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

Track B: Clinical Science

Tu.B.2191 -Tu.B.2196

and systemic factors were associated with occurrence of retinitis in ir pic- vio,!v uninvolved
eye. Earlier retinitis progression (750p movement or new lesion), a ri,er ure reed in clinical
trials comparing treatments for retinitis, was associated with vis on losJanet T Holbrook, Johns Hopkins University, 6 15 N Wolfe St. Rni 5JI, U.u, ire, MD
2 I 205, USA, 410 955 0930, 410-955-0932(fax), jholbroo@sph.; ri, ed. h c,a
Tu.B.21 9 I1
OUTPATIENT INDUCTION OF CYTOMEGALOVIRUS RETINITIS - A COMPARISON
BETWEEN SINGLE AND SPLIT GANCICLOVIR DOSING.
Tomlinson David R!, Reeves P, Brown A', Migdal C2. Departme n oa f
HIV/Genitourinary Medicine and 2Ophthalmology, St. Mary's tilS TI ait London, United
Kingdom W2 I NY
Objective: To assess the safety and efficacy of single daily dosing wa'rh!r-venous ganciclovir
10mg/kg/day compared to standard twice daily dosing during out ptie,iduct rion for
CMV retinitis in a prospective randomised feasibility study
Methods: All patients with first episode CMV from 1.6.93-1.9.94 v ere treal(ed as an outpatient and randomly assigned to either once daily (Group A) or twice a' nly (Groupi B) iv ganciclovir (total dose 10mg/kg/day) for 2 I days (I 6 patients). Patients were ta.ight self-administration techniques by a clinical nurse specialist (CNS) and monitonnrg -sr:;ents were
made by the CNS at Days 0, 5, 10, 14, 21 with additional follow-up visits 2 and 4 weeks
post induction, with opthalmological assessments at 0, 14, 21 and final follow- up visit. A simple patient acceptability profile was self completed at the end of induction and at the end
of the study period.
Results: Seven patients received once daily ganciclovir (Group A) and 9 twice daily (Group
B). No differences were seen in mean neutrophil count or the use of concomitant G-CSF.
Significant differences (unpaired t-test) were seen between the two groups in terms of
renal function and serum alkaline phosphatase. No difference in adverse events was seen
between the two arnms and patients in Group A rated self-treatment easy or very easy significantly more than those in Group B at both Day 2 I and follow up visit 2 (Wilcoxan rank
sum test p=0.94). All patients expressed strong preferences for outpatient treatment and
found self administration at home acceptable.With an average of 45.8 nur sairg hours during
the induction period per patient at a cost of ~8 1.45 per hour, the estimated total cost of
outpatient induction is ~3,730. Compared to hospitalisation costs for the same period of
~9,366, the financial saving alone for each patient undergoing out patient induction is about
~5,636.
Conclusions: This study has confirmed both the safety and efficacy of single daily dosing of
ganciclovir and the feasibility and cost effectiveness of out-patient inductaion by a team of
clinical nurse specialists, and this is now first line induction treatment of active CMV within
our unit.
D.R.Tomlinson, Jefferiss Wing, St.Mary's NHS Trust, London W2 I NY Englarnd Telephone:
0171 725-1570 Fax:[phone]
Tu.B.2 192
CORRELATION BETWEEN CMV GASTRINTESTINAL DISEASE AND SALMONELLA
SEPSIS
De Agostini Maura, Bianco Chinto M, Lipani F, Sinicco A*. Div. A Arnedeo di Savoia
Hospital, *I' Institute od Infectious Diseases, University ofTurin, Italy
Objective: To describe manifestations of CMV gastrointestinal disease,id to evaluate correlations between CMV infection and non-typhi Salmonella sepsis.
Methods: Retrospective chart review by clinicians following the patients prospectively
Results: Twenty-seven AIDS patients (13 homosexuals, 8 intravenous drug abusers, 6 heterosexuals) developed CMV gastrointestinal disease. All patients were admitted to our institution for fever and abdominal discomfort. Seventeen patients had henmocultures positive
for Salmonella spp. (non-typhi). Five patients developed intestinal perfior n.ior biopsies performed during surgery revealed CMV intestinal disease, with lesion, ioca!ized in colon, ileum,
caecum and appendix, respectively Other 13 patients were evaluated endoscopically In 3 of
them EGDS revealed large biopsy-proven gastric ulcers and subrnucoir a antral masses; 3
patients had CMV esophagitis, I patients had CMV duodenitis. In 5 patents we found diffuse lesions in colic mucosa; histological analysis confirmed the presence of CMV in every
specimen. One patient developed CMV rectosigmoiditis. One patient had hepatitis, cholangitis and pancreatitis due to CMV. Finally I 8 patients developed a serious diisserninated
CMV infection associated with gastroenteric disorders such as diarrthci, abdominal pain, due
to an active gastrointestinal CMV disease.
Conclusions: Our observations suggest an higher association between Salmronella sepsis
and active CMV gastrointestinal infection.
Maura De Agostini, Osp.A. Di Savoia. C. Suizzer A64-Torino Italy Fax: 039 It 7761 757
Tu.B.2193
EVALUATION OF A MONOCLONAL ANTIBODY BASED LATEX AGGLUTINATION
TEST FOR DETECTION OF CRYPTOCOCCAL POLYSACCHARIDE ANTIGEN.
Roux Patricia, Ould-Hocine H.,Treney J., Poirot J.L.
Saint-Antoine Medical University Paris, France
Objective: To evaluate the performance of Murex Cryptococcu test, a nose immunoglobulin M monoclonal antibody latex agglutination test, to detect polysahande antigen associated with cryptococcosis in serum, cerebrospinal fluid (CSF) and brorchoalveolar lavage
fluid (BALF).This test was compared with a test using polyclonal 'rne sera (Cypto LA
Test, International Biological Labs Inc.).
Method: We retrospectively tested, during a blinded study 130 frozer ( 80 c) clinical specimens (79 serum, 28 CSF, 23 BALF) fl-om patients with proven cryptooccosis (66 speci
mens from 28 patients) and without cryptococcosis (64 specimen fron 64 patients). I 2
sera contained rheumatoid factor 6 patients had a follow-up (3 msnt. to 2 years with a
mean of 5 samples). Sera and CSF were tested according the recorrendat ons of the
manufacturers; BALF were tested after centrifugation of supernatur a - d treated like serum.
Results: Sixty four specimens (42 serum, II CSF, II BALF) were positive with both tests
and fifty nine (25 serum, 22 CSF, I 2 BALF) were negative, I 0/I 2 serum positive for rhumatoi'd factor were negative with Murex and present a non specific positivity with Crypto
LA.The two latex reagents agreed for 62 of 79 serum (42 positive and 20 negative); for
27/28 CSF (5/6 positive and 22 negative); for 23/23 BALF (I I positive, I2 negative).

Conclusions: Murex Cryptococcus is a good test for detection of cryptococcal antigen in
serumn without any interaction with rheumatoid factor. Sensitivity and specificity in CSF and
BALF appear excellent, but furthermore studies have to be conducted with more negative
BALF sarnples.This test could also be used for monitoring titers in patients.
Roux Patnricia, Laboratoire de Parasitologie, Faculte de Medecine Saint-Antoine
27, Rue de Chaligny 75012 Paris France Telephone: 33 I 40 01 13 71 Fax: 33 I 40 01I 14
99
Tu.B.2 194
FUNGAL INFECTIONS: PREVALENCE IN HIV INFECTION
Maiello, Agostino, Sciandra M, Calvo MM, Dassio G, Meneghin G, Sinicco A. Institute of
Infectious Diseases, University of Turin, Italy
Objective: To evaluate the prevalence of the fungal infections in HIV infection.
Methods: From 1/90 to 12/95 all the HIV patients were studied to assess fungal infections.
Every case of suspected fungal infection was confirmed by cultural tests.We calculated the
time firom the first fungal infection to AIDS defining event, and death.
Results: Overall we saw 1295 patients: 277 (21.4%) showed at least one episode of fungal
infec Ion (2!3 BM, 64 F; IDU: 170, Homo: 66, Hetero: 33, blood recipients:8).The mean age
was 30 54 + 7.8 yrs.The prevalence of the first non AIDS defining fungal infections and of
the most prevalent type of them (oral candidiasis), the mean CD4+ cell count, the mean
time to AIDS and death are shown in table.
CD4+ mean count Time to AIDS Time to death

f ungaal nfecons (total)
(fl 200),I5.4(/,)
cO al candidas
(n 182) (9 1.0%)

2339+214.9/9t(R: 2-1230)
227.4 ~ 200.5/(L
(R: 2- 1230)

n=75; 16.7 ~15.6m
(R.: 0.3-66)
n=68; 16.9 ~ 15.8 m
(R. 0.3 -66)

n=60; 24.3 ~ 18.5 m
(R.: 1.9-78)
n=56; 24.3 ~ 19.6m
(IR: 1.9 78)

in other 77 cases (59 esophageal candidosis (76.6%), 17 cryptococcosis 22.0%), I
Aspergillosis (1.3%)) the fungal infection was the first AIDS defining event. Among oral candidiasis, we observed 39 (2 1.4%) relapses in a mean time of I12.8 ~ 13.8 m (R.: 0.5-64). In
19 (1I0.4%) subjects, the mean time from first episode of oral candidiasis to esophaegeal
candidiasis was 19.9 ~ 17.9 m (R.: 0.5 61).
Conclusion: Fungal infections are a common event in HIV patients. In particular, oral candidiasis shows a strong correlation with evolution to AIDS (37.4%) and to death (30.8%).
A. Maiello, Istitvto Malattie Infettive Universita'Di Torino Corso Svizzera 164, 10149 Torino,
Italia
Tel: 039- I -4393926 Fax: 039-I 1-7761757
Tu.B.2195
CRYPTOCOCCAL MENINGITIS AT BARAGWANATH HOSPITAL, SOUTH AFRICA
Crewe Brown HIH, Jones N, Khoosal M, Bhagoobhai L, Karstaedt AS*. *South African
Institute for Medical Research, Department of Medical Microbiology and Department of
Medicine; Baragwanath Hospital and the University of the Witwatersrand, Johannesburg,
South Af rica
Objective: To study cerebrospinal fluid (CSF) findings and clinical data in a retrospective
series of patients with cryptococcal meningitis.
Methods: Eighty two patients were admitted to Baragwanath Hospital, Soweto in South
Africa with cryptococcal meningitis over a four year period from 1991 to 1995. Laboratory
CSF findings and clinical records were analysed for each patient.
Results: Seventy nine patients were adult. HIV testing was carried out on 77 patients and
was positive in 71 (92%). CSF was examined in all cases. Microscopy of CSF was carried
out detecting white cells in 49 samples (60%), with a lymphocyte predominance in 39% and
neutrophil predominance in 21%. Biochemical studies of CSF showed protein to be elevated in 47 sanImples (57%) and glucose to be lowered in 50 samples (60%). Notably I 6 CSF
samples (20%) had no white cells on microscopy and were normal biochemically Nigrosin
staining of CSF detected encapsulated yeasts in 71 of 8 I samples (88%). Cryptococcal antigen was detected by latex agglutination in all of the 62 (100%) CSF samples tested.
Creptococcus rroformans was cultured from all 82 CSF samples. Case records were studied
for 59 patients. Symptoms and signs at presentation included: headache (85%), neck stiffness
(69%), fever (63%), impaired consciousness (56%) and nausea and vomiting (54%). Overall
mortality was 56%, with 36% of deaths occurring in the first three weeks after diagnosis.
However, follow up was not achieved in the majority of patients after discharged.
Conclusion: A high index of suspicion is required in the diagnosis of cryptococcal meningitis
in an HIIV positive patient with an apparently normal CSF according to biochemical and
microscopic findings. Latex agglutination detection of cryptococcal antigen in CSF provides a
sensitive early diagnostic tool for such cases.
HH Crewe Brown, Medical Microbiology Department, SAIMR, PO Box 1038 Johannesburg
2000, South Afica
Tel: [phone] Fax: I 1-489-8717
Tu.B.2196
ASPERGILLUS FUMIGATUS:AN UNUSUAL CAUSE OF EMPYEMA IN A PATIENT
WITH AIDS
Andersson. Monique', Huang, L #, Newman, MD#, Hopewell, PC#, Stansell, JD#. * Charing
Cross and Westminster Medical School, University of London, UK; # San Francisco General
Hospital, SF, CA. USA
Background: Aspergillus infections in patients with AIDS are relatively uncommon.We
describe a case of empyema due to Aspergillus fumigatus.
Case Report: 38 year old HIV seropositive man with a CD4+ lymphocyte count of
6cellsiul admitted with persistent fevers and a mild, dry non-productive cough. Past medical
history wa,' notable for: AIDS since 12/93 (no antiretroviral therapy), no history of opportunistic infections, mild AIDS dementia complex and HIV wasting syndrome with chronic
diarrhoea. He had no history of neutropenia, chronic corticosteroid use, or recent broad
spectrum antibiotic use. He occasionally used marijuana. His only medication was Dapsone
for Prvin i prophylaxis. On admission, the patient had 02 saturation of 85% on room air
and decreased breath sounds at the left base. Laboratory data was notable for a white

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