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

Track B: Clinical Science

Tu.B.2270 - Tu.B.2275

Results: Cognitive disorders rates were 43.3% on anamestic groi nds and 96.6% after neuropsychological tests. Anterograde amnesia (86%) was the most frequent disorder hallucination (1I6.6%) the least. The most discriminating parameters for the predictive value of disorders on diagnotic occurrence (93.3%) were: nenirt, tempral orientation, and the interaction spatial orientation/ constructional aprazia. With this subset of parameters, on a 14
maximal score, the patient group scored 7.5+4.4 and the control 13.4+0. 9. NeuroAIDS
patients mostly presented memory disturbances and constructional apr axia.
Conclusion: Neuropsychological testing is an available tool in the diagnosis of neuroAIDS
and tropical neuroendemics in our underequipped area. Further st.,dies with larger numbers are required to identify the vest parameters as for discriminarting efficiency and predictive value on respective diagnosis.
Prc Kayehbe Kalula Projet Sida Kinshasa c/o Jan I 55 National Straat 2000 Anvers. Belgium
Tu.B.2270
MUCOCUTANEOUS LESIONS IN HIV-INFECTED PATIENTS
Padro, Isabel.* Lupo S**, Bortolozzi R**,Taborda M*, Fay O*. *Cenie of Technology in
Public Health, University of Rosario. ** CAICI, Faculty of Medicine, Rovari, Argentina.
Mucocutaneous lesions (MCL) are commonly found in HIV-infected patients in the course
of infection, specially during the advanced stages of disease.The sites most frequently affected are oral and anogenital areas.
Objectives: Describe the MCL presented in HIV-infected patients, their evolution and clinical response to treatment.
Patients and Methods: We studied 27 MCL identified in 24 HIV infected patients: 16/8
male/female. Risk behavior: homosexual 9, heterosexual 7, intravenous drug user 7.The
average age was 29.8 years old (range 21I-54).The laboratory studies included mrycological
and bacteriological cultures, virological diagnosis using specific fluorescent conjugates
(Herpes simplex virus types 1I-2 (HSV I-2) and Varicella zoster virus (VZV); Bin Whittaker,
Inc) in a direct immunofluorescence assay (DFA) of the smears and biopsy in some cases.
The patients with HSV I -2 were treated with acyclovir (ACV) 2.5 gIda'y.
Results: 23 MCL were acute and 4 chronic (more than I month of evolution), 25 of them
were ulcerative and 2 vesicular. Localization: I 6 orolabial lesions (I 0 in the buccal mucosa, 5
along the lip and 2 along the tongue), 6 nogenital lesions (4 perianal and I genital) 14 MCL
were of single presentation and 13 multiple, 2 ulcers had more than 3 crn of diameter
(both diagnosed by tissue biopsy as gigantic aphthous ulcers). Bacteriological and mycological studies were negative. All DFA forVAV were negative. 22 MCL (8 1.5%) resulted positive
for HSV I-2 and 5 were negative (2 aphthous ulcers). 16 patients were at stage IV of disease (WHO Staging System); in one of them the diagnostic of a chronic ulcer HSV I-2 +
defined stage IVThe average count of CD4 + cells was 177.5/mm3 (range: 684).The treatment with ACV was effective in all cases (average time of healing: I 2 days).
Conclusions: I) The majority of the MCL were ulcerative, localized in the oral cavity and
with atypical presentation.The principal etiology agent of MCL was HSV I-2. 3) All the herpetic ulcers (acute and chronic) responded successfully to the antiviral therapy independently of the degree of immunosupression of the patient.
I. Padro, 531 Suipacha Street, (2000) Rosario, Santa Fe, Argentina.Tel.: [phone] Fax:
54-4 I-370765
Tu.B.227 I
CHRONIC PRURITIS IN HIV POSITIVE PATIENTS:A CLINICOPATHOLOGICAL
STUDY OF 13 CASES
Choudri S H, King R, Dancea 5, Kimani J. Njagi E, Plummer F. University of Manitoba,
Winnipeg, Manitoba, Canada.
Objective: To determine the etiology of a chronic pruritic maculopaprla.rr skin eruption in
HIV positive patients.
Materials and methods: Thirteen HIV +ve female sex workers presenting to tle Pumwani
Health Clinic, Nairobi, with chronic pruritic maculopapular eruptions were assessed and
biopsied. A detailed history and clinical examination was performed arid blood for white
blood cells, lymphocytes and CD4 and CD8 counts were obtained. 4 rrilliseter punch
biopsies were taken and 5 micron tissue sections were stained for herrmtoxylin and eosin,
toluidine blue, gram stain, periodic acid- Schiff with and without diastase, and alcian blue.
Biopsies from 2 HIV -ve patients from the same geographic region were used as controls.
Results: Patients age ranged from 25 to 52 years of age. All had pruritic maculopapular
hyperpigmented skin eruptions ranging in duration from I to 416 weeks and was located
on the legs, arms and trunk. One patient was on anti- TB drugs and another had associated
eczema. CD4 counts ranged from 35 to 73 1. Histologically a similar process was noted in
all biopsies consisting of a scant perivascular lymphocytic infiltrate iii the papillary and upper
reticular dermis with mild interstitial edema. Mast cells, many degranulated, were identified
in all cases and were located both interstitially and perivascularly. In 5 biopsies scattered
eosinophils were noted. Fungal and bacterial infectious agents were not identified. Pigment
incontinence with melanophages was a common finding in all cases.
Conclusions: The histological findings are characteristic of an urticarial process with the
presence of mast cells and mast cell degranulation a common denominatr: Activation of
mast cells by the non specific hypergammaglobulinemia present in HIV +-ve patients may in
part explain this reaction. Further studies are needed to elucidate lats m~echanism.
Dr S. Choudhri Room CS5124 - 409 Tache Avenue, Winnipeg, MB R2H dAL
Tu.B.2272
A RARE CASE OF PARAPSORIASIS (PITYRIASIS LICHENOIDES) IN A PATIENT WITH
HIV INFECTION
Stergiou G.D*, Nicolaidi A*, Evangelopoulou P, Mpoumpouresis K ), hers-i i rneas N**
Laskaris G**e, Papadopoulos A*. * I st IKA Hospital, Athens, Greece: Dermatology
Hospital e< Andreas Sigros v, Athens, Greece.
Objective: HIV- associated cutaneous disorders are presented in 90 %e of [t IV-irifrcted
patients.These disorders usually arn serious and atypical forms of common dermatoses or
unusual conditions but characteristic of HIV infection such au Kapour's s0 rcorra. Our objective is to present a very rare case of parapsoriasis (pityriasis lichenoides iin a DIV-infected
patient.

Method- Results: A woman, 42 years old, wife of a patient with AIDS, HIV seropositive for
4 years with two herpes zoster episodes 19 and 2 months ago. She was in stage B2 ( CDC
1993 ) with CD4 count 380 cells/mm3. She presented a non-pruritic papular rash mainly
in the trunk and lower limbs. Histologic examination of a biopsy specimen revealed hyperkeratosis with focal parakeratosis, slight acanthosis, papillomatosis, spongiosis, exocytosis, and
inflammatory perivascular lymphocyte infiltrations, findings consistent with pityriasis
lichenoides ( parapsoriasis ). Dipropionate betamnethasone was applied locally and she also
received antiretroviral therapyThe skin lesions dissappeared after a few weeks and the
patient remains in good condition after a year with no relapse.
Conclusions: Parapsoriasis should probably be included in the long list of HIV-associated
cutaneous disorders.
Mpoumpouresis Konstantine, 26 Valtinon st, Athens, Greece II 1473, 6439650 -fax [phone]
Tu.B.2273
IVERMECTIN TREATMENT FOR CRUSTED SCABIES IN AIDS
Anselmo Marco, De Leo R,* Repetto L., * Marcato P, o Barabino G.F., o Farris A. Infectious
Diseases, * Hospital Pharmacy o Dermatological Diseases, Ospedale San Paolo, Savona,
ITALY
Introduction: The dermatological symptoms in patients with Acquired Immunodeficiency
Syndrome (AIDS) are numberless. Among these, infections caused by Sarcoptes scabiei
(S.s.) are relatively frequent, particularly in the hyperkeratotic (Norwegian Scabies), or pluriacaric clinical manifestations. A therapeutic approach to this form is definitely much more
difficult, with a high percentage of relapse and therefore a higher transmission potential than
the nodular form.
Patients and Methods: Our case-report includes 2 patients with group IV C I (CDC 87)
HIV infection.The clinical diagnosis was confirmed at the microscope following dermal scarification. Both patients were given I12 mg of ivermectin in a single administration.The clinical
picture resolved on the fifth day after treatment. No patients suffered any relapse of the
dermatological picture after 100 days of follow-up.
Discussion: The costs of the products being used in treating scabies in our hospital were
analysed.The following table includes the global expense sustained for a treatment in US
dollars, as well as the percentage of the money spent to buy the product and a percentage
cost of the nursing assistance.
Day of therapy US dollars % drugs % nursing

BENZIL BENZOATE
HELMERICH-HARDY
COLLOIDAL SULPHUR
IVERMECTIN

59.04
41.45
71.60
8.66

52
24
73
100

48
76
27
0

NO
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ON
a)
0
u
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c0
a)
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cc
a)
U)
c0
U
cc
0
me
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Conclusion: The first cases treated with Ivermectin have promptly responded to the therapy. Particularly, there have been no relapses concerning the dermatological picture. A better
eradication of the infestation from S.s. at contained therapeutic costs may entail a remarkable reduction in the chances of transmission of the parasites in AIDS patients.
Marco Anseimo, Infectious Diseases, Ospedale San Paolo,Via Genova, Savona - Italy
Telephone: [phone] Fax: [phone]
Tu.B.2274
THALIDOMIDE FOR THE TREATMENT OF PRURIGO NODULARIS OF
HIV-INFECTED PATIENTS
MaurerToby A*, Poncelet A**, Badger J*, BergerTG*. *University of California, San
Francisco Dept of Dermatology*; **Dept of Neurology
Objective: To determine the safety and efficacy of thalidomide for the treatment of prurigo
nodularis (severely itchy skin nodules) in HIV-infected patients.
Methods: HIV-infected patients with prurigo nodularis refractory to treatment with high
potency steroids, ultraviolet light and antihistamines were enrolled into a randomized clinical
study All patients received thalidomide at 100 mg each day (Andrulis Pharmaceuticals).
After I month, patients were randomized to continue at this dose or receive 200 mg/day.
Patients were monitored for peripheral neuropathies with clinical and electromyelogram
exams at baseline, every 3 months and if new symptoms developed.The drug dose was
adjusted or discontinued depending on the severity of the symptoms.
Results: We present the results of the first 8 patients enrolled over a ten month period. Six
of eight patients were African-American, I was Asian and I was Caucasian. All patients
were photosensitive. Itch was reduced by 25% after I month of treatment and by at least
50% after 3 months with either dose of thalidomide.The size of the nodules decreased by
50% after 3-4 months of treatment. Average weight gain was 30 lbs. Half the patients developed a peripheral neuropathy which resolved when the dose was reduced.
Conclusions: Thalidomide appears to be an alternative therapy for prurigo nodularis in HIV.
Relief of pruritus is an early event. Monitoring for peripheral neuropathy is essential.
Reducing the dose may resolve the neuropathy.Thalidomide should be considered for the
treatment of other pruritic (itchy) diseases of HIV, the prevalence of which has been estimated to be 50% of HIV dermatologic manifestations.
Toby A. Maurer, San Francisco General Hospital, 1001 Potrero Ave, Bldg 90, Wd 92, Rm
224, San Francisco, CA 94 I I 0 Tel: [phone] Fax: [phone]
Tu.B.2275
INCREASED OXIDATIVE STRESS IN HUMANS INFECTED WITH HIV.
Allard Johane P, Aghdassi E, Chau J, Stacewicz-Sapuntzakis M, Salit I, Walmsley S. University
of Toronto,Toronto, Ontario, Canada.
Objectives: To determine the level of oxidative stress in patients with HIV-infection by measuring lipid peroxidation (LP).
Methods: Thirty-three subjects (I 5 HIV asymptomatic, CDC class AlI or A2; 13 AIDS, class
A3, B3 or C3; Age: 37~2 y, Body Mass Index: 23~ I kg/m2) without active opportunistic
infection were compared to 15 HIV negative controls. All subjects were non-smokers and
off vitamin supplements for 4 weeks. LP was assessed by measuring breath pentane (BPO)
and ethane output (BEG), malondialdehyde (MDA) and lipid peroxides (LPO). Plasma
antioxidant vitamins (C, E, B-carotene) were also measured.