonthly.
Results: Six patients showed retinitis relapse during the follow up period.The median was
9 weeks (range I12- 32) after the first episode. Quantitative antigenemia was positive in 5
patients. Four out of these 5 cases were found to be positive between the 4th and the
16th week before diagnosis. DNA hybridization was positive in all 6 patients. However 3 of
them were positive 6 weeks before retinitis relapse. CMV PCR was positive in 4 patients, of
whom 2 were positive 4 weeks before the relapse. In two patients, absence of both anti
genemia and quantitative DNA detection decrease was associated with clinical and virological antiviral resistance and lead to treatment modification.
Conclusions: Positiveness of antigenemia and quantitative DNA detection is associated with
clinical retinitis.These two diagnostic tests seems to be good predictive markers for relapse.
Their early positiveness should alert physician to perform close ophthalmological evaluation.
Moreover, these two tests seems to be good markers for antiviral treatment monitoring.
J.M. RISS- SERVICE D'OPHTALMOLOGIE, C.H.U.TIMONE 264, RUE St PIERRE 13385
MARSEILLE CED)EX 05 FRANCE TEL: [phone] FAX: [phone]
Mo.B. 1220
SAFETY PROFILE OF FOSCARNET ADMINISTERED BY PORTABLE INFUSION
DEVICE IN COMBINATION WITH ORAL HYDRATION (OH) IN
CYTOMEGALOVIRUS (CMV) INFECTIONS IN PATIENTS WITH AIDS
M Obadia*, A.Bicart-See*, C.Gonzalez*, S.Averous*, M.Maurette**, J.C.Auvergnat*. *Dept.
of Infectious Diseases, Hospital Purpan,Toulouse, France; "Ophtalmologist, 3 rue de
Montmorency,Toulouse France; ***Dept. of Internal Medicine, General Hospital, Castres,
France.
Objective: High frequency of CMV infections, necessity of burdensome maintenance therapy for patients more and more often in good general condition, has comitted us to pro
pose infusion of foscarnet by means of a portable infusion device with concomittant OH to
improve the quality of life in these patients.
Methods: Foscarnet (100 mg/kg) is given by infusion into an implantable reservoir using a
portable infusion device, Intermate Baxter L 100 (volume: 250 ml; flow rate: 100ml/h) once
a day. The infusion is given together with a minimum OH volume of I liter. This system is
proposed for outpatients with a Karnofsky status>70% and who fully understand the
importance of OH.The safety and efficacy of this treatment are evaluated once a month.
Results: Infusion devices have been used by II patients (10 chorioretinits, I peripheral
neuropathy) to administer foscarnet.The mean follow-up time is 6.7 months (range: 15 days
to over 22 months). OH has been achieved by intake of tap water (5 cases), alkaline miner
al water (5 cases) or soup (I case).The hydration volumes ranging from I liter (4 cases) to.5 liters (7 cases), were ingested either during the infusion (6 cases), after the infusion (3
cases), or at different times throughout the day (2 cases). One patient in whom hydration
was inadequate and erratic presented renal failure after I15 days (serum creatinine 650 pm)
that reversed on discontinuation of foscarnet.There has been no significant rise in serum
creatinine in the remaining patients and no other abnormal laboratory findings have been
reported.T he other adverse effects included reversible genital ulceration (I case) and infection of the implantable chamber (I case). Six patients presented relapsing retinitis requiring
the initial dose after a mean of 4 months (2-6 months) maintenance treatment. Four
patients died from other infections within a mean of 1 3.7 months after the diagnosis of
CMV infection. The 7 remaining patients has been already followed up for I 6.2 months (3 -36 months).
Conclusion: Our experience over the last 2 years confirms that administration of foscarnet
via a portable infusion device and concomitant OH provides a valuable alternative to stan
dard infusions. Safety is equivalent with a minimum of I liter of water preferably alkalinized.
taken during the infusion.This protocol produces a noteworthy improvement in the quality
of life of patients in good general condition by allowing them to remain unhospitalized, to
continue with their normal activities and to carry on a lifestyle much nearer to normal.
M. Obadia, Hipital De jour Smit, Chu Purpan 31059 Toulouse, France.Tel.: (33) 6 I 77 20 92
Fax: [phone]
Mo.B. I 2 I
IMPROVED SURGICAL TECHNIQUE FOR IMPLANTATION OF THE INTRAOCULAR
SUSTAINED-RELEASE GANCICLOVIR IMPLANT REDUCE POSTOPERATIVE
COMPLICATIONS IN PATIENTS WITH AIDS AND CMV-RETINITIS
CuemibelHermann OC, Rosenkranz C, Mauck K, Fries U, Schnaudigel OE, Even van G.
Ohroff C. Unversity Eye Clinics, Frankfurt am Main, Hessen, Germany
Objective: Cytomegalovirus (CMV) retinitis could be a marn problem because of a long
term venous access for administration of any antiviral therapy (ganciclovir foscarnet) and its
side effects. Direct ocular treatment with an intraocular sustained release ganciclovir implant

0
cO
0
a)
N
C
Ql)
a)
c
x
O.
+0
Xm
92