Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1080 Abstracts 60435-60438

12th World AIDS Conference

were performed, respectively, every, every three and six months. DC was defined
as the presence of diffuse left ventricular hypokinesia (ejection fraction <45%) and
left ventricular dilatation (left ventricular end diastolic volume index >80 ml/m2)
The patients with echocardiographic diagnosis of DC underwent endomyocardial
biopsy (EMB) for histologic, immunohistologic and virologic examination.
Results: During the follow-up period (60 + 5.3 months) echocardiograpic diagnosis of DC was made in 76 patients (7.9%), with a mean annual incidence
rate of 15.9 cases/1000. The relative risk for development of DC was greater, in
homosexual patients, in those with a CD4+ cell count <400/mm3 and in those
who received therapy with zidovudine. All patients with echocardiographic diagnosis of DC underwent EMB. Histological diagnosis of myocarditis was made in
63 patients (83%) (36 with active and 27 with borderline myocarditis) In the other
13 patients microscopic study revealed areas of interstitial and perivascular fibrosis without inflammatory cell infiltrates. Inflammatory infiltrate was predominantly
composed by CD3+ and CD8+ lymphocytes. Increase of CD57+ lymphocytes
was documented in 22 patients (35%), possibly reflecting the circulating cells
in these patients. Intense staining limited to MHC class I was found on myocytes of 54 patients (71%), whereas aberrant MHC class II (human leucocyte
antigen (HLA)-DR) staining was observed in 12 patients (29%). Of 63 patients
with histological diagnosi of myocarditis, the cultures of EMB samples were positive for Coxsakie virus group B in 15 patients (23.8%), for Cytomegalovirus in
4 patients (6.3%) and for Epstein-Barr virus in other 4 patients (6.3%). In the
myocytes of 58 patients (76.3% of patients with echocardiographic diagnosis of
DC and 92% of patients with histological diagnosis of myocarditis) HIV nucleic
acid sequences were detected using the technique of in situ DNA hybridization; among them, a coinfection with Coxsakie virus group B was detected in
16.6%, with cytomegalovirus in 5.5% and with Epstein-Barr virus in 2.7% of the
cases.
Conclusion: A specific action of HIV on the myocardial tissue, even in association with other cardiotropic viruses, may be assumed and a pathogenetic relation
between lymphocytic myocarditis and DC may be hypothesized.
60435 Potential use of cost of treatment and quality of life data
for decision making in antiretroviral therapy
Thorsten Koerner1, Erika Manck1, C.C. Claes2, G. Guenther1, W. Wulff1,
R.E. Schmidt1, J.M. Schulenburg2, M. Stoll1. 'Dep. Immunology; 2Dep. of
Economics, Univ of Hannover, MH-Hannover D-30623 Hannover, Germany
Objectives: Assessment of quality of life and cost of treatment in HIV/AIDS.
Design: Prospective follow-up of patients in a single institution in Northern
Germany.
Methods: This study analyses quality of life and cost of treatment data from
an outpatient-clinic a the University Hospital in Hannover, Germany. Measures
include SELT and EUROQUOL questionnaires for quality of life assessment.
Additionally multidimensional questionnaires and patient documentation are being used for cost evaluation in this ongoing project. In an attempt to assess
cost-effectiveness of ART, we linked quality of life scores to various antiretroviral
combination therapies.
Results: The quality of life instrument showed no significant difference between
various ART combinations. However, quadruple combination therapy (1) yielded
clearly higher QOL scores in CDC C3 patients than all triple combinations (2)
(Wilcoxon Rank Sum W test: Mean of QOL scores of 77.60 (1) (n = 4, SD = 5.762)
versus 62.97 (2) (n = 25, SD = 115.842); p = 0.0499; 95% confidence interval).
This advantage in quality of life does not outweigh the additional cost. Average
yearly cost of triple therapy was 25,950 DM (41,190 per QUALY), as compared
to 38,200 DM (49,230 per QUALY) for quadruple therapy. Further information will
derive from the growing number of interviews.
Conclusion: Quality of life data may inform decision making in HIV/AIDS therapy. In the context of transition of HIV infection from an acute fatal disease to a
more or less chronic condition, resources shift from long inpatient stays to more
aggressive ART. These expensive long-term therapies will necessitate further
cost-effectiveness studies.
60436 An estimate of pregnancy outcome in HIV infected
women in Italy, 1990-1994
Giuseppe Ippolito1, L. Rava2, E. Girardi2. 1Ctr. Rif. AIDS IRCCS L. Spallanzani
via Portuense 292 00148 Rome; 21RCCS L. Spallanzi, Italy
Objective: To estimate the prevalence of HIV infection among women of childbearing age and to evaluate the reproductive choice of HIV infected women in
Italy during the period 1990-94.
Methods: For each year from 1990 to 1994, the proportions of pregnancy
outcomes observed among HIV infected women, in a study conducted in the
Latium Region (Eur. J. Epid. 1997; 13: 373-8), were applied to the nationwide
prevalences of HIV infection among women delivering viable children estimated

by the Anonymous Unlinked Seroprevalence Study among newborns, conducted
in Italy since 1988.
Results: The table shows the estimated HIV prevalences among pregnant
women, the estimates of the total number of pregnancies, and of the proportions,
on the total number, of the different pregnancies outcomes among HIV infected
women in Italy during the period 1990-94.
Conclusions: The present analysis give evidence of a quite stable prevalence
of HIV infection among women of reproductive age in Italy. Moreover it suggests
that in Italy the attitude towards a voluntary termination of pregnancy among HIV
infected women is only slightly stronger if compared to that in the general female
population, and that it did not show any variation during the study period.
S60437 Clinical characteristics and survival of drug-resistant
pulmonary tuberculosis in HIV infected patients
Fabrizio Palmieri1, A.M. Pellicelli2, E. Girardi2, A. Demartino2, F. Spinazzola2
C. D'Amato2. 1 Circ.ne Gianicolense 248 A 00152 Rome; 2IRCCS L.
Spallanzani, Italy
Objective: To evaluate clinical characteristics and survival of HIV infected patients (pts) with pulmonary tuberculosis (TB) resistant to one drug (group R1)
or resistant to two or more first-line drugs (group R2) compared to HIV pt with
drug-susceptible TB (group S).
Methods: Retrospective chart review (chest X-ray, presence of fever and sputum smear at 0, 15, 30 days of treatment) of 118 HIV infected pts with pulmonary
TB hospitalized at IRCCS "L.Spallanzani", Rome, between 1987 and 1996. 88
pts were in group S, 20 pts in group R1, and 10 pts in group R2 (6 of whom were
resistant to both isoniazid and rifampicin).
Results: There was no significant difference among 3 groups in age, race,
antituberculous therapy, CD4+ count and proportions of previous AIDS diagnosis
(except for group S, 33% vs group R2, 70%). 72% of pts have died: 70% in group
S, 65% in group R1, and 100% in group R2. The overall median survival time
was 16 months: 19 months for group S, 11 months for group R1, and 6 months
for group R2 with a significant difference between group S and R2 (P = 0.002,
log-rank test), that remained after stratification for previous AIDS diagnosis. We
haven't found any significant difference for presence of fever and X-ray evolution
at 15 and 30 days of treatment, while sputum smear was signigicantly more
positive at 15 and 30 days in group R2 vs group S.
Conclusions: In HIV infected pts, pulmonary TB resistant to two or more
first-line drugs is associated with shorter survival compared to that of pts with
drug-susceptible TB. Pts with persistent positive sptutum smear after 15-30 days
of four-drug antituberculous regimen should be considered for broader empirical
therapy until drug susceptibility testing is available.
S60438 Incidence of nosocomial infections in HIV infected/AIDS
patients
M. Gobbi, P. Maggi, C. Arici, G. Fasulo, G. Gregis, S. Casari, D. Santoro,
A. Pan, P. Blanc, M. Libanore, F. Dodi, L. Incandela, M. De Gennaro, A. Barelli,
L. Irato, P. Di Mattei, A. Casella, M.E. Bonaventura, F. Pallavicini, G. Legnani,
A. Conte, G. Bove, M.L. Soranzo, D. Ballardini, S. Pasquinucci,
Nicola Petrosillo1, G. Ippolito1, E. Girardi1, L. Ortona2, G.P. Carosi2, M.L. Moro3,
G. Pugliese4. Members of Gruppo Italiano HIV e Infezioni Ospedaliere (GHIO);
'Centro Riferimento AIDS-IRCCS "Spallanzani" Via Portuense 292-00149
Roma; 2Clin. Infect. Dis.-UCSC "A. Gemelli" Roma; 3lstituto Superiore Di Sanita
Roma, Italy; 4ETNA Comm. LLC Chicago IL, USA
Objective: to determine incidence, identify the etiologic organisms, and analyze
some risk factors of nosocomial infections (NI) in HIV infected/AIDS patients
Design: Prospective multicenter study.
Methods: In 1997, HIV infected patients admitted in 21 infectious diseases
units participating in a multicenter study (GHIO)* were included. A questionnarie was filled out for each enrolled patient. Patient personal data, underlying
conditions, CD4+ level, neutrophil count, CDC HIV disease staging, antibiotic
treatment, invasive procedures performed, and outcome were ascertained. NI
were diagnosed according to current CDC definiton, and recorded by trained
personnel.
Results: Preliminary data are available on a total of 2777 admissions of 2025
patients. 207 patients (10.2%) developed 300 NI (10.8% per discharge). The distribution by site was as follows: 106 bacteremias, 3.8%, 76 urinary tract infections,
2.7%, 61 pneumonias, 2.2%, 13 skin and/or soft tissue infections, 0.5%, 6 surgical
wound infections, 0.2%, 28 other NIs, 1.0%. 56 patients out of 467, 12%, had a
sepsis related to central venous catheter or other totally implantable device; 54
patients out of 361, 15%, had a urinary tract infection related to urinary catheter.
Principal organisms isolated in sepsis/bacteremia were as follows: coagulasenegative staphylococci 14.3%, Staphylococcus aureus 7.1%, enterococci 4.1%,
Gram negative 11.2%.
Conclusion: Our results suggest that HIV infected/AIDS patients are at high
risk of nosocomial infections, mainly sepsis/bacteremia, especially if a central venous catheter or a totally implantable venous access device is present. Moreover,

the rate of urinary tract infections, most of them related to urinary catheter, is not
negligible, and other nosocomial infections, such as pneumonia, skin and/or soft
tissue infections should be surveilled.

Year Total no. of Deliveries
pregn. in Pre- ProporHIV+ women valence tion
1990 1,098 1.81%o 61%
1991 1,044 1.00%o 54%
1992 917 0.84%o 52%
1993 1,302 0.98%o 41%
1994 969 1.03%0 56%

Induced abortion
Pre- Proporvalence tion
2.30%o 34%
2.38%o 36%
2.63%o 43%
4.15%o 46%
2.39%o 34%

Spontaneous abortion
Pre- Proporvalence tion
1.00%o 5%
1.81%o 10%
0.84%o 5%
2.94%o 13%
1.51%o 10%