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

Mo.B.I 188 - Mo.B.I 192

Monday, July 8, 1996

3.-the WHO criterium: two env bands with or without gog or pol; 4. the manufacturer
criterium. In each serum all criteria were used.
Results: From 6.000 sera collected from March to December 1995, a total of 1149 were
repeatedly reactive by HIV-I/HIV-2 -EIAs.These samples were investigated with Western
Blot and results of each performance were noted. Out of 1149 samples, 957 were consid
ered reactive, 956 reactive by all the criteria used, and I reactive only by the CDCIASTPHL
and indeterminate by all the other criteria (this patient proved to be truly infected).
Another- 74 were negative by all the criteria and 74 indeterminate. However, 44 samples
showed discordant results: 39 were indeterminate by the ARC and reactive by any other criteria; 3 by the WHO criteria; and I by the CDC/ASTPHL. One sample was indeterminate by
ARC and WHO criteria and reactive by any other:
Conclusions: Our preliminary data suggest that that the CDCIASTPHL Western Blot criteria
fulfill most off the needs to be considered in our laboratories and that the ARC criteria
should not be used in clinical laboratories when a large number of high risk patients is
expected
Dr Guillermo R. Muchinik, Unidad de Virologia, Hospital "F.J.Muniz", Uspallata 2272, 1282
Buenos Aires, Argentina. Ph; (54- 1)305-0357 Fax:(54- I) 806-2078
Mo.B. I188
DRUG INTERACTIONS & ADVERSE DRUG REACTIONS IN HIV: CHAPTERS IN "HIV
INFECTION:A CLINICAL APPROACH, 2ND ED."
Tseng, Alice L*, Foisy M.**. *The Wellesley Health Centre, University ofToronto; *The
Wellesley Hospital, The University of Toronto,Toronto, Ontario, Canada
Issue: Human immunodeficiency virus (HIV) infected patients often require drug therapy
with multiple agents, especially in the later stages of illness. Polypharmacy is often associated
with complex drug interactions and additive drug toxicities, which may adversely affect
patient morbidity and/or mortality Howevenr, specific information practitioners need to identify, manage, and avoid these issues is often limited, unavailable, or not relevant to the HIV
population.
Project: Due to the complex nature of drug therapy in this population, chapters on drug
interactions and adverse drug reactions in HIV were written for a multidisciplinary reference manual, "HIV Infection: A Clinical Approach, 2nd edition", in order to promote rational
management of HIV drug therapy.
Results: Two chapters were written for the manual; each consisted of an introduction, comprehensive charts and tables, and a structured thought process to help practitioners utilize a
systematic and rational approach in identifying, managing, or avoiding drug interactions and
adverse drug reactions in HIV patients.These chapters were recently awarded the 1995/96
Janssen Award by the Canadian Society of Hospital Pharmacists as being valuable references
for contributing to the improvement in the use of drugs in infectious diseases. W B
Saunders Company will be printing the second edition of the manual for international commercial distribution in 1996.
Lessons Learned: Comprehensive information on drug interactions and adverse drug reactions was compiled for inclusion in a multidisciplinary HIV reference manual to assist students and practitioners manage such problems in the HIV population.
Alice Tseng,The Wellesley Health Centre, 4 I0 Sherbourne St, 4th FloorToronto, Ontario,
Canada, M4X I K2;Telephone [phone] ext. 4 144; Fax 4 I 6-926-51 15.
Mo.B. I 189
RELAPSE OF PENTAMIDINE-INDUCED DIABETES IN AIDS PATIENT
Ravaux., Rihet. R Quinson. A.M, Mars. M.E, Sellier. R H. Gallais. Conception Hospital, Marseille
A 34 years old HIV infected patient, diagnosed in 1988 (CD4 <50/mm3) treated with AZT
500 mg/day during 6 months, then by DDI 100mg bid since 12/93 and primary prophylaxis
by aerosolized Pentamidine isethionate (AePi) (Quincke's edema due to Cotrimoxazole)
presented a insulinopenic diabetes mellitus after intravenous Pentamidine (IVPi) for (PcP).
03/1993, the patient presented the I rst episod of PCP treated by IV PI (240 mg/day) during 3 weeks and secondary prophylaxia by Ae Pi (I/month).
Two months after, the patient presented an insulin dependant diabetes mellitus, blood glucose level was normalized after 8 days of IV insulinotherapy and remained controlled during
5 months.
02/1994, the patient presented a 2nd PCP treated by IV Pi and blood glucose level rapidly
increased. So we stopped IV Pi for Ae Pi.
05/1994, bilateral pneumothorax due to Pc (Pleural biopsy):Talc poudrage with chest tube
placement during thoracoscopy was performed but the patient died.
-Pentamidine toxicity to the islets cells is well known, diabetes is due to an extensive islet
necrosis and insulinopenia. In this case, relapse of diabetes mellitus confirm this toxicity
(antibodies anti islet cells were negative).Treatment of severe PCP with double intolerance
(Suifones - sulfonamides and Pentamidine) is a difficult problem witch atovaquone can't
resolve.
Ravaux, Isabelle, Pr Gallais Unit Hgpital de la Conception, 147 Bd Baille, Marseille 13005
Mo.B. I 190
NEPHROGENIC DIABETES INSIPIDUS RELATED TO FOSCARNET AND THIRST LOSS
RELATED TO CMV ENCEPHALITIS IN AIDS PATIENT
Force Gilles*, Blanchard A.3*, Leviel F.v*,Tugler M.H.*, Champetier de Ribes D.*. CHgpital
du Perpetuel Secours, Levallois-Perret, France; n*Hfpital Broussais, Paris, France
Introduction: Nephrogenic diabetes insipidus (NDI) is known to occur as a rare complication of several drugs. An AIDS patient with CMV disease developed NDI with foscarnet
(PFA) therapy A relative thirst loss was associated.
Case record: A 43-year old african HIV infected woman was evaluated for polydipsia and
polyuria. Six weeks before, CMV retinitis was diagnosed and therapy with PFA begun at
doses of 80mg/kg every I 2 hours with I L of normal saline; chronic lumbar pain was documented and CMV DNA was identified using PCR in the cerebrospinal fluid (CSF).The CD4
count was 4 x 106/LThere was no hyperealcemia and no hyperglycemia. PFA was stopped
and the symptoms were resolved after 3 weeks. Serum and clinical data were done before
PFA (AA), after 6 weeks of PtA (B), after the water deprivation test (C), after nasal spray of
2 xl l0- L aqueous vasopiressin (V) and fi-ee regime in water (D), and 3 weeks after PFA
stop (F):

Na+ K+ urea creatinine
(mmol/L) (mmol/L) (mmol/L) (pmol/L)

weight plasma urine
(kg) osmolahty osmolality
(mosmol/kg) (mosmol/kg)

142
148
151
148
135

3.9
3.1
2.8
2.9
5.1

2.9 55 70
3.4 178 62
- 60.2
5.3 92 65

307
316
306

I72
172

Discussion and conclusion: Dehydration (D) demonstrated by hypernatremia and a 2.9%
weight loss, was associated with a low urine osmolality nct ncreased by exogenous V This
response to V, and the appropriately elevated level of endogenous V at I 4.8 x 10 -12g/L, are
consistent with the diagnosis of NDI, associated temporally with the use of PFA. but the
mechanisms by which PFA induces NDI in the collecting duct are unclear. In the use of PFA,
we recommand to look for natremia and polyuria, to detect early NDI.With a free regime
in water we observed no sensation of thirst despite elevated plasma osmolality and
natremia; a lesion of thirst center in the central nervous system (CNS) was suspected and
CMV was incriminated because the presence of CMV in the CSF is correlated with CMV
disease of the CNS.The D was increased by thirst loss probably related to CMV encephalitis.
G. Force, HOpital du Perpetuel Secours, 4 rue Kleber, 923C0 Levalois Perret, France
Telephone: (33) I 47 59 55 24, Fax: (33) I 47 59 59 60
Mo.B.I 191
ZIDOVUDINE-INDUCED PURE RED CELL APLASIA
Gohchi Kengo, Gotoh M., Kawasugi K.,Tsukamoto M., Saitoh N., Matsuda J. The First
Department of Medicine,Teikyo University School of Medi ne,Tokyo, Japan
Zidovudine (AZT) is a well known drug to be beneficial for the treatment of HIV-infected
patients. However, AZT is also known to cause naematological toxicity such as megaloblastic
anemia.We experienced a case of pure red cell aplasia induced by AZT
Case:The patient was 25-year old male with Hemophilia A. He started to receive AZT
(300 mg) on April, 1993 because CD4+ counts were below 250/ p I. After two months
course of therapy, CD4+ counts were increased up to 650/ p I. In October 1993, he was
admitted to our ward because he developed severe anemia. On admission, erythrocyte
counts was 108 X 104/ pa I and hemoglobin was 4.5 g/dl with 12.6% hematocrit.There was
no evidence of gastrointestinal bleeding nor development of malignancy.The bone marrow
examination showed marked depletion of all erythroid elements with high myeloid ery
throid ratio (12.5). Parvovirus B19 antigen in peripheral blood was negative by PCR. After
the replacement of AZT with ddC, anemia was improved dramaticallyThese results highly
suggest that the AZT have caused pure red cell aplasia to this patient.
Conclusion: Accordingly, physicians have to pay attention to the occurrence of pure red cell
aplasia as well as megaloblastic anemia when treating HIV-infected patients with AZT
Gohchi Kengo, I I-I, Kaga 2-Chome, Itabasi-Ku,Tokyo I 73, Japan Telephone: [phone] II,
Fax: [phone]
Mo.B. I 192
PHARMACOEPIDEMIOLOGY AND DRUG INTERACTIONS IN AMBULATORY HIV
POSITIVE PATIENTS WITH < 100 CD4+ CELLS
MeisterTh, Ledergerber B, Merk B, Opravil M, Lbthy R. Division of Infectious Diseases,
Department of Medicine, University Hospital Zurich, Switzerland
Objective: To determine the patterns of drug use and the frequency of possible drug interactions in prescriptions of ambulatory HIV positive patients with less than 100 CD4+ cell
counts.
Methods: Two hundred and fifteen patients were seen at least once between January I st
and June 30th 1995 in our AIDS outpatient clinic. Drug prescriptions were retrospectively
evaluated based on pharmacy records and patient charts. Descriptive methods were used
to analyse prescription patterns and drug interactions were evaluated using the GAL
DATTM drug database (Version 2.0) which grades possible interactions with respect to
their clinical relevance (severity and likelihood).
Results: 21% of the 215 patients were female; 49% infected through homosexual contacts,
29% i.v drug use and 16% through heterosexual contacts.The total number of prescriptions
was 967, with a mean of 4.5 drugs per patient.The frequency distribution is displayed in the
table. Patients with CD4 cell counts of 50-99, 20 49, 10 -19 and 0-9 had a mean number of
3.6, 4.3, 4.7, and 5.8 prescriptions (Spearman correlation: p=C.000 I). Antiretrovlral drugs
were prescribed in 125/215 (58%) patients, 33/125 (26%) with a combination therapy
Antibacterial agents were noted in 198/215 (92%) patients, 25/198 (I 3%) with two, 8/198
(4%) with three and 14/198 (7%) with more than three compounds. Antifungal agents were
prescribed in 95/215 (44%) patients.The most frequent drugs were cotrimoxazole 147
(68%), zidovudine 90 (42%), fluconazole 89 (4 1%), acyclovir 42 (20%), zalcitabine 32 (I 5%),
dapsone 32 (I 5%), pyrimethamine 23 (1 1%), clarithromycin 22 (10%) and didanosine 2 I
(10%). In 13/197 (7%) patients receiving two or more drugs, 21 drug combinations with
known interactions of high or medium clinical relevance were identified. Bactericidal and
bacteriostatic antibiotics were combined in 14 cases, with cotrimoxazole being involved in
ten.Three interactions on the level of the oxidative hepatic metabolism
(Fluconazole/Rifampicin) and four on the cytochrome p450 metabolic pathway
(methadone/rifampicine, terfenadine/fluconazole/clarithromycin) were found in three
patients each.
n drugs n pat(%)
10-13 10 (5)
7-9 31 (14)
4-6 88 (41)
1-3 84 (39)
0 2 (I)
Conclusions: Although 60% of the patients received four- or erore drugs concurrtly we
observed a low frequency of known interamctions. Self medication, prescriptiens from other
care-providers and the introduction of new agents e g. protease inhib torts, however, have a
high potential for interactions which will need extended surveys in the future
Th Meister Div. of Infectious Diseases, University Hospital, CH-8091 Z~rich, Switzerland
Tel 4 I I 255 3367, Fax 41 I 255 329 I, email: tmeo uszsira.unizh.ch

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