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

Track B: Clinical Science

Tu.B.2305 - Tu.B.2310

immunosuppressives were used in 64.7% and 6 patients were associated with Fludarabine
therapy in the non-HIV group.
Discussion: The overall outcome of PCP was worse in non-HIV patients, though the recurrence of PCP was less and tolerance to contrimoxazole was better in this group. Increased
occurrence of PCP in non-HIV patients observed here are probably due to use of stronger
immunosuppressive regimens, more awareness to look for PCP anrid advanced diagnostic
technology. It is worth noting that in non-HIV patients CD4 counts were relatively higher
at the onset of PCP This suggests immunosuppressives no only reduce the CD4 cells probably also alters the function of CD4.
SP Raychaudhuri, 5 10 Ashton Av., Palo Alto, CA, 94306 USA Tel: 4 I 5-424-9147/I 848 Fax:
415 326-1262
Tu.B.2305
SERO-EPIDEMIOLOGIC INVESTIGATION OF HIV INFECTED PATIENTS AND MEDICAL STAFF
Karagas Natali V*, Rybalkina T*, Evseeva L.*, Manykin A.**, Raygoza-Anaya M.***. *
Gamaleya Inst.of Epidem.Microb.,**Ilvanovsky Inst. of Virology, Moscow, Russia,***
Inst.Region.de Invest. en Salud Publica.Univ.Guadalajara., Mexico.
Objective: To estimate the propability of pneumocystosis as AIDS- associated diseases it
have been investigated 209 serum samples from children and adults infected by HIV and
medical staff
Method: Serum samples of HIV infected patients and medical staff were tested by ELISA
(author modification - patent n. I 68599 I USSR) to determine antibodies to Pn.carinii.
Results: Diagnostic titre of IgG to Pn.carinii were detected in samples of seventy-four
patients (55.6%). IgG in children group were found in samples of fourty-five patients
(52.3%) and in adults group - in samples of twenty-nine patients (61.7%). IgM to Pn.carinii
(acute infection) were detected in samples of thirty-seven patients (27.8%): twenty-three
children (26.7%) and fourteen adults (29.8%). 58.8% of medical staff had IgG to Pn.carinii
and 25% of medical staff had IgM to Pn.carinii.
Conclusion: It is likely that medical staff may be one of sources of pneumocistosis infection
for HIV infected patients.
N.VKaragas, 18 Gamaleya Street,Moscow 123098,RussiaTel: [phone] Fax: (095)
193-61-83
Tu.B.2306
NEUROPSYCHOMOTOR DEVELOPMENT IN HIV+ CHILDREN
Silva, Carmem L.O, Othweiler L, Lago. I, Goldin, J.R, Galvfo, N.A.M, Rotta, N.T Federal
University of Rio Grande do Sul, Rio Grande do Sul, Brasil.
Objective: To evaluate the neuropsychomotor development and prevalence of neurologic
impairment in an ongoing cohort of seropositive children.
Methods: We studied I114 HIV + children between 11/89 and 12/93.Thirteen patients had
transfusional-associated HIV infection, 70 were born to HIV+ mothers and 31 were seroreverted controls born to HIV+ mothers. Neurologic and Cerebrospinal Fluid (CSF) examinations were done every 3 months, EEG and brain CT were done at baseline and at 12
months.
Results: Subjects were followed a median of 22.5 months (range= 2-72). Five hundred
twenty six evaluations were performed in our I 14 patients, being 60.5% abnormal. Of
these, 58% were encephalopathic (70% progressive and 30% static), 26% had developmental delay 7.2% opportunistic infections of the CNS, 4,3% HIV encephalitis, 2.9% epilepsy and
1,5% peripheral facial palsyThree hundred sixty nine CSF examinations were obtained,
being 69.7% abnormal. HIV antibodies were found in 59.3%, pleocytosis in 8.7%, acute infection in 10.3% and high protein in 10.6%.Two hundred eleven EEGs were performed, being
44.5% abnormal. Of these 79.8% had focal abnormalities, 8.5% slowing, 9.6% focal abnormalities and slowing and 2. I% were isoelectric. One hundred sixty nine Brain Cts were
done, being 36.7% abnormal. Of these 27.8% had atrophy, 8.3% calcifications, 2.4% acute
infection, I1.8% CVAs and I1.8% white matter hypodensities.
Conclusion: These was a significant association between being infected and having abnormalities in the CSF, EEG, brain CT and neurologic evaluations.The degree of neurologic
involvement in the beginning of the study was a strong predictor of encephalopathy On the
affected children there was an association between absence of CSF HIV antibodies and
death, EEG with focal abnormalities, basal ganglia calcifications, and association between the
use of ZDV and favorable outcome.
C.L.O. Silva, Rua Jos6 Honorato dos Santos n~ 100, Apto. 1I101, POA, RS, Brasil. Phone
0.55.51.2263686
Tu.B.2307
ULCERATIVE CMV-ESOPHAGITIS IN AN AFRICAN BOY WITH AIDS
Schulz Regina, Steinmuller A, Gerling B, Becker M, Grosch-Worner I.
Universitatskinderklinik,Virchow-Klinikum, Berlin, Germany
Introduction: CMV manifestations (chorioretinitis, gastrointestinal disease) are a known
complication in adults and children with progressing acquired immunodefciency syndrome.
Intravenous (iv) ganciclovir reduces or eliminates CMV virus excretion and CMV viremia
during administration. Hence a maintenance therapy is required but questionable concerning the problem of continuous iv administration.
History: A ten-yearnold african boy with a history of HIV infection presented with dysphagia, epigastric and retrosternal pain and weight loss.
Diagnostical findings: The boy presented with a severe decrease of the CD4 cell number
to 1%. X-ray of upper gastrointestinal tract and upper gastrointestinal endoscopy showed
ulcerative esophagitis with candida plaques.The biopsy specimen demonstrated intranuclear
inclusions and positive CMV-PCR. No CMV chorioretinitis was seen.
Treatment and clinical course: The patient underwent a 14 day course of iv ganciclovir 10
mg/kg/day divided into two doses and fluconazole 100 mg once a day Symptomatic therapy
was given with iv fluid and electrolyte substitution and xylocain gel administered locally
before oral food intake. After a few days of therapy the boy began to eat with appetite and
gained weight. In the second week ganciclovir induced progressing neutropenia occured.
Intermittent granulocyte-colony stimulating factor (G-CSF) treatment was successfully performed. Upper gastrointestinal reendoscopy showed a total restitution of esophageal
mucosa verified histologically Immunocytochemical pp65 CMV antigen in blood leukocytes

was negative at this time and followed continuously since six month. Clinical signs of CMV
reinfection are absent though progressing CD4 cell decrease.
Conclusions: I.) 14 days iv course of ganciclovir is successful in the treatment of CMV
esophagitis. 2.) Immunocytochemical pp 65 CMV antigen monitonring in blood leukocytes is
a helpful diagnostical tool in the detection of CMV reinfection. Concomitant ophthalmological controls should be performed in beware of CMV chorioretinitis. 3.) G-CSF stimulation is
successful in the treatement of ganciclovir induced severe neutropenia.
R. Schulz. HIV-Tagesklinik/Universit itskinderklinik Virchow. Heubnervweg 6. I14059 Berlin,
Germany Phone: [phone]/ Fax: [phone]
Tu.B.2308
PEDIATRIC EUROPEAN NETWORK FOR TREATMENT OF AIDS (PENTA)
Castelli G, Gibb D, Debrd M, Giaquinto C, Martinez M, Aboulker JR Darbyshire J. on behalf
of PENTA Steering Committee
Objectives: To undertake clinical trials of therapies for HIV infected children.
Methods: The PENTA trials are co-ordinated by the MRC HIV CTC (UK) and INSERM,
SC 10(France). Clinical centres from I0 European countries, Canada and Brazil link with one
of the 2 trials centres. Current trials are: PENTA I, a randomised trial to evaluate the early
use of Zidovudine (ZDV) in asymptomatic children infected vertically; PENTA 3, a phase II
study to evaluate the toxicity and tolerability of ddC plus AZT in children with symptomatic
disease not previously treated with antiretroviral therapy and PENTA 4, a phase II randomised double-blind trial to assess the safety and tolerability of adding lamivudine (3TC)
to current nucleoside antiretroviral therapy
Results: 197 children were enrolled in PENTA I. By October 1995 the average follow-up
was 20 months and 62% of children were still on trial medication. 32 children had started
open ZDV for disease progression, 13 had reached a trial endpoint of AIDS. Severe neutropenia developed in 10 children, 4 while on open ZDV. In 4 children high transaminase
levels led to dose reduction or interruption and 9 children stopped medication because of
minor gastrointestinal adverse events.The Data and Safety Monitoring Committee reviewed
the trial in October 1995 and reported no untoward toxicity However, in the light of the
results from the European/Australian Delta trial and ACTG 175, the PENTA Executive
Committee endorsed the recommendation to break the treatment code for all children so
that clinicians could decide on the most appropriate therapy It was decided not to break
the treatment code in PENTA 3 but to transfer all 34 children enrolled in the blinded phase
to open ddC.The study has continued to recruit as an open label study. Intake to PENTA 4
started in December 1995.
Conclusions: PENTA has recruited 264 children into clinical trials. Follow-up of all children
in PENTA I will continue and the results remain blinded. Follow-up of PENTA 3 will finish
in August 1996.Virological studies are being run in parallel to all trials and new PENTA trials
are under development.
Dott Guido Castelli, Reparto Malattie Infettive, Ospedale del Bambino Gesu, Piazza S.
Onofrio 4, 00165 Roma, ItalyTel: [phone] Fax: [phone]
Tu.B.2309
OLDER CHILDREN WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION AT
SAN JUAN CITY HOSPITAL, PEDIATRIC AIDS PROGRAM.
Mendez, Ingrid,Torres RTossas E, Santiago 5, Bonilla L, Jimenez E, Morales J. San Juan City
Hospital Department of Pediatrics, Pediatric AIDS Program, SJ, Puerto Rico
Issue:To describe clinical, immunological and psychosocial characteristic of children mostly
with perinatally acquired HIV between 9 y/o and 15 y/o.
Project: Descriptive study of 35 patients, 2 I of them are surviving perinatally acquired HIV
(AIDS) followed at San Juan City Hospital Pediatrics AIDS Program Center (which is part of
a medical center).The data was taken from medical records clinical, inmunological and psychosocial parameters.
Results: The group included a total of 35 patients, 6 boys & 29 girls with a mean age of
10.2 years. Of the 35 patient medical record data analyzed a total of 24 were living (infection acquired in 21 patient, 2 by blood transfusion, I by sexual abuse). A total of 5.7%
remain asymptomatic, 40% have AIDS, 45.7% have a CD4 count of greater than 500,
54.3% less than 500 cells/ul. Of those alive (and perinatally acquired infection) 67% are
orphaned as maternal death, 43% are taken care of by extended family members and 19%
at foster care. Disclosure has occurred in 29%. A total of 90% are at regular school, the
remainder are at a special school.
Lessons Learned: Significant immunologic deterioration and symptomatic disease progression was documented in this long term survivors group of children affecting their daily lives,
also the stigma associated with HIV leads to keep diagnosis secret.
I. Mendez, 1503 Ashford Ave. I I B Las Olas, Condado PR 009 II.
Telephone (809) 250- II 50, Fax [phone].
Tu.B.2310
RETENTION STRATEGIES FOR HIV INFECTED WOMEN, ADOLESCENTS AND CHILDREN IN CLINICAL TRIALS' AT THE SAN JUAN CITY HOSPITAL, PUERTO RICO
|imdnez, Eleanor, Carrer MT Rivera M, Abreu E, Pdrez L, Ramos M, Acevedo M. San Juan
City Hospital
Issue: Lost to follow up and poor compliance are major problems for institutions participating in AIDS clinical trials.
Project: The San Juan City Hospital, located at San Juan, the Capital City of Puerto Rico, has
been participating in Pediatric NIH founded AIDS Clinical Trials since 1988. Several strategies have been developed including intensive educational programs at referral sites, travel
and meals expenses, scheduled visits given in advanced to participants, frequent telephone
calls, postcards as reminders as well as to keep personal contact, outreach by community
nurses, combination of primary care and study visits, one step clinic which provide children
and mother's services at the same visit, and the creation of informal support groups.
Results: Since clinical trials were begun, Pediatrics and OB/GYN studies have accrued I 54
children and 76 women to different protocols with a total enrollment of 405. Of these only
5 children (3.2%) and I woman (I.3%) have been lost to follow up. Percent of retention in
Pediatric studies is 96.8% and 98.7% in OB/GYN studies.
Lessons Learned: With the development of well planned and comprehensive strategies,
accompanied by empathy and a personal touch, excellent results can be obtained in

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