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

Tu.B.2228 - Tu.B.2233

Tuesday July 9, 1996

Tu.B.2228
SYSTEMIC TREATMENT WITH HUMAN CHORIONIC GONADOTROPIN (HCG) IN
PATIENTS (PTS) WITH HIV-RELATED KAPOSI'S SARCOMA (KS).
Tavio Marcelo, Nasti G,VaccherFE, F.rrante D, Spina M, Simonelli C,Tirell U. Div. Medical
Oncology and AIDS,.,P..O. National Cancer Institute, Aviano, Italy
Background: The beta cain of humran chorionic gonadotropin (HCG) is able to block
tumorigenests and metstasi of neopiaste KS cell line in immune deficient mice (LunardiIskandar et al, Nature 1995, 375:64 -8). Moreover prehminary data by Harris (Lancet 1995,
346 I -9) show sorme evidence of activity of high doses of HCG also in human KS.
Objective: To investigate efficacy and toxicity of both low and high doses of HCG in the
treatment of HIV related KS.
Methods: We designrec two cinical trials with escalating doses of HCG. In trial I (low dose
trial [low T]) HCG was administered intr amuscolarly (im) 3 times weekly according to the
following schedule: 4.000 IU week (w) I-4; 8000 IU w 5-8;.6.000 IU w 9-12; 32.000 IU w
13-I 6. In trial 2 (high-dose tr ial [high T]) HCG was administered im 3 times weekly
100 000 IU wI 4: 200. 001 IU w 5-8; 300.000 IU w 9-12. Inclusion criteria were the same
for both trials male sex, PS - 2. progressive KS, absence of active and uncontrolled
opportunistic rinfecior Ifei expectncy more than 6 months and informed consent. CD4
lymphocytes count wasI < O0/mrn 3in all patients (pts). No antiretroviral therapy during
HCG -treatmient was allowed.
Results: Five pts entered low-T In these pts median time from KS diagnosis was 34 months
and KS staging accordin to Kriegel was stage II in one pt and stage III in 4 pts.All pts were
pre -treated with alfa Interferon (IFN) + zidovudine (AZT); 2 pts had also been previously
treated with radiotherapy and other 2 pts with chemotherapy (CT). All pts were evaluable
for- response after a mednr time of therapy of 12 weeks. No objective responses were
observed: 1 pt showed no cange (NC) and 4 pts underwent progressive disease (PD)
dunng the treatment. No side effects were observed with the exclusion of local pain in the
site of injection in I pt Five pts entered high-1 Median time from KS diagnosis was 18
months and KS staging according to Kregel was stage III in all pts. Pre-treatment included
IFN and AZT in 3 pts, low doses of HCG in I pt and CT in I pt.Two pts were not pretreated. Four out of 5 pts were evaluable for response after a median time of therapy of I10
weeks COne part a response, I NC and two PD were observed in this setting. No side
effects were noted with the exclusion of depression, possibly related to the treatment, in I
pt. No signif cant va iation in CD4 lyrmphocytes count had been observed in both trials. No
dat. are still available with regards to the possible antiretroviral activity of HCG.The cost of
a complete course of hormonal therapy for each pt participating the trial was 324 U.S. dolars and 37/38 U.S. dollars for ow-- T and high-T, respectively
Conclusions: HCG did not show any evidence of activity in low T while in high-T more pts
are clearly needed to establish the efficacy of HCG in human KS.
Supported by ISS and AIRC grant 95.
Marcello Tavio. Division rof Medical Oncology and AIDS, Centro di Riferimento Oncologico,
V Pedemontana 12, 33081 Aviano (PN), ItalyTel: 434/659284; Fax: [phone]
Tu.B.2229
DISSEMINATED STRONGYLOIDES STERCORALIS INFECTION IN AN AIDS PATIENT:
THE ROLE OF SUPPRESSIVE THERAPY
Levi, Guido C, Kallis r G, Lette, Ktia RM. Infectious Diseases Service. Hospital do
Servidor Publico Estadual, So Paulo, Brazil.
Patients with AIDS are prone to developing infections with opportunistic pathogens.
Unusual agents, such a Stro yloides sterIs alts, are also being described in this Syndrome,
resulting in disseminated disease, always severe and in some cases fatal.We describe a case
of a patient with AIDS and Sror yl ides terordis infection, involving the gastrointestinal
tract and the lungs.Ther apy with trhiabendazole for ten days led to resolution of the acute
episode. Suppressive therapy wilh 3 g thiabendazole once a week was then prescribed, and
repeated fecal examninaton were i eaive for larv:e.With discontinuation of treatment by
the patient, and with re-inrfection being extremely unlikely, he again had positive fecal examinati n fo Sr ylydeis i terr d s larvae. After re- treatment, the patient chose to discontinue
suppressive the rapy and subsequent fecal examination was again positive for Strongyloides
ser oris. Re -infection was thought to be unlikely. He was retreated with a shorter course
of therapy and the same schedule of suppressive therapy was reintroduced. In 4 months of
follow-up repe ted fecal oexaminations were negative. After 14 months of the initial episode,
pulmonary Strongyloide sterrorlrs infection was diagnosed, this time treated with cambendazole, for- 0 days. Stpp r essive therapy after disseminated Strongylorides stercoralis infection
may be necessary and 3 gras of thiabendvzole once a week may be adequate for this
purpose. Camrbendazole show; as an adequate alternative for disseminated Strongyloides
ster or lrs infection treatment.

Conclusion: Our opinion is that although the patient denies to live orhve e,.
streets, she presented awful hygienic habits. For that its possible to suppcj se that afte' te
appearance of syphilis genital lesions accompanied of other genital nlectionr fvrc,,
more purulent and bad smells.A fly sited the area and laid her eggs. As the..s' were not
removed the lesion grow quickly increasing the inflammatory and painful.roces c00 oited
even more difficulties to the hygiene. Once more we reaffir; the need ou- o.en '
tests (HIV and VDRL in any genital lesion).
'The work presents before and after of ther apeutics,fc tcgraphes,' 0 ettt.

Mauro Romero Leal Pas Sos-Setor De Dst-Universidade Federal Fi IIo5
Melo, 01--Anexo-Centro-Niteroi-Rio De Janeiro-242 0 -i30 Brasl.

I -f rs

Tu.B.223 I
LEISMANIASIS IN THE GREEK HIV-INFECTED POPULATION
Marios Lazanas, P Greka,V Papastamopoulos, A. Papadopoulos,V Paparizos. G Ster ou. N.
Vakalis, G. Saroglou. I st Dpt of Internal Medicine, AIDS Unit, Fvangelsnos Hospiti, Athers,
Greece
Visceral leishmaniasis (kala azar) is an enrdemic disease in the Medterr3oe rs',.
where it has been reported to be a complicating ilness, in patients n it HIVnfecti cn rese
reports suggest that HIV infected individuals are at a igreater risk fo r 5'0cera Itor -4r
mania due to the compromise oftheir cellular- immunity Our studay was des:ned to cathe prevalence of the disease in a large percentage of the Greek HIV seropoitive popu a
tion. During the years 1994-1996, 174 HIVseropositive individuals.ere tested, an'ori
whom 94 had AIDS (stages A3, B3 and C according to the 993 CC Dc s hit. Blood
speciments were received from all individuals and a bor ne mar o sp!:;e,0 ', ii: e
from the majority of AIDS patients (80/94). he presence r'1 ', in I' '.s
established using three different serological techniquesd (5 A, - I FIA;. 'e, i -,r0e
stained with Giemsa and a culture using the specific NNN ut,, e nedtros ' o ' e eor ed
in the AIDS-group.
Among the population tested, only four AIDS patients (2.2%) were diagnose r t,. vs
ceral leishmaniasis by the standard method of identification of the ps a.ste the e mr
row n acrophages.The sensitivity of the serological testing was 75 Fo' the rer5ning pop
ulation (170 people) both the serological testing and the bone marrow ap '<'t 0were
proven negative.
As a result, visceral leishmaniasis is not endemic among the reek HIV infec'e 0i r [rr,tin
but it should always cross a physician's mind when facing a AIDS pat ett w 'h r"o
haematological abnormalities and should be confirmed by the god tadrd fti:n o
scopical examiantion of a bone marrow aspirate whenever posi.'.
Marios Lazanas, I st Dpt of Internal Medicine, AIDS Unit. Evangelsmos Hospcti. Itaiitou
45-47, PK - 106 76 Athens - Greece
Tu.B.2232
RENAL DISEASE IN WOMEN INFECTED WITH HIV
Jenny Bach, MPH**, Rebecca A., Clark, MD, PhD., Patricia Kissir nger PhD Car, e Ml.
Pindaro, RN, CNP MSN, MPH*. *HIV Outpatient Program; Medical Ct. o' LA at New
Orleans *vTulane School of PHTM, N.O., LA
Objective and Methods: Prior reports studying HIV -associated nephropth, HIVAtN) ae
described predominantly male patients and there is little informatio r reg r d'0 n O r di i se
in HIV infected women.To better understand tIe ciinica presenta in in ai.e
HIVAN in women, a retrospective review of 25 women with this diagnos i - r Iorthe
MCLNO HIV Outpatient Program (HOP) was undertaken.
Results: Demographics of the 25 women were as folows: A' ica Arrmein i 092 I story (36%), median age (31 years), and median CD4 (78/mm Race, IL, i nd ge
were nriot significantly associated with HIVAN in comparing women withr' c Iia"o:'o
the remaining women enrolled in HOPTwelve women had undrrii'r medi conditions
(HTN DM, sepsis) that may have been the primary cause or cort ited to the 0i
ease.The median CD4 cell count and serum creatinr:ne on presentation were h her on
the IC women with HTN compared to the remaining 5 aorrre without I lVAJ
(338/mm3 versus 28/mrm3, and 3.5 versus 2.0, respectively). Medan time t et also dffered by HTN strata (484 days in 5 women with HTN versus 1 32 das r n 7 women with
out HTN). Renal ultrasounds consistently revealed on!y echogenic kidn5 d renb's opsies were not performed.
Conclusion: HIV-infected women with renal diseser may often ha e er0t i romdcl
conditions other than HIV, such as HTN, that may be the cause of thei rna ns' (-.
Non hypertensive women with probable HIVAN generally have advanc,,d HIV de r
a poorer survival prognosis than women with probably HTN induced rerCN ir' t %uffCNi
Carole M. Pindaro, RN, CNP MSN. MPH; 136 South Roman Str eet, N'a., O e /s
701 12; telephone [phone] I
Tu.B.2233
MICROALBUMINURIA IN PATIENTS HIV(+) AND ITS RELATIONSHIP WITH
IMMUNOLOGIC AND VIRAL MARKERS
Monje, AL(I, Bortolozzi R (2), SosaV (3), lupo 5 (2)
Taborda MA (4), Fay O (3-4). Padr
N, that may be the cause of their renal insufficiency Non hyper tr"lse '.'r en." ', r'e
ble HIVAN generally have advanced HIV disease and a pooren,1al ener 0.., Iin.
Medicas. U.N.R. Santa Fe 3100. Rosario,Argentina.
Introduction: Evaluate the renal function and the microalbumir i (MA) n pr'01 ts o i''(
and its relationship with the clinic state (CS) and with immuno i '. 0 i rnarr
Patients and Methods: We studied prospectively 48 patien ts (p) HIV(+)tH II.nt
(15 in CS I, 17 in CS II, 16 in CS IV) under the citeria establioed by the WHO. The
method used to document the infection by HIV was an enzymer.-nked imunos-orbent
assay lisa, Organon Teknika (OT) and confred by We i ter Bot OT The,1
was formed by 35 men and 13 woman with a mean age of ' -. r
tor (RF were evaluated and in the group ti ere ''e'e ' '
(He). 5 homosexuals (He) and I traflused (T. Irhee were inddea ci'e s,- ',
hypertensrae patients and 34 of them were u der tieatmen.00 r - a in u ins'
antbiotic therapy It was also determined Urem i (U) a, ia' ' ' e ' 5 i 0 rr
ods.llymphocyte subsets by indirect inr inof 'oesence. 4 A sin. l \ o, 1A1.

Esper G. Kallas. Rua di Consoi 0
II 88 1 1597. Fax [phone]. en

3638, ap. 64-C. 0 1416-000. So Paulo, Brazil. Phone: 55,spierr u.ansp.br

Tu.B.2230
GENITAL MYIASIS ASSOCIATED POSITIVE HIV SYPHILIS,TRICHOMONIASIS AND
CANDIDIASIS ON PREGNANT -CASE REPORT
Pas.os.R.L, Barreto, N.A., Salles, R.S., Slva. A.R.L., Monteiro, A.C.S.. Rocha, L.C.G, Santos,
C.C., Goulart Filho, R.A.
Objective: To relate the clinic case of patient with genita ulcers associate to positive HIV,
Syphilis, Tnichomoniasis nd Candidasis in pregnancy.
Methods: A.G.S., femile. 19 year s old, white, single, born in So Goncalo City, Rio de
Janeiro. he patient cane to STD Sector/Universidade Federal Fluminense, relating pain,
wound and genital disagreeable smell. With a lot of difficult was detected extensive genital
ulcera with mnore than hundred larvas. She was guided by Surgery Room and under anestheaia effect made an area cleanness. It collected blood to research of anti HIV antibodies
and syphilis, between others. The vaginal secretion material was collected for the cytology
Results: The development form larva to adult fly was identified as Sarcophaga.The serologic
tests were positive to sph iis and HIV The cytology oncotic revealed trichomoniasis and
candidiasis.The treatments usedI were conventional. After 30 days the genital lesions were in
phase of large scale ro, trization. How the patient showed period delay we made the pregnart test The result,, positive

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