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

Mo.B.1222 - Mo.B.1227

Monday, July 8, 1996

is known as very effective in delaying the progression of CMV retinitis. Sever e ocular complications like retinal detachement or endophthalmitis are frequent (I I-18%) 30-64 days
after surgery. A modified technique of implantation could reduce this rate.
Methods: A pg/h ganciclovir implant (Chiron/Adatomed, USA) is used in r patients with
CMV retinitis after administration of a retrobulbar block. In contrast to the prescribed technique a 9.0 nylon suture is passed through two holes of the base of the arcnorny Shut of
the device.The incision (5mm circumferentially) is placed 3.5 mm in the inferotemporal
quadrant and fixed at one side of the scleral )incision and closed with two intrascleral vicryl
sutures. Ophthalmological, ultrasonic and electrophysiological examinations would be performed regularly within a 6 month period.
Results: In one of 10 patients we could find one retinal tear along the border of a healed
retinitis 14 days after surgeryThere were no cases of endophthalmitis. Postoperatve astigmatism will not be a severe problem using vicryl and the modified suture technique.
Conclusions: Ocular complications after implantation of an intraocular sustained release
ganciclovir device could be reduced to a rate of 1% similar to the complication rate longterm results after intravitreal injections of ganciclovir with an improved technique of implantation.The advantage of this modification will be more quality of life for the patients and a
reduction of costs for hospitalization.
H.O.C. Guembel,Theodor Stern Kai 7, 60590 Frankfurt am Main, FRG
Telephone: [phone] Fax [phone]
Mo.B. 1222
CAUSES OF DEATH IN A COHORT OF PATIENTS WITH ADVANCED HIV DISEASE
ENROLLED IN AN INTERNATIONAL CYTOMEGALOVIRUS PROPHYLAXIS STUDY
Hurwitz, Shelley*, Holland F*, Owens S*, Coakley D**, Fry J*, Feinberg J**. *Harvard Univ.,
Boston, MA, USA **Glaxo Wellcome, USA/UK **Univ. of Cincinnati, Cincinnati, OH, USA for
the ACTG 204/Glaxo Wellcome 123-014 International CMV Prophylaxis Study Group
Objective: To describe the causes of death in a clinical trial cohort of patients (pts) with
advanced HIV disease receiving aggressive medical management.
Methods: We evaluated and categorized the causes of death among 1227 participants with
CMV IgG+ and CD4+ < 100 in a CMV prophylaxis study comparing valaciclovir to two
doses of ACV
Results: Pts were enrolled fom 12/92 to 10/94 at 72 sites in the US, Canada, Europe and
Australia. Endpoint data (CMV disease, mortality) were collected through 7/95. Median
entry CD4+ was 32; 67% had CD4+ <50. At entry, PCP fungal and MAC prophylaxis were
being taken by 93.1%, 50.4% and 25.2% of the total study population and 79.2% were
receiving one or more antiretroviral agents (AZT ddl, ddC, d4T and/or NVP). Median duration of follow-up was 57 wks. 488 pts died (39.8%). Median time to death was 54.2 wks;:
the product-limit estimate for time to death for all pts was 90.4 wks.The most common I
cause of death, occurring in 3.6% of all pts, was lymphoma (44 pts), evenly divided between
systemic non-Hodgkin lymphoma and primary CNS lymphoma. Other common IV causes
were non-PCP pneumonia (3.5%). which included bacterial pneumonias and cases where
no etiology was found, disseminated MAC (3.4%), wasting (3.1%), PCP (2.9%), sepsis (2.7%),
and KS (2.6%), respectively Causes of death occurring in > 1.0% of pts were: unspecified
"HIV disease progression", cardiopulmonary failure, PML_, AIDS dementia/HIV encephalopathy CNS lesions with no defined etiology CMV disease, and renal failure.
Conclusions: These changes in the most common causes of death from those seen earlier
in the epidemic suggests that aggressive medical management, including antiretrovirals and
l01 prophylaxis, has had an impact on causes of mortality with a shift to bacterial infections
and to diseases that are not currently preventable, including organ failure.
Shelley Hurwitz, PhD Harvard School of Public Health 665 Huntington Ave, I -1206 Boston,
MA, USA 02115 phone [phone] fax [phone]
Mo.B. 1223
HIGH DOSE (4 MG/. ICC) INTRAVITREAL GANCICLOVIR FOR ZONE I CMV
RETINITIS
Lieberman, Ronni M", Orellana j*, Chatterqee R*, Velez W*, Dauhajre J*, Adelson K. *Mount
Sinai School of Medicine, New York, NY USA
Objective: To determine the safety and efficacy of high dose (4.0 mg / 0. Icc) intravitreal
ganciclovir.
Methods: Ten patients (10 eyes) with progressing persistent Cytormegalovirus (CMV) retinitis
in zone I were treated with a combination of systemic antivirals and intravitreal ganciclovir.
The intravitreal dose was 4.0 mg / 0.1 cc injected under topical anesthesia twice per week
for three weeks. Systemic reinduction with their current antiviral was also done. Pre-therapy
visual acuities ranged from 20/30 to counting fingers. Pre-therapy and post-therapy electroretinograms were performed.
Results: Nine eyes (90%) demonstrated significant improvement in their fundus appearance. Seven eyes (70%) demonstrated complete resolution of their active C/MV retinitis.Two
eyes (20%) demonstrated incomplete resolution but no further progression, while one eye
(10%) demonstrated no resolution of the retinitis. (Disease progression defined as an
extension of the active border for more than 750 microns.) All eyes (100%) either
improved or stabilized their visual acuities on the ETDRS chart. Pre-therapy and post therapy electroretinograms did not demonstrate a significant change in wave function.
Conclusions: For patients who demonstrate persistent advancing CMV retinitis despite
intensive intravenous antiviral therapy high dose intravitreal ganciclovir can achieve a stabilization or an improvens rt in both their visual aciities and liical status.
Electrophysiologcal testing suggests thait sigh dose gariciclovir is not toxic to retinal tissues.
Ronni M. Lieberman, M.D. [phone] 944 Park Avenue New York, NY USA 1f3028
Mo.B. 1224
HUMAN CYTOMEGALOVIRUS, HUMAN HERPESVIRUS-6 AND HUMAN
HERPESVIRUS-7 DNA IN COLONIC MUCOSA FROM HIV-SEROPOSITIVE PATIENTS
WITH DIARRHEA
Gautheret A.", Monfort L*", Porel L, Desire N"*", Nicolas JC"', Agut H*, Beaugerie,
Laurent*. * Laboratoire de Virologie, CNRS EP57, H!6pital Pitie-Salpatriere 75013 Paris,
France; ** Service d'Hepato Gastroenterologie ct Nutrition; *'laboratoire de
Microbiologie Hfpital Rothschild 75012 Paris, France.

Objectives: fT r, tu t,e. sence of tHCMV, HHI-t-6 Iand HV i/ In the O,>;I rc. f
HIV-seropositiv,b.,ith diarrhea.
Methods: TI;,'.,,, i:uroposrtive patients with diarrhea w ere exploredi1A' 'iFA- e
colonoscop, i-, r,!,, bi'ospy cultures of stool and intestinal biopsy,alnple,
mopatholo c ri ' r, v-i ',re performed in all patients. Nucle c acidif.t, prept'f tr ir'f fIi
intestinal blospes n sn i fcal methods. Detection o/fH-IMV HIHV 6 aI d FIll / )INA
done by the pu. erae.ain reaction (PCR) usin specific prieroll,,,r; I, il Irii
tion with oligonucleotridic probes. H1uman herpesvirus-6 viariats wer e fi r itrfedh i r 1
PCR using variant-specific priners and by hybridization with vriant pe fic prof
Results: Of the 32 intestinal biopsies tested, 15 (47%). 8 (25%) at 3 (72i%) 1 te
for HCMV, HHV 6 and HHV 7 DNA, respecti vely. No corretion bet e thc del(_tr f
HCMV HHV-6 or HHV-7 DNA was evidenced. The aspect of coloi rncos i.vii rri,
erythematous, or ulcerative for 21 (66%),7 (22%) and 4- (12.5%), r aispectiely. iitit,,
ly significant association was evidenced between the endoscopic aspect of tr, c i
mucosa and the detection of each virus.
Conclusions: HCMV, HHV6 and FHV-7 sequences were detected in thecolor cos
with a large predominance of HHV 7 No statistical correlation was eidrieii cl h
analysing the concomitant detection of the viruses. M loreove; their detction r a s stt,,
tically linked to the endoscopic aspect of the colonic mucosa. However, these ultRio nt
give information on the nature of these viral infections. Thus, immunohistocheml (r ri ie
situ hybridization assays are presently underway to precise the cellar Io iz it of te
viruses in this tissue, the state of their infection, and their p ative role it i le It i i.
L. Beaugerie, Service d fHepato-Gastroenterologie et Nutrition, H6pital Rothel r d
Picpus 75012 Paris, France.Telephone: 33 (I) 40 19 31 10. Fax: 33(I) 109 3 t1
Mo.B. 1225
FREQUENCY OF CMV-INFECTION OF THE LUNG IN AIDS-PATIENTS AND ITS
PATHOGENIC IMPACT
Bieniek, Bemhard j*', Arasteh K*, Heise \N, Futh U ", Averdunk R ''",Ir re' ', IL
M*. Auguste Viktoria Hospital, Berlin, Germany; *Department for itriitnal red n, '
Department for Laboratory ** Inst. of Pathology
Objective: To evaluate the role of CMV-infection of the lung in severe ther ifs istit
pneumonia or spontaneous pneumothoraces in AIDS-patients
Method: Fifteen HIVinfected men with symptomns of severe pnenureoniaiha be ' oI er.cvI
Detection of cytomegalo virus-cells and CMVimmuno histochemistry in Iute tu.
Results: In 5 cases of spontaneous pneumothoraces (total umber: 10) theinfu rt, tiu e,
gained by lung resection (4) or ipsilateral transbronchial biopsy (7), proved lCMV-posite
histological and immunohistochemical finding. In one case (of two) the bronchoaeol
lavage showed a positive result for pp65. In two cases of severe therapy-resistant itersttfor
pneumonia (total number: 5) the lung tissue won by transbronchial biopsy show,i I of
CMV-Infection histologically and immunehostochemically. In 4 of the 7 CMiV po te ri, ti
sue cases an antiviral therapy with intravenous Foscarnet lead to an improerrrnt/i r 5 es
of the interstitial pneumonia.
Conclusion: CMV-Infection of the lung tissue is a frequent finding in therap reslstnt cere
pneumonia as well as in spontaneous pneumothoraces in AIDS- patients Antviral tre itmert
seems to be helpful in these cases. For earlier detection we initiate 1attid o',)ar ii
pp65 evidence in bronchoalveolar lavage and histological findings in lung tsue.
B.J. Bieniek, Auguste-Victonra Hospital, Rubensst: I 26, Berlin, Gerany
Telephone: [phone], Fax [phone]
Mo.B. 1226
PREDICTIVE VALUES OF CMV-pp 65 ANTIGENEMIA FOR THE DIAGNOSIS OF CMV
DISEASE IN HIV-INFECTED ADULTS
Reynes, Jacques, Montes B, Atoui N, Segondy M. Centre Hospitalif 'r s rta,',i
Montpellier Montpellier France
Objective:To establish the diagnostic value of the cytomealovi-us ((,MV'. pp6r,n r Ie
mia in CMV disease occurring in HIV-infected patiernts.
Methods: CMV-pp65 antigen in polymorphonuclear leukocytes (Pt-ls),ay, a 0_ed
373 samples from 138 randomly-included adults followed up for a sy ptomatcis ii V I
infection (71,7 % had AIDS, median CD4 count was 20/ramm3). The correlition b t,,,eei
CMV pp65 antigenemia and diagnosis of CMV disease was investigated.
Results: Thirty-seven CMV disease episodes were observed in 30 patients and 9.2 % of
these episodes were assoaated with a positive CMV pp65 anrtigenemia iFor t ritlei
who developed a positive CMV pp65 antigenemia and presented a subsequent progre,
toward a CMV disease, the delay between the posivity of the aay and the Iyr f
the disease was 102 ~ 39 days (range 40 172 days). In contrst. 94 of theai tr sii,
tive for CMV-pp65 antigenemia remained flree of CMV disease
Patients with CMV disease had significantly higher levels of CMV pp l ii 'e eor than
CMV disease-free patients (695 positive cells/2 x 105 PMN.Ls versus 28 positiv els/2 x
105 PMNLs).The positive and negative predictive values of a positive antrirnern were -t
% and 94 %, respectively, but were 93 % and 80 %, respectively, when a CMV-ppC1,ntite
emia level of > 100 positive cells/2 x 105 PMNLs was taken into consideit
Conclusions: High levels of CMV-pp65 antienemia are significantly aocated with (VrfI
organ involvements. CMV-pp65 antigenermia assay is usefis for the r tiin I,
the diagnosis of CMV disease in HIV-infected patients.
F Reynes, CHU Gui de Chauliac, F 34295, Montpellie, France Telephor: 6/ 1 /2
Fax: [phone]
Mo.B. 1227
FUNGEMIA IN PATIENTS WITH AIDS: ETIOLOGICAL ASPECTS
Silva, ML*, Melhem, Marcia*, Orozco,SFB*, NinomiyaA*, Palhares.Mc A' ' 'itir AoI
Lutz-Secretary of Health;*CSTD/AIDS Reference &I rai,, F enti sO rt i Il
Saio Paulo State,SPaulo, Brazil.
Objective:To detersrine the etiological agents respo nsib e for I err i ii -- I I i.
with AIDS.
Methods: From 1989 to 1995, 2884 saiples from i 628 febr n-le t if a,
by CDC AIDS case-definition criteria were analysed. Blood saplcs 'ccieo Ir I r
onto brain heart infusion (BHI) medium or casein contnng ed ic' (Ni FfR1,1fa /I91.

93