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

12th World AIDS Conference

Abstracts 60968-60972 1177

emerged as critical drugs for these patients and nelfinavir is one of the most recent
and most potent. Hypersensitivity reactions have been observed with ritonavir
and indinavir. We report here three cases of urticaria induced by nelfinavir, with
positive reintroduction challenges. Two of them were successfully desensitized to
nelfinavir.
Patients: Three 36, 37, 40-year-old men presenting with AIDS were treated
with nelfinavir 750 mg TID, because of a resistance to the other three protease
inhibitors (ritonavir, indinavir and saquinavir). Their CD4+ lymphocyte counts
were still low (65, 37, 6/mm3 respectively) and viral loads remained high (103,
125, 370,000, and 363,000 copies/mL respectively). They were also all taking
for over 12 months zidovudine 300 mg daily, didanosine 300 mg daily and cotrimoxazole 1 tab a day. 8-10 days after starting nelfinavir, they developed a
generalized urticaria. Nelfinavir was withdrawn and antihistamines were started,
leading to a rapid disappearance of the cutaneous reaction. Six days later, patient
3 reintroduced nelfinavir and experienced similar symptoms.
Methods: Desensitization protocols were started 12, 2 and 3 weeks respectively after nelfinavir was stopped. Patients 1 and 2 received 12 doses of nelfinavir
every half-hour (from 25 /g to 1,000 mg) on a one-day, protocol followed by 750
mg TID. Patient 3 received 750 mg of nelfinavir the first day and increased his
dose by 750 mg every three days on a 3-week protocol, up to 750 mg TID.
Results: Patients 1 and 2 both experienced a mild and transient urticaria on
day 2 and 10 respectively, reinforcing the hypersensitivity diagnosis. Although
well controlled by antihistamines, patient 1 refused to carry on nelfinavir. Patients
2 and 3 were desensitized successfully.
Conclusion: Nelfinavir-allergic patients can successfully be desensitized.
60968 Antiretroviral drug resistance detection by LiPA HIV1-RT:
A useful tool for therapeutic choices?
Maurizio Setti1, Filippo Ansaldi2, B.M. Bruzzone2, V. Venturino2, P. Borelli1,
E. Cresta2, A. Ciucci2. 1 DIMI, Viale Bendetto XV 6 Genoa; 2lnstitute of
Hygiene-Univ. of Genoa, Genoa, Italy
Though the introduction of protease inhibitors (PI) in the treatment of HIV infection,
in addiction to a broadening spectrum of reverse-transcriptase inhibitors (RTI),
has greatly enhanced clinical efficacy, more and more numerous reports of therapeutic failures due to the onset of drug resistances are being reported. Several
mutant strains yielding resistances to various RTI are known since long. Crossresistances have also been observed for most of them, which limit the chances of
finding equally effective substitutive protocols. Mutants with resistances to various
PI are emerging as well. At contrast with other examples in antiinfective therapy,
multidrug treatment of HIV infection seem to have not produce the expected
results in terms of prevention of selection of resistant strains. Previously acquired
resistances to one or more of selected drugs, unknown and umpredictable at the
moment of start may be responsible for this partial failure. On these bases we
applied a test for the detection of HIV mutants with various RTI resistances in
a cohort of twenty thoroughly followed HIV positive patients with the purposes
of establishing whether a retrospective study using stored blood samples was
feasible and of evaluating the impact that information about resistance patterns
of viral strains might have had in therapeutic choices. Genotyping and resistance
study was performed by line probe assay (LiPA) wich utilises inverse hibridization
of a biotinylated PCR fragment of the HIV-1 RT with short probes. The RT gene
is first amplificated from patients' plasmas and labelled PCR amplicons are then
captured with a set of probes in nitrocellulose filters. The presence of hibridization
is detected by using a biotine-streptavidine colour reaction. Each frozen plasma
samples resulted perfectly suitable for our longitudinal study. All patients had
a wild type HIV pattern at the begining of the period of observation. Mutation
associated to RTI resistances occurred with remarkable overall rate (21 in 20
patients studied). In the 6 patients 2 resistances strains were contemporally found
(5 to AZT and 3TC and 1 to 3TC). Five patients did not develop any resistances.
The most frequent resistance resulted to be to AZT (11/16) followed the ones to
3TC (9/20) and ddC (1/20). The onset of mutant strains was inversely proportional
to the number of drugs in use and significantly higher during one or two-drug
regimens than three-drug ones. Patients who developed those resistance had
a pattern of resistance to one or more RTI actually included in the therapeutic
protocols at the moment of the start of PI inhibitors. The information about viral
strain could have therefore better addressed therapeutic choices with predictable
biological benefits and minor global expences.
609691 Oral health trends in institutionalised children living with
HIV
Wambeti Njiru, M.L. Chindia, E.N. Wainaina. University of Nairobi, Nairobi, Kenya
Issues: The oral and facial presentation of HIV/AIDS in a group of African children
is explored, and the findings compared with those from other parts of the world.
Project: This paper is based on clinical studies already done in 31 children
living with HIV/AIDS residing in an orphanage.
Results: From the time of inception of the home to the time of performing the
study, a period of 3 years, 78 children had been at the home. Of these, 36 had

left the home, 31 were still resident there, and 10 had passed away. Of the 36,
33 had deconverted to HIV seronegative.
More than half the children enjoyed good health. A large number had persistent,
asymptomatic lymphadenopathy and a little more than half the population had
skin lesions. Mucous membrane lesions manifested with pseudomembraneous
candidiasis and angular cheilitis. This was seen in only a small proportion of the
group. Caries was seen in almost half the population, while gingivitis was seen in

less than 10% of the population. These two conditions seemed more associated
with previous feeding habits and oral hygiene than with the HIV disease process
per se.
Lessons Learned: These children are a select group. Their medical, nutritional, psychological, spiritual and all other special needs were met. This provides
an environment for a happier, healthier, and possibly longer, life.
60970 Immune status of HIV-infected patients with Kaposi's
sarcoma in an African KS endemic area
Hiroshi Terunuma1, P. Matondo2, G. Mulundu3, J. Banda4, R. Saito5,
Y. Numazaki5. 1Dept. Microbiology, Yamanashi Medical Univ. Tamaho-Cho,
Yamanashi 409-3898, Japan; 2Dept. Medicine Univ. Zambia, Lusaka; 3 Dept. of
Microbiology Univ. Zambia, Lusaka; 4 Virology Lab. Univ. Teaching Hosp.,
Lusaka; 5JICA Infectious Diseases Control Project, Lusaka, Zambia
Objectives: To determine whether the immune status of KS patients in the endemic areas is the same as that in western countries which KS is recognized as
an AIDS-defining disease commonly among homosexual men.
Methods: We measured the number of CD4+ T-lymphocytes of adult patients
at Virology Laboratory, University Teaching Hospital (UTH) in Lusaka. Eightyseven HIV-seropositive asymptomatic carrier (AC), 83 consecutive KS patients
with HIV infection presenting to the KS clinic at UTH, and 125 HIV-seronegative
blood donor were recruited. We measured the number of CD4+ T-lymphocytes
of these individuals with the combination of a flow cytometer (FACScan, Becton
Dickinson) and an automated total leukocyte counter (Coulter T-660).
Results: The CD4+ T-cells of KS patients, seropositive AC declined to a mean
SSD of 230 ~ 262/pl and 466 + 331 respectively, while a mean of reference
CD4 counts determined from healthy blood donor were 740 ~ 266 respectively.
Forty-nine KS patients (59%) fulfilled the criteria for a diagnosis of AIDS as
determined by a CD4 count of less than 200/1c and 34 (41%) KS patients with
CD4 counts greater than 200//Il. Although the clinical manifestations including
age, genda, site(s) and the number of KS lesions, of KS patients with CD4 counts
less than 200//1 were almost indistinguishable from those with CD4 counts less
than 200/p I, there was a statistically significant association between oral KS and
an AIDS defining CD4 count (Fisher's exact p-value = 0.001).
Conclusion: Our results suggest that oral KS may be more appropriate for an
AIDS-defining disease than any KS in an African KS endemic area.
60971 Has anything changed in HIV related tuberculosis?
Pasquale Narciso, G.F. Groce, B. del Grosso, M. de Marco, G. D'Urso,
R. Giannuzzi, A. Sampaolesi. 4th Division Hospital L. Spallanzani Via Portuense
292 00149 Roma, Italy
Study Population: a review of 416 HIV infected patients admitted in our division
in 1997 for various pathologies, showed 35 cases of Tuberculosis (TB) with an
incidence of 8.5%. The male patients were 31 (female/male ratio = 1:7); the
median age of overall patients was 36 (range 27-50), 30 in the females and
36 in the males. Risk factor was drug addiction for 97.1% of the patients; 1
(2.8%) was also an African immigrant. Clinical and epidemiological features of
HIV related TB cases were the sequent: Extrapulmonary localization of TB = 5
patients (14.2%): 2 meningeal, 1 gastic, 1 hepatic, 1 genitourinary. Pulmonary
TB = 30 patients (85.8%) with chest radiography evidence of: interstitial/miliary
8 (22.9%), cavitations 10 (28.5%), hilar adenopathy 2 (5.7%), pleuritis 2 (5.7%),
pneumothorax 2 (5.7%).
Results: the immunological data showed a mean CD4+ cells count of 96/mmc
(range 2-293); it's noticeable that mean CD4+ cells were 128/mmc in the patients
with pulmonary cavitations, 63/mmc in those with interstitial/miliaric pneumopathy
and 89/mmc in those with extrapulmonary localizations only. The comparison
of actual data with statistics drawn in a series of 39 patients with HIV related
tuberculosis in the years 1989-90, shows a significant difference in the mean
CD4+ count (96 in the 1997 vs. 166 in the past: p < 0.001) and for clinical and
radiological features, such as extrapulmonary localizations (14.2% vs 15.3%) and
interstitial/miliaric (22.9% vs 30.7%). Risk factors also have changed: in 1989-90
omosexual were the 15.3%, African immigrants 7.6% and drug addicts 77.1%.
Conclusions: while in the past TB was an early complication of AIDS, at the
present better clinical controls and changes in lifestyle, antiretroviral therapy and
primary chemioprophylaxis, determine the onset of TB as a late complicating
disease. The wide range of active antimycobacterial drugs permits a favourable
outcome and a longer survival, with a lower risk of spreading virulent bacilli in the
environment and to closer contacts.
| 60972 1 Participatory monitoring and evaluation: A key to
improve sexual health programme performance
Sutupa Bhattacharya1, K. Verma2, N. Agarwal2, J. Hague2, S. Sengupta2,
R. Narayan2, S. Ray2. WBSHP, 9A, Little Russel Street Calcutta-700071 West
Bengal; West Benga; 2Sexual Health Project, Calcutta, WB, India

Issue: For sexual health interventions to be effective, monitoring should be participatory. This will ensure that learnings from the project are internalised leading
to empowerment of the target community.
Project: The West Bengal Sexual Health Project has initiated the process
of participatory monitoring and evaluation of projects. The project has developed need based and user-friendly monitoring systems through inputs received
from primary and secondary stakeholders. In this process the project has devel