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

1160 Abstracts 60872-60876

12th World AIDS Conference

non HIV-infected patients, T LGL is usually a clonal proliferation associated with
neutropenia.
Objective: To describe the clinical and immunologic aspects of LGL proliferation
in a monocentric cohort of HIV-1 infected patients.
Patients: Consecutive sample of 7 patients with increased numbers of LGL
(>1000/mm3) for more than 6 months.
Results: 5 Caucasian men and 2 African women (4 homosexuals, 2 heterosexuals and 1 drug addict) were studied. At diagnosis, the CDC stage was A2 in
2 patients, B1 in 1 patient, B3 in 2 patients and C in 2 patients. One patient had
undergone splenectomy. The LGL proliferation was associated with persistent
lymphocytosis (>3000/mm3) in all cases and with neutropenia below 1500/mm3
in 5 cases. The LGL coexpress CD3 and CD8 but not CD16 in all cases. In 4
cases, DNA studies using TCR b and g probe showed no clonal rearrangement
of T-cell receptor gene. The neutropenia was present before any therapy in 1
patient. The 4 others patients received potential neutropenic therapies such as
cotrimoxazole and/or zidovudine. These ones were stopped in 3 cases without
correction of neutropenia. The mean follow-up was 23 months. Bacterial infections occurred in 3 cases, sinusitis (n = 2) and pneumonia (n = 2). In 4 cases,
the LGL count decreased parallel to the HIV viral load decrease under 2.6 log
copies/ml.
Conclusions: 1) Neutropenia may be secondary to LGL proliferation in HIV+
patients. 2) LGL were polyclonally expanded and their proliferation seemed to be
correlate to HIV viral load.
60872 | Effects of exogenous Nef and Tat proteins on HIV-1
infected or uninfected lymphoid cells
Luisa Gennero1'2, Agostino Pugliese2, A. Pigarino2, C. Cantamessa2,
A. Savarino2, M.R. Barilaro2, P.G. Pich3, D. Torre4. 1Corso Svizzera, 164, 10169
Torino; 2Dip. Discipline Medico-Chirurgiche, Torino IT; 3Laboratorio Di Analisi
Cliniche, Torino IT, 4Div Di Mal. Infective-Osp. Reg. Di Varese, Varese IT Italia
Objectives: To evaluate some effects of exogenous Nef and Tat proteins on
lymphoid cells.
Design: Evaluation of apoptosis, cellular replication, CD4, FN (fibronectin),
CD71 (transferrin receptor) expression, a and y interferon (IFN) production.
Methods: the modulation of FN, CD4, CD71 expression, induced by exogenous
Tat (p14) and Net proteins, in T lymphocytic cells permissive to HIV-1 replication
(MT-4 and H9), was evaluated using immunofluorescence techniques and FACS
analysis. Moreover, the affinity of Nef and Tat to cell membranes and their effects
on cellular replication were studied. The effects of such proteins on apoptosis
were determined by the TUNEL technique. Finally, levels of IFN a, induced by
poly I:C, and of IFN y, induced by Con A, with or without Nef or Tat, were detected
on PBMC, obtained from seronegative individuals.
Results: The results obtained demonstrate that p14 exerts multifunctional activities on HIV-1 infected and uninfected target cells, interacts in a specific manner
with cell surface, especially in infected cells, enhances the expression of FN and
its receptor (FNR) but not that of CD4. Moreover p14 increases significantly cell
replication, a and y IFN production and slightly stimulates apoptosis. Exogenous
Nef protein also is able of specific binding to lymphocyte membranes. Moreover
the same produced a significant up-regulation of FN, especially on uninfected
cells, and a significant down-modulation of CD4 and CD71 both on uninfected and
on acutely or chronically infected cells. Nef protein inhibited cellular proliferation,
particularly on uninfected H9 cells after 24 h of incubation in a dose-dependent
manner. On the other hand, in this cell line Nef showed to be able to induce
apoptosis in a dose-dependent manner. Nef protein did not seem to influence
significantly a and y IFN production in vitro at the doses employed.
Conclusion: Our data suggest that Tat protein, enhancing T-lymphocytic replication, increases the susceptibility to HIV-1 infection in the target cells and that Net
protein can regulate cellular metabolism, promoting HIV replication. Furthermore,
Nef protein could favour HIV release, inducing apoptosis.
608731 Perceived and actual risks of occupational HIV
transmission among health care workers in Lusaka,
Zambia
Rachel Baggaley1, Z. Kasongo1, M. Keteta2, E. Sakala3, M. Tolosi3,
T. Chabala4, C. Gilks5. 1ASD WHO, Geneva, Switz; 2University Teaching
Hospital (UTH), Lusaka; 3UTH, Lusuka; 4Kara Counselling & Training Trust,
Lusuka, Zambia; 5Liverpool School of Tropical Medicine, Liberpool, UK
Objectives: To ascertain the perceived risks of occupational HIV transmission
of health workers at the University Teaching Hospital (UTH) and to investigate
if and how these risks are being reduced by application of existing universal
precautions.
Methods: 324 observations of clinical procedures in various clinical settings
were made by the researchers. 20 focus group discussions and 38 key informant
interviews were held with 177 health workers at UTH.
Results: Although knowledge of universal precautions was generally good,
these were not always followed due to inadequate supplies of protective clothing,

sharps disposal boxes, gloves or sterilising fluids. Many health workers worried
about being infected with HIV by exposure at work. 71% had, at some time during
their career, a needle stick injury and 87% a blood spill accident but very few had
counselling or HIV testing (c & t) following this experience. Most said that there
were not aware of confidential c&t services within the hospital and many said
even if services were available they would be reluctant to undergo testing. None
had had post exposure ARV prophylaxis. Many also worried about being infected

in their personal lives. Many health workers said that they found it distressing and
difficult caring for young people with HIV for whom they often felt there was little
that could be done.
Conclusion: The importance of using universal precautions should be emphasised, even if they have to be modified due to shortages. There is a need
for all health workers to have access to health education about HIV and reassurance about ways that HIV cannot be transmitted as well as advice on post
exposure treatment. Counselling services should also be made available, not
only to discuss health workers' own fears about HIV, but also help them to cope
with demoralising work. Personnel counselling services should be confidential
and if possible away from the hospital so that hospital staff do not worry about
information being shared with their colleagues.
60874 Comparison of prevalence of HIV infection in pregnant
women in rural area and urban area
Affoue Sangare Kouassi, K.L. Koff Leon, O.K.N. Odi Koume Nazaire, K.B. Kone
Brahima. 01 BP 490 Abidjan Institut Pasteur Abidjan, Cote D'lvoire
Objective: to learn about HIV spreading in rural regionlN C6te d'lvoire
Material and Method: 654 pregnant women attending for antenatal care: 254
in rural center care, and 350 in one town. These women were recruited consecutively and anonymously. According our national strategy of detecting antibodies
to HIV in healthy subject, we used one test: Enzygnost PLUS HIV1/HIV2.
Result: in general 71/654 women was positive for antibodies to HIV = 11.75%.
Rural Area: 21/254 were positive: 8.26%. Urban Area: 50/350 were positive =
10%. The statistical difference is not significative
Discussion: the prevalence of HIV is as high in rural region as in urban region.
Conclusion: these results confirm that HIV is spreading in all region of the
country.
60875 1 Long-term follow-up of a cohort of 144
nucleosides-experienced patients treated with D4T + 3TC
+ indinavir (IDV)
Pierre de Truchis1, D. Zucman2, C. Dupont3, A.M. Simonpoli4, J. Doll5,
H. Berthe1, J. Leibowitch1. 1Hopital Raymond Poincare, 92380 - Garches;
2CISIH 92, Hopital Foch, Suresnes; 3CISIH 92, Hopital Anbroise Pare,
Boulogne; 4CISIH 92 Hop. L. Mourier; 5Hopital A. Mignot, Versailles 78, France
Objective: to study the clinical outcome (AIDS defining events and deaths) in a
cohort of 144 patients heavily pretreated with nucleoside-analogs and severely immunocompromised, and who received a tritherapy with D4T+3TC+IDV instituted
between May and Dec 1996, in an intent-to-treat-analysis.
Patients: the 144 patients, 51% CDC-group C, were pretreated with nucleoside-analogs during a mean of 34.5 ~ 23 months. At baseline, CD4 cell count
was 85 ~ 67/mm3, and viral load 4.52 ~ 0.93 log Eq RNA/ml. At month 12
follow-up visit, the study treatment was interrupted or challenged in 50% of
patients (virological escape: 24%, intolerance: 16.8%, lost for follow-up: 4.3%,
death: 2.9%) 139 patients (lost for follow-up: 5) were assessed in an intent to
treat analysis for clinical events, with a mean follow-up of 17 months.
Results: Death occurred in 9/144 patients (6.25%), but was AIDS-related in
only 6 cases; 27 AIDS-related events occurred in 19/144 patients (13.6%): pneumocystosis (1), oesophagal candidiasis (3), CMV encephalitis (3) or retinitis (3),
MAC (1), herpes zoster (1), listeriosis (1), HIV-encephalopathy (2), progression
of Kaposi (3), Hodgkin (2) and lymphomas (3), neoplasias (3), cachexia (1). AIDS
events or death occurred in 24 patients (16.6%)
Conclusion: Despite frequent virological failure under tritherapy with a protease inhibitor, we observed a relatively low rate of clinical progression in these
heavily pretreated and severly immunocompromised patients.
60876 | Epidemiology of tuberculosis in HIV-infected patients in
Denmark
Ulrik Bak Dragted. Department Infectious Disease Hvidovre Hospital, 2650
Hvidorve, Denmark
Background: Denmark is a low-incidence area for HIV and tuberculosis (TB).
The number of new HIV cases has been stable during the 90'ies, but the number
of TB cases has doubled in Denmark during past decade due to immigration.
Among native Danes the TB incidence has increased in the younger age groups
indicating more newly infected persons.
Objective: To assess the impact of the HIV epidemic and of immigration to
Denmark on the TB incidence among native Danes. Further to reveal transmission
patterns of TB among HIV-positive patients.
Design: Retrospective data collection from medical records from co-infected
patients identified in the national registers of TB and AIDS from 1992 through
1995. Restricted Fragment Length Polymorphism (RFLP) analyses of TB isolates from co-infected patients were compared with all patterns registered in the
nation-wide Danish RFLP database (approximately 7000 patterns).

Results: We identified 54 co-infected patients, 41% Danes and 59% immigrants. Danish co-infected patients were part of a cluster, i.e. had RFLP patterns
identical to one or more in the RFLP database, more often than immigrants (79%
vs. 37%), Danish HIV-TB co-infected patients with pulmonary TB were more often
i.v. drug users (IVDUs) than co-infected immigrants. Almost no TB transmission
was seen between co-infected Danes and immigrants. No evidence of nosocomial
TB transmission was found.