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

Track B: Clinical Science

Mo.B.1361 - Mo.B.1366

Conclusion: In any young person with recurrent and re-infections, HIV infection must be
considered as a differential diagnosis. Developing Countries can adopt WHO clinical criteria
for AIDS in the outpatient clinics in selecting patients for HIV counseling/testing. All young
persons with PulmonaryTB should be counseled for HIV risk factors.
N Kumarasamy Medical OfficerYR Gaitonde Centre for AIDS Research and Eduation,
I Raman Street,T Nagar, Madras 600017, India
Mo.B. 1361
COMPARATIVE STUDY OF DRUG RESISTANCE PATTERN IN HIV POSITIVE AND
HIV NEGATIVE CASES OF TUBERCULOSIS.
* Shetty K, Bhave Geeta*, Salvi V**. * Seth G.S.Medical College And Kern Hospital,
Bombay India; ** Group Of Tb Hospital, Sewree, Bombay, India.
Objective: Drug resistance is the main problem in TB control programme.The main objective
of this study was to compare drug resistance pattern in HIV positive and negative cases ofTB.
Method: A total of 500 sputum sample from clinically suspected cases of TB were
processed for smear, culture and for the identification of type of Mycobacteria using standard techniques. All positive cultures of M. tuberculosis were tested for drug susceptibility to
Isoniazid, Rifampicin, Streptomycin and Ethambutol by proportion method on L.J. medium.
Result: Out of the 500 samples 66 (13.2%) were found to be HIV positive. Among the 66
HIV positive, 31 (46.96%) were culture positive. Out of 434 HIV negatives, 221 (50.92%)
were culture positive. Majority of the culture isolates in both HIV positives 28 (90.32%) and
HIV negatives 203 (9 I1.66%) were of M. tuberculosis.
Out of I I HIV positive patients 9% showed primary resistance to Isoniazid and 36% were
resistant to Rifampicin whereas no resistance was seen to Streptomycin and Ethambutol.
However, out of 107 HIV negative patients primary resistance to Isoniazid, Streptomycin,
Rifampicin and Ethambutol was 26%, 19%, 12% and 9% respectively
Out of 17 HIV positive patients with prior history of AKT 47% were resistant to Isoniazid,
53% to Streptomycin, 65% to Rifampicin and 24% to Ethambutol whereas resistance pattern of strains isolated from 96 HIV negative patients with prior history of AKT was isoniazid (47%), Streptomycin (29%), Rifampicin (25%) and Ethambutol (I 2.5%).
Conclusion: There is a high risk ofTB outbreaks with resistant strain. Rifampicin resistance
was three times higher in HIV Positive patients.This high Rifampicin resistance needs further
study HIV testing and counselling facilities forTB patients are urgently needed.
Bhave Geeta, BI-5/358 Municipal Tenements, Government Dairy Road, Worli,
Bombay-400 018, India.Tel: [phone]
Mo.B. 1362
FREQUENCE OF NATURAL RESISTANCE AND CROSS RESISTANCE OF RIFABUTIN
AND OTHER ANTIMYCOBACTERIAL DRUGS ON M.AVIUM COMPLEX
Rossi Rosaria, Miraglia N, Della Bruna C. Pharmacia & Upjohn Research Center:
Nerviano(MI), Italy
Objective: To study the behaviour of antimycobacterial drugs belonging to different chemical structures respect to frequence of naturally resistant mutants and cross resistance.
Method:Six Mycobacterium avium complex(MAC) strains were tested in Middlebrook7H II
for their susceptibility to rifabutin(RBT), rifampicin(RMP), amikacin(AK), pyrazinamide(PZA),
isoniazid(INH), ethambutol(EMB), lomefloxacin(LX), clofazimine(CLO), clarithromycin(CLA)
and azithromycin(AZ); in a second step the frequence of natural resistance (FNR) was
determined by plating bacteria on plates containing 4 - 8 - 1I6X MIC of each drug displaying
activity Selected colonies were tested for their susceptibility to RBT and to other drugs to
assess cross resistance.
Results and Discussion:
Range of: a) MIC values (mg/I) and b) n~ of resistant cfu x 10-8 at 4XMIC
RBT RMP CLA AZ LX AK PZA EMB INI I CLO
a 0.062-2 0.5-.32 1-16 32->128 16-64 64->128 >128 864 16-128 0.015-0.12
b 0.1-41 0.1-54 0.5-1620 -600 1-300 1-20 NE NE NE NE
NE: not evaluable, confluent growth.
RBT, CLA and CLO showed the best activity with MIC range of 0.062-2 mg/I, I - I 6 and
0.015-0.1I2 respectively RMP and LX were less active with MICs ranging from 0.5 - 32 and
I 6 - 64 mg/I respectively As expected, all other drugs exerted poor or no activity the MIC
values for most strains being >128 mg/I. Concerning the FNR, the two rifamycins shared
similar figures, in the same low range of AK. Conversely the FNR for CLA, AZ and LX was
consistently higher while for all other drugs tested a confluent growth was observed, It
must be stressed that, for several drugs, AZ included, the concentration used for selection
was extremely high (up to 1024 mg/I) due to the low intrinsic activity Similar pattern of
selection, although with lower frequencies, was obtained with 8 and 16X MIC. Cross resistance was observed between drugs belonging to the same chemical class, while no cross
resistance was found when drugs with different structures were tested.
R. Rossi, Pharmacia & Upjohn / Microbiology Lab. 20014 Nerviano (MI) Italy
Telephone: [phone] Fax: [phone]
Mo.B. 1363
INCREASED CENTRAL NERVOUS SYSTEM INVOLVEMENT OF TUBERCULOSIS
(CNS-TB) AFTER INCOMPLETE TREATMENT
Pulido F, Pehia JM*, Rubio R, Gonzalez J*, Costa JR,Vaizquez Jj*. Hospitals I 2 de Octubre &
*La Paz. Madrid. SPAIN.
Objective: To determine the risk of Central Nervous System involvement of tuberculosis
(CNS-TB) in HIV-infected patients who abandoned antituberculous treatment before 6
months as compared with HIV-infected patients with a first episode of tuberculosis (TB).
Methods: Two hundred and seventy six HIV-infected patients with culture-proven TB were
diagnosed in 2 general hospitals between 1986 and 1992. An history of a previous episode
of TB and information about its treatment was obtained. CNS-TB was diagnosed if a positive culture for M. tuberculosis was present in cerebrospinal fluid (CSF) or CNS tissue, or
when M. tuberculosis was isolated from any other sample with a clinical picture of CNS
involvement. A previous incomplete antituberculous therapy was established when a patient
had been treated for a previous TB during less than 6 months.

Results:Twenty nine patients (10.5% 95%CI 7.3-14.9) had CNS-TB (2 I patients with a
positive CSF culture, 2 with positive tissue culture and 6 with M. tuberculosis cultured from
another site and clinical CNS-TB.Twenty four patients had an history of previous tuberculosis and incomplete antituberculous therapy Patients with CNS-TB had an history of
incomplete antituberculous treatment more frequent than tuberculous HIV-infected
patients without CNS involvement (6 out of 29 [21%] vs. 18 out of 247 [7%]: Odds Ratio
3.3 95%CI 1.2-10.6).
Conclusions: Incomplete antituberculous treatment in HIV-infected patients is associated
with a higher prevalence of CNS-TB.
Federico Pulido. Unidad VIH. Hospital I 2 de Octubre - Ctr de Andalucia, Km. 5,4. 2804 I -
MADRID - SPAIN. FAX: [phone]
Mo.B.1364
DISSEMINATED MYCOBACTERIUM GENAVENSE INFECTION: CLINICAL AND
MICROBIOLOGICAL FEATURES.
Sambeat M.Antonia2, Rodriguez P 1, March FI, Garrig6 M 1, Moreno C1, Fuster M2
Cadafalch J2, Barrio J2, Gurgui M2, Coll P 1. Departments of MicrobiologyI and Medicine2.
Hospital de Sant Pau. Universitat Authnoma de Barcelona. Spain.
Objective: Description of clinical and laboratory features of 5 disseminated infections
caused by M. genovense in HIV infected patients.
Methods: Retrospective analysis of five cases. Clinical samples were inoculated onto Bactec
12B or 13A and Lowenstein-Jensen. Strain identification was based on NAP-test, nucleic
acid hybridization, gas liquid chromatography and amplified 65-kDa protein and restriction
enzyme analysis.
Results: Clinical features and response to empirical therapy mimicked those of disseminated
M. aviumrn complex (MAC) infection. M. genovense was always isolated from blood and bone
marrow in Bactec 13 A medium and failed to grow on subcultures in solid media. Strains
were NAP susceptible, did not hybridize with MAC or M. tuberculosis complex specific
probes, chromatograms were similars to those of M. simiae and PCR-restriction enzyme
pattern consisted of two fragments of 325 bp and 125 bp with BstEll and two fragments of
I 40 bp and 105 bp with Hoelll.
Conclusions: M. genovense represented the 9% of 56 disseminated micobacteria infections
in HIV patients during a two years period. Decontamination procedures inhibited the
growth. Conventional NAP-test in acidic Bactec I12B and PCR-restriction enzyme patterns
enable the strains identification.
M.A.Sambeat. Department of Internal Medicine. Hospital de la Santa Creu i Sant Pau. Sant
Antoni M. Claret I 67. 08025 Barcelona. Spain.Telephone: 29.93.43. Fax: 34-3-29 I1.92.69
Mo.B. 1365
MANTOUX IN INTRAVENOUS DRUG USERS: DIFFERENCES DEPENDING ON HIV
SEROLOGY
Aldamiz-e M, Portu JJ, Ortiz de Barron J Arevalo J, Larrea MJ, Herrera A, Pinedo A. Hospital
Txagorritxu. Spain.
Objective:To assess Mantoux test in active search for tuberculous infection (TB) in
Intravenous Drug Using patients (IVDU) and its different results in HIV+ and HIV- people.
Scope of study: A therapeutic community of IVDU rehabilitation and IVDU patients treated
in Hospital Txagorritxu (Vitoria-Gasteiz, Basque Country, Spain) between October 199 I
and January 1995.
Patients: 529 patients with a history of intravenous drug addiction. Amongst them, 47%
were HIV+.
Methods: A Mantoux test was carried out with 2UI of PPD RT 23 and, for negative cases, a
second test seven days later (booster effect). HIV serology was analyzed in all patients and
in HIV+ patients CD4 lymphocytes were counted. Mantoux was considered to be positive
in both groups when > 5mm.
Results: A positive reaction to Mantoux was significantly more frequent in IVDU/HIVpatients than in IVDU/HIV+ ones (50.0% vs 20.9%; OR 3.77 (2.52-5.67)(p=0.000)).The
reaction was significantly more intense in IVDU/HIV- (p=0.000). A booster effect was
observed in 7.5% HIV+ patients and in 21.7% HIV-patients.The percentage of Mantoux+ in
IVDU/HIV+ decreases especially below 200 cels/mm3 (CD4< 200; 7.7%) but also in HIV
early stages (CD4 201-500:30.3%: CD4>501: 30%). If CD4> 900 lymphocytes are counted,
both percentages become equal.
Conclusions: - Mantoux sensitivity in detecting TB infections decreases in IVDU/HIV+
patients.- IVDU present a high percentage of booster effect cases. - Our data does not indicate from which CD4 level is a Mantoux negative result of little value.This is due to the fact
we have few HIV+ patients with high CD4 values. It may be the case that Mantoux test is
reduced during the early stages of HIV infections.
Aldamiz-e M. Hospital Txagorritxu. Medicina Interna. Jose Achotegui s/n. 01009-Vitoria.
Spain. 945242600
Mo.B. 1366
DISSEMINATED MAC INFECTION IN HIV/AIDS: EXPERIENCE IN RAMATHIBODI
HOSPITAL,THAILAND
Sathapatayavongs, Boonmee, I Chuchottaworn C,2 Prachaktam R. I I Dept. of Medicine,
Rtamathibodi Hospital; 2Central Chest Hospital, Bangkok,Thailand
Objective: To identify and describe clinical features of cases of disseminated Mycobacterium
avium complex (MAC) infection in a subgroup of HIV/AIDS patients presenting with unexplained prolonged fever and/or weight loss.
Methods: From Jan. to Aug. 1995, blood or bone marrow culture for Mycobacteria was
performed in the above described patients, using radiometric technique-BACTEC 13 A
media. When cases identified, retrospective review of clinical features were performed.
Results: Out of these 37 patients, MAC was isolated from blood in 5 patients and from
bone marrow in 3 patients (8 out of 37 - 21.6%). MAC is the AIDS-defining illness in only
one patient. In the others, AIDS-defining illnesses are cryptococcal meningitis 3, tuberculosis
2, PCP I, cryptosporidiosis I. MAC is the second or third major Ol in these casesThe associated symptoms and signs include cough (5), diarrhea (3), abdominal pain (2), dyspnea (2),
hepatomegaly (5), splenomegaly (I), cutaneous lesion containing AFB (I). Absolute total
lymphocyte count ranges from 17 I-1708/cumin (mean 802/cumor). Elevated alkaline phosphatase without jaundice is noted in 5 patients.Three patients died prior to the diagnosis.

\D
O
8)
0
u
c
80
(0
c
0
8)
C
82
8g
u
c
U
c
c
82
c
c
X
11