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

Mo.B.1301 - Mo.B.1306

Monday, July 8, 1996

CDC stage, patients with arthritis were more likely to progress to death (P<.00 I). Time to
event analysis including CD4 <200/mm3 and AIDS defining illness will be presented.
Conclusions: I1. Arthritis, myositis and CTD are not uncommon in the setting of HIV infection. 2. Many patients with objective articular disease have arthritic conditions of unknown
etiology. 3. Inflammatory arthritis appears to be a marker of poor prognosis.
LH Calabrese, 9500 Euclid Avenue, Cleveland, OH 44 195 Telephone: [phone]
Fax: [phone] email: [email protected]
Mo.B. 1301
SLEEP DISORDERS IN HIV POSITIVE PATIENTS.
CURABLE CAUSES OF DAYTIME FATIGUE AND SLEEPINESS
Francis B. Buda M.D. ABSM, ABPN: Atlanta, Georgia, USA Associate Professor Morehouse
School of Medicine
Issues: HIV+ patients complain of daytime fatigue/excessive daytime somnolence (EDS) and
insomnia. Previous studies on sleep in HIV+ have identified disrupted sleep architecture, and
recently obstructive sleep apnea (OSA) secondary to tonsillar hypertrophy
Project: Six HIV+ patients were evaluated by a board certified sleep medicine physician
and received polysomnography in an accredited sleep-center All had daytime fatigue; 4 EDS;
3 sleep maintenance arid initiation insomnia; 4 enlarged tonsils, 5 were male, I female; ages
29-37 yrs.
Results: Three met the criteria for periodic leg movement syndrome (PLMS) and were successfully treated with clonazepam.Three met criteria for OSA, all with enlarged tonsils; 2
were treated with tonsillectomy and I with CPAP. One with PLMS had significant tonsillar
hypertrophy without sleep apnea. Insomnia was noted in 2 with PLMS and I with OSA. In
all instances, treatment of the medical sleep disorder lead to elimination of the EDS, daytime fatigue and/or insomnia.
Lessons Learned: From this limited group of patients it can be inferred that many HIV+
individuals with daytime fatigue/EDS have medical sleep disorders. Proper diagnosis and
medical treatoment of the sleep disorder produced significant impiovement in quality of life.
Individuals treating HIV+ patients need to be aware of medical sleep disorders as treatable
causes of daytime fatigue, EDS and insomnia. Warning signs of medical sleep disorders will
be discussed.
Francis B. Buda, M.D. 207 Westminster Dr NE Atlanta, Georgia 30309 [phone]
Office (404) 85-9282 Fax FBBMD~taol.com
Mo.B. 1302
EVIDENCE FOR AN INCREASED INCIDENCE OF RENAL CELL CARCINOMA IN
PATIENTS WITH HIV INFECTION
Baynham, S.A., Cleveland, K.B., Katner, Harold P., Smith, M.U. Mercer University School of
Medicine, Macon, Georgia, USA
Objective: To determine if the incidence of renal cell carcinoma (RCC) ic a population of
patients with HIV is greater than in the general population.
Methods: All 85,532 adult admissions to a 518 bed general hospital in the USA from 1990
to 1994 were reviewed to determine the total number of HIV admissions, the total number
of patients with renal cell carcinoma, and the total number of patients with concomitant
renal cell carcinoma and HIV infection.The incidence of HIV positive adults in this hospital
population presenting with RCC was calculated and compared to the incidence predicted
from the national incidence of RCC based on the Poisson distribution.
Results: 309 admissions were HIV infected, three of which had concomitant renal cell carcinoma. A total of 48 additional cases of renal cell carcinoma were documented during this
time.The calculated probability of an adult presenting to this institution with renal cell carcinoma is 0.0006.The estimated probability of the national incidence of RCC is 0.000 I. Using
these densities in the Poisson Equation, the probability of observing three cases of RCC in
309 HIV admissions was 0.0000053 compared nationally and 0.0008667 compared locally.
A comparison of two proportions was performed for the national and local data. National
results yielded a r value of 9.956 at a P<0.00I with a power of 0.874. Locally the z value
was 4.808 at P<0.001 with a power of 0.786.
Conclusions: Our data reveals that the incidence of RCC in HIV patients is 97 times
greater than in the general population. If this finding is supported in future studies, consideration should be rade to classify RCC as an AIDS defining illness.
Harold P Katnerc M.D., FACP PO. Box 6000, Macon, Georgia 31208 USA
Telephone: [phone] Fax: [phone]
Mo.B. 1303
OTONEUROLOGY ALTERATIONS IN HIV PATIENTS.
Pena C, Cano C. Hospital General Centro Medico La Raza IMSS, Mexico.
Objective: To determine the otoneurology alterations presents in patients HIV (+-).
Methods: 50 patients HIV + were evaluated, none oportunistic infection previous, none
otoneurology disease previous, none eighth nerve previous alteration, none ototoxic drugs
antecedeit or central nervous system disease were included. Clinical evaluation, otoscopy
audiology study Auditive Potencials Evoke from Brainstem (APEB), and vestibular study with
electronistagmografic were made.
Results: Thse pincipal alterations were found in the APEB study It showed conduction central alectatron in the afferent auditive way froei Brainstem (I12 cases), despite that these
patients haid normal audition. On the other hand, the vestibular study showed affectation in
the vestibulo-cei-ebellar ways and peripheral vestibular paresis: sacadics movements with
hipometries I case, bilateral sacadic tracer 22 cases, pasive asimetric optoquinetic nyctagmus
33 cases, optovestibular asimetric response 39 cases, failure in the visual suppresiori of the
vestibular response 38 cases, psi-n vestibular with bilateral paresis 35 cases.
Conclusion: we concluded that the HIV + patients can to present subrllnic otoneurologic
alterations, despite that Ia HIV infection is asymptomatic, and the HIV infection may be considered in the diferencial diagnoses in patients with unexplained anormal result of otoneurologic study.
Cecilia Pehia Contreras Aveniddda 5 De Mayo I152 I Col. Lomas De Tarango Ap. 19- 132
Mexico U. F. Phone: 6431I849

Mo.B. 1304
ROUTINE CHILDHOOD VACCINATIONS: EFFECT ON HIV- I SEROCONVERSION
Embree. Joann* ", Nageierke N* **, Datta P**, Njenga S**, Ndinya-Achola JO**
Plummer FA "*. *Uni ve sitof Manitoba, Winnipeg, MB, Canada; **University of Nairobi,
Nairobi, Kenya
Background and Objectives: Concerns have been expressed regarding the effect of childhood vaccinations and or, the transmission of HIV- I virus from mother to child. Certain
vaccines may stimulate Th I to Th2 switches of primary immune responses resulting in a
predominantly humnoral rather than cell mediated responses to antigen challenge. Cell mediated responses may be protective in HIV- I infection.Thus, a switch to a predominantly
humoral antibody response triggered by vaccinations in children exposed to HIV- I in breast
milk could'result in an increased risk of HIV- I acquision.The study objective was to investigate whether administration of childhood vaccinations in childen born to HIV-I seropositive breast feeding mothers would result in an increased risk of postnatal HIV-I infection.
Methods: Infants enrolled in the Nairobi HIV- I Mother-to-Child Transmission Study were
assessed. HIV- I transmission was studied based on the receipt of BCG, a complete or
incomplete course of DPT and for oral polio and measles vaccination. Children born to
HIV- I seropositive mothers were followed at regular visits at the Research Clinic and HIV- I
antibody status was determined at each visit. Children who were seropositive following 15
months of age were considered HIV-I seropositive and were divided into two groups: peisistently infected (seropositive at each follow-up visit) and converters (demonstrated loss of
maternal antibody then reconverted). Children who died or were otherwise lost to followup prior to determination of infection status were excluded f-om analysis.
Results: There was no differnce in BCG administration among negative (282/297, 94.9%),
persistently positive (65/69, 94.3%) or converting children (39/4 I, 95. I %).The number completing their DPT/oral polio vaccinations was also similar: 94.3% of negative, 91.3% of persistently positive, and 95. 1% of converting children.There was also no difference with measles
vaccination: 90.5% negative, 85.5% persistently positive, and 92.6% of converting children.
Conclusions: For children surviving to 15 months of age, routine immunization does not
appear to increase the risk of postnatal HIV- I transmission.-Whether the Th I/Th2 switch
induced by some vaccinations is significant for children who acquire and/or succumb to
HIV- I infection during the first year of life will be assessed by molecular technology.
Dr. Joanne E. Embree, Department of Medical Microbiology, University of Manitoba,
Room 530, 730 William Avenue, Winnipeg, MB, Canada R3EOW3
Mo.B. 1305
PAINFUL PERIPHERAL NEUROPATHY WITH CMV INFECTION IN A PEDIATRIC AIDS
PATIENT
Leroy J, Estavoyer JM, Lassauge F, Desmurs H, Mueller E, Jeangirard M, Couaquette A.
University Hospital of Besancon, Besanon, France.
Introduction: Cytomegalovirus (CMV) is well recognized as an opportunistic pathogen in
children with HIV infection. Neuropathy caused by CMV is a rare but serious neurological
disorder that occurs late in the course of HIV - I infection in adults.To date cases of
peripheral nerve dysfunction in pediatric patients have been unfrequently reported.We
present a patient with severe painful neuropathy caused by CMV infection.
Clinical case: an 1 8- month old female child with AIDS was admitted for fever and vomiting. Past medical history included lung pneumocystis and liver CMV infection and at time of
admission the CD4 cell count was 0,66 x 10 9/L. She was whithdrawn showed paroxysmal
arching of the back and limb extention with intense crying, even in her-sleep.The patient
demonstrated hypersensitivity to tactile stimulation (allodynia). All of these signs evoqued
the diagnosis of peripheral neuropathy.The involvement of CMV infection was supported
by CMV found in peripheral blood samples and the negativity of all investigation including
studies of CSF, for bacteria, fungi, parasites and other viruses.The child received gancyclovir
(5 mg/kg intravenously, twice a day) and morphine sulphate was gradually increased to 4
mg/kg/day. A sustained clinical and biological response was obtained but impression of pain
continued in spite of the increased morphine dose.Within I day of treatment by clonazepam (0,05 mg/kg/day increased in 3 days to 0,I mg/kg/day) child's behaviour dramatically
improved with a complete reduction of paroxysms, including quiet undisturbed sleep.
Morphine was stopped; she was doing well, and clonazepam was gradually reduced and
stopped by one month.
Conclusion: The management of HIV infection and its complications results in considerable
pain that is frequently underestimated. Painful peripheral neuropathy in pediatric AIDS
patients with CMV infection must be suspected despite difficulty in recognition. In this case,
the key to success was not opioid analgesia but rather a drug co-analgesia such clonazepam.
J.M. Estavoyr 2 place St Jacques, 25030 Besancon Cedex, France Tel.: [phone]
Fax: [phone]
Mo.B. 1306
EFFECT OF COMBINATION THERAPY WITH ZDV/DDI OR ZDV/3TC ON PLASMA
HIV-RNA IN HIV-INFECTED INFANTS AND ADOLESCENTS
S nder B. #,Wintergerst U. 8, Notheis Gondola #, Eberle J., Gmirtler L., Belohradsky B.#.
#Immunodeficiency Department, Children's-Hospital: Mbax-vori-Pettenkofer-lnstmtute,
Ludwig-Maximilian's-University, Munich, ERG
Issue: To assess HIV-RNA load in HIV-infected children and adolescents (< I 8 years, mean
age 7. I years) under antiretioviral combination therapy.
Patients and Methods: 5 patients with disease progression under their prior antiietroviial
therapy were treated with ZDV (4x9Omg/m 2/d)/DDI (2x I00mg/m2/d) (group A) and 6
patients with ZDV (4x9Omg/m2/d)/3TC (4x2mg/kg/d) (group B). Patients were followed up
every 4-8 weeks for an avdrage period of 8.6 months.Viral copy numbers and lymsphocyte
subsets were determined by QC/RT-PCR (Amplicorc Roche) and flow cytometry using antiLeo 4, anti-Leo 3a and anti-Leo 2a. In addition, in an attempt to balsnce the simultaneous
effects of antiretroviral therapy on the immune system and the viral load we calculated the
ratio of viral load per CD4-cell (copies/tpI/CD4-cells/plI).
Results: In group A patients mean relative changes in C D4 cells were a 20% (0.08 log1I0)
increase after 4 months (n.s.) and a return to baseline after 8 months: in group B patients
mean relative increases of CD4-cells were 72%/ (0.23 log10, pr=0.03) and 50% (0.1I7 logt10,
nes-), respetively. In group A mean relative viral load increases 2 1% (0,08 log 10 n.s.) and
7I% (log 0.2310, n.s.),whra ngrop B tia oad decreases 22% (0. I log10, n.s.) and

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