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

Track B: Clinical Science

Tu.B.2293 - Tu.B.2298

Results: I 2 Ifirst episodes of...6.%,, 17 PCP occurred in 199 1/92 and
199 dbu Proru oa errupto Miu o f103 in 1993/94 among 4 14 and
- " 525 cases of AIDS, respectively.
___ a NAConclusions: I-In 1993/94, over
50% of PCP episodes concerned
patients e th ir norlnt of their HiIV status or not receiving medical attention. However,
impovement in medical follow- up has resulted in a reduction of first occurrences of PCR in
spite of an increasing incidence of AIDS. Fa llure and interruption of prophylaxis account for.I large proportion (33%) of cases and efforts should focus on further promoting strategies
o treatment efficacy and compliance, while convincing incentives for screening and medical
str villanc i reman,i na i tret.
C. Pradi ci, Cish, Nice Unwvrsiry I Hospital, Bp 79, 06202 Nice Cedex 3 Tel: [phone];
F;x: 33.92.01.56.27
Tu.B.2293
REASONS FOR DELAYED INITIATION OF PRIMARY PROPHYLAXIS FOR
PNEYMOCYSTIS CARINII PNEUMONIA
rys. e o'ryge, Gar,ayran s P, Giarisello Bo rbfouiis E.J., Provis A., Stephanou J., Kosmidis
J. Special Itfections Unit, Cnera1 Athens Hospital" G. Genrinimatas", Athens
Th' iir, tis sIudy was to I.ed out the HIV positive patients with CD4 (+) Tlymphocyte
cint be!o 302x 10 cell/L who do nrot receive primary prophylaxis for Pneumocystis
cainii pneuron F (PC.P) and to investigate the reasons for this fact.
We eval ted the occurrence of PC.Pamong 97 HIV (+) patients with fewer than 0.2 xlO09
F) (-+, cel!:Iswho w'ere f lowed up in our HIV unit for the last ten years. Among these
pitent. onl 41 '(t2.3%) were receiving primary prophylaxis for the prevention of a first
episo'de of P's.P From a tota iF 28 patients with a history of PC.P,24 (85,7%) had never
reeid p phylrxis before thei first episode of PC.P.or discontinued the prophylactic
agents for a varety of reasones Twelve of the patients (50%) were diagnosed as HIV
seropositives after the first episode of PC.P,four ( 6.7%) were followed up for a period of
time inr other HIV unitsfour (16.7%) stopped the prophylactic agents because of side
efr:,,sand four (I 6,7~') i, e t) refused to receive anyn medicine at all.
ur di; su5gtes that we sC1ould 1try to diagnose HIV infection as early as possible in order
not only to star etarset,;iat treatment but when the CD4 (+) cell count is lower
'thln 0.2x109/[ prevention of PCP.is exceedingly important and thereby improve survival
in pesonss itc ivanced disea'e. On the other hand co-operation between the HIV units
is necessary ifr the best fo low up of these patients.
G. Chr ysos. 37 Pindou Street. Papagou. 156 69 Athens, Greece
Telephone: - 4301 6523567 Faxe [phone]
Tu.B.2294
INHALED PENTAMIDINEVS COTRIMOXAZOLE FOR PRIMARY PROPHILAXIS OF
PNEUMOCYSTIS CARINII PNEUMONIA (PCP) IN HIV+.
Sciandra, Mauro, Dassio G. Maello A. Calv o MM, Meneghin G. Sinicco A. Institute of
Infectious Driseases, University of Turin, Italy
Objective: To eviruate efficacy and tolerability of inhaled pentamidine vs. cotrimoxazole for
primary prevenrtion of PCP in HIV + patients.
Methods: Fr-,r Jnuary 19 'I to February 1995 we enrolled 129 HIV + patients (89 males,
40 females; mean age 30.5 _ 6.8 years: 97 intravenous drug users, 18 homosexual men, 14
heterosexual: 98 group IV(2) CDC, 31 III CDC) with an absolute CD4 + cells count <
200/pL.They received either 1300 mg of pentamidine isethionate by inhaler (group A) or
960 mrg s by other day of cotrimoxazole (group B). Every patient was giving antiretroviral
therapy and vwas AIDS fl-re"ee ait entry of the study All the patients were followed for at least
10 months fiom the enr olmrent. Patients with side effects were excluded from the evaluation of the efficacy.
Results: Group A:We enrolled 90 patients (56 males, 34 females) with a mean CD4+ cells
count of 12/ + 64/pL. Out of therem. 2 had side effects (bronchospasm).Twenty four had a
PCP after a mean time of 6.4 + 2, I nonths. Group B:We enrolled 39 patients (33 males, 6
females) with a mean CD1+ cells count of 130 + 57/pL. Out of them, 15 had side effects
(cutaneous rash). Six had a PCP after a mean time of 6. I + 2.5 months. No significative difference was observed regard to the efficacy among the two groups (chi square = 0.001; p
-- 0.970), while we noted a significative difference reg ard to the tolerability Pentamidine vs.
oxtrims azol cii square 28..1i:4; p - 0.000
Conclusion: Pentamidine:nd.otri moxazol e are equivsent to prevent PCP but the second
Ihad a poor tolerability.
M. Sciandra, Istitto Malaltie I Inetetive Universita'dl Torino Corso Svizzera 164 - 10149
Torino, Italia
rTe!: 039-I 1t393980 Fax:039 I 7761757
Tu.B.2295
UNUSUAL IMAGIOLOGICAL FINDINGS IN PNEUMOCYSTIS CARINII PNEUMONIA
- CASE REPORT
CviF, RIst ado E*, A' -f, Pombo V*, Saraiva da Cunha J*, Cfrte-Real R'*, Melyo-.c.t A"2 inlectios 1Dr s Department- HUC, 3049 COIMBRA CODEX POR
IF' AL
P arn-, ' s s r ieted ''oo~cal findings ms be quite 'riable.We report the case
of s youn bisexual man who complained of a fever of 3 weeks duration, anorexia, we ght
loss and night sweats. -he 5-o rotyenosraphic findings revealed multiple bilateral round
'is, sur'runded b a t in wIl, consistent with numerous pneumatocelae.The ELISA and
Wertern blot tes Humn isir ismunodetic encyVirus type I were positive and the CD4
ir.u t si 2, 1ia'a A i ':is CT scan conirmed the presence of disseminated cavist'es,:f isl,2 r i, t!, s re '; a' wela the superior segmrents of the lower lobes.
Pe,, i the" i b,. iveo'ar fluid: other possible e e lo.ie r. namely
a, tot:. '. 3o,. " ia sp p: d rI/tx; 5occus equ w e re exclud e d.T he p ati e nt
L:.eled,,th. /:', u tk~ f:.tl:r~x.ao' t~e 4y anld was discharged, free of symTptors.
Neeks later A thorac T a, performed duing follow up, still sevealed "2 cavitary images
at the right,uperior lobe, probably corresponding to residual lesions".
Meliyo Sirvestre A:- Department Of Infectious Diseases University Hospital Of Coimbra
3045 Coifisra Codex PortoJ2l

Tu.B.2296
PNEUMOCYSTIS CARINII PNEUMONIA IN CHILDREN WITH HIV-INFECTION
Ramos IT, Ruiz-Contreras J. De Jose MI. Pochevile I, Hern ndez Sampelayo T Cillerueio MJ.
Fortuny C, Ciria L. the Spanish Pediatric-AIDS Collaborative Group
Objective: To determine the clinical course, laboratory findings and outcome of
Pneumocystis crinii pneumonia (PCP) in children infected with HIV
Methods: The medical records of HIV inlfected children younger than 15 years of age with a
definitive diagnosis of PCP were retrospectively reviewed. A total of 23 episodes P crin
related respiratory failure in 22 patients (4t.4%) were diagnosed among 454 HIV infected
children followed from 1985 until December 1995 in 7 large spanish hospitals. The diagnosis
was carried out by the identification of Pcirini cysts of fluid obtained by brenchoalveolar
avage (16 episodes), induced sputum or lung biopsy and in two patients postmortem.
Results: Infection with HIV was acquired periratlly in 17 childreen (median ae at PCP diagnosis 4.5 months), and through contamina ted lood products in 5 patients (mnedian age 1 26
months). For 65% of the episodes. PCP was the first AIDS-defining condition. In 6 infants
the HIV infection status was unknown at admission to the hospital. Four children were
receiving trimeethoprims suifinmettoxazole prophylaxis it diagnosis of PCP In vertically infected children, the CD4 cell count was above 1500 cells/mm 3 in 2 patients ( 13%). and the
CD4 percentage above 5% in 6 cases (40%).The overall mortality attributable to PCP was
26%. Children younger than two years of age required more frequently mechanical ventilation (p<0.05) and had a lower survival than older children.
Conclusions: PCP is common in HIV infected children, and frequently the first AIDS-defning
diagnosis.The CD4 cell count and CD4 percentage have a limited value in predicting PCP
in infants. Older children have a better outcome.Ii n chi dren at risk of HIV infection, a high
index of suspicion is necessary ftor the possibility of PCF, despite prophylaxs.
JoseTomas Ramos Arn lor. Hospita Materno Infitil i2 de Octubre Depaitirento de
Pediatria. Seccion de Inrmunodeiciencas. Plinta 6A. ICtr de Andalu a Km 5,400. Madnd
28041.Telf 34-1-3908569; Fax [phone].
Tu.B.2297
FANSIDAR FOR PROPHYLAXIS OF PNEUMOCYSTIS CARINII PNEUMONIA AND
TOXOPLASMIC ENCEPHALITIS IN AIDS PATIENTS WITH POOR COMPLIANCE.
Casado JL, Antela A, Perez Flias MJ, Frutos B', doreno A, Redondo F Martin DJvila P
Guerrero A. Enfermedades Infecciosas. Medicina Interna*. Hospital Ramon y Caial. Madrid.
Spain.
Objective: To determine the safety and efficacy of fansidar as prophylaxis against Pciiiis
pneumonia (PCP) and toxoplasmic encephalitis (TE) in an AIDS population with poor compliance to other prophylactic regimens.
Methods: A review of medical records of 70 patients receiving fansidar (one tablet weekly)
since 1987 as primary or secondary prophilaxis against PCP
Results: Fansidar was administered for 904 patient mssonths (mean 13 months). Suspected
or confirmed non-compliance with tinmethopris-sulfaimethoxazole (TMP SMX) and
aerosolized pentamidine (PA) was the main reason for fansidar use in 54 2% of patients. In
the remaining 45.7% there were non-serious previous reactions with TMP-SMX.Twenty
patients (28.6%) received fansidar as secondary prophylaxis. Compliance with fansidar was
considered adequate in 91.4% of the cases. Mean CD4 cell count was of 90 cell/pL ( 212).
For patients receiving primary prophylaxis, none developed PCP Of those receiving secondary prophylaxis, seven out of 20 (35%) developed PCP two of them associated with
poor compliance, in a mean time of 8 months Probability of remaining free of PCP was
75% at 24 months.Twenty--four patients were seropositive for Toxopl sni gondi and two of
them (8.3%) developed TE on fansidar prophylaxis. Drug discontinuation due to toxicity was
observed in 18 patients (27.3%); however serious adverse events (anaphylaxis or StevensJohnson syndrome) ocurred only in 3 patients (4.2%). No patient death was attributed to
fansidar prophylaxis.
Conclusions: Fansidar weekly appears to be effect ive as prophylaxis for PCP and TE in
AIDS patients with poor corpliance to TMP-SMX or PA.
Begona Frutos. Department of Internal Medicine Hospital Ramon y Cajal. Cra. Colrnsenar
Km. 9. I 28034- Madrid.Spain.PhIone- Fax: [phone]
Tu.B.2298
PNEUMOCYSTIS CARINII PNEUMONIA (PCP) IN THE PRIMARY PROPHYLAXIS ERA:
A NESTED CASE-CONTROL STUDY
Ledergerber Bruno, Fiepp M. Schenker C, Luithy R. Egger M*, the Swiss tHIV Cohort Study
Division of Infectious Diseases. Dept. of Medicine, Unersity Hospital Zurich; "Dept. of
Social and Preven tive Medicine, University of Iausanne and Be rne, Switzerland
Objective: To examine risk factors for PcP is first AIDS inicator disease within the large.
prospective Swiss HIV Cohort Study (SHCS), 1993 94.
Methods: Case control study with concurrent sampling of controls within the SHCS. Cases
with PcP as their first clinical AIDS defining event during 1993 and 1994 who attended
study clinics (all Swiss University Clinics and two Cantonal Hospitals) were matched to I-2
controls for time of cic visit (+ 3 months) and CD4 cell counts (-: I0%). Conditional logistic regession was used fo-stat' ticai analysis
Results: 99 cases were srimpared with 186 conltoi. Median CD4 cell counts at PcP diagnosis or matching date were 5 ind h8 for cses and cr5n,. respectively Abserce of PP
prophylaxis was the only sigriificant rsk f rctor )veral, the protective effect of any prophylaxis was esmrnated to reduce risk 22 fold (OR 0.016.95% CI 0.0090.22, pC0.0001).
However, this effect was stronyy modified by the type of the pophylact c regimen and the
duration and regularity of use (all nteraction erms pI0.05). A patient taking cotn moxazole
regularly for more than 2 ironths hs had aI 57 fold reduced risk 1i(0.)46x0.14) whereas
protection was conside-bly educed or even abohshed when intake w s discontinued or
when prophylaxIss a irstItd ess than two 'onsis. Ite lat'er probably occurred
becus s ''e lilnt f s ll itn. Irs nls
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Effect modifying factor

Odds ratio

Cotrimoxazole vs. other
Irregular ivs. regular use
Duration < 2 vs. > 2 months

0.14
35
189