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

Track B: Clinical Science
Abboth and beta2 Microglobulin (beta2M) by EIA. Lab. Serex, Analysis of urine samples and
MA. by immunologic semicuantitative methods (Boehring Arg.). Stadistic studies have been
made by paired t- Test and X2.
Results: The 18 p studied had renal function normal and 9 of them (19%) had MA (+),
(roup I (G ). The mean age of GI was 32 ~ 5 and in the p with MA (-), Group II (G II) was
28.62 t 5. In G I was 3 bmc female.bmp (33.3%) and 6 bmc male.bmp (66.7%) and in G II,
10 bmc female.bmp (25.6%) and 29 bmc male.bmp (74.4%).The RF in G I there were A
55.6%, He 22.2%, Ho I I%,T I 1% and in G II A 64%, He 25%, Ho 10.3%. In the G I the CS I
wrs IL1%, CS III 33.3% and CS IV 55.6% (p < 0.05) and in the G II the CS I was 35.9%, CS
III 35.9% and CS IV 28.2%.The levels of CD4 (%-absolute) in G I were 13.89% + 6% and
238 2 39r nd in G II 21.56 ~ 8% and 355 ~ 273.The total lymphocyte count was in G I
123 - 813 and in Gt II 1484 ~ 894.The beta2M in the G I was 9.78 ~ 1.4 (p < 0.05) and
in G II 4.98 1t.7.The percentage of P24AG in G I was 77% (p <0.05) and in G 11 32.4%.
The levels of U and C in G I were 22 + 9.7 mg% and 0.60 ~ 0.37 mg% respectively and in
G 11 25.6 ~ 8 mg% and 0.8 ~ 0.23 rnmg% respectively
Conclusions: In a group of 48 p HIV(+) there have been identified (19%) with MA(+),
which has been corrnelationed with a CS more avanced (p<0.05) and with higher levels of
beta2M (p- 0.05). It was also found a correlationship between the MA and the levels pf
P2'A(t (p-O.05). We conclude that the existence of a higher clinic and immunologic
engagemrent suggests that the patient is more susceptible of present microalbuminuria and
its precoz detection will lead to detect the group on risk of develop nefropaty.
Monje, AL, 12 15 Rodicuez Street, Rosario, Santa Fe, 2000 Argentina,Telephone: 54-41 -
248045 Fiax: 54 4 1-248045
Tu.B.2235
PROTON MAGNETIC RESONANCE SPECTROSCOPY (MRS) OF HIV SEROPOSITIVE
ASYMPTOMATIC PATIENTS
Frank, lan*, Lenkinski, R E, Saykin AJ". *University of Pennsylvania, Philadelphia PA, 19104,
' Dartmouth Medical School, Lebanon NH 03756, USA
Objective: There has been recent interest in employing proton Magnetic Resonance
Spectroscopy (MRS) to study the effects of HIV infection in the CNS.The purpose of this
study was to assess the role of MRS in determining early central nervous system involve'ent of HIV
Methods: As part of an ongoing longitudinal study proton MRS studies were conducted on
90 1IV infected patients with no evidence of clinical symptoms and normal appearing MRI.
Shese results were compared with similar studies carried out on normal controls (n=-30).
Results: We found that there were statistically significant increases in the levels of peaks
which we assign to amino acids (AA) in the spectra of the patients. Using the level of creatine (Cr) as an nternal standard we found a mean value of 1.5+ 0.7 for the AA/Cr ratio in
the patients as compared with 0.5 0.5 in the control population.These differences were
srficant at the p<O0.001 level.
Conclusions: T hese results show that MRS can identify early changes in brain metabolism
that may provide the earliest indicator of the migration of the virus into the CNS.We suggest that these changes reflect metabolic alterations associated with immune activation and
precede any changes associated with gliosis or neuronal loss.
I r ank, M.D., Infectious Disease Division, Univ. of Pennsylvania Medical Center, 552 Johnson
Pavilion, Philadelphia, PA 19 104
Tu.B.2236
TRENDS IN AIDS-RELATED ILLNESS IN AUSTRALIA:THE AUSTRALIAN AIDS
COHORT.
SDo ne, Kald or, J Hoy, S MallaI,Y Li, A Mijch, M French, D Cooper. National Centre in HIV
Epidermiology and Clinical Research, Sydney St.Vincent's Hospital, Sydney Fairfield Infectious
Diseases Hospital, Melbourne, Royal Perth Hospital.
Objective: To assess time trends in the incidence of AIDS-related opportunistic infections
(OIs) and cancers in Australia, both at and following the diagnosis of AIDS.
Methods: A retrospective cohort of people with AIDS from three major HIV medical units
was established Data abstracted included date and CD4 cell count at initial and subsequent
AIDS related illnesses. Sub cohorts of people with AIDS were formed by interval of AIDS
Iia'nsis; 1983- 1987, 1988-1990, 199 I-1994. For selected Ols and cancers, disease free survival at and followirng AIDS was estimated using the Kaplan-Meier method. Incidence rates
per 100 person years (py) were calculated for six monthly intervals up to two years following AIDS diagnosis.
Results: Informration was available on AIDS-related illnesses in 2580 people with AIDS diagnosed firm 1983 to 3 I December 1994. Most common AIDS-related illnesses were
a eu oiysri t linii pneumonia (PCP) (49.7% of all subjects), Mycobocterium ovium complex
infection (MAC) (34.6%), cytomegalovirus disease (CMV) (28.6%), and Kaposi's sarcoma
(KS) (278%). A decline over time in median CD4 cell count at AIDS diagnosis was
observed, from s/m 3 in 1983-1987 to 34/mm3 in 1991-1994 (p<0.001).The cumulative
ris estimate two years following AIDS declined for PCP from 70% in 1983-1987 to 50% in
99 I 1994 (p<0.000 I), and for KS from 44% to 32% (p<0.O00 I), while there was an
increase i, CMV from 33% to 4 % (p<0.O0 I), MAC from 45% to 5 1% (p<0.O001) and
nesophayeal candidiasis from 26% to 32% (p<0.0001). Incidence rates following AIDS were
26, 00 p for MAC, 20/!00 py for CMV, 18/100 py for PCP and 12/100 py for KS.These
rtes Ae re s able for MAC and CMV but declined for PCP and KS with time interval folIowin AIDS.
Conclusion: Incidence of PCP and KS among people with AIDS in Australia has declined
bstantially whle the incidence of CMV and MAC has increased. High, and constant incialanc rites over time following' AIDS for MAC and CMV suggest that the vast majority of
peope with AIDS are at risk of developing these two major Ols.
Professor John M Kaldo r National Centre in HIV Epidemiology and Clinical Research, 376
Victo Stret, Darlinghurst 2010, Sydney Australia.Tel. [phone]; Fax. [phone].
Tu.B.2237
HIV INFECTION IN PATIENTS OLDER THAN 50 YEARS

Rizzo Fortunato, Alessandrini A., Camera M., Gaffuri L.
Department of Infectious Diseases, S. Martino Hospital, Genoa, Italy
Objective:To describe some epidemiological and clinical characteristics of patients with HIVinfection and older than 50 year s.

Tu.B.2235 -Tu.B.2239
Methods: We observed, through December 1995, 57 patients with HIV-infection and more
than 50 years.We defined: the risk groups, the stage, the distribution of opportunistic infections, the progression of disease.
Results: 57 patients (48m. 9f.) with average age of 59,75 (range 50-83). The transfusion
recipients and I accidental exposure. 30/57 patients had AIDS and the AIDS-defining diagnoses were: 7 Pneumocystis carinii pneumonia, 5 wasting syndrome. 5 CNS-toxoplasmrosis,
3 Kaposi's sarcoma, 2 tuberculosis, I Cryptococcal meningitis, I Salmonella bacteremia
recurrent.We reported a total number of 342 cases of AIDS and 30/342 (8.77%) were
over 50 years of age. Frequently in HIV-patients who are older than 50 years there was a
fortuitous checking of HIV infection during blood examination or blood donors. Of the 30
AIDS patients 5 are currently alive, 24 are dead with average survival of 125 days (range 4 -730), I dropped out.
Conclusion: We remark patients aged over 50 as compared to a younger- age group exhibit: a more rapid progression of disease to the death; a similar prevalence of the opportunistic infections; a higher proportion of cases due to sexual transmission (hetero- and homo-)
compared to drug addiction in younger age groups; the frequent fortuitous checking of HIV
infection.
F. Rizzo Department of Infectious Diseases, S.Martino Hospital,VIe Benedetto XV, 16 100
Genoa,ItalyTel.: 39105552571 Fax: [phone]
Tu.B.2238
QUALITATIVE AND QUANTITATIVE DYNAMICS OF HIV- I QUASISPECIES BEFORE
AND AFTER CD4 DEPLETION
Ida Setsuko, Oka S, Gatanaga H. ShiodaaT, Nagai Y Iwamoto A. Institute of Medical Science,
University ofTokyo,Tokyo, Japan.
Objective: To investigate qualita- and quantitative dynamics of SI or NSI variants along clinical courses.
Methods:Viral load in sera were measured by the b-DNA. Genetic changes of the envelopeV3 of two Japanese hemophiliacs were examined by the PCR sequencing. Both
patients were infected with HIV around 1983 and the rapid decline of CD4 counts were
observed in 1988 in one patient and in 1990 in the other:
Results: In both cases, putative SI variants estimated from the V3 sequence (putative SI
genotype) emerged before the decline of the CD4 counts. Quasispecies was formed by
populations of the SI and NSI genotype thereafter In either case, major clones with the SI
genotype disappeared and other clones with the same genotype took over in less than 13
months before and during the rapid decline of the CD4 counts. However, after CD4 depletion below 100/pl, the changes in the SI genotype were slowed down. Although population
change within the NSI genotype were also observed, the same clone persisted longer than
three to six years even when the patient had high CD4 counts.These persistency of the
NSI clone might be the substantial of the pathogenesis of disease.When the SI genotype
was detected at first, it existed as one of the dominant populations and was associated with
a transient increase in the viral load from 104 to 105 order RNA/ml in either case.
However, the same SI genotype had never persisted as the dominant clone and changed
with additive mutations along their clinical courses. Surprisingly there was a spike increase
and steep decline of viral load even after severe CD4 depletion in both cases.
Conclusion: These results suggested that the SI genotype was exposed to the strong
immune pressure before CD4 depletion and the NSI genotype must be the escape mutant
throughout the clinical course.
Setsuko Ida, Dept. Infect. Dis., Inst. Med. Sc., Univ.Tokyo, 4-6- I, Shrokanedas, Minato-ku,
Tokto. 108, Japan.TEL: [phone]. FAX: [phone]
Tu.B.2239
COMPARISON OF RATE OF DISEASE PROGRESSION IN HIV-I SUPTYPES A, B, C
AND D INFECTED INDIVIDUALS LIVING IN SWEDEN
Albert, Jan*, Alaeus A**, LeitnerT*, Lidman Ks*. aSwedish Inst. for Infect.Dis. Control and
**Dept. of Infect.Dis., Karolinska Inst.,Danderyds Hosp., Stockholm, Sweden.
Objective: HIV- I can be divided into at least 9 genetic subtypes. All genetic subypes have
been found in central Africa, whereas subtype B dominates in Europe and the U.S. It is not
known if there exist subtype specific differences in virulence.We have studied HIV- I infected individuals of Af ican origin to investigate which subtypes are represented in Sweden
and to study if there exist subtype specific differences in rate of disease progression.
Methods:The HIV-I subtype carried by 55 individuals of African origin Iving in Sweden was
determined by direct DNA sequencing of the V3 domain of the HIV I envelope.
Epidemiological, clinical and immunological data, including country of origin, CDC stage, antiretroviral treatment, CD4+ lymphocyte count were collected. Rate of CD4 lymphocyte
decline (CD4 slope) was calculated from all available CD4 determinations by linear regression for individuals with more than two years follow-up.To each individual of African origin
we matched (by age, sex and CD4 count at entry) a Swedish HIV-I case infected through
homosexual intercourse or intravenous drug use. Previous studies have shown that an
absolute majority of individuals from these risk groups carry subtype B virus.
Results: The patients originated from I 2 different African countries. A maority (27/55)
were of Ugandan origin.We found 6 established HIV-I subtypes among the patients: 20A,
14D, 10C, 4B, 2G, 2H, and in addition I A/D recombinant and 2 indavduals fom Zaire with
a previous not reported subtype. Correlation between subtype and clinical and immunological data were only evaluated for individuals who carted subtype A, C and D and their
matched subtype B infected controls.There were no significant differences an CD4+ counts
at entry or completion of the study Within each subtype there were large differences sn the
slope of CD4 cell loss and there were no significant differences in CD4 slope between subtypes.
Conclusions: Most HIV I subtypes have entered Sweden.There were no evidence for subtype-specisc differences in rate of disease progression as measured by rate of CD4+ lymphocyte loss.
Jan Albert, Swedish Institute for Infectious Disease Control, S- 105 2 Stockholm, Sweden.
Tel.: [phone] Fax: [phone] email: [email protected]

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