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

Mo.B.1267 - Mo.B.1272

Monday, July 8, 1996

Diagnosis

< 1990,n = 3,102 > 1990,n= 5,024
lI(e,.D4 ouit at ir of dtg) pts % CD4 pts % CD42 rel
change,orra ].00 i38 49 098 29 0.98
S28 0.90 ) I 80 1.59 175 1. 76
_M:b, r,,, c l., r, MAr 26 0.84 72 612.13 42 1.35
r% synr onr,e25 0.81 I 1! 66!.31 1') 7 16:3
24 0.77 09 70 1.39 77 1.8.
r,. 'F. or t1 2? 0.74 91 1.81 91 2.44
5 0.48 170 34 068 I'6 1.40
r y, 1,4 0.45 92 47 0.86 64 1)30
r,, r r e r9 0.29 149 0.10 -1 034
7 yt 4 p7n7purpir {lP) 8 0.26 447 74 1.47 2410 5.71, (,,kercopholop 7Fhy (PMI 8 0.26 134 57 1.1/ 3 t 16 4.40
St r,5 0.16 52 16 0.2 64 1.98
S!asocated diseases rema in rare with the exception of ITP eand PMLu
r, lted during the observation period in the SHCS.The incidence of pulSl slightly ncresed and is not yet a ma7or epidemiologic pr obler in

Conclusion: R,
which nmtrkedly
onary t7 iu er l
Sw 7tzerlnd

BE Burckh, ar dt Kn tonsspital Basel, Medizinische Poliklinik, Petersgraben 4, 4031 Basel
Telephone: 01 6 1-265 25 25 Fax: 0 I 41 6 1-265 46 04
Mo.B. 1267
ASSOCiATION BETWEEN DIARRHOEA AND THE PRESENCE OF HIV-RNA IN
STOOL SAMPLES OF HIV-INFECTED PATIENTS.
Frns r77 St '" L van der HoOck", SA Danner*, J Goudsmit"-, C Sol*'". *Division of
Infectious Diseses, Tropical Medicine and AIDS, **Department of Human Retrovirology,
"* ' Departmernt of Medical Microbiology Academic Medical CenterAmsterdam,The
Netherlands.
Objectives: Dia rrhoea is a common clinical problem in HIV -infected patients. Although
many enteric pathogens have been implicated, the etiology remains unexplained in approximately one third of the patients. HIV itself might play a role, but studies on the relationship
between the presence of HIV in the intestinal mucosa and gastrointestinal symptoms have
yielded inconsistent results, maybe due to small numbers as endoscopy was required for
obtaining intestinal biopsies. Since we have developed a detection method for HIV RNA in
faeces, a large study could be performed. Our objective was to evaluate whether an association exists between diarrhoea and the presence of HIV-RNA in faeces.
Methods: Stool samples, venous blood, and questionnaires were obtained from 201 consecutive HIVrinfected patients with and without diarrhoea. Besides parasitological stool examination and bactenral cultures, HIV-RNA was isolated from stool and RT PCR was performed.
The X2 test was applied.
Results: The major-ity of the 20 patients were homosexual men. Half of the patients (49%)
had an AIDS-defining illness. Forty patients had diarrhoea. In 17 patients, of whom 9 had
diarrhoea, pathogens (4 Cryptosporidia, 9 Microsporidia, 2 Giardia, I Salmonella, I
Clostridium difficile) were detected. Among the 40 patients with diarrhoea 25 (62%) had
HIV-RNA in their stool and among the 161 patients without diarrhoea 70 (43%, P=0,03). If
the 9 patients, in whom no HIV RNA could be detected in blood (all with relatively high
CD4 cel count) were excluded, this difference was still significant (P=0.04).
Conclusion: L)htrhoea is significantly associated with the presence of HIV RNA in stool of
HIV ifected ptients. Cur rently therelationship between plama HIV-RNA load and the
pr-esence of IV RNA n stool is studied. Whether HIV itself can be the cause of the diarrh to among such patients, remains to be elucidated.
Sven A. Danner F5, AMC, PO Box 22700, I 100 DE Amsterdam,The Netherlands. Fax: 31
20 696327 1, tel: [phone]
Mo.B. 1268
HOW USEFUL IS ROUTINE INTRAVENOUS GADOLINIUM IN MRI IMAGING OF
THE BRAIN IN HIV INFECTED PATIENTS?
Bnereice A.K., Malcolm PN., Howlett DC., Saks A., Bingharm J.S., Bingham J.B.. Cox TC.S.
Dept of 7d oogy and Gento-Urinary Medine* Guys and St Thomass Hospital, London
Objective: To investigate whether the routine use of an intravenous contrast agent is useful
in magnetic resonance imaging of the brain in HIV patients.
Method: I0 IHIlV patients were studied prospectively and all were given intravenous
gadopenate dimeglumine (0. I mmol/kg) routinely for their brain scans.The scans were
asssesed by two experienced radiologists for the presence of new lesions revealed following contrast administration.
Results: New lesions were revealed in 13% of scans. Contrast was particularly helpful in
showing men ngeal lesions and also revealing lesions within oedematous areas.
Conclusion: Ae conrlude t'hat a normal unenhanced scan does not always mean that the
enhaced sc. n will be normal. Although new abnormalities may be seen, major alterations
in managemcng t are rare.
A.K. Baneree, Department of Radiology, Birmingham Heartlands Hospital, Birmingham, B9
555, UK T-l 012I 766 66 1 Ext 4214 Fax [phone]
Mo.B. 1269
IDIOPATHIC CD4+ T-LYMPHOCYTOPENIA (ICL) - A FOLLOW-UP OF REPORTED
CASES IN THE UNITED STATES
Spira,Thomras J. National Center for Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, GA, USA
Objective: To determine the cur ent status of ICL patients in the United States reported to
CDC as of July 1993.
Methods: State and local health departments and local physicians reporting ICL patients
meeting the CDC case definition were asked to provide follow up information by questionnaire between June and November 1994.
Results: One hundred ten ICL patients had been reported as of July 1993. Of these, 33
(30%) were either lost to follow up or information of current status was unavailable. Of the
remaining 77, 17 (22%) had resolution of their low CD4+T-lymphocyte counts. Eleven

(14%) had diagnoses made of underlying diseases which could account for the CD4+
lymphocytopenia.These included leukemia/lymphoma, 5: myelodysplas,, I; pancyopenia and
sepsis, I; carcinorma, 2; sarcoidosis, I; and end stage liver disease, I. Of the remai'ni t49
patients, 8 (6%) had died.Ofthese 8, I had died of opportuni, inrfection and 2 from
malignancy (disseminated squamous cell carcinoma and EBV relted ymphom). For the
remaining 5, information as to the cause of death was unavailable, althou one s over
70 and 2 over 80 years old.
Conclusions: ICL is a diagnosis of exclusion, that is, other underying d,ea7es vhc a7y
cause lymphopenia must be excluded. Underlying diseases have been d.gr;osed ri number
of reported cases. Other individuals may have transent CD4+ T-lyrnpnocytopena that later
resolves. Patients who continue to meet the case definition are uncommon 'Of these, a rela
tively low proportion had died, and these usually of complications of thei munodeticency.
TJ Spira, CDC - MS-D08, 1600 Clifton Road, Atlanta, GCA 30333, USA Tel: [phone]
Fax: [phone], email: [email protected]
Mo.B. 1270
STUDY OF ELECTROCARDIOGRAPHIC ABNORMALITIES IN DIFFERENT
EVOLUTIVE PHASES OF AIDS
Meira, Domingo s Alves*, Zacchi B", Souza LR, Franco MPF, Curi PR'. I 1ver 7dade E
stadual Paulista - UNESP Botucatu, Sto Paulo, Brasil
Introduction and objective: The cardiac involvement in AIDS has been referred interedcal literature mainly by the presence of pathologic changes observed in au'ops/ The oblec
tive of this study was to verify electrocardiographcal (ECG),abnormalties in the different
evolutive periods of infection by HIV in relation to CD4 count.
Patients and Methods: Fifty-four HIV+ male and female patients over i5 years old were
examined and submitted to follow-up visits in the period between February/93 and
September/95. At every occasion of ECG recording the following tests were also per
formed: CD4 and CD8 count by flow cytometry; heart area (X -ray); hemoglobin (7b) lu
and serum levels of LDH and CK. All patients had the weight and the clnic-7t evolution
determined during the observation period. According to CD4 count they were classified in
3 groups: GI (n-=15); CD4+/mm3 >400; G2 (n= 10): 200 < CD4 rm3 <-400; G3 (n 29):
CD4+/mm3 < 200.
Results: ECG recording with abnormalities of any parameter considered (p >0.25) or ever
low QRS complexes alone (p > 0.50) were early and frequent findings in the groups (CI
G2 = G3).There was significant difference between the following parameters of the groups:
CD8 count, weight variation and number of survivors: (GI = Cu) ' G3, p < 0.001; Hb (GI
= G2) > G3, p < 0.05; corrected QT interval (QTc): (G I = G2) < G3. p < 0.001.There
was a negative correlation between QTc and all the other paramneters studied, including
CD4 count.
Conclusions: Changes in ECG recording can be seen in patients since the clinical latency
phase; the QTc is increased during the progressive phase of the disease: g enera 7zed low
voltage and increased QTc in the ECG recording may be suggestive of myocard opathy
Financial support: Fundacao Coordena go de Aperfenoamento de Pessoal de Nive
Superior (CAPES) - Brasil.
DA Meira, Faculdade de Medicina, Botucatu, Sao Paulo, Brasl, 186 18-000, PO-BOX 522,
Telephone [phone], FAX: [phone] I email drmera@fmb une sp.br
Mo.B. 127 I
ACUTE HEART FAILURE DUE TO CMV MYOCARDITIS CONFIRMED BY
MYOCARDIAL BIOPSY IN A CASE WITH AIDS
Kimura, Satoshi, Masuo M*, RyuT Oka S*, Mor n S*'. Social Health Insurance Medical
Center; *alnst of Med Sri, Univ of Tokyo.Tokyo, Japan
Case Report: For ty-six year old HIV-positive homosexual m<rn presented with DCM-hke
symptoms and acute cardiac failure in December, 1994. He had a history of Pner,s
ctrinr pneumonia two years ago, which was successfully treated with Co tnmoxazo e and
pentamidine. Cardiac failure was controlled with diuretica and digitals preparation, ai
zidovudine and didanosine were started. In July, 1995, he admitted to our hospital because
of severe dyspnea and palpitaticn. On admission his heart rate was 124/min (reg), ECG: ST
T change in I, II aVL, aVF, V4-V6, CTR; 50%. Echocardiogram revealed sever hypoknesisi
anteroseptal region. EF was 20%. Other findings were; CAG, normal; myocardal scrtra,
defect n anteroseptal region; CD4 count,27/1; CMV antigeneia. (+). Myocardal biopsy
disclosed numerous cytomegalic inclusion bodies which were positively sta ned woth nmooclonal antibody against CMV -EA His cardiac function partially recovered by treatment with
diuretica and digitals preparation. In October 1995, ganclovr a0dinistration was started
because CMV retinitis was detected.The administration of ganclovi seemed to have no
effect on his cardiac function.
Conclusion: C1V myocarditis was confirmned by myocardial biopsy Administrat ion of ganc
clovir, several months after the onset of mryocarditis, showed no effect on cardiac function,.
suggesting the necessity of early diagnos s (biopsy) and treatment of CMV myocarditis.
Satoshi Kimura 5-2 Tsukudohachiman-cho, Shinjuku-ku,Tokyo 62. JAPAN
Mo.B. 1272
CARDIAC INVOLVEMENT IS COMPARABLE AMONG HIV POSITIVE AND HIV NEGATIVE PATIENTS AT RISK FOR ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
5Sal, _n., Sukernik, M R, EI-SadrW Conn r J N,Vanderbush, E J. Fran's, C K Harlem
Hospital Center Columbia University New York, New York.
Objective: Cardiac abnormalities have been reported in persons at risk for HIV but the
echocardiographic pattern and prevalence of these abnormalties have not been extensively
studied.
Methods: We reviewed 2-D Doppler echocardiograms (ECHO) in 294 HIV positive and
230 HIV negative patients from an inner ty predominantly black populaton. Mean age for
the study and the control group was 42 + 14 and 47.5 + 14 yr (p-0.0001) respectely
There was no significant difference in gender distribution (Males / Females 157/ 37 vs
128/102 p=0.64) or the number of injection drug users (IDU) 189/294 (64%) vs. 136/230
(64%) p-0.92) between HIV positive and HIV negative patients respectoely.
However HIV infected IDU had a higher frequency of vegetat7ons as compared to HIV
nfected non-IDU;30 (15.9%) vs. 6 (5.7%) p=0.02. Also among HIV negatoes, vegetations
were more frequent among IDU 20 (I 3.7%) than among non-tDU 3 (3.6%) p=0.03.

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