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

Mo.C.1652 - Mo.C.1657

Monday, July 8, 1996

Mo.C.I1652
INTERACTION HIV/TUBERCULOSIS IN BRAZIL:THE FIRST 15 YEARS AND TTAE
FUTURE
Rodrigues, Lair GM, Castilho E, Chequer P Fonseca, MGOP Loures L. Ministry of Health,
Brasilia, Brazil
Objective: To examine the impact of tuberculosis (TB) in the morbidity /mortality of AIDS
and mainly the impact of HIV in the incidence ofTB in Brazil.
Methods: Data from different national sources were evaluated: AIDS and TB case surveillance; HIV sentinel surveillance; mortality registers and special studies. In addition the future
number of TB cases associated to HIV infection was estimated using EPIMODEL, a WHO
model based upon a theorethical epidemic curve for AIDS empirical data.To make possible
the use of EPIMODEL was adopted the assumption that all co-infected persons that
progress to AIDS will develop TB.
Results: (I) At the time of reporting 27% of the AIDS cases have already been diagnosed
with TB.This proportion increases to 60% if one follows a cohort of HIV-infected persons.
Taken into account the rapidly evolving HIV epidemic among young injecting drug users
(IDU) in Brazil note that TB is more frequent in IDU-associated AIDS cases (26%) than in
persons with AIDS transmitted through sexual intercourse (21%).
(2) HIV infection is a risk factor for development of active TB in all the Brazilian regions.While
it was observed a differential distribution of TB incidence among these regions, results from
sentinel surveys showed ihomogenous distribution of HIV infection. Nowadays an increase in
the TB mortality rates has been reported in cities with the highest AIDS incidence. Up to the
end of this decade as many as 6 1000 newTB cases will occur nationwide as a result of HIVassociated immunodeficiency Considering the current annual incidence ofTB - 60000 cases -
one can expected an excess of 14000 cases (25%) related to HIV in 1999.
Conclusions: AIDS and TB Control Programs in Brazil should develop interprogram action.
Aggressive prophylaxis forTB among HIVinfected persons and HIV testing and counseling
for TB patients are important.
Lair Rodrigues, Programa Nacional de DST/AIDS, Ministerio da Saude, sobreloja, sala II
70.058-900 / Brasilia, Brazil Tel: [phone] Fax: [phone]
Mo.C.1653
HIV/TUBERCULOSIS CONINFECTION IN AN EVERGENCY HOSPITAL IN RIO DE
JANEIRO, BRAZIL
Cortes, Ely EM, 1 Saraceni V.2 IHospital da Lagoa; 2Hospital Rocha Maia, Rio de Janeiro, RJ,
Brazil
Objective: To determine the ratio of HIV/Tuberculosis (TB) coinfection in patients presenting in an Emergency Hospital.
Methods: We analyzed the notifications of AIDS and TB cases from January I to December
31, 1994 made at Hospital Miguel Couto, City Department of Health.There were 69 cases
of AIDS and 90 cases of TB in this period. Patients that were discharged from the
Emergency Room or died prior to admission were excluded, as also the patients that did
not meet the diagnostic criteria, as follows: chest radiographs, sputum smears and lymph
nodes and pleural biopsies, positive to TB.
Results: Thirty patients out of 69 HIV+ admitted to the Internal Medicine Clinic of our
hospital were coinfected with TB (43.47%).The relative risk (RR) for an individual HIV+ to
have TB was 0.61 (95% Cl, 0.42<RR<0.87), p=0.0059. Of these, 30% were female, 70%
male, mean age at diagnosis was 35.17 years (range 18-59, SD=9.4 I), no signicative differences in race, 63.3% had less than 8 years of schooling. Only I I (36.7%) were aware of
their HIV status prior to admission. Only I had cavitary TB, all the rest had disseminated
forms of the disease. On the other hand, one third of 90 patients with TB were HIV+.
Conclusions: World Health Organization estimates that 24-28% of HIV+ in Brazil are
infected with M. tuberculosis. Our findings showed that 43.47% of the HIV+ admitted to
our hospital through the Emergency Room were coinfected.This fact probably happened
because this hospital isn't a reference for AIDS, but is the second in number of admissions
due to any medical reason in our city
EEM Cortes, Rua Mario Portela, I 6 I/C/804, Rio de Janeiro, RJ, 2224 I -000 Brazil.
Tel: [phone]; Fax: [phone]
Mo.C.1654
HIV INFECTION AMONG TB PATIENTS: GEOGRAPHIC VARIABILITY IN MOZAMBIQUE
MacArthur Jr, A.*, Hellstrom, P E., Noya, A. *, Barreto, A.**. *National Tuberculosis and
Leprosy Control Programme, **National STD/AIDS Control Programme.
Objective:To investigate the HIV seroprevalence among TB patients according to the geographical location.
Methods: 31 districts with well performing Tuberculosis Control Programmes on the corridors of Nacala, Beira and Limpopo and non-corridor areas of the corresponding northern,
central and southern regions respectively were chosen for a cross-sectional survey of the
HIV seroprevalence in TB patients. 10 experienced laboratory technicians were trained to
perform 2 rapid tests (Testpack and HIV SPOT).They were accompanied by the Provincial
TB and Leprosy Supervisors to the district health centers during the field work. All TB
patients, irrespective of theirTB classification, 15 to 59 years of age in the initial phase of
treatment and those in the maintenance phase coming for clinical check ups were included
in the survey
Results: From June to September 1994, 1437 TB patients (639 females and 798 males)
were studied.The average age was 33 (+/- I I). 1193 new, 237 retreatment and 7 chronic
cases of tuberculosis were identified.The patients of the Central Region were found to have
the highest HIV seroprevalence. (Beira corridor 30.3, the corresponding central non-corridor area 20.4 %). A dominance of women was observed in all areas except the northern
corridorThe seroprevalence rates in the districts alongthe Beira corridor increased fiom
Beira town to the Zimbabwean border (p< 0.001, Chi test for linear trends of proportions). Patients living in districts on the border of Zimbabwe, Malawi and RSA had significantly higher risks of being HIV infected compared to those living in the other districts (OR
4.30, RR 2.89, p< 0.05).
Conclusions: The results all for changes in the key elements of both the health policy and the TB
Control programme strategy, particularly in areas with the highest HIV seroprevalence rates.
Mac Arthur Ji: Ministry Of Health. Nacional Std/Aids Control Program Cp 264 Maputo
Mozambique Tel. 258- I -431305 Fax [phone]

Mo.C.1655
HOSPITAL-BASED CASE MANAGEMENT AND DIRECTLY OBSERVED THERAPY
PROGRAMS REDUCE READMISSION RATES FOR TUBERCULOSIS
Boulanger Catherine-, C penter R, Zabala J3. Jackson Memorial Hospital, Marrri, FL:
2University of liami School of Medicine, Miami, FL: 3Dade County Public Health
Department, Miami, fL.
Objective: To assess the effect that hospital-based directly observed therapy (DOT) corn
bined with case management intervention have in the compliance and outcome of patents
dually infected with HIV and tuberculosis (TB).
Setting: A 1500 bed inner-city hospital in Dade County FL. A state-of-the-art respiratory
isolation unit is used for outpatient clinic. Dade County probably has the highest incdence
of patients dually infected with HIV and TB in the United States.
Methods: In May of I1994 we instituted case management and DOT A hospital-based nuse
case manager oversaw a clinical pathway for tuberculosis. A program for hospita-based
DOT and tracking of delinquent patients was instituted through a collaborative effort will
the Dade County Health Department.We compared rates of readmission to the hospaal
for active TB for the 7 months before and after May 15, I 994.
Results:The number of patients on DOT increased from 10 to 45.The rates of readmssionr
forTB decreased from I I.5% to 1.5% (p=0.000 I).The rates of readmission for the HIVrespiratory clinic patients decreased from I 8.75% to 0% (p=0.000 1). Cost benefit analysis
revealed an estimated savings of $400,000.
Conclusion: The institution of hospital-based DOT and case management is effective in
increasing compliance and decreasing hospital readrmission rates.
Catherine Boulanger M.D. 901 N.W 17th St, Suite D, Miarmi, FL 33136, Park Plaz ast
Tel: [phone] Fax: [phone]
Mo.C. 1656
NOSOCOMIAL OUTBREAK OF MULTIDRUG RESISTANT TUBERCULOSIS
EVALUATION OF CONTROL MEASURES
Masini, Rubn, Metta H, Corti N., Cangelos D, y col Hospital F.J. Muriz. Pabellon 22,
Buenos Aires, Argentina.
Objective:To determinate clinical and epidemiological characteristics of a multidrug resi,,
tant tuberculosis outbreak in an AIDS ward and to establish the efficiency of the measures
taken to control it.
Methods: One hundred and thirty AIDS patients (115 male and 15 female) have been followed between 01-01-94 up to I I-30-95.A case was defined as every patiernt whohi li
multidrug resistant tuberculosis strain.This population was divided into one group of 74
patients before the control measures were taken and in a second group of 56 patents fter
they were taken. In record cards "ad hoc the clinical, epidemiological and bacte 1ological
data were registered.The laboratory diagnosis and sensibility methods were the conventional and the identification of the strains was made with RFLP Control measures were: the
systematic use of respiratory masks, isolation of patients with respiratory symptoms, use Ol
HEPA filtration and second line therapy treatment.
Results: Of the 130 patients, 64 had pulmonary disease (49.3%), 9 had extrapulmonary dsease (6.9%) and 57 presented disseminated tuberculosis. One hundred and fifty six s. pies
were taken for bacteriological studies, the sputum turned out to have the best profit in rte
diagnosis (64. I%). Ninety two strains were resistant to five or more drugs (70.7%). Seventy six
strains were analyzed by RFLP method and 72 of them (94.7) resulted in identical patir-s.
Conclusions: There were no significative differences between the two groups whichr re'arls
to the delay in the time of diagnosis, the time between the diagnosis and death arid the tme
of survival.The control measures adopted to date don't modify the outbreak characteristrcs.
Masini, R, Indart 10 I, iLomas del Mirador: Buenos Aires. 1752 Argentina
Telephone: (54 I) 44 I 3046 Fax [phone]
Mo.C.1657
INCIDENCE OF TUBERCULOSIS IN A COHORT OF HIV- I INFECTED WOMEN IN
RIO DE JANEIRO, BRAZIL.
Pinho, AMF, Lopes, GS, Lima, LAA, Schechter, M. Hospital Univer sta rio Clem'er n. Frai
Filho, Universidade Federal do Rio de Janeiro, Brazil.
Objective:To study the incidence of active tuberculosis (TB) in a cohort of HIV-infected
women in Rio de Janeire, Brazil.
Methods:We prospectively collected data on participants of a cohort study inve;tigating
the natural history of HIV infection in a developing country that began in August I9 I. In
the present study only women who had a baseline tuberculin skin test (PPD) were mluded. Diagnosis of TB was based on one of the following criteria: (I) positive culture (2) presence of acid-fast bacilli in Ziehil-Nielsen stains, (3) caseating granuloma in a biopsyrple
(4) clinical and radiological response to appropriate anti-TB treatsent.
Results: One hundred seventy eight patients were included in the study. Rsk f ratosorHIV
infection was heterosexual contact in 136 (76.4%) patients, IV drug use in 3 (.t
sion of blood products in 16 (9%) and unknown in 23 (12.9%). At baseline, the PPD tes
was positive in 60 (33.7%) and negative in I 13 (66.3%) patients. Total follow up t sime,
outTB prophylaxis was 340.5 patient-years. Eight cases ofTB occurred dunng this pensod.
Median CD4 count at the time ofTB diagnosis was 137 (13%) cells/mm3.Ther wre
cases of TB among patients with a positive PPD (incidence - 3.6% per 100 patoient-yer s
and 3 cases among patients with negative tests (incidence I!.5% per 1130 patient -ears.
The relative risk was 2.39 (95% I C=0.57 to 10.0, p--NS). Eighteen patients recorved dshif -
ent prophylatic regimens (isoniazid for 6 to 12 months, or rifampin plus pyraz n nude for
months). Follow-up time after completion of prophylaxis was 19.2 patient-yea,.
one case ofTB in a patient who completed 9 months of isonsazid (incdence - 5.2 p
patient-years).
Conclusions: Although this study was carried out in an area of high presolence or
Mycobcterium tuberculosis infection, the encountered incdence of TB was lower tr's
ly reported in similar studies.The very low proportion of IV drug users included ir tri
studied population may account for these results.
T is study was partially funded by a groant frois Petrurbi SA
Ana Maria Felix de Pinho, Rua Justiniano da Rocha, 20 1/302 Vila Isabel. Rio de Janetro, R),
Brazil, 2055 1-010

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