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

Track B: Clinical Science

Mo.B.1307 - Mo.B.131 I

74 (0.58 log10, p--0.03) below baseline after 4 and 8 months, resac. t', /he ratio of
viral load/C([)4' cell count was low (< I) in patients with CD4-cell coat_, 'at.ew 250/pi
eflecting a low viral turn over per CD4-cell in these patients. Ho.i:, ir p tierits with
advanced disease (<250/pl) this ratio was above I before starting:,tini 1i therapy
iicrting a higher viral production per CD4-cell in these patients.;r,;tprtng antiretroviial ctntiriation tlherapy in group A there was a trend of a decrn- i alio, but the differences were not significant (Mean~SD: 1.4~2.7, 1.0.0~1.5, 0.6~0.9 it,I id 8 months)
whereas in group B this ratio significantly decreased (Mean~SD: 5 6 U ) 0.9, 0.75~1.0
at 0,4 anid 8 months, p-0.046 and 0.01, respectively).
Conclusion: In a small cohort of pediatric patients therapy with Z)V/ 1 I rd a significantly stronger and more sustained effect on the reconstitution of CI1 )ic! " and on the long
te decrease of the viral load than treatment with ZDV/DDI.;indul Notiheis, University Children's Hospital, Lindwurmstr. 4 37 iriu' i I,i FRG.
Phone: [phone] I iax: [phone]
Mo.B. 1307
CNS -AFFECTION IN PERINATALLY HIV- INFECTED CHILDREN
J.Josep Steiner; M. Funk, D.Mentzer, G. Jakobi, WKreuz. Department, f P ditrics, Johann
Wolfgang Goethe University Frankfurt/M. Germany
Introduction: Soon after the initial description of paediatric AIDS, ii'itr.l r ' vous system
(CNS) irnvolvement was recognized as a frequent anifestation. hiis presen"tation summait7 the nect ologica iripairermnts, the diagnostic tools used and the therapies, in a paedisltic col itseeni is our out-patient clinic.
Patients: In 34 perinatally HIV infected children time of manifestati-in type ar i treatability
of neurologic disorders wer e investigated for a period of 7 years I 987 - 1994).
Methods: Neurological examinations were done every 6 monthI EEtntis InI RIiCT were
exar cied initially in the asymptomatic stage and were repeated -her; neurologic symptoms
cccured. Zidovudine therapy was started after onset of symptorns, ri sage was raised, when
treatient with Zidovudine had already begun (600 - 720 mg/ a /day)
Results: Various neurological manifestations were seen in 4 of 12 p rtienti sin sptage B (33%)
anrd in I of 14 children in AIDS (80%). 7 of the 14 AIDS-patients (50%) developed a subacute progresive course os r progressive plateau course and 4 of I' ', itiets (29%) showed
sa i e atc eol rrsof encep hopthy.
Pathologi Iical changes in EEG were observed in 54 % of investigalted ptit' I with neurologicil defickits. Neuroimaging revea.led pathological findings in all symptorntic saubjects, 6 of II
fia entsin AIDS (55%) had a severe general cerebral atrophy and rrnutifrcal,'white matter
lesions. Zidovudine tad a positive temporary effect from 6 to 12 ronth si ini 5 of I I treated
ittieis (45%).
Summary: At present a thorough neurological examination is the r iost sensitive method to
detect neurclogical irrpair ient in HIV infected children. In most cases c (I/RI scan provides irfor rmation about the course of CNS affections. Antiretrovral lherapy has a limited
benefit, i f neurologic symptoms start after the second year of life.
J.Josep Stn ner; Depar tment of Pediatrics, J.W. Goethe-University -ii rnkfir t,rTheodor-Sternai7, I_ ()0590 Franrkfurt ari Main, Germrany Telephone: 06 9/ 6 10 I 6090
i 6 9/16301 649 I1
Mo.B. 1308
CHRONIC HEPATITIS IN CHILDREN WITH VERTICALLY ACQUIRED HIV INFECTION
LE.Kug 1- t. Sa to*,, C.Giaquinto*, R.D'Elia", EZacchello*, L. Zancs. * Dipartimento di
Pediat ia, Universitsi degli Studi di Padova, Italy.
Objective: Io evaluate the prevalence, the characteristics and the prognostic value of
ciironic hepaitis in children with vertically acquired HIV infection.
Methods: We prospectively studied '7 HIV infected chrildr en, 23 of them from birth.
Ch Idren were evaluated clinically immunologically and virologically at least every 3 months
Arninoti s ferasis (AST, ALT) were routinely measured. Chronic HIV hepatitis was defined
as an increase of AST and ALT more than twice normal levels, persisting for at least 6
months without any other common infective (HBV, HCV, CMV EBV, Adenovirus) and drugs
related causes of liver dysfunction.
Results: lwenty three children were followed up fiom birth for a mean of 5,2 years (range:
8n-9y). Fifleern (65%) of them developed hepatitis by 5 years (range: 2m Sy). All but one
ci ld kii a persistent increase of AST and AL. Eleven (48%) developed It IV hepatitis; the
rea i'level of AS I was persistently higher than ALT, GGT and triglyce ide s were also elevaled. I ie four (1 7%) remaining children were HCV positive and had, as,pectecd, an higher lev'l of Al I than AST, whereas the levels of GGT and triglycerid w' sri is aitrTal.
In sl cildrenr studied (n=47) we evaluated the relative risks of pr i' cr nto AIDS and to
deatir at I year after developing I IV hepatitis:

to the 1994 CDC classification system for HIV infection in children; histologic features and
phenotype of malignant cells; previous anti-retroviral therapy; initial treatment; and survival
from time of treatment to death or to December 1995.
Results: Among 664 HIV-infected children younger than 14 years, malignancies developed in
14 (2%). In 3 of these patients the diagnosis was made postmortem.The age ranged from 2
to 13 years (median 4.5) All the children, except 3 who acquired HIV-infection from transfusion of factor VIII, had vertically transmitted HIV-infection.Ten patients had received previous zidovudine therapy.
Eleven children had non-Hodgkin's lymphoma (NHL) (9 with B-cell phenotype and 2 with
T-cell phenotype); 2 had lymphoblastic B-cell leukemia (L3); and I had a rabdomyosarcoma.
All the patients with NHL, except one, had extranodal disease: brain, liver, bowel, lung, kidney, bone marrow and mediastinum were the sites involved.
The majority of children had an advanced stage of HIV disease and/or severe immunosuppression (category C3, 7 children; B3, 3 children; and categories AI and A2 and A3, I children each). In one patient the tumor was the first recognized manifestation of HIV infection
and AIDS. The response to chemotherapy was poor: All the children, except one, died
shortly after the diagnosis of malignancy
Conclusions: The prevalence of rmalignancies in Spanish HIV-infected children is about 2%,
but may be higher as suggested by postmortem diagnosis in 2 patients.The majority of neoplasias have B cell origin, involve extranodal sites and develop in children with advanced
HIV-disease or severe imnmunosuppression.The high malignancy-related mortality rate found
in our series rnight be due to the advanced stage of HIV disease.
Jesus Ruiz Contreras - Hospital 12 de Octubre - Cra. Andalucia Km. 5.4 - 28041 Madrid -
Tel [phone] Fax [phone]
Mo.B.1310
NOSOCOMIAL OUTBREAK OF MULTIDRUG RESISTANT TUBERCULOSIS IN HIV
INFECTED CHILDREN
Mellado Mi, M Fontelos R Cilleruelo Mj, Garcia M, Barreiro G, P Jurado MI, Ortega A*,Villota
J. Instituto De Salud Carlos Ill. CIC. Servicio De Pediatria. *Unidad De Micobacterias.
Madrid, Spain.
We present a nosocomial outbreak of multidrug-resistant tuberculosis (MDR-TB) in a -
Pediatric Infectious Unit, attending HIIV -infected children.
Case I: Female 10y Father IVDA with TB and bad compliance to treatment. On Jan/95
CD4=55 culture of M.TB +.Treatment: H+R+Z, 4weeks later culture resistant to H,R,SE
and susceptible to Eth.We changed to: Eth+ Of+ C+ Pas. Exitus 26 weeks after diagnosis.
Case 2: Male 3y. Exposure to case I; 6weeks later culture of M.TB+, CD4=40.Treatment
H+R+Z. After 3 weeks culture remains + and we added Of+ Pr+ AK. Exitus 6 weeks after
diagnosis.
Case 3: Female 9y.Exposure to case I; 6weeks later culture of M.TB+, CD4=85.Treatment
H+R+Z One week later we add Of+ Pr+ AK. Exitus 6 weeks after diagnosis.
Case 4: Female 4y. Exposure to cases 2 and 3; 8 weeks later culture of M.TB +, CD4=32.
Treatment H+ - R+ Z, we withdrew drugs by liver failure. Death 3 weeks after diagnosis.
Resistance pattern of M.TB: similar to case I.
Comments: In our experience, MDR-TB in severely immunocompromised HIV-infected children is an extremely infectiousness illness, despite of severe respiratory isolation measures.
The second line anti-TB drugs, have been badly tolerated and non-effective in our serie.
-The disease show an agressive behaviour, high mortality (100%) and the median survival
time from diagnosis has been of II weeks in our cases.
H:lsoniacid, R:Rifampin, Z:Pirazinamide, S:Streptomicine, E:Ethambutol, Eth:Ethionamide,
Of:Ofloxacin, Pr:Prothionamide, C:Capreomicine, AK:Amikacine.
Ma. Jose Mellado. Instituto de Salud Carlos III. CIC. Servicio de Pediatria. C/ Sinesio Delgado,
10. 28029 Mladrid. Spain.Tfi 3-14-08-07. Fax: [phone]
Mo.B.131 I
BARTONELLA HENSELAE LYMPHADENITIS IN AN HIV POSITIVE CHILD:
A DIAGNOSTIC AND THERAPEUTIC CHALLENGE
Wyler Claire Anne*, MassereyV*, Lironi A**, Suter S*, Borisch B***, Siegrist C-A.*.
*Department of pediatrics, **Department of pediatric surgery ***Department of pathology University of Geneva, Switzerland.
Issue: Brrtonell henselue is associated with benign cat-scratch disease in healthy children, or
bacillary angiomnatosis, retinitis, prolonged and severe malaise, disseminated infections in HIV
infected immunodeficient adults.We here describe the diagnostic and therapeutic challenges
of a severe B.liensele submandibular lymphadenitis in an HIV infected child with partial
immrunodeficiency
Case report: A 3 year-old male caucasian born to an asymptomatic HIV positive mother
was doing well on IVIG and Zidovudine since the age of 6 months. His HIV infection was
classified as stage B2 (CD4+ count above 800/mm3) at time of admission for a febrile left
submandibular lymphadenitis. US examination revealed abscess formation, which led to surgical incision and drainage. Culture of pus was positive for a group A streptococcus. A first histologi cal examination of an adjacent lymph node indicated features of follicular hyperplasia. In
spite of intravenous antibiotic treatment, recurrent abscess formation occured in adjacent
nodes of the left submandibular area and required additional surgical procedures.The child
eventually improved slowly when administered imipenerm, which had to be maintained for 5
weeks. A repeat biopsy obtained 3 weeks after admission revealed histological features suggestive of cut scratch disease - although less prominent than in immunocompetent individuals
- confirmed by positive specific coloration for B. henselae. Serology was non contributive.
Discussion: Partial immunodeficiency did not allow this 3 year-old HIV infected boy to build
the strong immune responses usually induced by cat-scratch disease and resulting in positive
serology and typical histopathological findings.Thus, B. henselue infection should be considered in the differential diagnosis of localized lymphadenitis in HIV infected children even in
the absence of classical diagnostic criteria. It requires prolonged administration of antibiotics
active against B hensele, but does not necessarily lead to disseminated infection as
observed in adults with more advanced immunodeficiency
C-A. Wyler; Dept of pediatrics, University Hospital of Geneva 6 rue Willy-Donz6, 121 I
Geneva 14, Switzerland Telephone: +4 I 22 382 68 I8, Fax: +4 I 22 382 46 24

Cm
m)
Ga
0
V
cin
c0
Ia

AS I/Ai 2X
AST- AI I 5X
AST AII 10X

Progression to AIDS
RR(95 % CI)
4.8 (0.6 38)
5.8 (1.04 32)
10.8 (2.5 46.4)

Death
RR(9S % CI)
2 (0.8? 122)
I, (.0,! 108)
i, (25! 4., )

I

S Conclusions: ItlIV infected children frequently develop HIV hepati v "sit, A - F!AlT ratio >
I I rdi elevated levels of (GGf and triglycerides. High levels of ALT md A 1/I ( ' atimes) are
C signirficantly correlated with the progression to AIDS and the risk i 'I elh.
O
U E.M.Ruga, Diptartimen to di Pediatria,Via Giustiniani, 3, 35I28 Padov, italy lelephone: +
- 39.49.82 13585 Fax -+ 39.49.8753865 email:[email protected]
O Mo.B.1309
1, MALIGNANCIES IN SPANISH CHILDREN WITH HIV INFECTION
c Ruiz Contrerasj, De Jose Ml, Ramos JT, Fortuny C, Hernandez-Sarinp,,.1 I Porheviche I.
) the Spanish Pediatric AIDS Collaborative Group
c:c Objective:-lo letermine the prevalence, types, clinical manifestations and outconme of malignancies in HIV infected children.
X Methods:- his is a multi-centric retrospective study We identified all I-V infected children
who developed cancer, from 1984 to 1995, in 10 hospitals in Spai,. WVse collected the clinical
I 08 andl labioratory data; status of HIV infection and severity of immunosui 's onr according