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

Mo.B.304 - Mo.B.312

Monday, July 8, 1996

with particular attention to I) chemical class of bioactive compounds identified,
2) ethnomedicine background, 3) mechanisms of anti-HIV actions, and 4) state of research
of the compounds or extracts.
Results:Tens of thousands of crude natural extracts have been screened for anti-HIV activity Of plants and herbs screened, 70 compounds and 76 crude extracts from 123 species
ranging from common food and drink (e.g. soy) to tropical rainforest specirymens (eg.
Collophylum lanrigerum) reportedly exhibited HIV inhibitory activity in vitro. Amongst the
bioactive materials, there were 29 terpenes (15 diterpenes. 14 triterpenes), 29 flavonoids,
15 polysaccharides, 8 coumarins, 6 tannins, 4 lectins, 4 quinolones, 2 peptides, and 7 other
alkaloids. Mechanisms of action elucidated included competitive and non-competitive
reverse transcriptase inhibition, protease inhibition, and interference of infection at the viral
cell entry level. Of bioactive species, 63 are found in the Chinese materia medica and at
least another 8 are derived from other ethnomedicines. However, only a handful of such
active extracts* and compounds (e.g. ganoderma*, momordica*, viscum ablbum*, curcumin,
acemannan, glycyrrhizin, Lentinan, hypericin, GLQ233, PCK-4,) have been formally assessed
in clinical studies of HIV patients, and most trials were observational and uncontrolled.
Conclusion: Many compounds and extracts have been demonstrated to harbor HIV
inhibitory activity and their elucidated mechanisms may provide valuable leads for further
investigations. Only HIV inhibitory compounds or plant materials are reported here,
although many more natural materials inhibit HIV and other plants or herbs may attenuate
the course of HIV infection via immune enhancement, cytokine or other pathways, or act
synergistically in herbal formulas and not as single species or pure componds. In all, plants
and herbs offer excellent prospects in the search for potential treatment for HIV.
RY Chang, I 275 York Avenue, New York, New York 1002 I, USA Telephone: 2 I 2-639-8137,
Fax 2 I 2-7 I17-3367, e mail [email protected]
Mo.B.304
EFFECTS OF AEROBIC AND RESISTIVE EXERCISE ON SYMPTOMS, IMMUNE STATUS,
AND VIRAL LOAD IN HIV + MEN AND WOMEN
Smith,Barbara A,**, Neidig,J.*, Nickel,J.**, Frid,D.*, Para,M.*, Fass,R.*. The Ohio State
University (Medicine *, Nursing**) Columbus, OH, USA
Objective: The effect of aerobic and resistive exercise on HIV + adults has not been completely characterized.This experimental study will evaluate a supervised aerobic and resistive exercise protocol in 60 HIV + adults with CD4 counts of 200-499. Impact on symptoms, immune markers, viral load, mood states, body composition, and aerobic power will
be measured.
Methods: Subjects were randomized to a supervised exercise condition (I 2 wks, 3 days/wk
for 60 min) or control condition (I 2 wks usual activity). Controls were crossed over and
exercised weeks 13-24. Continuous heart rate monrtoring and personal trainers assured
exercise at appropriate intensity Symptoms, immune status (CD4/8/56, anergy neopterin, b2
microglobulin), PCR-RNA, mood states (POMS,Beck), body composition, and aerobic power
(VO2MAX) were measured at wks 0, 12, 24, 48, 60. Effects of antiretrovirals, daily activity
diet were examined.
Results: Pre-study values among 22 subjects entered to date (I 8 men, 4 women; 15 caucasians, 6 Africans, I Hispanic) indicate a sedentary sample (VO2MAX 35~+6.3), age 38~+7;
weight I177~24; CD4 350~70. Preliminary results for I 2 subjects completing I 2 wks, show
an increase in VO2MAX (t=2.0, p=.07) and time on treadmill (t=2.08, p=.06) but no difference in CD4 (H=. 12, p=.73) when exercise was compared to control. POMS subscales
showed improvement in 3 of 4 exercisers and decline in 6 of 8 controls.Two subjects (9%)
have been lost to follow-up.
Conclusions: This study will provide empirical data about the effects of exercise on the
above variables in a racially diverse group of HIV+ men and women. Early results on
VO2MAX, time on treadmill, and POMS subscales (particularly depression, anxiety vigor)
are promising. Using personal trainers is thought to have improved subject retention.
B. A. Smith, 486 Richards Rd, Columbus, Ohio, USA Telephone [phone]
Fax [phone] email [email protected]
Mo.B.305
HERBAL MEDICINE:AN ALTERNATIVE THERAPY IN POOR RURAL AREAS.
Margaret Ssemukasa* Sofia Apio** Home Care And Herbal Research Project Officer
Concern Worldwide And Sofia Apio, Botanist, Natural Chemotherapeutic Laboratory Uganda.
In Rakai District, Uganda. most families with sick people due mainly to HIV/AIDS cannot
afford the high cost of Western Medicine and are often reluctant to use the cheaper local
herbal medicine due to uncertainty about their effectiveness. Health facilities in health centres are unavailable to the majority of the population.
Objective: To identify and promote the possible alternatives to Western Medicine that can
be used effectively in the treatment of opportunistic infections and to find ways of improving accessibility to treatment at no or minimum cost.
Method: A study group of 73 people with knowledge and experience of local herbs was
identified for Community Based Research. AIDS related diseases also identifed and the
commonly used herbs for their treatment.The most effective snd easily available ones were
selected and samples collected for scientifc analysis. Individual interviews were carried out
with the study group on preparaton, administration and other usesThe results of the stiestfic analysis and individual interviews were fed back so the study group and the community
This included recommendations for the selection, preparation, administration and side
effects if any.
Results: 25 different types of herbs have bseen r-ecommended and made available to the
patients at no cost by a network of community-based home care volunteers who have also
set up herbal gardens and First Aid Boxes. Patients interviewed reported relief snd consolation.There is improved and shared knowledge of the herbs, improved access to the herbs
and appreciation of their effectiveness by the community.
Conclusion: Given the constraints outlined above, and donor fatigue, is is important to start
looking at how best the local resources can be utilized in developing countries for the
improvement of the quality of life.
Margaret Ssemukasa, Concern Worldwide, PO. Box I644, Masaka, Uganda. Fax. 256-48 I-20514

Mo.B.310
DISEASE PATTERNS IN AIDS-RELATED FOCAL BRAIN LESION (FBL)-CAUSING
DISORDERS:A PROSPECTIVE COHORT STUDY ON NEURORADIOLOGICAL AND
CLINICAL CHARACTERISTICS COMBINED WITH CSF PCR ANALYSIS.
Ammassari Adr an.,De I ia A., Cingolani A., #Fortini M., Scoppettuolo G., Murn R.,
+Cattani Pi Gro RR"F, taglioneT. "Larocca L.M., ~Scerrati M., Antinori A. Dept. of
Infectious Diseases, I a obiology *Radiology 'Pathologlg yNeurosurgery, Catholic
University; Methodological Studies, National Statistical Irstitute: Rome, Italy.
Objective: I.To identify disease patterns based on the ccmbination of neuroradiological
and clinical characteristics as well as PCR tests on cerebrospinal fluid (CSF) for the diagnosis
of different focal brain lesion (FBL)-causing disorders in HIV+ patients (pts); 2.To build a
decision-making algorithm to be employed in the differential diagnosis of FBL in AIDS.
Methods: Population. All HIV+- pts with at least one first-ever FBL between Oct,'91 and
Dec,'95. Design. Prospective cohort study. Data collected previous AIDS, CD4+.,antiretroviral therapy Tgondii serology (TAb). concurrent anti-T.gondi prophylaxis (TPr), time from
onset, presence at CT/MRI of mass effect (ME), contrast enhancement, and number of
lesions. Definitive diagnoses were: i) histopathologic examination of bioptical/autoptical br-ain
tissue; ii) complete/partial resolution of FBL after anti-Tgondci therapy PCR onalyis. In 69 pts
CSF was obtained, nested PCR performed to detect DNA of EBV, JCV and Tirnd.
Sensitivity and specificity resulted of 85% and 98% for EBV 90% and 99% for JCV, 50% and
100% for Tgondii. Statistics.To identify variables associated with FBL-causing disorders exact
odds ratios (OR) and a multiple logistic regression analysis were employed. Based on these
variables a probability-tree was build and Bayes theorem used to calculate the posterior
probability of each disorder:
Results: 136 pts had a definitive diagnosis: toxoplasmic encephalitis (TE)=58. PCNSL= 39,
PML=27,TBC=3, mycetoma=3, HIV encephalopathy= 3, CMV encephalitis 2. vasculitis-I
TAb+ orTPr+ resulted associated in an opposite way with the risk ofTE (OR 152.7:
p<0.00 I and OR 0.17; p=0.007, respectively) and PCNSL (OR 0.07: p<0.001 and OR 3.5;
p=0.04, respectively). ME+ raised the risk of TE (OR 7. 1; p=0.05) and PCNSL (OR 36.2;
p=0.006), whereas PML resulted very unlikely (OR 0.01; p<0.00 I). Among ME+ c ces
probability of TE in pts Tab+/TPr- was 0.87: probability of PCNSL in pts TAb-/TPr+ resulted
0.89. Positive EBV-DNA or T.gondii-DNA in ME+ pts determines probabilities of PCNSL or
TE from 0.95 to 0.99. Probability of TE in ME+/TAb+/TPr+ pts with negative PCR tests
remained 0.79. Probability of PCNSL in ME+ pts negatrve for EBV-DNA reached 0.48. PML.
probability in ME- pts was 0.67. Positive JCV-DNA increased this probability to >0.98. but
probability was still 0.1I9-0.40 in PCR negative cases.
Conclusions: Empiric anti-tigondii therapy is first-line approach irn ME+,'TAb+/TPr pts. Inrl
other ME+ pts lumbar puncture, if possible, should be performed. CSF investigation for EBVDNA is crucial: positive EBV-DNA represents a helpful tool for the selection to bran bop
sy PCR for T.gondi-DNA seems advisable even though, d.e to its low sensitivity a negative
results does not exclude TE. Among ME- pts PML is the most probable disorder and CSF
diagnosis by JCV-DNA PCR is highly reliable.
Ammassari Adriana, Clinic Of Infection Diseases Catholic University, L.Go A. Gemrelli, 8,
00168 Rome - ItalyTel.:00396 - 30154934 Fax:[phone]
Mo.B.31 I
MOLECULAR CHARACTERIZATION OF JCV STRAINS DETECTED IN CSF, PBMcS
AND URINE OF AIDS PATIENTS WITH AND WITHOUT PML.
P Ferrante, R. Caldarelli-Stefano, E. Omodeo-Zorini, L. Losale. M. Mediati. L.Vago, A. Cai'i,
PCereda, R. Maserati. Institute of Medical Microbiology University of Milan; Don C Gnochi
Foundation, IRCCS, Milan;V Chair of Anatomical Pathology L. Sacco Hospital MilarI:
Infectious Diseases Department of Monza; Institute of Microbiology University of Prv.,
Infectious Diseases Department, Pavia; Italy.
Objective: To establish the frequency and the distribution of JC virus (JCV) amon AIDS
patients with and without progressive multi-focal leukoercephalopath7y (PML) and the rele
vance of different JCV strains in the pathogenesis of this demyelinating disease.
Methods: JCV DNA was searched, using a nested polymerase chain reaction (n PCR),
which amplify a conserved region (LT) of JCV genome, in the cerebrospinal fluid Sf),
peripheral blood nononuclear cells (PBMCs) and urine,:ollected from 80 AIDS patients,
suffering from different neurological disorders, including 14 suspected PML cases.The
PBMCs and the urine from a group of 40 healthy controls (HC) were also examined. The
JCV positive samples, were then assayed to define molecular characteristics of JCV isoltes.
Therefore, to discriminate archetypal from rearranged JCV strains, n-PCR for regulitor y (R)
and VPI regions of JCV genome, followed by restriction Iragment length polymor-phisms
(RFLPs) of the amplified products were performed.
Results:Among I 4 PML patients, JCV DNA was detected in 12 (86%) CSF, I i 1(79)
PBMCs and 10 (7 I%) urine samples. All the CSF from AIDS patients without PML were
negative, while 4 (6%) PBMCs and 18 (27%) urine resulted positive for JCV DNA.
Interestingly 10% of the PBMCs and 17% of the urine samples from the -IC were also posi
tive for JCV DNA.The JCV DNA detected in the urine samples from all the AIDS patients
and the HC belong to the subtype I.The (CV found in the PBMCs of AIDS patients without
PML and HC belong to the (CV type I while the (CV type II his been detected only in CSE
and PBMCs of PML cases.
Conclusions: Our data indicate that the detection of(CS!/in CSF is reliabie marker for PML
diagnosis.The results of the molecular characterization. sofigest thsat fienonsir varr~stOns ot
(CV are needed for viraul reactivation and that PBMCs could play an insportmant irole for the
spreading of these (CV strains to the brain.
Pasquale Ferrante; via Capecelatro 66, 20148 Milano, Italy: 0039-2-403082 II
Mo.B.312
A PROSPECTIVE, RANDOMIZED TRIAL OF TRIMETHOPRIM-SULPHAETHOXAZOLE
VERSUS PYRIMETHAMINE-SULFADIAZINE IN AIDS PATIENTS WITH CEREBRAL
TOXOPLASMOSIS.A PRELIMINARY REPORT.
Terre D* Casari S**, Speranza F*, Orani A***,Angarano G**", Chiodo G *.., Fion
GP*, Carosi GR** and the Italian Collaborative Treatment Group. Departments mf
Infectious Diseases,*Varese; **Brescia; ***Lecco; ***Bari; **Bologna: Italy.
Objectives: The efficacy of trimethoprim-sulphametoxazole (TMP-SMZ) in cerebrai toxoplasmosis (CT) of patients with AIDS has not yet been established in randomized tr al.

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