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

Mo.B.1334 - Mo.B.1338

Monday, July 8, 1996

ton. Five days later he left hospital with a diagnosis of simple viral diarrhea. After one week
followng a digestive relapse, persisting high temperature and thrombopenia and having disc losed his bisexuality he was proposed an HIV test.The Western Blot revealed the beginnin of ainfectionr with positive resu lts for gp160 (+++). gp120 (+), p24 (+++): one
month later the whole panel was positive. M eanwhile, the diarrhea was attributed to cryp
tospondosis, thrornbopenia regressed, a facial paralysis also appeared to recress as a result
of anti-inflaoirnatory treatment, the level of CD4 increased from 275 irn to 510 /rem3.
Two months nlater the original lyrnphocytosis had disappeared; the plat i, o-wee it
3 I0000/mrnm3. the CD4 at 550/mrm3 there were no more cryptosponrdo, e stools
and platelet antibodies were positive. AZT treatment was proposed at 250 twice a day.
This case report recalls:a) The now commonly recognized signs of HIV pr-iiar infection
b) The particularities of cryptostondosis and of their transmission mode (homosexu l?)
c) The relation with opportunistic infections and depletion of CD4 (the most common r
infection being oesophageal candidiais and reports of pulmonary pneumocysts and tuber
cular r niirgt s).
d) The importance underlined of prophylactic treatment by AZT after symptomatic primary
infection
Dr. J. Jobrd, Modecine B Av. Adrien Daurelle-e 5 05 Brianon Cedex France
Mo.B. 1334
ANALYSIS OF PRESENTING SYMPTOM COMPLEX & CLINICAL FEATURES OF HIV
POSITIVE SUBJECTS IN GUJARAT - INDIA.
Dr Atul K. Pate. * Hon. Ass t. Prof. of Medicine, N.H.L. Municipal Medical College,
Ahmedabad. Gujara t, India.
Objective: To determine clinical pr esentation of HIV disease in Gularat state-India.
Method: 88 patients are selected from first 60 patients(pts.) referred to my clinic dunng
last 18 months. Apart from routine hematological, bochemical & radiological investigations,
specific test for suspected opportunistic infection are carried out.
Result:lotal 88 pt., 539 male, 29 female, M: F 1:0.5. Mode of transmission-sexual-42, blood
transfusion 40,verticil transmission-I, unknown5 pts.8 1.8 pts. fall nto age group 2 1-40
yrs.Common clrical presentations are;fever- 75%, weight loss-60.2%, cough-45.5%, skin disor
ders 36.4%, diarrhea- 31.8%, neurological- 22.7%, odynophagia- 6.8%. On examination:oral
trus 7.4%, recurrent oral ulcer -8,generalised lymphadenopathy-25%. oral hairy leucoplakia 5.%, arthropathy 6.8%. Final diagnosis: tuberculosis is found in 59% of
pts.(29. 5%each pulmonary & extra pulmonary).recurrent pneumonia 5.7%, pneumocystis
oirirs pneumonia 3.1% wasting syndrome 15.9%, progressive multifocal leucoencephatopathy 3.4%. neurotoxoplasrnosis 2.3%, cryptococcal mreningitis I%, candida esophagitis 6.8%,?cryptospondial d rihea r%, granulomatous hepatitis 3.4%, adrenal insufficiency 4.5%.
Hematological abnormaltis leucopenia 17%, coombs positive hemolytic anemia 2.3%,
I..P I%. 57 patients are regularly followed up, 14 patients lost follow up, & 17 patients died.
Conclusion: Incli hs entered in to second phase of HIV epidemic.Awareness regarding
various clinical presentations of HIV disease is important to detect & manage such cases.
PUO, unexplained weight loss, prolong diarrhea, dermatitis, skin pigmentation, vasculitis,
cuta nious herpes etc.are common npresenting complaints. On exam: oral thrush, lymphadenopathy& [B.are common associated condition.
Dr Atul K. Patel, 4 I, Sundervan Twin Bunglows,Vastrapur Ahmedabad -380 0 I
Cuiir-at, India.
Mo.B.1335
CD8H CTL RESPONSE AND VIRUS FITNESS DURING PRIMARY INFECTION
WITH HIV-I
Fedas U Daar F:1, Lech W *, Grovit Ferbas K*, Detels R*, Giorgi JV *, Kaplan AH*.
SUniversity of Caifornia at Los Angeles (UCLA), and (Cedars-Sinal Medical Center, Los
Angeles, CA, USA
Objective: To identify host and vsiral factors which contribute to homeostasis during primary
HIV infect ion.
Methods: An ingunal lymph node and blood sample was obtained from a donor at risk for
(sexual) HIV exposure because of lifestyle. Unexpectedly this donor was in the initial stages
of infection and reported symptoms consistent with I" infection shortly after surgery (day
0). Three additional blood specimens were therefore obtained for further study Although
informed, this donor declined use of anti-retroviral agents during the 11 8 day observation

Mo.B. 1336
SYMPTOMATIC SEROCONVERTING ILLNESS IS ASSOCIATED WITH MORE RAPID
NEUROLOGIC IMPAIRMENT
Wallace, Mark R*ftC, Nelson JA', PMCutchan JA*, Heaton RK '. Mller LK". GaIr,I tt
HNRC group*. University of so, rnia and *'Naval Med rd s (,,t,, r, iif:..
Objective: To determine wheth HIV -infected subjects with,sip5i or s aticoerr
tilness (SCI) have an increased of neurologic impa irnert.
Methods: 166 dated HIV ser e rtors (all U.S mita,-y) with sk r, dae t iv.:
conversion within three year - 1positivity were evaluated fo, iito,-of S. A,e
plained, prolonged febrile illness t-ng the period of dated seroconver soon was 5 dourertd
in 29 (17.4%). All 166 subjects we~e tested initially and then eveer y 6 i 2 n Moths t
counts and neuro-psychologi c, [iP) testing including an expanded Halsted RePcst,,,ittr,
andWAIS-R.The NP scores were ubjected to blind cinclt is t ovei NtE,
from I (best) to 9 (worst) scale, th 5 being diagnosti ccl nrl NPr pai ncult
Results: Subjects with a histo, SCI were sima to those,;ut, SCI5t,
educational level and timne sinre omrated date of seroconver, bt th,
CD4 counts were significantly alo r (455 vs 562 cells/ri p0.029 bPl A
analysis of follow-up CD4 co; it r-evealed more rapd pro;. 5 to C[-+i.5 t 5th
SCI cohort; the median time CD4 < 400 is 960 vs5 d, fi,,
test). Initial global NP scores. rrlan (3 90 vs 3.67 p 0.4 b, Ar VA),,t
with a SCI developed clin ica t P pa5rnent sooner r, i s ii5v:,ir5as, the ' - ) c
tll NP > 5 was 1 074 vs 686 ppOO byWcoxon test).
Conclusions: We Pave confsrme thSat subjects weith ist)f t p ti sif 5p iir: l 5> i.,,
increased risk of rapid immunologic progression and CD4 depletitd e,.Add,u5ii,, t-ie-,i
jects appear to be at increased risk of moore rapid reurlog c 1 5d,(t. i, - 5,. -t'
viral therapy may protect both immune an pt ve uct n 0 t, c
Dr Mark R.Wallace, Naval Medical Center, San Diego, CA 92 i iselpnot, in 5
Fax: [phone]
Mo.B. 1337
TRIPLE NUCLEOSIDE ANALOG COMBINATION THERAPY IN PRIMARY HIV- I
INFECTION SUPPRESSES LYMPH NODE INFECTIOUS VIRAL BURDEN.
Tamalet Catherines, Lafeuilade A*,Tourres C*, Duclos N'i.Tiv I - sp "vr,-i,
departmentTimone Hospital, Marseille,' General Hospital, Toulor Fr arce.
Objective: To assess the short- term impact (90 days) of a triple d rug co,,iirb!.d
and lymph node viral burden in patients (pts) with prar y HIVIV i rtor (1f1).
Methods: In 3 HIV I infected pts presenting symiptomatic PHI. i ttoer ap,
Zidovudine (200 mg tid)+dsdanosine (200 mg bid)+ LFnvudie (I 5Or1..' to,
IO, 15 and 30 days respectively after the first syrmptom0. - I f i ts tested b, urttn
tive (q) coculture techniques, q DNA PCR, q RNA PCR (Anipl dicor ritoNTM Roe
Neuilly S/Seine, France)
Results: A mean 48% increase in CD4+T cell count was observed at d 14,r 5..:t,dt
d 90 in 2 cases. Log PBMC infectious virus titer (IVT) deo eased frorn.P 0.7. i f,
14 and 30 days respectively Log Imph node IVT decreased from.8. 1i.4 to 0 90 day
Log DNA copy number (nb) /106 PBMCs decreased from 2,.i 28 to 0, O0. i.7 90 daiys
Log DNA copy nb/1 06 tlymph node Mcs dec reased 2 2 0.' t P0.7,, 0.7970 days.
Log plasrna HIV- fIRNA titers/ml decreased fom 5.,3.t1, 5. 1ito 35,, 2.7 n 90 ds.
Conclusion: A decrease of viral load (I to 2 log) in PBMCs, plas m and lyn f node Mcs
was associated with a trip!e nucleoside combination therapy wit3, 90 days i,;ptn,
infected pts. Long term foow up and more pts could confirm du able suppr,,eof
infectious viral load in lymph nodes under early triple ther-apy.
Dr Catherine TamaletVirology Department, Hopital Timone. Bd Jean- Mostr. 13 in
Marseille Cedex 5, France.Tel: [phone]. Fax: [phone]
Mo.B. 1338
LIMITED VALUE OF SERUM HIV RNA LEVELS AS PREDICTORS FOR DISEASE
PROGRESSION IN HIV INFECTION.
Sarcletti Marno, Steinhuber S*, Fuchs D*, Most ', Zanrerle P.. r t 5 - n.. -
Innsbruck, Austria
Objective: We assessed the role of serun levels of HIV RNA t..,,l i - s - de5l,
in the CD4 cell count, chinical AIDS and urvival, compared to i:, -r,....
neopterin, (2-microglobulin and soluble tumor necrosis factor receptor 7 tI ters
Methods: A cohort of 47 individuals with a nmedian CD4+ cell coun t of 3,i,L
8-1389) at study entry were analyzed for 5) the dechne in CD4+ cels o, in c i or
period 2) the development of clinical AIDS and 3) survival (mredian follow-up,i rths.
range, 6-57). Serum was stored at -20~C for one year and three years at 80 C bef i
measurement of HIV RNA by quantitative PCR (Ampicor Roche).
Results: A stronger correlation was found between CD4+ cell cou t at stude s, d
HIV RNA levels (r = -0.47, p<0.01) than for the immunre actation nr-ker s. However, th
percentage of the change of the CD4+ cell count correlated with levels of HIV RNA on
weakly (r - -0.32, p = 0.03), in contrast to the correlations found 5o neoptn, in - 2
microglobulin and sTNFR 75 (r - 0.51 r - -0.4 I and r - 0.42; al p<0.0 ) I te Kpla
Meier analysis increased levels of sTNFR 75 were the strongest easker for po sn i
AIDS (log-rank test p<0.O).The best predictors for poor surinva s erer
neoptenn (log-rank test p<0.O01) and a higher rate of decine S-n CD4 cel i i in S
p<O.001). No progression to AIDS or death was obsered nr irdwdua s in.th t-fV RNA
copy number of <20000/mL.The final Coxs proportonal zrd unode to pre ci S in
AIDS and survival revealed that the CD4+ cell decline over a one year period predicts
both, whereas the CD4 cell count was predictive only for surwa sTNFR 75 was jointly snificant for predicting clinical AIDS and neopterin was jointly signiicant for suriaL Levels of
serum HIV RNA did not independently predict AIDS or survial. Nudeoside monotherapy
did not infuence the predictive power of these markers
Conclusion: The accuracy of HIV RNA as a predictor of dive see prporesson should be corpared with other sensitive predictors (e.g. sTNFR 75 and thre nt of decline of CD4+ cells)
Marie Sarcetti, AIDS Unit, University of Innsbruck, Anichstrafe 35, 6020 Innsbruck Austri
Fax: [phone];Telephone [phone]

pe iod.
Results: fHIV pro- v irus was detected in
blood (92 copes/10 0 cells) and lymph
node cells (1 658 copies/104 cells) despite
HIV negative serology
on day 0. Plasmi HIV RNA burden
(assessed by Roche RTPCR) increased by
-2 togs durng the first 12 days of infection but decreased co-incident winth
CD8+ cell expansion. Notably anti HIV
CD8+ CTL were not evident on day 0
but were Gag Pol- Env and Nef specific
on day 62.The viral genotype from day 0
and phenotype of 18 plasma-derived bio
logic clones from days 0,12 and 62 was

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HIV psma,RN
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Days from acute onset of symptoms

also determined.These viruses retained non syncytum-inducing sequences and phenotype
in an MT 2 cell assay but the replication rate in CD4 cells (i.e., fitness) increased as a
function of time. Days from acute onset of symptoms
Conclusions: Viral fitness appeared to increase during I~ infection, yet viral burden and
CD4+ cell numbers stabilized after seroconversion and the emergence of anti HIV CTL.
The dramatic rise in viral burden from day 0 52 was noteworthy Even though viral fitness
was at its minimum, viral burden approached 106.5 copies of RNA/ml of plasma - presumably due to the lack of opposition by CTL.Taken together this case study supports prompt
use of antiretroviral agents during I~ infection because of the potential to limit vral spread
and damage to the host while HIVspecif immunity develops.
John Ferbas. University of California at Los Angeles, 2-939 Factor Building, Los Angeles, CA.
90024.Tel.: [phone] Fax: 3 I0 794-2145 email: [email protected]

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