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

Track B: Clinical Science
in a patient with HIV infection.To report the ability of PCR to.st T -., DNA in brain
tissue samples.
Case report: 2 I year old Argentinean IVDU/HIV+ male was admi,-_d t: hospital with fever
and disorientation. Physical exam revealed a fever of 39~C, Gla:-,w cov;e, s ore of 9, neck
stiffness and bilateral IllIrd cranial nerve palsy MRI brain scan revi, 'd a inlc, target" lesion
in the posterior cerebellar peduncle. Serum IgM and IgG antiboc,, o i-t 'by nmuno-fluorescence (IFA) toT cruzi epimastigotes were I/128 and 1/64, re,.spe( ive Ict-IFA to
T.gondii was negative; blood and CSF smears revealed organisi. e t, morphologic
appearance ofT cruizi.The patient died on the 18th day hospitaihzd P!c.i ti ortem
histopathology of the CNS demonstrated an area of necrotizii ei;iap ihtis in the brain
stem, however, no microorganisms were identified.T cruzi DNA w dIt.ec:td by PCR performed on brain paraffin embedded tissue using the oligonucleotid pm 1 or: S35 and S36
to amplify a 330 base pairs minicircle DNA fragment.Trypomasti:,t, vvec recovered
from six Rockland mice intraperitoneally inoculated with the pat it' (li -
Conclusion:We describe a case of Chagas' disease presenting i i ireibral mass in an HIVinfected individual.T cruzi DNA detection using PCR can identify1 is:,u, i.araites undetectable by conventional staining techniques.
Mariana Ceriotto, MD, Department of Microbiology Faculty of Med ine, r, Univcr sity of
Buenos Aires, Paraguay 2 I 55, I 2 II Buenos Aires, Argentina.
Tu.B.2212
ANALYSIS OF MYCOPLASMA PENETRANS SEROLOGY DURING THE COURSE OF
HIV INFECTION
Grau. *, Bahraoui E*, Slizewicz B*a*, LaunayV*, Rannou M-t' ', i' anie-r M"5,Tuppin
P*, Delfiraissy J-F **, Montagnier L*. *Institut Pasteur, Paris; **Univers;te Paul Sabatier,
Toulouse; ***Sanofi Diagnostics Pasteur, Marnes-La-Coquette; 'H6pitall de Bicetre, Le
Kremlin-Bicetre, France
Objective: Previous studies by several groups including ours (Gra t ial, J. Inflect. Dis. 1995,
172:672-681I), suggest that Mycoplasma penetrans (i) could be a,oflctcr of IliV (ii) is probably a sexually transmitted agent, (iii) is probably not an etiologic (gent of Kaposi s sarcoma.
In this study we characterized the humoral response to M. pene ins dunring the course of
HIV infection.
Methods: Anti-M. penetrans IgG titers in 3 sequential sera fromn 52 HIV-seropositive homosexuals (Bclere Hosp., Clamart) were analyzed by ELISA and We,,tern blotting. Biological
and clinical characteristics of each patient were obtained.The mean interval between collection of the first and the third samples was 34 months (standard deviaton, 19 months; median, 29 months).The mean T4 cell counts per mm3 of the patients were 120, 264, and 22 I
when the first, second and third samples were collected respectively;(standard deviations,
177, 184 and 208 cells/mm3 respectively; medians, 315, 230 and I8_ 5 ellsimmni3 respectively).
Results: Nineteen patients (37%) had IgO to M. penetrans in at ea, t ore sample.The
changes in antibody titer with time fell into four types: increasing levels (5 patients), decreasing levels (3 patients), constant and high level of antibody (I patien) and, constant and low
level of antibody or low level of antibody in at least one sample and negative tests for the
other(s) (10 patients). IgO titers were higher in patients with T4.% bri eer, 9 and 15 than
in other patients.
Conclusions: The evolution of anti-M. penetrons antibody titers in the population analyzed
was varied. In a large proportion of M. penetrans-seropositive patients the antibodies directed against M. penetrans were detected over a long period of time. M. poeci rans infection
can thus be persistant.The evolution of M. penetrans serology relative to clinical and biological status of patients is currently being studied in more detail and wi be presented.
Odile Grau - Institut Pasteur, Unite d'OncologieVirale, 28 rue du Dr i Piu x, 75724 Paris
cedex 15, France Telephone [phone] Fax [phone] ii
Tu.B.2213
HYPERKERATOTIC EPIDERMAL INVAGINATIONS IN CHRONIC HERPES ZOSTER
Schoppelrey Hans-Peter*, Gummer M*, Emminger C**, Breit R*. Department of
Dermatology and Allergology, City Hospital Schwabing, Munich I' 4th Me dical Department,
City Hospital Schwabing. Munich, Germany
Case Report: In May 1995 a 47-year-old white homosexual mai: wilit AIDS / C3 developed
typical signs of Herpes Zoster on his left arm and shoulder which w0re i, a Th I and Th2
dermatomal distribution. After 10 days of acyclovir therapy the lecons completely cleared
but postzoster neuralgia persisted.
In October 1995 the patient presented with multiple papules in almos;t ithe same location.
As the lesions clinically appeared as Lichen striatus this case was tr eated with topical glucocorticoids. After a week there was no improvement, but neuralgia dramatically increased.
Although there were no vesicles we presumed an atypical zoster and initiated a systemic
therapy with 15 days of acyclovii.The neuralgia completely disappeared bt the lesions only
partly resolved.Two weeks after completion of treatment the hyperkertotic papules flared
up again. A skin biopsy specimen obtained at that time showed hype keis: tic epidermal
invaginations of viral material which was identified as Varizella Zoster Virus by PCR.
As an exclusively antiviral therapy seems to be not sufficient in hyperkeratotirc zoster, the
eruptions are now debrided with topical Tretinoin in combination with x I000 mg
Valacyclovir p.o.
Dr Hans-Peter Schoppelrey, Krankenhaus Munchen-Schwabing, Kolner ilz i, 80804
Munchen GermanyTel: 0049/89 4480628 Fax: [phone]:1
Tu.B.22 14
PRIMARY PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS HIV RELATED WITH
AZITHROMYCIN, PYRIMETHAMINE AND RIFABUTIN. PRELIMINARY RESULTS IN A
COHRT OF 100 PATIENTS.
Bruno B, Patruno S.F.A., Zara F, Caprioglio 5, Maffezzini E, Filice G. (ii::: ol nfectious and
Tropical Diseases, University of Pavia IRCCS "S.Matteo" Pavia Italy

Objective: To evaluate the effectiveness of a regimen of opportu i: _ iie- tion (0.1.) primary prophylaxis in HIV infection including Azithromycin, Pyrimethniii ic id Ritubutin.

Tu.B.2212 - Tu.B.2216
Methods: 100 patients with HIV infection still uncomplicated by O.I. were enrolled.Inclusion
criteria for primnary prophylaxis were:I) CD4+ lymphocytes <I50/mm3 2) ALT< 100 UI/mi
3)Normal activity of G6PD. Exclusion criteria were:I) CD4 + lymphocytes > 150/rnm32)
ALT> 100 UI/mt 3)G6PD deficiency 4) Recorded allergy to above drugs. 56/100 pts. underwent primary prophylaxis according to the following schedule: Azithromycin 500 mg,
Pyrimethamine 50 mg. Rifabutin 300 mg three times a week.The incidence of O.I. was evaluated over a 6 month - follow-up. 44/100 patients,reluctant to any treatment, were given
no prophilaxys and followed-up over 6 months.The rate of survival free of O.I. was
obtained usin Kaplan -Meir methods.
Results: I patient discontinued prophylaxis due to Rifabutin-induced fever. 54 patients who
were given primary prophylaxis with Azithromnycin, Pyrimethamine and Rifabutin displayed
the whole 6 month-follow-up free of 0.1.; in I pt. Pcorinii pneumonia occurred.Among 44
pts. with no prophylaxis 2 pt. developed symptomatic Cryptosporidiosis; 4 pts. presented
with P.corinii pneumonia and 4 pt. dysplayed symptoms and radiological evidence of
Toxoplasmic encephalitis.The difference between the two arms is significant according to
statistic.
Conclusions primary prophylaxis of O.I. with Azithromycin, Pyrimethamine, Rifabutin provides a longer survival free of O.I.The probed regimen encounters a good compliance and
fitting of treated patients.Furthr observation of a longer follow-up is warranted.
Bruno Raflaele, Divisione Malattie lhfettve E Tropicali Irccs Policlinico S.Matteo Via Taramelli
No. 5, 27 100 Pavia - Italy
Tu.B.22 15
CHLAMYDIA PNEUMONIAE SEROPREVALENCE AMONG HIV- I INFECTED AND
UNINFECTED SUBJECTS
Visco Comandini Ubaldo, Massetti AR Zaccarelli M*, Marchese R, Santopadre R Falciano M,
Vuilo V Dept. Infect.Trop. Dis., La Sapienza University; * L. Spallanzani Hospital, Rome, Italy
Objective: To evaluate the prevalence of Chlomydia pneurnmonioe (Cpn) antibodies in an
Italian population of HIV-infected and uninfected individuals with known HIV risk factor:
Methods: A perspective evaluation of Cpn microimmunofluorescence immunoglobulin
(lg)G and IgM titer, related to gender, age, absolute CD4+ cell count and HIV risk factor in
332 HIVinfected and uninfected individuals without respiratory symptoms, attending the
tertiary-care institution at the Department of Infectious and Tropical Diseases of the
University "La Sapienza" of Rome, during the years 1994 and 1995.
Results: A statistically significative higher Cpn seroprevalence was found to be related by
nmultivariate analysis to gender, age and the presence of HIV risk factor, but not to HIV
infection itself
Among HIIV-positive subjects, Cpn seroprevalence seems to decrease with absolute CD4+
cell count and is lower in CDC stage "C" of HIV infection.
Furthermore, high Cpn IgG titers (indicative of recent or current asymptomatic Cpn infection) were found to be related to CDC stage "A" of HIV disease and to a CD4+ cell count
>500/mmc.
Conclusion: Cpn seroprevalence is higher in intravenous drug addicts and in subjects with
promiscuous heterosexual contacts. A previous segnalation of a higher Cpn seroprevalence
among HIV-infected subjects (compared to the normal population) was probably due to
the presence of HIV risk factor and not to HIV infection itself.
HIVinfected subjects seem to progressively loose Cpn-lgG antibodies in advanced stages of
HIV infection, when asymptomatic Cpn infection is also rarely observed.
Ubaldo Visco Comandini, Dept. Infectious and Tropical Diseases, La Sapienza University,
Policlinico Umberto IViale del Policlinico I 55, 001 6 I Rome, Italy
Tel: [phone] Fax: [phone]
Tu.B.2216
HERPES ZOSTER AND PROGRESSION TO AIDS IN A COHORT OF HIV
SEROCONVERTERS
Alliegro MB, Dorrucci M, Pezzotti R Petrucci A, Rezza G, for the HIV-Italian Seroconversion
Study Istituto Superiore di Sanita, Rome.
Objectives: To estimate the incidence and determinants of herpes zoster (HZ).To compare
the progression to AIDS among individuals with and without HZ.To evaluate if specific
manifestations of HZ are predictive of a more rapid progression to AIDS.
Methods: Prospective study of HIV-positive individuals with known seroconversion (SC)
dates, belonging to different exposure categories. A total of 1,198 individuals with an HIVnegative test followed by a positive test within two years.The cumulative probability of
developing HZ was estimated by time from SC. Relative hazards (RH) of developing AIDS
were calculated considering HZ, CD4 cells count, and other symptoms as time-dependent
covariates.
Results: HZ was diagnosed in 48 individuals for an overall cumulative probability of 6.6%
(95% C1:4.5%-8.2%) after six years from SC. Individuals acquiring HIV through sexual contact had a higher risk to develop HZ than injecting drug users [RH= I.83 (95% Cl: 1.03 -3.26)], but this RH slightly decreased when adjusting for CD4 cells count [RH- I.50 (95%
Cl: 0.83-2.70)].The RH of AIDS for individuals who had at least one episode of HZ compared to those who had none during the follow-up time was 2.44 (95% Cl: 1.46-4. I0),
decreasing to I.08 (95% Cl: 0.63-1.87) after adjusting for age at SC, CD4 cells count, and
presence of pre-AIDS HIV-related pathologies other than HZ. Estimates of RHs of AIDS for
different clinical manifestations of HZ (fever, pain, # of dermatomes involved) showed that
only the presence of fever was significantly associated with a higher risk of AIDS [RH 3.27
(95% Cl: 1.05- 10.21)], independently of the CD4 cells count at HZ diagnosis.
Conclusions: Individuals acquiring HIV through sexual transmission appeared to have a
higher risk of developing HZ even if the RH slightly decreased when adjusting for CD4 cells
count. In a similar way, we observed that after adjusting for CD4 count, there was no evidence of a more rapid progression to AIDS in individuals with HZ. However among the
individuals with HZ, those who had fever had a higher risk of developing AIDS compared
to those without feverThese results suggest that HZ "per se" does not seem to be an
independent cofactor of HIV-disease progression.

Maria B. Alliegro, Istituto Superiore di Sanit),Viale Regina Elena 299, 00161 Roma, Italy
Tel:(39) (6) 4990 2337; Fax (39) (6) 4456 74 1: email: COORTE @ ISS.IT

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