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

Mo.B.1367 - Mo.B.1372

Monday, July 8, 1996

Five patients have been treated with coprofloxacin/ofloxacin plus clarithromycin
(+ amikacin), 4 are still alive by Dec. 1995.
Conclusion: Our experience should alert the physicians in developing countries that MAC
is also common in HIV patients, at least in South East Asia region. Cases emnerge when we
look harder for them and perhaps our AIDS patients survive longer
B Sathapatayavongs, Rama VI Rd, Bangkok, 10400 Thailand Tel: 66-2-201-I 58 I;
Fax: [phone]
Mo.B. 1367
BONE MARROW SAMPLING AS A DIAGNOSTIC TOOL IN HIV-POSITIVE PATIENTS
WITH PYREXIA OF UNKNOWN ORIGIN (PUO)
Brook, M Gary*, Ayles H**, Harrison C***, Rowntree C***, Miller RF*/**. * Mortimer
Market Centre; * Middlesex Hospital, ** University College Hospital, London
Objectives: To assess the effectiveness of bone marrow sampling in the diagnosis of the
causes of PUO in HIV positive patients.
Methods: Patients who had undergone bone marrow sampling as one of the investigations for
PUO between 1987 and 1995 were identified. From patient records and computer data the
value of the marrow samples in achieving a diagnosis of the cause of the PUO was assessed.
Results: I 17 patients had 121 imarrow aspiration and 1 13 marrow trephine samples.
Microscopic examination of the marrow revealed the cause of the pyrexia in 33 (27%) of
patients from 30 (27%) trephine and 4 (3%) aspiration samples.The diagnoses made were:
mycobacterial infection (25), lymphoma (7) and toxoplasmosis (1). Factors more commonly
found in patients with positive marrow samples than those with negative samples were low
haemoglobin (mean 8.5 g/dl Vs 9.9 g/dl, p<0.05), low CD4 count (mean 0.06 Vs 0.102
x 10 /I,p<0.05) and recent significant fall in any of the haemoglobin (<8g/dl), white cell
(<2xl0 /I1) or platelet count (<80x109/1) (18/33 [55%] Vs 27/88 [31%] of patients with
diagnostic and non-diagnostic samples respectively p<0.05).When mycobacterial infection
was diagnosed by microscopy of a marrow sample, this was achieved a mean (range) of 25
(8-60) days earlier than the first positive culture. Marrow trephine samples had a sensitivity
of 25/39 (64%) for the detection of mycobacterial infection.
Conclusion: Marrow sampling, especially marrow trephines, contributed significantly to the
early diagnosis of the cause of PUO.This success was due to the detection of mycobacterial infection, lymphoma and disseminated toxoplasmosis Samples were most likely to be
positive in patients with anaemia, low CD4 count or recent fall in platelet, red or white
blood cell count.
M Gary Brook, Mortimer Market Centre, Mortimer Market, Off Capper Street, London
WCI E 6AU UK.KTel (0)171 530 5077/5014 Fax [phone]
Mo.B. 1368
EVALUATION OF PPD-BATTEY AS A DIAGNOSTIC TOOL IN PERSONS WITH
SMALL INDURATION SIZES TO CONVENTIONAL PPD
Gourevitch, Marc N, Steinhart R, Schoenbaum EE, Hartel D, Klein RS. Montefiore Medical
Center/Albert Einstein College of Medicine, Bronx, NY, USA
Objective: To determine whether small (< 10 mm) reactions to PPD reflect cross reactivity to
a common nontuberculous mycobacterial antigen in persons with and without HIV infection.
Methods: Persons enrolled in a study of M. tuberculosis infection in drug users were tested
at baseline with PPD (5 TU, Mantoux method) and PPD-Battey (PPD-B, manufactured by
Connaught Laboratories, Ontario) derived from M. avium intracellulare (0.05 mcg in 0. I ml,
Mantoux method) and the MultitestR CMI device (to assess cutaneous anergy). Induration
was assessed at 48 72 hours. Pts developing >2 mm induration to PPD or PPD-B were
classified as reactors. Reactions to one skin test exceeding the other by >5 mm were classified as dominant. HIV serology was also performed.
Results: Complete data were available for 32 1/330 subjects enrolled to date. Of these, 60
had cutaneous aner gy and were excluded from analysis. Of the 270 remaining patients, 93
(34%) reacted to PPD, 1 18 (44%) to PPD--B, and 76 (28%) to both. Only I12 (I 3%) PPD
reactors (9 HIV positive and 3 HIV negative) had indurations of 2-9 mm. Among these, only
I was dominant to PPD-B, 5 were dominant to PPD, and 3 were non-dominant. Among all
270 reactors, induration sizes to PPD and PPD B were well-correlated [Spearman's r=0.66
(95% CI 0.58 0.72)].This correlation did not differ between HIV positive and HIV-negative
patients when examined separately
Conclusions: Few reactors have small induration sizes to PPD. Reaction to PPD-Battey is
common in this population.These data do not suggest that small PPD reaction sizes reflect
infection with M. aviur. Further study is needed to define the significance of PPD- Battey
reactions among persons reacting to PPD.
MN Gourevitch, Montefiore Med Ctr; Il Fast 210th Street, Bronx, NY, USA 10467.
Tele: [phone] Fax: [phone] email: gourevitarecom.yu.edu
Mo.B. 1369
INTERACTIVE EFFECTS OF RIFABUTIN COMBINED WITH OTHER ANTIMICROBIAL
AGENTS AGAINST MYCOBACTERIUM AVIUM COMPLEX (MAC)
Yajko, David M, Cawthon VL, Madej JJ, Hadley VWK. University of California, San Francisco
General H spita, San Francisco, CA USA
Objective: It has been recommended that treatment of disseminated MAC infection in
patients with AIDS include at least two Cntimicrobial agents.When used in combination,
deugs an nterarct is an addive, synergistic, or antagonistic mannerThe interactive effects
of drugs rgainst MAC are poorly understood. Rifabutin, clarithromycin (CLA), azithromycin
(AZI), ciprofloxarin (CIR), ethambutol (FMB), and clofazimine (CLO) have all beers suiggested for- use ira the treartment of disseminated MAC infectronThe objective of this study was
to determine the effect on intracellular MAC survival of the combination of each one of
these agents with rfabutinTo accomplish this, we first determined the concentration of
each drug which caused a small but measurable decrease in intracellular MAC survival. We
then combined the 2 drugs at these concentrations and determined whether the combined
effect on MAC survival was greater than (synergistic), equal to (additive), or less than
(antagonistic) the effect of each drug used alone.
Methods: Three MAC strains with varying levels of drug susceptibility were used to infect
cells of the macrophage derived mouse cell line J774. Macrophages were treated with single
drugs, and the concentration of each drug that caused a 25% reduction in intracellular MAC

survival was determninecl Experiments were then repeated using a mixture of 2 drugs. each
drug being used at the, oncentration which caused a 25% reduction in survival.
Results: For 2 MAC stras r the interaction of rifabutin + CIP was consistent with the 2
drugs acting inr an addii.e, anner For one MAC strain the combination of rifabutin + EMB
was additive. For all other ombinations (and all 3 strains of MAC) the interaction of drugs
with rifabutin appeared to be synergistic. Differences among strains in level of susceptibility
to rifabutin seemed to have little effect on combination results.
Conclusions: This study provides evidence that rifabutin acts synergistically with CLA, AZI,
and CLO against MAC in vitro, and may act in an additive manner with CIP and EMB
against some strains.There was no evidence of antagonism between rifabutin and any of
the drugs tested.
DavidYajko, Clin. Labs Rm 2M35 Son Francisco Gen. Hosp. 1001 Potrero Ave. San
Francisco, California, USA 94110 Telephone: 4 I 5-476 4604 Fax:[phone]
e-mail: [email protected]
Mo.B. 1370
PREVALENCE AND RISK FACTORS FOR TUBERCULIN POSITIVITY IN A COHORT
OF HIV INFECTED AND UNINFECTED AT-RISK WOMEN.
Anastos Kathryn,Telzak E, Chirgwin K, Benson C, Delapenha B, Palacio H. Stonis L, Kalish L.
The Women's Interagency HIV Study (WIHS)
Objective: To determine the prevalence of and risk factors for tuberculin (PPD) positivi
ty among HIV seropositive and seronegative at-risk women enrolled in a prospective
cohort study
Methods: The WIHS, a multi-site study of HIV infected and uninfected at-risk women,
enrolled 1,761 women at six sites in the U.S. from October I, 1994 to May 1, 1995 This
analysis reports results for 885 women who received intradermal tuberculin skin tests with
0. I ml 5-tuberculin-unit purified protein derivative (PPD), and delayed type hypersensitivity
testing (DTH) by separate intradermal injection of mumps, tetanus, and candida antigens,
whose HIV serostatus was confirmed and readings of skin testing at 48 to 72 hours were
available. PPD reactivity (PPD+) is defined as induration of >10 mm in HIV- women, and
of >5 mm in HIV+ women. DTH negative (DTH-) status is defined as failure to respond to
non-PPD antigens.
Results: The prevalence of PPD+ was 3% in the 750 HIV+ and 15% in the 135 HIV
women. PPD+ was 7% in African American women (N -= 468), 4% in Latinas (N - 22 I)
and 1% in white women (N - 173). 42% of HIV+ and 14% of HIV- women were DTH
negative. PPD+ in HIV- women was not associated with DTH status (I 6% in DTH+ and
15% in DTH- women), Among HIV+ women, 4.4% of DTH+ and 1.6% of DTH- women
were PPD+, p = 0.04. Among HIV+ women, 7 of the 32 (22%) reactive PPD's were in
DTH- women. Independent predictors of PPD+ in multivariate logistic regression analyses
were: HIV serostatus (p<.00 I); race/ethnicity (p =.006), low CD4 cell count (p-. 001), location (Calif., <1%, vs other sites 4% to 9%, p -.007), and a prior history of tuberculosis (by
self-report), 5% vs 16%, p -.03.There was not an observed association of PPD reactivity
with foreign birth, history of IDU, use of crack/cocaine, number of sexual partners,
exchange of sex for money or drugs, or household history of TB.
Conclusion: PPD+ in this cohort of HIV infected and at risk women was associated most
strongly with HIV negative serostatus and CD4 cell count > 500/nam as well as geographic
site, non-white race, a personal history of TB, and in HIV+ women, DTH+ status. DTH- status may not be an indication to discontinue PPD skin tests in HIV+ women.
Kathryn Anastos, MD [phone] FAX #[phone] Jerome Avenue, Bronx
New York 10467
Mo.B.137 I
MAIC AND THE EFFECT OF PREDNISONE ON DISEASE PROGRESSION IN AIDS
PATIENTS
Graves, Marilyn, Salvato, P,Thompson, C. Twelve Oaks Hospital. Houston,Texas, USA.
Objective: To assess the effect of steroid therapy in combination with standard MAIC therapy in patients with AIDS.
Methods: 52 patients infected with HIV (CD4 8-I21) who received oral prednisone (.5
mg/kg daily) with standard 3-5 drug treatment for MAIC were compared to 4 I patients who
received only standard 3-5 drug MAIC treatment. After one (I ) year of treatment medical
records were reviewed to evaluate death rate, CD4 count changes, and weight changes. 86%
of all patients were on combination antiviral therapy for the I year data collection period.
Results: Patients on standard 3-5 drug MAIC therapy without prednisone adjunct therapy
experienced a 34% increase in deaths as compared to those patients receiving both stan
dard MAIC therapy and adjunctive treatment with prednisone. Increase in mean CD4
counts and weight were greater in the group receiving prednisone.

Type Therapy # Patients
Prednisone.5mg/kg QD 52
No Prednisone 41

Parameters Measured
Deaths CD4 Count A
#23 %44 xT 27
#32 %78 x,39

Weight A
x 14 Ibs
x 31 Ilbs

Conclusions: Treating HIV patients with steroids presents considerable challenge to most
clinicians.This study demonstrates significant survival advantages in the treatrment of MAIC
with the addition of once daily.5 mg/kg prednisone to standard treatment regirsen. In addition, weight gain was significantly improved as were CD4 counts. Steroid treatment in
patients with MAIC clearly warrant further study.
Marilyn Graves, 4120 Southwest Fwy, Suite 200, Houston,Texas. 77027 Tel: [phone],
Fax: [phone]
Mo.B. 1372
COMBINATION CLARITHROMYCIN AND A QUINOLONE IN THE TREATMENT OF
DISSEMINATED MYCOBACTERIUM AVIUM-INTRACELLULARE INFECTION
Alkhal, AM*, Ross. ack W*, Sherwood, DJ**. *Hartford Hospital, Hartford, CT
USA;**University of Connecticut, Farmington, CT USA.
Objective: To determine the efficacy of combination therapy of oral clarithromycin and a
quinolone in the treatment of disseminated mycobacterium-avium intracellulare complex
(MAC) infection in patients with AIDS.