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

Track B: Clinical Science

Mo.B.1339 - Mo.B.1344

Mo.B. 1339
FIRST COHORT OF HIV POSITIVE PEOPLE IN BRAZILIAN HEALTH PUBLIC INSTITUTION: FACTORS RELATED TO SURVIVAL
Lima, Dirce B*, Gomes V*, Gomes G*, Fernandes O*,Tura B*. *Universidade do Estado do
Rio de Janeiro, Rio de Janeiro, Brasil.
Objective: To determine AIDS-related survival and describe factors associated with this in
an ongoing cohort of seropositive adult people.
Methods: In this study, the first and the last day of observation were March, 5th 1985 and
December 31st 1990. Five hundred and fifty-six HIV positive people (495 men and 6I
women) have been followed.We have used the Epi-info 6.02 software package to determine survival rate and to correlate this with other markers (age, sex, ethnic group, risk situation to HIV infection and opportunistic disease).This cohort study is ongoing.
Results: The mean age of the sample was 35.4~ 10.5 years (mean~SD), range 18 to 82.
Prevalence was higher in whites than nonwhites. Sexual contact was the most common risk
situation followed by blood contamination. It was observed 88 I cases of opportunistic diseases and tuberculosis was the most frequent one.The survival time (ST) was 17.9~ 15.5
months. It did not change with sex, race and risk behavioun Before 50 years old the ST was
I 8.4~ 15.7 months and after that age, the ST was 14.0~ 13.4 months (p<0.05). After 50
years old the greatest ST was 40 months and before that age, 63 months (p<0.05; Odds
ratio 7.79).The survival times with and without P carinii pneumonia were I 5.6~ 14.5 months
and I I.7~ 12.7 months, respectively (p<O.O I).The ST without CMV disease was 15.5~ 14.5
months and with this viruses, the ST was 10.0~ 10.4 months (p<0.05).
Conclusions: Younger people (age) were associated with longer ST in HIV infection. P. carinii
pneumonia and CMV disease were clinical markers of a shorter ST
Lima, Dirce B. Rua Rodolfo de Souza, 105 - Vila Isabel - Rio de Janeiro RJ Brazil - CEP
2055 I -270
Mo.B. 1340
USEFULNESS OF ANTI-P24 ANTIBODIES AS A MARKER FOR AIDS. FIVE YEARS FOLLOW-UP IN CUBAN HIV SEROPOSITIVES.
Benitez Jesds.) I), Palenzuela Daniel(I), Rivero Juan(2), Ganz6 Oscar(I). (I)- CIGB, Box
6162; (2)- SSV, Havana, Cuba
Objective:To evaluate the usefulness of a the anti-p24 antibody titer determined with a single point dilution procedure as a marker for the prognosis of AIDS in a five year follow-up
of Cuban HIV- I seropositives.
Methods: We used an ELISA for anti-p24 antibodies, based on recombinant HIV- I p24.The
titer was determined by a single point dilution procedure with an a-formula. Anti-p24 antibody titers were quantified for I 607 samples from 383 HIV infected individuals representative of all the stages of the infection. Patients with neurological disorders were studied as a
separate group. In the longitudinal study serum samples from 256 patients were sequentially
evaluated for five years.
Results and Conclusions: Titers lower than 1:500 and I:100 were obtained respectively for
80. 1% and 67.3% of the group 4 patients. Forty percent of the group 2/3 individuals had
titers higher than I:1000, which contrast with only 4.4% of the AIDS patients. In the longitudinal 5-years study for 87% of the patients a decrease of the anti-p24 titer was observed 3
to 6 months prior to or in correlation with the AIDS progression. We conclude that antip24 titer constitutes an accurate marker for the progression to AIDS.The use of the single
point dilution procedure makes this assay an extremely economic choice for the follow up
of HIV seropositives in developing countries.
Jesis V. Benitez. Ctr Genetic Engineer. Biotechnol. POBox 6162, Havana, Cuba. phone:(53-7)
2 I -8 I-64, fax: (53-7) 2I-80-70, e-mail: [email protected]
Mo.B.1341
EVENTS IN EARLY HIV INFECTION DETERMINE THE LONG TERM OUTCOME OF
THE INFECTION.
Pedersen Court I, Katzenstein T2, Nielsen C3, Lundgren JD I, Gerstoft J2. Departments
Infectious Diseases, I Hvidovre Hospital and 2Rigshospital, 3Statens Seruminstitut,
Copenhagen, Denmark.
Objective: To describe importance of early HIV related events for subsequent disease
progression.
Methods: Ninety-three HIV seroconverters(no more than I 2 months between latests
seronegative and first seropositive samples) were followed for a median of 6 years. CD4
cell counts and serum HIV RNA level were measured 6 to 18 months after seroconversion.
Disease progression was analysed using Kaplan-Meier methods. Outcome measures were I)
Progression to AIDS (CDC, 1987), 2) Progression to CD4 cell count less than 200 x 106/I.
Patients were grouped according to duration of primary illness (>14 days, < 14 days,
unknown in 10 patients; CD4 cell count ( > 500, <500 x 106/I); serum HIV RNA (_ 103,
< 103 copies/ml). A Cox model is being analysed.
Results:

Mo.B. 1342
THE INFLUENCE OF AGE AT SEROCONVERSION AND LABORATORY MARKERS
ON HIV DISEASE PROGRESSION
Lee Christine A, Sabin CA*, Phillips AN*, Bofill M**, Elford J*, Janossy G**. Haemophilia
Centre and Departments of Haemostasis, *Primary Care and Population Sciences, and
**Clinical Immunology, Royal Free Hospital, London, UK.
Objectives: To describe the influence of age and immune and viral parameters (CD4/CD8
counts, IgA and beta -2 microglobulin levels, and p24 antigenaemia) on HIV disease progression in a cohort of men with haemophilia.
Methods: I II men with haemophilia were infected with HIV between 1979 and 1985.The
men are seen every 3-6 months; laboratory markers are measured at each visit.The prognostic roles of age (fixed at seroconversion) and all laboratory markers (time-updated) are
investigated using proportional hazards models.
Results: By I st January 1996, 53 men had developed AIDS and 54 men had died. In univariate models, age is a strong predictor of both the development of AIDS and death (relative
hazard (RH) for AIDS: I1.20 per 5 year increase, p=0.0001, for death: 1.32 per 5 years,
p=0.0001). In univariate models, a drop in the CD4 count, an increase in IgA level and the
development of p24 antigenaemia all had prognostic value for the development of AIDS.
After adjusting for these markers, age remained an important predictor for the development
of AIDS (RH I. 14, p=0.0 1).A drop in the CD4 count and the development of p24 antigenriaemia retained prognostic value in this model (CD4 count: 1.33 per I log drop, p=0.0001,
p24 antigenaemia 2.73, p=0.00 I). In univariate models, the development of p24 antigenaemia, CD4 and CD8 count, IgA level and B2M level each had prognostic value for death.
After adjusting for these variables, age remained significantly associated with survival (RH
1.27, p=0.009). All laboratory markers except the development of p24 antigenaemia provided independent prognostic information in this model (CD4: I.18 per I log drop, p=0.03,
B2M: I1.43 per I mg/I increase, p=0.003 and CD8 per 100 cells/mm3 drop: 1.23, p=0.04).
Conclusions: Age at seroconversion remains an important predictor for the development
of AIDS and death in this cohort.The effect of age, however, is not explained by changes in
other markers of HIV progression (CD4 and CD8 count, IgA and B2M level and p24 antigenaemia), which continue to provide additional prognostic information for both the development of AIDS and death.
Dr C.A.Lee, Haemophilia Centre and Haemostasis Unit, Royal Free Hospital NHS Trust,
Pond Street, London NW3 2QF, England.Tel: 017 I 830 2238. Fax: 017 I 830 2178.
Mo.B. 1343
IN VITRO CYTOPATHOGENICITY OF THE HUMAN IMMUNODEFICIENCY VIRUS
(HIV) PREDICTS SURVIVAL IN HIV-INFECTED HEMOPHILIACS
Rockstroh, Jurgen K*, BauerT**, Ewig S*, Gross W***, Schneweis KE***, Kaiser R****
Brackmann HH*****, Matz B****. *Dept. of Medicine, Univ. of Bonn; **Dept. of Medicine,
Univ. of Bochum; ***Department of Pediatrics; ****Dept. of Medical Microbiology and
Immunology; and *****Inst. for Experimental Hematology and Transfusion Medicine,
University of Bonn, Germany
Objective: Cytopathogenicity of HIV has been correlated with the course of HIV infection.
However, the prognostic value of graded cytopathogenicity in addition to the CD4 count
has not been evaluated in a prospective study
Methods: A total of 22 I HIV-seropositive hemophiliacs were followed up from I1985 to
1995 (mean follow-up 5.7 ~ 2.2 years, median 6, range: I to 10 years). Blood samples for
virus culture and CD4-cell counts were obtained during identical visits. In vitro virulence of
the virus isolate was determined according to methods described previously and graded
fl-om A (strongest cytopathogenic effect (CPE)) to D (no CPE detectable) and 0 (negative
virus culture) Irrespective of later investigations the results of the first investigation were
considered. Means were compared by student's t-test, survival among patients with different
virus isolates was calculated as time-to-event distributions (Kaplan-Meier) and factors associated with decreased survival were analyzed by Cox regression analysis.
Results: During follow-up 77 patients developed AIDS (34.7 %) and 65 died (29,3%). Mean
observation times in patients with isolate A were 4.04 ~ 1.9 years (n - 22), with isolate B
4.7 ~ 2.0 years (n = 2 I), with isolate C 5,7 ~ I1.6 years (n = 9), with isolate D 5.8 ~ 1.9
years (n- 10) and 6.2 ~ 2. I years (n = 159) in patients with a negative virus culture (p <
0.01). Multiple cox regression showed significant associations with outcome for age (p
<0.01), type of virus culture (p < 0.01) and CD4 count (p < 0.0I).The presence of an isolate A revealed the strongest odds ratio (4.3, ClI= 2.2 - 8.3).
Conclusion: The presence of a virus isolate A represents a strong risk factor for mortality in
the course of HIV infection.The prognostic information is independent from CD4 count. (I.
Schneweis KE et al., Med Microbiol Immunol (1990) 179:193 - 203)
Dr Jorgen Rockstroh, Dept. of Medicine, University of Bonn, Sigmund-Freud-Str 25, 53105
Bonn, Germany 0049-228-287 6558 (FAX: [phone])
Mo.B.1344

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Proportion of patients without event (95%
AIDS CD4<20

Patient group number of patients
All 93
Primary illness >14 days 30
< 14 days 53

CD4 _ 500x 106/I
CD4 < 500x 106/1
HIV-RNA > 103copies/ml
HIV RNA< 103copies/ml

45
48
37
56

0.68 (0.56-0.8 1)
0.46 (023-0.70)*
0.86(0.73-0.98)
0.80 (0.66-0.94)*
0.56 (0.35 0.78)
0.48 (0.27-0.70)*
0.78 (0.66 092)

0.40 (0.27-0
0.28 (0.09-0
0.5 1 (0.32-0
0.64 (0.45-0
0.17 (0.04-0.
0.14(0.03-0.:
0.53 (0.370.

conf, limits) at 7 years SEX DIFFERENCES IN DISEASE PROGRESSION: EVIDENCE FROM THE SWISS HIV
0 COHORT STUDY (SHCS)
Battegay Manuel,Twisselmann W*, Steuerwald M, Gyr, K, Janin Jacquat B**, Ledergerber.54) B***, Egger M**, and the SHCS, Policlinic of Intern. Med. and ***Div. Infect. Dis., Univ. Hosp..47)** log rank test: Basle and ***ZOrich, Depart. of Social and Preventive Medicine, University of *Z0rich and.69) *p<0.01 **Lausanne.
84)* **p<0.05 Objective: To examine sex differences in HIV disease progression among participants of a.30) prospective cohort study
29)* Methods: The Swiss HIV Cohort Study (SHCS) is a large nation-wide prospective study of.70) HIV-infected adults. Participants are followed up in six-monthly intervals at five Univ.
Hospitals and one Cantonal hospital. Over 7,000 participants were enrolled since 1988.The
mt for the subse- present analysis is based on participants free of AIDS at entry who were infected either by
IV/DU or heterosexuallyThe rate of developing AIDS-defining events and survival was comspital, DK-2650, pared in multivariate Cox regression analyses adjusting for CD4 cell counts, age, transmission group and year of registration.
Results: 1,042 women and 1507 men fulfilled the inclusion criteria.The mean age was 29
and 32 years, mean (median) CD4 cell counts at entry were 504 (432) and 440 (380) cells
x 106/ I, respectively Mean follow-up was 3 years. 1, 1 10 disease events were recorded.
There were few statistically significant sex differences. A higher risk of Pneumocystis carinil

Conclusion: Events taking place in early HIV infection are very importa
quent course of the infection.
Court Pedersen, Department of Infectious Diseases, 144, Hvidovre Ho:
Denmark. Fax [phone]