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

Track C: Epidemiology & Public Health

Mo.C.1660 - Mo.C.1664

Mo.C.1660
HUMAN TUBERCULOSIS (MHTB) AND MULTIDRUG-RESISTANCE: CLINICOEPIDEMIOLOGICAL REMARKS FOLLOWING A NOSOCOMIAL OUTBREAK.
Caggese L.t,Volonterio A.~, Orcese C., Penati V'', Astolfi A.*, Rastreli. ".M Infetious Diseaseso,
Microbiology*, Health Direction^, Niguarda Hospital;Villa Marelli Institu eI Milan.,Italy
From July 1992 to December 1995, 63 cases of MHTB were observed it infectious
Diseases (ID) of our Hospital. ID is a facility with two floors of inpatie- (O50-42 beds),
Day- Hospital (6- I 2 beds), and an outpatient ward (4-5000 visits pi syeari Of all cases, 31
were due to the same strain and were nosocomially acquired in the irst 6 months of 1993.
Overall distribution of MHTB was as follows: 7 in 1992 (last 6 montci), 35 in 1 993, 12 in
1994, 10 in 1995.31 patients (nosocomial outbreak) showed an ic.l-:id pa stern of drug
resistance on antibiogram (9 of 10 tested drugs: Rifampicin, Isoniazid, Eth rnbctc:l,
Streptomicin, Amikacin, Kanamicin, Cicloserin,Terizidon, Ofloxacin; only Piazofolin was susceptible). After the outbreak no patient with the same pattern was identified except in one
case when 4/4 tested drugs were resistant.The patient, though, had no d, ar epidemiological
link to the nosocomial outbreak. 14 other patients were susceptibl,, to at ieast 3 of 4 major
anti- MHTB drugs, but showed resistance to 2-6 other minor drug- Of these, c linical outcome and response to therapy were all favourable except in two caes,egardless of risk,
age or CD4 counts. Availability of PCR testing (July 93), awareness of the peculiar course of
MDR-TB, reduced overcrowding in HIV ward, better spacing of faclities, precise scheduling
of outpatient work, rigid compliance to isolation measures for febrile,nrid respiratory
patients, limitation of transportation outside the building for diagnostic purposes, health care
prevention programs all allowed containment and eventual interruption of nosocomial
transmission. No health- care worker developed the disease.The conti'ui'g presence of different strains of MDR-TB in 94-95, though unrelated to nosocomi,l acqiisition, raises concern on the new potential of a formerly treatable disease, espec iiy in irc,,unocompromised hosts when no negative pressure facilities are available: enforcing s trict isolation procedures remains mandatory for such Institutions.
Dr:Liliana Caggese Ospedale Niguarda P. Zza Ospedale Maggiore 3 20162 Milano,
Fax [phone]
Mo.C.1661
POOR SENSITIVITY AND PREDICTIVE VALUE OF DIAGNOSTIC TESTS FOR
PULMONARY TUBERCULOSIS (TB) AMONG HIV PATIENTS IN A HIGHLY TB
PREVALENT SETTING
Garcia Garcia Ma. de Lourdes*,Valdespino JL*, Mayar ME*, Palacios -, GCrca-Sancho C*,
Balandrano S**, Sepulveda J*. *National Institute of Public Health, 'iNDRE, Ministry of
Health, Mexico
Objective: To measure the value of tests usually available for diagnosis of pulmonaryTb in
primary care centers providing care for groups at risk for HIV inrfection.
Methods: Ambulatory patients attending HIV screening centers were examined for active pulmonaryTb (clinical history Rx, PPD,AFB smear and culture) and HIV infection (ELISA-WB).
Results: 2668 patients were screened, bacteriologically confirmed pulmonary M. tuberculosis
was found in 27 (I.0%) patients. HIV infection was diagnosed in 56%; 19 pulmonary Tb
cases were diagnosed in this group. Comparison of different tests vs cuture confirmed
M.tuberculosis according to HIV was as follows:

Conclusions: Lymphoscintigraphic study allowed anatomical and functional evaluation of
lymphatic system of lower legs in epidemic, iatrogenic and classic KS patients. It was not
possible to identify differences in pattern of images among the three types of KS. Lymphatic
disorders were identified in all cases, even in absence of clinical signs of lymphoedema. A
focal pattern was registered in these cases, and it was not observed in patientes with nonKS lymphoedema.
Carolina M.Takizawa, R.Manoel Coelho da Silva no33, Sao Paulo, 04 137-000, Brazil
Phone/Fax: 55- II -2760663
Mo.C.1663
GEOGRAPHICAL VARIATION OF AIDS ASSOCIATED KAPOSI'S SARCOMA (KS) IN
EUROPE
EbrahimsSH, Peterman TA1, Hamers F2. Division of HIV/AIDS, CDC, Atlanta, USA I &
Europ. Cent. for Epid. Monit. of AIDS, Saint-Maurice, France2.
Objective: Classical KS has been reported with higher frequency in the Mediterranean
region and southern Europe.To explore this association in relation to AIDS-associated KS,
we analyzed the European AIDS data set as of Dec. 1994.
Methods: We included the 13 countries with a cumulative total of >50 KS cases as the presenting manifestation of AIDS. Analyses were stratified by gender HIV transmission risk,
country age and year of diagnosis.
Results: KS was the presenting manifestation of AIDS for 13.8% (14,886/ 107,919) of men
and 2% (424/21,106) of women. Among men, KS was diagnosed for 25.6% of gay/bisexuals,
13.2% of gay/bisexuals who are IDUs, 7.5% of heterosexuals, 3.5% of transfusion recipients,
and I1.8% of IDUs. Among women, 2% of heterosexuals, 2.3% of transfusion recipients and
1.5% of IDUs had KS. Among heterosexuals KS most common among persons from countries where heterosexual transmission is frequent (7.8%, 324/4,180), men with partners
from countries where heterosexual transmission is frequent (7.8%, 95/I 2 I 8), and female
partners of bisexual men (5.6%, I 8/320)). Among gay/bisexual men, KS was more common
in France (31%, 5,228/I 6,633), Belgium (28%, 203/732) and Portugal (27%, 199/738) than in
Sweden (18%, 1 32/735), Denmark (I18%, 213/1 160) and Greece (19%, 101/537). Among
IDUs, KS was slightly lower in Denmark (0/ I I), Sweden (0/I 14) and Austria (0. I%, 2/353)
compared to Switzerland (2.4%, 40/1I,647), Belgium (2.7%,3/ 11 3) and Greece
(9.8%,4/4 I)(p>.05). For heterosexual women not from countries where heterosexual transmission is frequent, KS was lowest in Greece (0/36), Sweden (0/38) and Denmark (0/55)
and highest in France (2.4%, 34/1I,414), Austria (2.7%,2/74) and UK (3.5%, 7/201 )(p>.05). KS
increased from 10% in ages 15-19 years to 23% in ages 20-24 years among gay/bisexual
men. KS did nriot change with age among IDUs. All children (<12 years) with KS were boys
(5/1,15 I 7). In all countries, KS rates declined over time.
Conclusions: We found no consistent geographic pattern for AIDS associated KS in W
Europe. Gender differences in KS risk are not significant for IDUs and transfusion recipients.
Among heterosexuals, persons from countries where heterosexual transmission is frequent
and women having sex with bisexuals are at higher risk of KS.
Shahul Ebrahim CDC, I 600 Clifton RD E45, Atlanta, GA 30333 USA.Tel: [phone]
Fax: [phone] E-mail: sbe2@cpsstd I.em.cdc.gov
Mo.C. 1664
HIV-2 SEROPREVALENCE IN EUROPE:A REVIEW OF EXISTING DATA
Cazein F, Hamers FF, Alix lane, Brunet J-B. European Centre for the Epidemiological
Monitoring of AIDS, Saint-Maurice, France
Objective: To evaluate the extent of HIV-2 infection in Europe using existing seroprevalence data.
Methods: We used the European HIV Prevalence Database (managed by the European
Centre for the Epidemiological Monitoring of AIDS, France) which includes aggregate data
on I 86 published and unpublished seroprevalence studies provided by the national
FI-V/AIDS surveillance coordinators.We examined studies f-rom 1989 to 1995 which gave
information on HIV-2 seroprevalence.
Results: A total of 45 studies provided data on both HIV- I and HIV-2.These studies include
national results from screening blood donations from 17 countries, seroprevalence studies in
pregnant women from 5 countries and seroprevalence studies in other selected populations.
including sexually transmitted disease (STD) patients from 6 countries. Of the 35 156 852
blood donations tested, 855 (2.43/105) were positive for HIV- I and only 6 (0.02/105) for
HIV2. HIV-2 was found only in Estonia, France, Greece and United Kingdom (UK). Among
the 652 350 pre nant women tested in France, Netherlands, Slovak Republic, Slovenia and
UK, 962 (147/10 ) were positive for HIV- I and only 14 (2/105) for HIV-2; of those HIV-2
positive, 3 were in Paris (n tested=22 210), 8 in London (n=275 874) and 3 in Netherlands
in women seeking an abortion (n=719). Among 275 340 STD patients tested in Czech
Republic, France, Portugal, Slovak Republic, Slovenia and UK, 3888 (1412/105) were positive
for HIV I and I I (4/10 ) for HIV-2; of those HIV-2 positive, 5 were in UK (n tested=205
879) and 6 in Lisbon (n= 1048). In addition, in Lisbon, one HIV-2 positive case was found
among 2342 injecting drug users tested and 4 cases among 767 tuberculosis patients.
Conclusions: Although these data are sparse and sometime incomplete (e.g. national data
on blood donations from Portugal not included), they confirm that HIV-2 is still rare in
Europe. HIV 2 accounts for less than I% of all HIV in most studies examined. However, in
Portugal, the prevalence of HIV-2 appears to be considerably higher than in the other countries examined, and accounts for I 3% of all HIV positive STD patients and 29% of all HIV
positive TB patients.
Jane Alix, European Centre for the Epidemiological Monitoring of AIDS, H6pital National de
S aint Maurice, 14 rue du Val d Osne, 944 10 Saint-Maurice cedex, France Tel: (33- I) 43 96
65 45; Fax: (3- I) 43 96 50 81: Email: [email protected]

Sensitivity (%) Specificity(%)
HIV+ HIV- HIV+ HIM

Positive
Predictive
value (%)
IIlV+ HIV1 5.3
5 12
2 0.1
33 40

Clinical history
Rx
PPD
AFB smear

43 20
12 17
53 67
29 33

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97
67
99

97
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99

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Conclusions: Sensitivity and positive predictive value of available tests i. very poor compared to usage of cultures for M. tuberculosis among this group. Rx and AFB have lower sensitivity and positive predictive value among HIV positive patients for,ianosis of pulmonary
Tb. Prevailing policies should be modified for the diagnosis ofTb airnong this population.
Availability of cultures should be extended to primary care centers.
Partially supported by NIH/PAHO
Ma. deLourdes Garcia Garcia, National Institute of Public Health Av. Univ. N.o 655, Sta. Maria
Ahuacatitlan, C.P 62508, Cuernavaca, Mor.Telfax: 9173 11 22 I 8
Mo.C.1662
LYMPHOSCINTIGRAPHIC STUDY OF LOWER LIMBS IN EPIDEMIC, CLASSIC AND
IATROGENIC KAPOSI'S SARCOMA.
Takizawa, Carolina M*, Cestari SCP*, PetriV*, Nishio CER*, Nishio PA*. *cederal University
of Sao Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil, Departm'ent oCi iDermatology
Objective: Evaluation, by lymphoscintigraphy of the lymphatic systern of lower limbs of
patients with epidemic, classic and iatrogenic Kaposi's sarcoma (KS), regardless of clinical
signs of lymnphoedema.These patients were compared with those i..thi ly'phoedema of
other origins. Some peculiar images may correspond to "focal" retention associated with
angiogenic stimulus for KS development.
Methods:Thirteen KS patients were studied, being 10 AIDS assoi,, 2. c form and
one iatrogenic (renal transplant recipient), II men and 2 women, aye rc:,riing forn 21 to
85 years. Lymphoscintigraphic study was performed (labelled Dex r rn.[fx-99m--c) injecting labelled substance in the first interdigital spaces of the feet. Pevi, rbdomrinl and lower
leg images were obtained.
Results: Lymphatic alterations of all lower limbs were observed in ll patients, even those
with no clinical signs of lymphoedema. In eleven cases (84.6%) lymn Ittc vessels were visibilized in both lower limbs and in two cases (I 5.4%) it occurred cniy it the left lower limb.
Radioindicator was retained in 84.6%. A focal pattern was nriot observed in non KS lymphoedema. Dermal reflux was observed in 78%, being bilateral in. Collateral circulation
was observed in 77% and hypoconcentration or absence of corcenatl of radioindicator
in ganglionar chains were observed in 92.3%.