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

1150 Abstracts 60813-60818

12th World AIDS Conference

Results:- Overall there was a 54% probability of the patients achieving an
undetectable viral load 500 copies/mL) by 24 weeks after starting the protease
inhibitor. In a multiple Cox regression model, those with higher initial CD4 counts
were more likely to achieve such levels (Relative hazard 1.15 per 100 /mm3
higher; 95% Cl 1.02-1.29; p = 0.02) after adjusting for initial viral load (RH 0.70
per log higher; p = 0.03) and number of new drugs started at same time as
the protease inhibitor (RH 1.70 per new drug; p = 0.003). In those 103 patients
achieving undetectable viral load within 24 weeks, there was an estimated 15%
probability of re-appearance of detectable viral load by 24 Weeks from the first
undetectable value. Re-appearance of detactable plasma virus was less likely in
patients with higher initial CD4 counts (RH 0.65; 95% CI 0.45-0.94; p = 0.02),
after adjustment for other factors.
Conclusion:- For a given viral load when starting a protease inhibitor-containing regimen patients with higher CD4 counts appear more likely to reach an
undetectable viral load and to sustain such a low level than patients with lower
CD4 counts.
S60813 Premature mortality in Italy during the first decade of
AIDS epidemic
Susanna Conti, M. Masocco, G. Farchi, G. Rezza, V. Toccaceli, M. Vichi.
Instituto Superiore Di Sanita V Regina, Elena 299 Roma, Italy
Background: AIDS has become a leading cause of premature mortality in many
countries, owing to the decline in other major causes of premature death and
the increase in AIDS itself. This study was carried out to determine the trends in
premature mortality due to selected causes in Italy.
Methods: Data from the Italian Mortality Data Base, for the ten years from
1984 to 1993 (the first decade of the AIDS epidemic) were analysed. Premature
mortality was measured in terms of years of potential life lost before the age of
70 years (YPLL), excluding infant mortality. Trends in premature mortality due
to AIDS were compared with those of the principal causes of premature death:
lung cancer, colon-rectum cancer, stomach cancer, leukaemia, female breast
cancer, uterine cancer, myocardial infarction, stroke, liver diseases, suicide, road
accidents and overdose.
Results: In this period there has been a marked increase in premature mortality from AIDS both among males aged 1-69 years (from a rate of YPLL of
0.01 per 1000 in 1984 to 3.71 in 1993) and females of the same age group
(from 0 deaths in 1984 to a rate of YPLL of 1.02). Throughout the same period
all the other causes of premature death have been declining, with the exception
of suicide and overdose among males, and overdose and lung cancer among
females. For people aged 25-44 years, AIDS has become the greatest cause
of premature death. The increasing trend in premature mortality due to AIDS is
most pronounced in the northern and central areas of Italy.
Conclusion: AIDS is the leading cause of death among males aged 25-44
years in Italy and is having an important impact on premature mortality among
females in the same age group.
60815 HIV testing in pregnancy: What happens in counselling
Sherr Lorraine', C.N. Hudson2, A.M. Bergemstr6m1. EU Team 1Dept. of Primary
Care & Population Sciences, Royal Free Hospital School of Medicine, London;
2St. Bartholomew's School London, UK
Background: Little is known about how HIV discussion is currently handled in
the context of general maternity care. This study was conducted to examine the
impact of HIV testing for pregnant women, the content of pre-HIV test counselling
and the obstetric staff perspective of HIV discussion.
Method: The study was carried out in four phases. Consecutive attenders in
four London antenatal clinics, with different testing policies, completed a questionnaire prior to an antenatal consultation (N = 697). A selection of the consultations
were observed (N = 154) and a questionnaire was subsequently completed by a
sub sample of women (N = 226) following the consultation. Finally, a sample of
obstetric staff (N = 345) completed a questionnaire.
Results: A average of 1.7 minutes was spent on discussing HIV infection and
testing during the antenatal consultations which lasted a mean of 33.1 minutes.
Although immediately before the consultation 31.4% of the women intended to
have an HIV test the rate of intention decreased to 17.6% after the consultation.
The mention of HIV risk factors during the consultation was infrequent; the most
common being sexual behaviour, which was mentioned in 11.7% of the consultations. Where potential interventions to reduce vertical transmission were raised
(20% of consultations) retroviral treatment was mentioned for fewer than one in
ten women and mode of infant feeding with one in five women. Discussion on
possible mental health implications and future HIV risk reduction was infrequent.
Conclusion: The available time to discuss HIV issues within the context of
antenatal clinics is limited. Although many women are already informed about
HIV a drive to promote HIV testing is a disincentive for many to test. Strategies
to promote HIV testing may be short-sighted and perhaps strategies aimed at
women to provide them with more realistic information, update and a two way
dialogue may be the better way forward.

60816 1 Viral load: Risk independent factor for anergy in HIV
infection
Pompeyo Viciana', Francisco Martinez-Marcos2, L. Lopez Cortes', M. Del
Nozal1, M.D. Rodriguez-Hernandez', M. Bernabev', G. Pachon'. 'Infectious
Diseases Service, University Hospital, Virgen Rocio Avenue, Manuel Siurot S/N
41013-Seville; 2lnternal Medicine Service, Hospital Juan Ramon J., Huelva,
Spain
Objective: To determine if the viral load is an independent risk factor for cutaneous
anergy in HIV-infected patients.
Methods: Eighty-two ambulatory HIV-infected persons were skin-tested with
tuberculin purified protein derivative, Candida albicans and tetanus toxoid administered by Mantoux method: 2 UI of PPD (Llorente-Evans, Madrid, Spain), extract
of Candida albicans 1:10 (Ifidesa-Aristegui, Bilbao, Spain) and tetanus toxoide
purified 1:5 (Berna, Madrid, Espaha). Anergy was considered if all reactions were
<5 mm in induration. In a logistic regression model, we assessed the lymphocyte
count, viral load (RT-PCR, HIV Monitor, Roche), /12-microglobulin, serum albumin,
prealbumin, transferrin, skinfold thickness and arm muscular circumference as
predictors of cutaneous anergy (determined in the same visit).
Results: Only lymphocyte count and viral load were statistically significant
predictors of anergy:
CD4/pIL n Anergy (%) OR (95% CI) RNA-HIV log/mL n Anergy (%) OR (95% CI)
-50 10 80 9.2 (0.9-91.2) -6 (20) 20 70 3.5 (0.8-14.7)
50-200 19 58 2.3 (0.4-12.7) 5-6(19) 19 42 1.5(0.4-5.9)
200-500 42 24 0.7 (0.1-3.7) 4-2.3 (22) 22 18 0.4 (0.1-2.1)
-500 11 27 1.0 -2.3 20 29 1.0
Conclusions: Viral load is an independent risk factor for cutaneous anergy in
HIV-infected persons
60817 Spontaneous regressions of an AIDS-related high-grade
non-Hodgkin lymphoma with HAART
Pompeyo Viciana1, G. Lopez-Hidalgo1, G.A. Garcia Canton', M. Piris2,
M. Nogver3, M.D. Prados', A. Alarcon'. 'Infectious Diseases Services Seville,
University Hospital Virgen Rocio Avenue Manuel Siurot S/N 41013, Service;
2Pathology Departament (Hospital V Salud), Toledo; 30ncology Service Seville
(University Hospital of V. Rocio), Seville, Spain
Background: AIDS patients suffer lymphomas more frequently than healthy
population. This higher frequency has been related to their immunodeficiency.
Spontaneous regressions (SR) of low-grade ones have been described in transplant recipients after recovering their immunity, and only one temporal SR of
an AIDS-related high-grade non-Hodgkin lymphoma (NHL). A case of SR of a
high-grade NHL is described.
Case: A 35-years-old man had been diagnosed of HIV infection in May 1994 in
relation to PCP and an oral Kaposi's sarcoma. He had 29 CD4+ lymphocytes. He
began to take zidovudine (ZDV) + didanosine (ddC) and prophylaxis with co-trimoxazole. In may 1995 Kaposi's sarcoma had regressed and reappeared from
August to October in right side, right ear, forehead and mouth. In February 1996 he
suffered a zoster and was treated with famciclovir. He began to take ZDV+ddC+
indinavir (IDV) in July and Kaposi's sarcoma regressed again 2 months after. In
November 1996 treatment was changed to lamivudine + estavudine + IDV. Ten
months after he note a hard mass in his jaw (4 x 8 cm) displacing the teeth
and hindering mouth closing. He had no symptoms and the remaining physical
examination was normal. CD4+ lymphocyte count increased (CD4 = +290), and
viral load decreased from 5.3 x 105 (logs = -2.6). A biopsy was informed as
a uniform proliferation of large immunoblastic plasmacytoid cells that infiltrated
the parotid gland and the surrounding soft tissues. The tumor phenotype was
CD20-, CD38+, EBV-LMP-, p53-, with a high mitotic index (Ki67 > 90%),
and was genotype policlonal (high-grade large cell immunoblastic plasmacytoid
lymphoma, IgH- and TCRy-). EBV genome was detected by PCR. A thoracic
and abdominal CT and a bone marrow biopsy were normal. The patient denied
chemotherapy, but kept on taking antiretroviral therapy. Two months later the
tumor had regressed, and keep on so to date.
Comments: This case is an indirect evidence that support the role of the immunity in SR of lymphomas. Cases of SR of AIDS-related high-grade NHL are very
uncommon. AIDS-related NHL usually have a polyclonal phenotype, contrasting
with the monoclonal one of the present case. Finally, in this patient both Kaposi's sarcoma and NHL regressed soon regarding to his immunity improvement
developed with the high activity antiretroviral therapy.
|60818 Whole blood CapcelliaR CD4/CD8 immunoassay for
enumeration of the CD4+ and CD8+ peripheral T
lymphocytes
Dominique Carriere', J.P. Vendrell2, C. Fontaine3, J. Reynes4, C. Molzmann5,
M. Laprade3, B. Pau6. 1 Sanofi Recherche- 371 av Prof Blayac, 34184

Montpellier Cedex 04; 21mmunologie Hopital Lapeyronie, Montpellier; 3Sanofi
Recherche, Montpellier; 4Maladies Infectieuses Hopital G. de Chauliac,
Montpellier; 5Sanofi Diagnostics Pastuer, Marnes-La-Coquette; 6CNRS UMR
9921, Montpellier, France
Background: Alternative methods for counting CD4+ and CD8+ T cells without
the use of a flow cytometer have been developed for applications in developing
countries. We evaluate here an immunoenzymatic method called Whole Blood