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

Mo.C.1641 - Mo.C.1646

Monday, July 8, 1996

Mo.C.164 1
HIVTESTING IN PEDIATRIC PATIENTS WITH TUBERCULOSIS AT IMIP'S HOSPITAL:
NO EVIDENCE OF CO-INFECTION
Souza. Edvaldo S, Silva G,Vilarim J,Vasconcelos F Nobre J, Guciros T. Institute Matcrnor o
Infantil de Pernambuco (IMIP), Recife, Pernambuco, Brazil.
Objective: To determine the seroprevalence of HIV infection among pediatric patients with
diagnosis of tuberculosis (TB) at Instituto Materno Infantil de Pernambuco's (IMIP) Hospital
and describe the clinical features of tuberculosis cases in a pilot cross-sectional study
Methods: During June and July 1993, 40 pediatric patients who were initiating or continuing
treatment for tuberculosis at IMIP were asked to participate in this study after their parents
counseling and informed consenting. Blood samples were taken, frozen and tested for the
presence of antibodies against HIV- I and HIV 2 by Vitek Immuno Diagnostic Assay System
(VIDAS). Medical records were reviewed for all patients with a diagnosis of tuberculosis
during and 18 months after the HIV screening.
Results: Thirty-one patients participated in this study The median age at diagnosis was 5
years (range I I to 17 years). Seventy one percent lived at Recife Metropoitan Area.The
median weight at diagnosis was 200 Kg (range 6.6 to 49.0) with reported protein energy
malnutrition in 5 (I 6. I%) of the patients.Twenty-four (77.4%) patients had received BCG
immunization. Mantoux tuberculin test (MTT) was performed in 27 (87. 1%) patients and
yielded positive in 21. Eleven (44.0%) had suggestive history of a household TB case contact
and were more prone to have a positive MTT compared with patients with casual outside
the home contact (P<0.05). Intrathoracic disease alone was present in I 5 (54.8%).
Fourteen patients had extrapulmonaryTB (8 cervical adenitis, 4 bones/joints, I central nervous system and I disseminated). Most diagnoses were done based in epidemiological/clinical evidences and therapeutic responses. None of the blood samples taken from the
patients resulted positive for antibodies against HIV I and HIV-2. All patients completed
therapy No patient presented 18 months after the HIV screening signs or symptoms suggestive of HIV infection and/or relapse or recurrence ofTB.
Conclusions: There was no case of HIV infection detected by this study among patients with
primary diagnosis ofTB at IMIPs hospital.This might reflex a higher prevalence ofTB compared with HIV infection in this region and among the study population. Isolation and identification of M. tuberculosis from appropriate fluids and tissues must be encouraged in all cases.
Edvaldo Souza. Rua dos Coelhos, 300, Boa Vista, Recife-PE, 50070-000, Brazil.
Fax: [phone] I1
Mo.C.1642
TUBERCULIN SKIN TEST CONVERSION AMONG CLOSE CONTACTS OF
PULMONARY TUBERCULOSIS PATIENTS, INFECTED OR NOT BY HIV.
Carvalho, ACC., Brito, ZN., Oliveira, OT, Soares, F, Ferraz, L., Cunha, MP, Dall 'Olio,C.,
Fonseca, A., Boechat, N., Lapa e Silva, JR., Muzzy de Souza, GR., Kritski, AI. Servico Pneumo
do HUCFF/UFRJ.
Objective: Evaluate the risk ofTB infection among close contacts (CC) of Pulmonary
Tuberculosis patients (PTB).
Methods: A prospective study has been carried out from Feb 25, and Dec 28, 1995, in
University General Hospital. Occurrence ofTB disease or infection among 120 (69 women)
CC of 26 index cases-ICs (7 HIV+) was prospectively evaluated. They were divded in
Group A: 92 CCs of HIV/IC and Group B: 28 CCs of HIV+/IC. After informed consent,
questionnaire, radiological, bacteriological tests, and serology for HIV were performed. All
tuberculin skin test I(TT) used 2 UT of PPD RT 23 (Serumr Institut, Denmark).The initial TF
was read 48 to 72 hs after application. Anong those who had TT less than I0 arm (or 5
mm for HIV+),TT was repeated 4 months later:TT conversion was defined as an increased
in induration at least of 10 amm.
Results: Forty three (36%) CCs were below I5 years of age; 55 (46%) cases had a positive
TE One CC (3.6%; I/28) was HIV+ (from Group B), and one (I%, 1/92) had TB disease
(from Group A).TT was repeated in 34 CC; TT conversion occurred in 7.8% (2/26 from
group A). Positive-TT was associated with presence of cavity on chest-x-ray (p=0.007) and
cough -> 4 weeks (p=0.008) among their ICs.There was no significant association between
TTF conversion and the following variables: I) cavitation on chest x -ray or length of disease
among ICs; 2) BCC vaccination, sex and race of the contacts; e) frequency of contact (daily
or weekly with the index cases).
Conclusion:These prelimc rnary data suggest that the risk of tuberculous infection rate seems
to be higher in the group of close contacts of HIV-seronegative index cases.
This study w as supported by World Bank/STD/AIDS Progcrar m/inistry of Health, Brazil.
Cont.003/94
Anna C.C.Carvalho, M.D. Unidade de Pesquisa em Tuberculose-Servigo de Pneurmo do
HUCFF/UFRJ- Ilha Fundao - Av Brig.Trompowsky s/n: Rio de Janeiro, Brazil.
Tel.: [phone] Fax: [phone]
Mo.C. 1643
TUBERCULOSIS AS OPPORTUNISTIC DISEASE AMONG AIDS IN THE CITY OF RIO
DE JANEIRO
Silva G, Barnrera D. Health Secretariat of Rio de Janeiro City Rj, Brazil
Objective: To evaluate the significance of tuberculosis (TB) as an opportunistic disease ira
AIDS cases reported in the city of Rio de Janeiro.
Methods: All AIDS cases reported to the Health Secretanat of the city of Rio de Janeiro
from 1982 to 1995 were studied, observing the prevalence of the main opportunistic diseases in the moment of reporting.The data back was analyzed with the software
EPIINFO (EPI6)
Results: We observed an important increase in AIDS cases fSom 82 to 89 and a slighter
from 90 to 95 when the trend was towards stabilization. Until 92 TB was the second
prevalent opportunistic disease (OD) to candidiasis in the city of Rio de Jane ro. From this
time on TB became the most prevalent OD followed by candidiasis and by pneumocystis
carini pneumonia (PCP), this latter being always the third prevalent one. In Brazil, till 92
candidiasis was the main AIDS related OD by the time of reporting followed by PCP and
by TB (all kinds). From 93 on TB was the predominant OD followed by PCP and candidiasis.This picture remained unchangeable until the end of the studied period. Analyzing the
trends for the city of Rio de Janeiro we observed that it points to an important increase
of TB and PC P

Discussion: T uber- -,,:he city of Rio de Janeiro Is more expressive as an opportunistic
disease related t Al than in Brazil as a whole. Probably the high incidence of the disease
in the munripty 6/' '0.000 inhab. against 65/100.000 inhab, to the country) is responsible for its si c rcar c a w a compared with the other opportunistic diseases. Concerning
to the predomai,,Yn ce -,f ver candidiass after 93 we should comment that the data of
candidiasis were refer ed i to the disease of trachea, esophagus, bronchus and lungs
(CDC criteria) n, to or,l dsease. Another fact that could explain the increase of TB
reported after 9) wars she Implementation of a training program in co infection TB/HIV to
health care professionals.
Conclusions: Aiming to avoid the occurrence of the main OD in AIDS in the city of Rio de
Janeiro one should: () implement the TB Control Program activities, and (2) irmplement
AIDS Program prevention activities, like training for health care professionals and chemoprophylaxis for TB amrong~ AIDS patients. Efforts should also be dome to control PCP
almost as high as TB in the spectrum of opportunistic diseases related with AIDS in Rio de
Janeiro.
D Barreira, RuaAfonsor tavlcanti, 455 sl. 856 Cidade Nova 20.2 1 110, Rio de Janero, RJ,
Brazil.Tel: [phone]: Fax: [phone]; E-mai: bdurovnIaax.apc.org
Mo.C. 1644
PRIMARY RESISTANCES TO ANTITUBERCULOSIS DRUGS AMONG HIV INFECTED
AND UNINFECTED PATIENTS.A NATIONAL SURVEY IN COTE D'IVOIRE IN 1995-96
Coulibal IM, Bonnard D2, Bamba A I, Msellati p3, Vincent V4, Doulhourou C ', Peyre MI -5
Traore M 1, Koffi K6,Trebucq A7, Boulahbal F7. the Ivoirian Study Group on luberculosis
Resistances and Dosso M6. I Programme National de Lutte contre le SIDA. les MST et as
Tuberculose, 2 CeDReS - CFIU de Treichville, 3 ORSTOM Petit Bassam, Albidja,. Cte
d'Ivoire, 4 Institut Pasteur Paris - France, 5 Prolet Sante Abidjan, French Cooperation, 6
Institut Pasteur de CSte d'ivoire, 7 International Union againstTuberculosis, Par.ns - France
Objectives: Estimate the prevalence rate of primary resistances of ia 6ly ticit rr losis to antituberculosis drugs used by the Ivoirian National Program Against Tuberculosis and
compare this rate between HIV infected and uninfected p stients
Methods: A cluster samplng at random was used to select consecutive new tuberculous
patients with positive smear from all Tuberculous Centers and some Rurl Hearlth Centres
in Ivory Coast. Detailed interviews were performed to identify patients who could have
been already treated for tuberculosis and exclude them. Cultures were performed in less
than 5 days after inclusion. Negative cultures were consecutively replaced. Drug susceptibili
ty was tested against five antibiotics (ElHRSZ), used by the national program. The cultures
and antibiograms were systematically controlled by a mycobacteries reference laboratory in
Franrce. HIV was tested (Elisr. Peptilav) for tuberculous patients from the 8 tuber( ilous centers.The last antibiogramrs will be finished in April 1996.
Results: 30 clusters of 12 consecutive new tuberculous patients with positive r were
collected from May 1995 to January 1996. these clusters camere from 8 tuberculous centers
(21 clusters) and 8 rural health centers (9 clusters). At 25th January 1996, 365 c tltures
were received by laboratories, and 285 were positive (78%). 200 antih ograis have been
read. On these prelimiianr results, the global rate of resistance seems to be below 15%. For
213 of these,the HIV status has been tested and the prevalence of HIV s over 0%.We
will be able to present in the conference compari sonr of resistances to tuberculosr cus
between HIV infected and uninfected patients. In conclusion this survey on re.istarces to
antituberculous cr gs will g ive informat ion orn prevalence of resistance etween I IV infected and uninfected patients in Ivory Coast.
Coulibaly Issa Malick. Direction Executive Du RNLS, 04 BP 2 11 3. 04 Abidn Cote D' [)lvoire
Tel[phone]
Mo.C. 1645
HIV SEROPREVALENCE IN TUBERCULOSIS PATIENTS IN MOROCCO.
Mahjour J., El Yassem A, flai Baba A., Zidouh A, Ottmani S., Benchel NI. Ministr of
public Health.
Objective: To estirrimate the prevalence of HIV infection amiong tuberculosis patients n rationwide and to establish baseline date in order to follow the evolution of HlV it-tction among
this group.
Methods: Eight hundred fifty seven tuberculosis Patients (40% Wormen; 60% eNr) hosptalised in 27 provincial hospitals, were selected for anonymous nomlinked HIV testing.
Blood sameplo er tSiaken fom all patients aind tested for presence of HIV antibodies by
an ELISA. Positive ELISA tsls were confirmed by western Blot.
Results: Among the hospitalized tuberculosis patients tested for IHIV, one individual was
found positive on the ELISA.This case was confirmed by western Blot
Conclusion: In Morocco, the seroprevalence rate among tuberculosis patients is,2 %0.
Dr Filati Baba Abderrahn-an, Dermatologue- Venerologue, 55. Street Oukavneden,
10.000 - Rabat Agdal - Maroc.Tel: [phone]. Fax: [phone].
Mo.C. 1646
RESISTANT TUBERCULOSIS AND HIV INFECTION IN PUERTO RICO SINCE 1980
Cunningham, Ernst L. h/niver-srty of Puerto Rico School of Meditre Ri o Pedras, Puerto Rico
Objectives:To study resist nt tubercuosis (RTB), both to a single drug and to alt pe
drugs in those with HIV infection (RTB-HIVI and those without, in PuertS Rico
Methods: All patients reported to the 3 B program in Puerto Rico srnce i 80 with at least
one culture showing resistance to at least one druig were studied. Demoyraphic data, all
culture results, treatment regimens and dates, and patient outcomes were determined for
each case, as well as whether a positive test for HIV was reported at any time.
Results: RTB was found in 449 (8.I%) of 5571 patients reported with TB since 1980, 53
(1.8%) of which were HIV+.Twothirds (68.4%) of RTB were male, rnd 83.0% of RTB
HIV. With regard to age, 60% of RTB were spread evenly between the ages of 30 and 59,
whereas 50% of RTB-HIV were between 30 and 39 years of age. Whereas 40.8% of all
RTB had single drug resistance, 54.7% of RTB-HIV did Of RTB. 30.0% died while 46.9%
were declared TB class IV, or cured. Of RTB-HIV 56.6% died, while 18.9% were declared
TB class IV
Conclusions: RTB-HIV cases were more like AIDS than RTB with regard to ae, sex, and
outcome profiles but the pattern of resistance in RTB HIV ws more -ke RTB w'ith I IV

165