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

12th World AIDS Conference

Abstracts 60514-60519 1095

60514 Diagnosis cytopathologic of subclinical hairy
leucoplakia
Eliane Dias, A. Silva Junior, E.C. Feijo, G.A.C. Polignano, V.C.F. Gonyalves.
Universidade Federal Fluminense, Rua BR Itapagipe 401 Bloco2 APT' 201,
Tijuca Rio De Janeiro CEP 20261-000, Brazil
Objectives: Oral Hairy Leucoplakia (OHL) is associated with infection by EpsteinBarr virus. The histopathologic and cytopathology features are specific. The first
report of the subclinical EBV infection was published in 1995 and indicated the in
situ hybridization to detect very early or subclinical EBV before the appearance of
typical clinical signs of OHL Considering that the identification of nuclear features
are diagnostic of the OHL, the purpose of this study was investigate the possibility
of subclinical EBV infection diagnosis by cytopathology.
Design: Prospective, controlled study.
Methods: Samples were obtained from 100 patients with AIDS without OHL.
Smears were obtained scraping of lateral bordes the tongue, and stained with
Papanicolaou stain. The features investigated were: arrangement of epithelial
cells, orangeophilic cells, nuclear changes (Cowdry type A, ground-glass and
nuclear beading) and Candida sp.
Results: Smears from 100 patients displayed similar appearence, with two
types of squamous cells, with either orangeophilic or cyanophilic cytoplam. The
cells were either isolated or clustered. All of the smears displayed orangeophilic
cells and clustered cells, frequently in association with Candida sp. Nuclear
changes were recognized in 23 (23%) cases and Candida sp in 20 (20%).
Conclusion: The Cytopathology appeared to be an adequate method to detect
very early or subclinical EBV before the appearance of typical clinical signs of
HL. We propose the cytophatology as an investigation method in clinical routine
to detect the early signs of AIDS and follow up of seropositive patients.
60515Subclinical oral hairy leukoplakia: Histopathological
features
Eliane P. Dias, Kyria S Spyrides, M.L. Rocha, A. Silva Junior, E.C. Fonseca,
B.S. Beauclair. 1 Universidade Federal Fluminense, Rua BR Itapagipe 401
Bloco2 APT" 201 Tijuca Rio De Janeiro CEP 20261-000, Brazil
Objectives: To describe the morphologic characteristics of the subclinical stage
of Oral Hairy Leukoplakia (OHL) and the molecular constitution of the nuclear
beading.
Design: Prospective, from AIDS necropsies.
Methods: In 1996, tongues from 8 patients, who had died with AIDS, were
removed at necropsy. The necropsies were accomplished in Antonio Pedro Hospital - Universidade Federal Fluminense -Niteroi/Brasil. The lateral borders of the
tongues were removed and each border was divided in three regions: anterior,
middle and posterior. All the samples were routinely processed and stained with
H&E. In situ hybridization (ISH) and immunohistochemical study for Epstein-Barr
virus (EBV) were performed.
Results: From 8 cases, 3 showed histopathological findings that included:
absence of keratin projections, mild or no parakeratosis, mild acanthosis, balloning cells in the stratum spinosum and the nuclear alterations (ground-glass
nuclei, nuclear beading and Cowdry type A inclusion), that are most specific
finding of OHL. The Cowdry type A was the most prevalent. EBV immunostained
positive and ISH investigation demonstrated that the positivity was confined to
ground-glass nuclei and Cowdry type A inclusion.
Conclusion: There is a subclinical OHL identified by histhopathological features with a specific appearence and confirmed presence of EBV in the nuclear
inclusions. The nuclear beading is constituted by human DNA.
60516 Use of cigarettes, alcohol, and currently illegal drugs in
women with HIV infection
Catherine Hankins1, Normand Lapointe2, T. Tran3, L. Hum3, J. Samson3. Can.
Women's HIV Study Group, 11616 Rene-Lecesque West, 3rd Floor Montreal,
Quebec. H3H 1P8, 2Hopital Sainte-Justine, Montreal; 3Montreal Regional Public
Health Dept., Montreal, Canada
Objectives: To document evolution in the use of cigarettes, alcohol, and currently
illegal drugs among 323 women participating in the Canadian Women's HIV
Study.
Methods: Women with HIV in 13 sites across Canada were asked about alcohol, cigarette, and injection drug consumption in their lifetime, in the 6 months
prior to study entry, and during 6-monthly follow-up visits. CD4+ counts were
determined locally.
Results: At study entry, 57.0% (184/323) of women had smoked cigarettes
ever and 35.9% (116/323) were current smokers, 53.5% of whom smoked -15
cigarettes daily. At last study visit a median of 19.5 months later, 40.2% (130/323)
were smoking of whom 48.2% smoked -15 cigarettes daily). No association was
seen between changes in cigarette consumption by CD4+ group ( -500, 200-500,
200/Il1). The proportion of women who consumed alcohol declined from 59.3%
(191/322) in the 6 months before study entry to 49.5% (159/321) [p: 0.001,

McNemars test for paired data]at last study visit (median weekly consumption = 2
drinks). Weekly consumption of -15 drinks was reported by 5.5% (17/309) at first
study visit and 3.8% (12/316) at last study visit (p = NS). There was a tendency for
women in the 200-500 and -.200 CD4+ count groups toward decreased alcohol
consumption at the last visit. 15.5% (50/322) of women had injected drugs ever
(8% heroin, 46% cocaine, 18% heroin and cocaine, 2% others); 5.9% did so in
the 6 months prior to study entry and 3.7% at last study visit. 12.1% (39/323)

reported marijuana use at last study visit (10.5% for those with CD4 - 500 versus
19.4% for those -500, p = 0.005).
Conclusion: Alcohol use declined significantly in this cohort of HIV-positive
women and injection drug use remained at low levels while cigarette smoking
tended to rise. This is of concern given the potential impact on health of tobacco
use in immunosuppressed women. Marihuana use did not increase with declining
CD4. Further study is needed to better understand substance use in HIV infected
women.
160517 Viral load response to HAART is an unpredictable
indicator of BCM anabolism or catabolism
Marcie Abbaticola1, A.E. Fisher2. 1400 Reservoir Avenue, Providence, RI;
2Brown University AIDS Program, Providence, RI. USA
Background: Highly active antiretroviral therapy (HAART) resulting in maximal
suppression of viral load (VL) is believed to have eliminated loss of Body Cell
Mass (BCM) leading to wasting. BCM is protoplasmic tissue necessary for glucose oxidation, protein synthesis, and immune system function. Catabolism of
BCM correlates with HIV infection morbidity and mortality. Bioelectric Impedance
Analysis (BIA) accurately monitors BCM.
Objectives: To measure the response of BCM to HAART in patients with HIV.
Methods: Retrospective chart review of 39 HIV patients treated with HAART
who achieved VL - 400 copies/mL for -50 days or had VL - 50,000 copies/mL
for -120 days. BCM was monitored using BIA. All patients received nutrition
intervention, anabolic agent (AA) or growth hormone therapy (r-hgH). BCM, VL
and AA/r-hgH therapies were analyzed. Karnofsky score (KS) was assessed at
baseline and endpoint.
Results: 23 patients VL - 400 copies/ml for -50 days (average 252 days). 11
patients (48%) lost BCM (average 1.3 kg); 5 patients (22%) BCM fell below normal
limits (NL). 12 of the 23 patients (52%) gained or had stable BCM (average gain
1.9 kg). 16 patients failed HAART; VL: 50,000 copies/mL - 120 days (average
324 days). 3 (19%) of the 16 patients lost BCM (average loss 2.1 kg). 13 (81%)
gained BCM (average gain 1.8 kg). 7 patients (44%) with BCM below NL gained to
a level within NL; all 7 patients were receiving AA or r-hGH. Mean KS decreased
from baseline to endpoint by 11.4 points for patients who lost BCM and increased
by 8.0 points for patients who gained BCM.
Conclusion: Catabolism of BCM leading to wasting in HIV infection occurs
despite undetectable VL. BCM must be monitored and treated independently
of VL. Appropriate interventions, including adequate nutrition, AA and/or r-hgH
promote BCM anabolism. Improved KS correlated with increased BCM.
60518 Comprehensive treatment reverses wasting independent
of virologic response to HAART - A case study
presentation
Marcie AbbaticolA1, A.E. Fisher2. 400 Reservoir Avenue, Providence, RI; Brown
Univeristy AIDS Program, Providence, RI, USA
Background: AIDS wasting (AW) is multifactorial and occurs independent of virologic response to highly active antiretroviral therapy (HAART). It is characterized
by the loss of body cell mass (BCM), visceral and somatic tissue required for
metabolism and immune function. Repletion and maintenance of BCM requires
multiple treatment modalities. HAART, management of opportunistic infection
(01), nutrition support (NS), growth hormone (r-hGH), anabolic agents (AA), psychosocial therapy, exercise, and financial assistance factor into the management
of wasting. Bioelectrical Impedance Analysis (BIA) monitors BCM in the course
of comprehensive care.
Objective: To analyze the multidisciplinary treatment interventions utilized to
reverse AW - defined as loss of BCM.
Methods: Retrospective chart review of patients who recovered from AW. BCM
was monitored by BIA and multidisciplinary interventions analyzed. Antiretroviral
therapy, CD4 cell counts, viral load (VL), r-hGH and/or AA therapy, NS, psychosocial treatment, reimbursement and quality of life measured by Karnofsky score
(KS) were monitored.
Results: Twelve patient charts were reviewed; all patients gained BCM (average 3.9 kg) to within normal limits. All patients were on HAART. 6/12 patients
achieved VL < 400 copies/mL. In 6/12 patients VL remained -50,000 copies/mL.
7/12 experienced concurrent 01. 12/12 received r-hGH and/or AA, 12/12 were
treated for micronutrient deficiencies, 9/12 received NS, 7/12 received psychosocial counseling, 8/12 began regular exercise programs, 8/12 received financial
assistance. 12/12 increased KS - 80%.
Conclusion: BCM wasting occurs independent of VL. Optimization of a multidisciplinary approach to treatment makes BCM repletion possible despite the
incidence of concurrent 01.
S60519 A prospective study of HHV8 prevalence in patients
presenting at a STD department
Bernard Masquelier1, C. Cazorla2, A. Simon3, P. Caminade1, M. Geniaux1,

M. Dupon2, H.J.A. Fleury1. Laboratorie de Virologie, CHU Boreaux Place,
Amelie Raba Leon, Bordeaux Cedex; 2Departement d'lnfectiologie CHU
Bordeaux, 3Departement de Dermatologie CHU Bordeaux, Bordeaux, France
Background: Kaposi's Sarcoma-associated herpesvirus (HHV8), has been
shown to be mainly restricted to some populations, i.e. HIV-infected homosexuals, in the western developped countries. In order to study the prevalence of