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

Tu.B.2367 - Tu.B.2371

Tuesday July 9, 1996

Results: MAC
months).

inted in 3 prients (10%,median time 5 months from 2 1o 24

Durirng the sttudy t r, died. Death
isolated. In this cs, Aroi w h,, poor de'th
(from I to 6morfth
Lessons learned: RPif ibutin, could be I'tar led be
Recently we started, ph it t1codyrr i( study i

occhred in 9 patients while a MAC was
occuring after a mean period of months
fore a CD4 count lower than 50/mrnl.
n patients with diarrhea.

Vittecoq, Infectious Disease, Hpitrl Parul Brousse 12 Avenue PV. Couturier 94804 Villejuif,
France
Tu.B.2367
PCR AND THE MISDIAGNOSIS OF ACTIVE TUBERCULOSIS
Maccabrun A, Caseli D', Marone P~, Michelone G, DeiCas A. Departments of Infectious
Diseases, Department of Pedatn 'Research Laboratory Infectious Disearses~. IRCCS
Policilnico San Matteo, Urverity of Pavia. Italy
Introduction: here is, srtrtrong epidemiologicalo evidence inkng the outbreak of HIV nfectin to the rising indence of tubercolosis (TB).This increase in rate of tubercolosis was initally reported only in,duits is a result of mmunosoppression-induced reactivation of
latent infection more reec rntly a nsn number of cases ofTB also in HIV-infected children
has been repor ted. The most rimportant labor atory tst for the diagnos is and mranagement
of TB s the rycobac terin culture. A promising method for rapid diagnosis is represented by
the tec hnique of polymerr se chain reac to (PCR) for detection of M.tuberc olosis DNA in
sputun ind n other clr icl specimens, but the predictive value of this test remains up to
now unclear
Case report: R.F. is 7 year old white boy, penrnatally HIV nfected with severe immunosop
pres on (CD4 count 50rnmm3.He came t o the Hospital with fever, productive cough and
severe asthenia: i chest X ray film showed a round cavitaion in the right upper lobe.
Sputum, gastric asp rates, riine and stool cultures resulted negative for M.tubercolosis, as
well as for orn tuberculous orycobacteria.Two sputum specimens were positive for
M.tuberculosis by PCR. (On the basis of the results of the PCR test alone, empiric therapy
was started with isoniazide, rifampin and pyramzinamide. After a month of antituberculous
treatment the patients s ill presented with ntermittent fever and respiratory distress As the
blood and sputum cultures resulted positrue for Pseudomonas aerupinosa, the antrtubercu
ous treatmrent was suspenrded and an adequate antibiotic therapy was initiated Some
weeks later the patent ws persistenly apiretic and clnically almost asymptormatoic; the chest
film at that time showed,nliaont reduct on of the pulmonary cavitation.
Conclusion: The reported c se confi rrs that TB diseas e shouldn't be diagnosed on the
bais of the PCR test Ilor e prtcularly in HtVinfected and mmunocomprom sed patients it
s rimportant to avoid tunne essary and sometimes toxic drugs and to provide a prompt and
adequate tretrent of infectious complications.
A. Marcabrurnil Dept Infect ious Diseases University Policlinico S. Matteo,
ViaT rameil. 5, Pavia, Itl Fax: [phone]
Tu.B.2368
MYCOBACTERIAL DISEASE IN VIRGINIA HIV+ PATIENTS (P), 1992-1995: DECLINE
IN TUBERCULOSIS AND NO CHANGE IN DISSEMINATED MAC.
Settlene, Fisher E,Weymouth I_ Medical College ofVirginia (MCV)/Virginia
Commonwealth Universy t
Objectives: Compare nurmber of (ases/yr of active tuberculosis (TB) and MAC in P of
Virginia's largest HIVAIDS c enter (2) Determine total number nycobacterial cultures (MC)
done o n a subset of these P over the past 18 months.
Methods: Retrospective char t/ib review was done to identify confirmed cases of TB and
MAC with onset betweer /1/92 -12/31/95 and #MC performed between 7/94-12/95 on a
subse of P called recent cohort (RC) (all P with <I of the following: CD4<200/pL, admisson, or death from 7/94 2/95.)
Results Between 1 992 and 1995 the #P followed rose from 900 to I 00, and the proportion (PR) with CD4 -200 rose from.40 to.47. Annual # ofTB and MAC cases were:
Year 1992 1993 1994 1995
TB 6 6 8(+ recurrence) 2(+ I recurrence)
MAC 28 55 60 57
Clinic staff PPD conversions were 4 in 1992, I in 1993 and 0 in 1994 95 among 30 staff.TB
control measures initiated in 1993-94 included negative pressure rooms, and INH prophylaxis ()x) of anergic incarcerated P Around 63% of eligible P were on MAC px (mostly
rifabutrn) by 199. #MC were ascertained on the RC, consisting of 746 P with mean observation time= I 1.6 mo/P RC demographics were similar to the overall clinic population (CP),
except for PR of women: women. 20 in RC vs.27 in CP black=.74, white=.25, hispanic=.0 I,; incarcerated=. I 7;/ r sk behavior: male-o rale sex-.34, DU=.29, multiple heterosexual
partners-=.25.91% of the RC had CD4 cells <200.852 respiratory (mean-1.18/P yr. 884
blood (mean= 1.22P yr), and 478 other (mean-=0.66/P yr) MC were performed from 7/94 -12/95 (1/3 of all MC done in the MCV lab).There was no change in the mean #MC/mo
over the 18 moe.
Conclusions: There has been a decline in active TB without a decline n MAC. Reasons for
the TB decline are most Ilely multiple. Lack of decline in MAC most likely reflects inconsistent use of px, a greater #P and higher PR of P with low CD4. No trend to change in mean
#PMCimo wrs seen over the past 1 8 ino, suestip no difference in ascertainment.
E. Fi he Mt V/VCB 980049, I E. Marsht S.,P h ndVA 23298-0049
-elephorio 0104 825 1 ix: 804 828-339/ owii of orne ''ii v u.edu

Tu.B.2369
TUBERCULOSIS SCREENING
Minuty Jean Gardy*+, Pape, J.W* +, Johnson, WD.Jr
Objectives:Determine the importance ofTB screening in individuals seen for HIV testing
and best clinical criteria by non medical personnel
Materials and methods:From 09/95 to I /95 446 ndividuals tested for HIV were evtlu teI
forTB if they had one of the following: a) cough> I month b) fever norh a 8 )
weight loss > 10% of body weight d) hemoptists e) cervico facit lyaphadenopath'
weeks f) dyspnea g) night sweat > t week h) thoracic pain.The first creenr, rs'edo
a questionnaire administered by a social worke FThose who had one or ot fthe
signs were referred immediately to M.D. to venlfy social workers indiar i ndnt on of
therapy the same day after sputum was obtained for AFB smear and culture. X-ray was
performed within 72 hours of enrollment. Patients were asked to return within 3 weeks for
fur:her evaluation.Those found to have TB are maintained on therapy: those who did not
have TB but were HIV+ were placed on INH prophyt rxs.
Results:
I) Overall, I 6% of all individuals tested for HIV were found to have active TB.
2) Based on one symptom, cough, 90% of patients with active TB were identifed.
3) 46% of all individuals identfied by social workers on bass of siyns Ind,mptos on
had active TB.
4) X-ray was essential for establishing diagnosis which would have beer msed o ihesv-e n
more than 2/3 of cases
Conclusions:Social workers were capable to properly identfy TB ctses.Ths easy procedure
allows the rapid identification of potential TB cases avoriding fute pread of the inctonn
waiting rooms and other places.
Jean Minuty, Division International Medicine, Corne ll University Medical College, A-43 I - 300
York Avenue, NewYork, NY lO02.Telephone: [phone]
Tu.B.2370
PEDIATRIC HIV I INFECTION AND VIRAL QUANTIFICATION
*Dollfus Catherine, *Courpotin C, *'Jacomet C,k '"Nicolas C, *'Levrer pea CG'See
d'Hemato Oncologie Pediatrique Hopital d'Enfants Armand Trousseau, AP tOP Pains, France.
*"Laboratoire deVirologie H6pital Rothschild, AP HP Paris, France.
Objectives: To determine the usefulness of viral load (VL) quantification in a HIV infected
pediatric population, to correlate VL with previously evaluated surrogate markers of evolu
tion and to prospectively assess changes resulting from modifications of antiretrovral therapy.
Methods: Population: primary results have been obtained in 47 children age 8 months to 9
years old (median 5) infected with HIVI. Route of transm rsson: vertical (4 1 tr ansfusion
(5), unknown (I). CDC Classification: N I (1), A I (I8), A2 (8), Ar (5), B2 () 83 (2), I (I
C2 (2), C3 (9). All children but one were treated with antiretroviral therapy for at least 5
months before first assessment. Samples were obtained during routine outpatient consultations included in the standard work up. Children with acute infections or recent s-nrz
tion were excluded.
Me hods: VL was measured by Chiron branched DNA assay. Change in VL was considered
significant if titre was modified by at least 0.5 Iop10.
Results: BaselineVL ranged fro e < 10 x 103 copies/m to 9.3 x 106; 13 children had low VL
values (< 0 x 103), 28 interrmediate values (10 x 103 to 200 x 103), 6 had hgh VL values
(> 200 x 03).VL Iog 10 was positively correlated with immunological CDC classfication at
p: 0.01 6 and with clinical CDC classification at p: 0.056 using Kruskall Wallis ststcal test
p24 antigen was highly correlated withVL Iog10 r=0659 (p<0.01),IgA level was negately
corelated withVL Iogl0 r=-0.53 (p: 0.01); there was no significant correlaton with CD4
cell count (Spearman correlation test). Comparson of positive p24 antigen v VI t,sod
value of 10xl03 copies/m showed a high specificity (92%) and a moderates enstuty
(75%). 26 cases had a secondVL quantification 3 months (I.5 to 6) after basene assess
mernt.VL was stable in 16 cases (7 at low levels and 9 at moderate to high levels),
decreased in 6 cases, increased in 4 cases.Treatment moddcation (21/26) 1etveen the VL
measurements was not associated with significant change in VL.
Conclusion: VL quantification was correlated to CDC clinical and rimmunological clasfictior and to p24 antigen. Prospective usefulness in monitoring the effect of therapeutc
changes onVL needs further evaluation.
Dollfus Catherine, Sce Hemato-Oncologie,HOpital d Enfants Armand Trousseau
26 avenue du Dr Arnold Netter 75571 Paris edex 12. France
Telephone: (33-I) 44.73.64.77. Fax: (33-I) 44.73.65.73
Tu.B.237 I
ASSESSMENT OF HUMAN IMMUNODEFICIENCY VIRUS TYPE I (HIV-I) RNA
PLASMA QUANTITATION FOR THE FOLLOW-UP OF HIV-INFECTED PATIENTS IN
AN AIDS REFERENCE CENTER.
Bocket L.(*), Ajana F.(**), Gerard Y(*"), Beuscart C.("), Hober D.(), Queyrel V(*), Bervar
J.F(),Vermersch A.("), Bonnevie F.()), Chdiat C.(__, Mouton Y.( "),Wattre P*).(
Laboratoire deVirologie, CHRU [ilte, 59045 Lille Cedex France () Service Rgional &
Universitaire des Maladies Infectieuses & du Voyapeur-CH Tourcopng-59208 Toupcoing
Cedex-France.
Objectives:To place and to compare the value of plasIatc HIV-RNA copy numbers as the
measure of viral load, in relation to other surrogate markers nd clinic parameters he
routine monitoring of HIV infected mdviduals
Methodologies: 445 samples from 185 patients from the North France AIDS reference
center: at all stages of disease were obtained during 1995.They were tested for pla -a HIV
RNA levels using the quantitative RTPCR (*Amplcon Roche), p24 antlgenema n sra o t er
ICD and CD4 cell counts.
Results: The results were expressed in RNA copies number (and Log i transformed} per
ml and ranged from negative (<200 in treated pitents) to very high levels (>2.000.000 n
patients with severe progression). In the clinically stable patients, we observed low irta
dividual variations of HIV RNA levels: in 82 patients with two determnatons wthn I ali
to 6 months both values were correlated )r- 0,899) rnd the Alop HIV RNA p02 log.We
found no correlations between HIV RNA eves tnd oter sirro ate markerst'at pat ora
whalever the stageof the disease rod the Ireatmi elt II 'e~ve ma obItroed statistically

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