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

Mo.B.1355 - Mo.B.1360

Monday, July 8, 1996

CD8 counts on treatment (fitted as time dependent covariates) showed no correl c)n
with progression to ARC or AIDS during the course of the trials.
Conclusions: The absolute CD8 cell count is not correlated with suppression of HIV I
RNA or the rate progression of CDC B/C disease in this nucleostde analogue treaten
population.
Andrew M Hill Glaxo- Wellcome Research and Development, Greenford Road, rceenford
UB60OHE, UKTeI:0181 966 2001 e-mail: amh2 l1374ggr.co.uk Fax: [phone]-'5
Mo.B. 1355
EARLY DIAGNOSIS OF TUBERCULOSIS (TB) IN HIV PATIENTS BY STANDARD
METHODS AND POLYMERASE CHAIN REACTION (PCR).
Losso, Marcelo*, Fischer N*, Kalina M*, Olavegogeascoechea P*, Saenz C, 'Benetuc J
ASanguinetti C*, Smayevsky L *, Montoto M, Schijman A f. *Hosp Rmaos Mejuy iHosp
Muniz; * Lab Biocencia, Buenos Aires
Objectives: To compare the results of the common diagnostic methods ofTB (clinical preventive diagnosis, direct smear and culture) and PCR in patients w th HIV infection and
pulmonary infiltrates.
Design: Prospective, controlled study.
Methods: Adult patients with confirmed HIV infection and active pulmonary disease were
included and a clinical preventive diagnosis was defined on admission. We exclude patients
who received antimycobacterial treatment in the 9 weeks prior to admission. Pulmonary
samples, blood and extrapulmonary sites specimens were processed for smear rind culture
of common bacteria, mycobacteria and fungi. Bold cultures were processed by ysis-centrifu
gation. Direct smears of pulmonary samples were stained for detection of P cotinn. NestedPCR was performed in all samples using oligonucleotides based on the repetitive sequence
IS6110, specific of M. tuberculosis complex.The gold standard for TB was defined as all positive culture for M. tuberculosis or objective response to standard anti tuberculous treatment
when no other therapy was applied.
Results: A total of 80 episodes were analyzed, 30% (24/80) were diagnosed as TB.The
sensitivity and specificity of PCR were 95, 65 % and 97,77 % respectively as compared with
the initial clinical diagnosis (82,6 % and 73,33 %), direct smear (47,8 % and 93,33 %) and
culture (52,5 % and 100 %).We observed four false positive results with PCR, three in
patients without clinical diagnosis ofTB and one with M. kanson.
Conclusions: PCR appeared to be an adequate nmethod in the clinical scena io. The combi
nation of clinical diagnosis and PCR are useful to initiate early and safe anti-tuberculous
treatment in patients with HIV infection and pulmonary infiltrates
Marcelo H. Losso. Laprida 19 I16 5~ I I, 1425 Buenos Aires, Argentina.Tel: (54 I) 785- 7884,
FAX: [phone]
Mo.B. 1356
DISSEMINATED INFECTION WITH MYCOBACTERIUM GENAVENSE IN A PATIENT
WITH AIDS.
Lacor Patrick, Seghers M., Pierard D., Keymeulen B., Simons P. Somners GCr., Lauwers S.
Akademisch Ziekenhuis,Vrije Universiteit Brussel, Brussels, Belgium.
Disseminated infection with atypical mycobacteria is an emerging opportunistic disease in
patients with AIDS. In recent years, a new Mycobocteriurm species has been isolated from
AIDS patients with wasting and fever. It was named: Mycobictenum r genvense. Identification
of M. genovense is hamrpered by its inability to grow on standard solid medi.
We present a case of a 24 years old HIV -infected male who was admitted to our hospital
with left paraumbilical pain, intermittent fever and weight loss. His CD4 cell count was
extremely low (I 3/mm3). Computerized tomography of the abdomen revealed the pres
ence of a mesenterial mass consisting of enlarged, confluent and partially necrotic lymph
nodes.They were biopsied during an exploratory laparotomy. On histologic exanination
the lymph node structure was completely disrupted and replaced by histiocytic cells with
numerous intracytoplasmic acid fast micro-organisms. Similar cells were seen as a compo
nent of multiple granulomas that were demonstrated on biopsy specimens of the liver and
the bone marrow. Combined treatment with clarithromycin, rifampicin, isoniazide and
ethambutol was instituted, leading to clinical improvement with resolution of fever and disappearance of abdominal pain within a week. After 8 weeks of incubation, Mycoactern i
genovense was cultured from the lymph node material by using 7H1 0 medium s upplemented with mycobactin J.To our knowledge this is the first case in Belgium of disserninated M.
genavense infection in a patient with AIDS.
Dr P. Lacor, A.Z. VU.B., Dept. of Internal Medicine, Laarbeeklaan 10 1, B--1090 Bruels,
Belgium.Tel: [phone] - Fax: [phone]
Mo.B. 1357
THE CANADIAN RANDOMIZED OPEN-LABELTRIAL OF COMBINATION THERAPY
FOR MAC BACTEREMIA: CHARACTERISTICS AND OUTCOME OF SUBJECTS WITH
NEGATIVE BLOOD CULTURES AT BASELINE
Zarowny Donald,Thorne A, Khorasheh S, Shafran S,Toma E, Miller M, Duperval R, Srmaill F,
Lemieux C, Cameron W, Schlech W, Mackie I, McFadden D, KamalPM, DiPietro*N. the Canadian
MAC Study Group of the Canadian HIV Trials Network and Pharmacia* Uptohn. Canada.
Objective: A randomized open-label trial showed that a three drug arm of clar ithro y r
1000 mg BID, rifabutin 600/300 mg QD, and ethambutol 15 mg/kg QD was associated with
significantly more frequent and faster clearance of bacteremia and increased survival com
pared to a four drug arm (ciprofloxacin, ethambutol, rifampin, and clofazimine) in HIV+
patients with Mycobacterium avium complex.This subanalysis describes the characteristics
and outcome of patients recruited to the trial who had negative baseline blood cultures for
MAC and were not included in the primary analysis, and compares them to the cohort
who were baseline positive.
Methods: Eligible patients with positive blood cultures done at their local clinical facility
were enrolled. Enrollment cultures were then obtained and shipped to a central laboratory
for quantitative culture using BACTEC and conventional methods and speciation by DNA
probe. Patients were treated and followed intensively for 16 weeks with additional blood
cultures. Investigational drug treatment was available for life. Post-study follow-up was done
to obtain survival information. Descriptive statistics were used to characterize the two
groups (central lab negative versus central lab positive) at randomization. Survival was compared by using the log rank test.

Results: Of r9, di omized, 8 were ineligible or had non MAC mycobacteremia,
34 (15%) h,,ret. cultures in the specimens sent to the central lab and 187
(82%) were baser r 1he niegative and positive groups were similar in age (36.9 yrs.
versus 38.2) de. ile), previous rifabut n propthylaxis (32% versus 23%), median
CD4 count l 0 e i,,r, and median Karnofsky (70) The baseline culture negative group
was heavier (mea,t. 8 4 yg versus 58.8, p.05), were les lfrequent users of ketoconazole (p <.05)a d,.1ved trerds to greiter use of ddC and AZT (p=.05 and p=.07
respectively). In 3 th, t subjects at least one post baseline culture wa sobtained. One
or more of these cultur w re positive for MAC in 6 of the 32 Whie the dflerence in
surval was not sgicrit (p 27), a sonewgat longer ' med in surviv w observed in the
negatives (9. I a v6.6 mort).
Conclusion: There was ro difference in surviva l between HIV+ patients with baseline nega
tve or intermitrtenti posite ood culture and paients with posit e baseline cultures in a
prospective randoi/nd trial of two treaten S remens for M. s uni complex infection.
Donald ZarownyCaadiar I IIV Trials Network, 200 1033 Davie Street,Vancouver Canada,
V6E IM7 tel [phone] I/8, x 604 631 5210, eral, donohvinet.ubc.ca
Mo.B. 1358
PLEURAL TUBERCULOSIS IN PATIENTS INFECTED WITH HIV IN ADDIS ABABA.
Getachew A. KibrebealM. N, Guta Z. Black Lion Hospital. Department of Internal Medicine,
Addis Ababa University, Ethopia.
Setting: Black Lion Hospital.i tertiary care referral hospfital in Addis Ababa.
Objective:To determine te prevalence of HIV I infection in patients with pleural tubercu
osis and compate the ctnical and radiolog cal characteristics, effects and side effects of
drugs, compliance to treatent and outcome by FIV status.
Methods: A hospital based, prospective study involving 90 adult patients with pleural tuberculosis. 120 surgical p tients admitted fo r nonHIV related conditions served as controls.
Results: 22% of the patients with pleural tuberculosis ve rsus 6.7% for the controls (p<0.0 I)
were seropositive for HIVI. Amorngst patients with pleural tuberculosis,. HIV seropositive
patients were more likely to be male, and had longer duration of illness prior to coming to
hospital (P<0.05).They had nre disserminated disease (P<0.01. b ilateral pleural effusion
(P<0.05), adverse reaction to antituberculosis drugs (p- 0.05) ind rncreased mortal ity
(p<-0.05). Hepatitis was the most common side effect observed. There was no difference in
the size of the effusion, clinica iprovement, radiographi c resolution or defaiulter rate.
Conclusion: HIV associated pleural tuberculoss commonly occur s with other forms of
extra pulmonaryTB and responds wel t treatr eInt. I epatitis is ri frequent side effect and
entails poor or noss. We ti erefore reon ti iTcareful documertatio of a previo us hisatory of liver function tests efore initide tio of tretmen.TheIniofbiite pleural effusion may indicate the presernce of urnder 17r) IHIV inflection.

Getachew Aderaye, Addis Abi, Ethiopia, FO.Box 380 Tel. 2

0653 F1x 25 I 513099

Mo.B. 1359
BACTERIOLOGICAL ASSESSMENT OF RIFABUTIN VERSUS PLACEBO FOR M.avium
BACTEREMIA IN AIDS PATIENTS.
Dautzenberg B.*, Castellani P", Truffot Pernot Ch I erng B'. Sassella D "G.H. Pite
Salpetriere Paris; 'Hpita l Pelleyrin Bordeaux, France; " Pharman Milan Ital.
Objective: To determine activit' of rifabutin as a single agent in the treatment of M. ri
bacteraemia in AIDS patient.
Methods: Rifabutin 600 mg/d was randomly conmpared to placebo in a doubleblrid 14 days
trial in AIDS patients with culture proven M aiii bacteraemia. After 14 days, an open
treatment combination was proposed. All subjects gave written informed consent.Two
quantitative blood cultures were performed t DO.)3, D7 D 10 and D I4. Only patients
with positive blood culture t DO were eligible. Main endpont was bacteriological success
defined as a reduction in the number of colony forming units of M a.urn orgarnisms/ml of
blood by factor >0.5 log or i negative blood culture.
Results: A total of 36 patienrts were randoiszed. Because oflnegative blood culture at baseline (n = 10) or othe r reas ons (n - 3), ontly 23 patients were assessed at the endpoint (10
received rifabutin and I 3 placebo) median CD4 was '4.5/mn3 in nfabutin group and
II/rm3 in placebo group: Bacterological success was recorded in /10 (70 %) of patients
assigned to placebo (p = 0.002).
Conclusion: Rifabutirs r rsi le agent i a ta in i, rst S a/Mv sn nid can contribute to treatment regimens for M, m,, i t cteraeri in AIDS patents.
Pr Bertrand Dautzenber g Pn eumologie. H. Piti, Salptnerie. f, I Par codex 13
France.T letphon e ( ) i, / 67 70 Fix ( ),. 9
Mo.B. 1360
CLINICAL CHARACTERISATION OF PHIV/AIDS IN TAMILNADU, INDIA
N.Kumarasamy*, Suniti Slomon', Ganesh AI', R Edwin Amara ". S A Jayaker Paul' Yrg
Care. Madras; Stastis i- /oisultant
Objective: To document the clinical profile of Persons living with HIV/AIDS in Tamilnadu, India
Methodology: SEItINa: Govt General Hospital, Madras from Jan 89 Mar 93 and Walk -in
clinic at YRG Centre fo AIDS Research and Education, Madras from Apr 93- Dec 95
Design: Cross Sectional Study
Subjects: Persons who were tested positive to HIV antibodies (WB) and 1tending the
AIDS Clinics with symptoms
Results: 252 PHIV/AIDS were studied. Of these 176 (69.8%) were males. 202 (80. 1%)
were in the age group of 20 -149 yrs. 21.8% were truck drivers. 238 (94.4%) had weight loss,
224 (88.9%) had fevern 124 (49.2%) had diarrhoea and 204 (8 1.0%) had persistent cough.
Other symptoms included dysphagia (48.0%),. headache (23.4%), body pain (61.5%), prurSit
(43.7%) and memory loss (6.7%). 97 (38.%) received treatment for genital ulcers
Pulronaryluberculosis was the most common Opportunistic Infection (55%). Other lOI
detected were Orophrynel candidtis/ s (I 06/42.1%), fungainfections of the skin
(48/19.2%), cryptosporidial diarrhoea (1 8/7.2%), Hrpes 7oster (1 0/4.0%),. Herpes simplex
(10/4.0%), PCP (7/2.8%), CMV retinitis (I /3.8%), parasitic diarrhoea (1 6/6.4%), scabies
(5/2.0%) and Pneumococccl pnreumonia (4/.6%). I patient had Kaposi's sarcoma.
Gasteroenteropathy was detected in 72 (28.5%) and non- specific lower respiratory infections in 46 (1 8.3%). NHL was diagnosed in 6 (2.4%). Middle and lower lobe infitrate was
observed in chest radiog~ phs of 50.5% of Pul. TB Patients

117