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

Track B: Clinical Science

Tu.B.2361 -Tu.B.2366

INH/RlPI/PZA/EMB.Treatment: CM/CS/Ethio/Cipro; however, the patient became non-compliant. In 8/94 he was admitted, CD4 19, and previous treatment was restarted with good
response, iter changed to Cipro/Clofaz/CS.While on treatment, presented in 10/95 with
progressive pulmonary infiltrates, lymphadenopathy. Sputum and lymph node biopsy positive
for MDRTB.-Treatment: CS/PZA/Cipro/CM/Clofaz/EMB; Ethio was added in 12/95. Patient
died of disseminaten TB in I/96. Survival I1220 days.
Conclusions: Longer survival in AIDS patients with MDRTB than previously reported can
occur with appropriate prolonged therapy. Progression and death from tuberculosis eventually occurred in these two cases even though patients remained on therapyThese cases
raise the issue of placement of AIDS patients with "treated" MDRTB in congregate settings
with other immunocompromised individuals.
Jazila Al Attar, 415 I West 5 1st StreetThe Spellman Center for HIV Related Diseases, St.
Clare's Hospital, New York City, NY 10022; USA
Phone: [phone] Fax: [phone]
Tu.B.236 I1
EPIDEMIOLOGIC AND CLINICAL CHARACTERISTICS OF HIV POSITIVE PATIENTS
WITH MDRTB
Carey, J*, Chopra., Anju, Sepkowitz, K*, Sethi H*, Sharp,V*. *The Spellman Center for HIV
Related Diseases, St. Clare's Hospital, NewYork City NY USA
Objective: To determine the epidemiologic and clinical characteristics of HIV positive (+)
patients diagnosed with multidrug resistant tuberculosis (MDRTB) from 1989 to 1995 at St.
Clare's Hospital (SCH).
Methods: A retrospective chart review was conducted of all HIV + patients with microbiologically proven MDRTB admitted to SCH, a hospital in New York City with a 92 bed AIDS
unit that includes a 25 bed secured prison ward. MDRTB was defined as any isolate resist.ant to at least both isoniazid and rifampin.
Results: 109 cases were identified.The mean age was 37 years, the ratio of men to women
was 10:1. HIV risk factors included intravenous drug use (IVDU) (74%); men who have sex
with men (14%), heterosexual sex (8%) and unknown (12%). In comparison, HIV + patients
treated at SCH between 1989 and 1995 overall had a mean age of 36, male to female ratio
of 3:1, and risk factors of IVDU (56%), men who have sex with men (10%), heterosexual
sex (2 I%) and unknown (I 3%).The mean CD4 count in our population was 94 (median,
30, range=0-I I63). Potential risks for MDRTB included recent incarceration in a state
prison (45%), prior hospitalization at SCH (6 1%), or both (28%). One third of the patients
(33%) hsd received previous treatment forTB. Common presenting symptoms were nonspecific. including fever (79%) and weight loss (54%). Only 50% of patients had a noted productive cough. Sites of disease were pulmonary only (68%), extrapulmonary only (5%) and
disseminated (27%). Of the 97 patients with pulmonaryTB, 19% had a normal chest x-ray.
Conclusions: In our review, MDRTB affected disproportionately high numbers of men,
IVDU's and prisoners. Only 33% of the patients had been previously treated forTB, suggesting that much of the MDRTB was the result of primary resistance.The signs and symptoms
of MDRTB can be subtle and non-specific, as suggested by the high rate of normal chest xrays and the relative irfrequency of pulmonary symptoms.
Anju Chopra, 4 15 West 5 I st Street,The Spellman Center for HIV Related Diseases, St.
Clare's Hospital, New York City NY 0022; USA
Phone: [phone] Fax: [phone]
Tu.B.2362
HIGH INCIDENCE OF PULMONARY TUBERCULOSIS AND FALLING PREVALENCE
OF HIV, MIAMI, FLORIDA
Klaskaia W, Wllians R**, Sosa C***, Baum MK*. *University of Miami School of Medicine
Dpt. Epidemiology & Public Health; **Dade County Dpt. of Public Health, ***Fogarty
International Traininy, Program University of Miami
Objective: To describe HIV prevalence in relation to incidence of Pulmonary Tuberculosis
(TB) among attendants of the Chest Clinics at the Department of Public Health in Miami,
Florida.
Methods: Review of computerized clinical records of the four Miami TB clinics for 199I1 -1995.
Results: Of 28,372 cens attending the Miami TB clinics between January 1991 -
December 995; 4,367 (I 5%) wee diagnosed with PulmonaryTB (pulm-TB); 2925 (10%)
were TB suspects; I 005 (4%) had Mycobacterial infections other than TB (MOTe) and
20.003 (71%) were given preventive treatment, Between 300-400 new TB cases were diagnosed annually. Of those, 85--90% were classified as PulmonaryTuberculosis.The minorities
accounted for more than two-thirds of all cases: 50% were US born, During a five year period the number of clients who were tested for HIV antibodies has gradually decreased by
30%. Among those tested and diagnosed with pulm-TB the overall annual HIV seropositivity
rate declined from 33% in 1991 to 20% in 1995. Individuals with dual infection (TB/HIV+)
had 18% mortality rate in 199I comparing to 6% in 1995.
Conclusions: Incidence of pulmonary TB in Miami is extremely high compared to the US
general population.The data, however, are restricted to the clients of public health care clinics. Minority status appears to be associated with increased risk of TB and HIV infection.
Decreasing trend in HIV seropositivity requires further evaluation of HIV testing and counselling services offered in the clinics.
Ronald Williams, U of Miami, Dpt. Epidemiology & Public Health (R669), PO. Box 016069,
Miami, FL 33I1 Tel.: [phone]
Tu.B.2363
AIDS-RELATED DISEASES AMONG IMMIGRANTS FROM AFRICA, HOSPITALIZED IN
ROME:THE IMPORTANCE OF TUBERCULOSIS.
Spinazzola F., Narcso Pasquale, Causo T, Ferri F., Zaccarelli M.,Visco G. Lazzaro Spallanzani
Hospital, Rome, Italy.
Objective: To describe the clinical features of HIV-positive patients from Africa, admitted in
an infectious diseases hospital in Rome.
Methods: A retrospective analysis of all patients hospitalized between January 1986 and
June I995 was performed. HIV-positive patients were classified by country of origin. A
descriptive analysis of the main clinical features of patients fiom Africa was done. Chi-square
test was used to assess statistical differences between groups. AIDS diagnoses followed the
1993 European AIDS Case Definition.

Results: Sixty HIV patients from Africa (0.9% of 6384 total number of HIV patients) were
hospitalized during the study period, of whom 20 patients were from North African and 40
from Sub-saharianan countries.The most frequent diagnosis was Tuberculosis (TB) with 15
cases, of which 8 of Pulmonary and 7 of Extrapulmonary TB. Other dignoses included
Cytomegalovirus Infection (6 cases), Pneumocystis Carini Pneumonia (5), Cerebral
Toxoplasmosis (5). HIV Encephalopaty (3),Wasting Syndrome (2), Esophageal Candidiasis
(2), Kaposi Sarcoma (I), Disseminated Criptococcosis (I) and Recurrent Salmonellosis (I).
Eighteen patients had minor HIV-related symptoms and I had malaria.The proportion of TB
cases among African patients was higher than among other HIV patients (I 5/60, 25.0% vs
287/6037, 4.5%; RR-5.5, 95% C1=3.5-8.7) and was still higher among sub-saharian (13/40,
32.5%) than among other patients (RR=7.2, 95% CI=4.5- I I.4).The median CD4+ lymphocytes count among all TB patients was II 9 per cubic millimeter (range 25-700), but it was
52 (25-374) in ExtrapulmonaryTB patients and 336 (74-700) in Pulmonary TB patients.
Conclusions: TB is a major emerging public health problem all over the world. In developed
countries, the immigration contributes to TB diffusion.TB must be suspected in HIV patients
of African origin and with relevant symptoms, independently by the CD4+ cell count.
Pasquale Narciso, Spallanzani Hospital,Via Portuense 292.,00149 - Roma. ItalyTelaphone 39 -6-5584744 Fax [phone] I email [email protected]
Tu.B.2364
CUTANEUS TUBERCULOSIS IN PATIENTS WITH ACQUIRED INMUNODEFICIENCY
SYNDROME(AIDS)
Oliva SM,. Redini L, Santucho E, Ortega G. Bases OM. Maranzana A, Carlevaro RO,
Benetucci JA. Hospital de Infecciosas Muniz, Sala 17,. FUNDAI, Buenos Aires, Argentina.
Objective:To emphasize the characteristics of the cutaneous tuberculosis(cTBC)in patients
with AIDS.
Method:215 patients with AIDS were attended during 1995. 64 had extrapulmonary TBC;
three of them cutaneous lesions.The similarities and differences between them are
analysed.
Results: All were males, heterosexuals, intravenous drug abusers; median age was 27 years.
The CD4 count was less than 1I00/mm3.Two of them had cutaneous involvement in the
course of disseminated TBC in treatment. In the other case, cutaneous lesions were the
only evidence of the disease and was a single lesion.The patients presented with macules,
papules and ulcers covered by crusts on the trunk and lower extremities. Acid fast bacillies
were found in the skin biopsy The diagnosis was performed pre-mortem in the two
patients with disseminated disease and both had MR-TBC (multi-resistent tuberculosis).The
third one had total remission with treatment and he is still alive.
Conclusions: CutaneousTBC is a rare entity. We recommend a careful exam of the skin by
the physician in order to find any suspicious lesion, because it is an accessible organ for the
diagnosis in these cases. C-TBC could be the expression of a MR-TBC.
Oliva Sm. Unidad 17. Hospital De Infecciosas Muniz. Uspallata 2272. Cp. I 282. Buenos Aires,
Argentina. Phone: 54(0 I).826-5137
Tu.B.2365
PROGNOSTIC FACTORS ASSOCIATED WITH SURVIVAL IN AIDS PATIENTS WITH
DISSEMINATED MYCOBACTERIUM AVIUM COMPLEX (DMAC) INFECTION.
Miailhes, P,Vittecoq D, Mathieu D, David M.F. Hpital Paul Brousse,Villejuif, France.
Objective:To determine factors associated with shorter survival in HIV + patients with
DMAC.
Methods: Fifty four cases of DMAC were identified from january 1993 to september 1995
(blood and/or bone marrow positive culture). Studied factors were: age, sex, HIV risk-factors, prior opportunistic infection, feve, wasting syndrome (WS, CDC defined), AIDS before
DMAC, time between AIDS and DMAC, infectious or tumoral diseases associated with
DMAC (ITDA), antiretroviral treatment, number of blood culture +/pt, P24 antigenemia,
hemoglobin (Hb), cholestasis, total lymphocyte count, CD4 and CD8 cell count. Follow up
was stopped in december 1995.
Results: 46 men (85%) and 8 women were studied: homosexual 67 %, IV drug users 17 %,
heterosexual 5 % and others I I%. Median CD4 count was 5/mm3 (mean: 29/mm3: 0 -590). 83 % (n= 45) pts died with median survival of 4 months (mo)(0-20). 9 pts are still
alive, follow-up flom 4 to 35 m. 22 pts have a survival < 3 mo ( group I, median of 2 me); 22 pts a survival > 3 and < 12 mo (group 2, median of 7 m); and 10 a survival > 12 mo
(group 3, median 19 me). All pts in group I are anaemic ( hb < 12 g/dl) and mean hb is
9 g/dI vs 9,6 (group2) vs 10,8 (group3) (p<0,05). Other factors associated with shorter-survival are respectively: W S (68 % vs 55 % vs 20 %: p < 0,05): total lymphocytes count
326/mm3 vs 353 vs 759: p < 0,05); mean CD4 count ( 6/ml vs 12 vs 115: p < 0,05):
cholestasis (55 % vs 45 % vs 0 %: p < 0,05);number of"ITDA" / pt (1.14 vs 0,068 vs 0,20,
Tu.B.2366
FACTORS ASSOCIATED TO RIFABUTIN PROPHYLAXIS FAILURE IN AIDS PATIENTS.
Vittecoq Daniel F, Mathieu D, Minozzi C, Dumitrescu L, Auperin I, Bary M. Hopital Paul
BrousseVillejuif, France.
Issue: Rifabutin is efficient to prevent MAC infection in AIDS. However failures may occure
which are not related to the emergence of resistant MAC species. Our purpose was to
evaluate prospectively some factors specific of the host in a cohort of HIV infected patients
receiving rifabutin and finally to appreciate if such factors could be clearly associated to the
onset of bacteremia.
Project: 1i30 HIV infected patients without clinical symptoms suggesting MAC infection, presenting a CD4 count < I00/m and a negative blood culture (Isolator) received rifabutin
(300 mg/day).The evaluation started in october 1993.The median time of follow-up was 17
months (3 to 26 months). Patients were clinically and biologically evaluated at inclusion:
blood culture, CD4 count, CDC status, presence or not of severe chronic diarrhea (>4
stools per day), hypoalbuminemia (<30g/I).They were prospectively evaluated every 3
months: blood culture, onset of severe diarrhea, hypoalbuminemia, cryptosporidiosis, antitumoral chemotherapy

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