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

12th World AIDS Conference

Abstracts 13245-13249 135

bacterial, viral, fungal, protozal and other relevant neoplasms. (c)-Laboratory
surrogate markers-Routine haemogram, routine biochemical analysis, bacteriological, fungal examinations and serology. (d)-Radiological studies including Ultra
Sound and CT Scan where applicable.
Results: (a)-The most common bacterial infections were Tuberculosis (Pulmonary and Extra Pulmonary), Atypical Pneumonia, (streptococcal, Staphylococcal, Pneumoccocal and H. Influenzae). (b)-ln the Protozal group Malaria,
Helminthiasis and Toxoplasmosis, Leishnansiasis were common. While Pneumocystis Carinii was uncommon. (b)-The common Fungal infections were: - Candidiasis, Cryptoccoccosis, Dermatophytosis, and Pityriasis Versicolor. (d)-Amongst
the Viral infections, Herpes Zoster was the most dominant followed by Hepatitis
B, Herpes Simplex, Cytomgalovirus and Human Papilloma Virus infection.
Comments: This is an initial pilot study and an ongoing prospective controlled
study is being carried out to correlate between opportunistic infections and immonological (CD4/CD8) and Virological Markers (Viral Load) in HIV patients in
Africa.
Conclusion: This study shows that the commonest opportunistic infections in
our patient in our patient population were Tuberculosis 32%, Candidiasis 18%,
Herpes Zoster 10%, Herpes Simplex 7%, Helminthic Infections 19%, Cyptococcosis 13% and Leishnansiasis 1% whereas in most studies conducted in Europe and
North America PCP, Toxoplasmosis, Cryptosporidiva and Human Papillomavirus
are common.
S13245 Changing pattern of opportunistic infections
Janak Maniar1, D.G. Saple1, T. Kurimura2. 1GT Hospital Grant Medical College,
69/2 Walkeshwar Road, Bombay, India; 2Osaka University, Osaka, Japan
Objectives: To study changes in pattern of opportunistic infections (01) in
HIV/AIDS individuals over a period of ten years.
Design: Prospective Study.
Methods: The data of HIV+ve individuals registered at referral AIDS clinic were
analysed for age, sex, risk factor, type of HIV infection and incidence of 01. Over
25,000 HIV+ve individuals have attended this clinic since 1986.
Results: Gender ratio M:F 3:1. Routes of transmission; sexual 93%, transfusion
5%, unknown 2.0%. Types of HIV seropositivity; HIV - 175%, HIV 1 & 2 16.5%,
HIV - 28.5%. Age range; 13 to 78 yrs., maximum between 22 to 36 yrs. Periodical
pattern of Ols observed as follows:

Opportunistic
infections
T.B
Oral cadidiasis
Herpes zoster
OHL
Cryptococcal menigitis
Scabies
Infective diarrhea
Tinea
Cerebral toxoplasmosis
Bacterial pneumonia
Pyoderma
Septicaemia
PCP 1%
CMV retinitis
Cryptococcosis
Polymyositis
Histoplasmosis

1988
n = 120
40%
8%
24%
8%
6%
10%
2%
3%
3%
1%

1990
n =750
48%
14%
48%
8%
6%
12%
4%
14%
5%
18%
4%
6%
4%
1%
1%

1992
n 1950
58%
21%
53%
18%
11%
18%
6%
18%
11%
24%
6%
4%
5%
3%
0.2%
2%

1994
n =2100
64%
33%
64%
24%
18%
22%
12%
22%
16%
18%
8%
6%
6%
3%
0.4%
1.5%

1997
n = 4250
90%
76%
72%
36%
26%
25%
25%
24%
22%
16%
9%
8%
6%
4%
1%
0.3%

were lower than the incidence rate among 20-59 year olds in the community
(1543/100,000).
Conclusion: Tuberculosis has increase amongst hospital staff, secondary to
the impact of IHV on tuberculosis incidence. We observed no increased risk
among health workers compared to ancillary staff, suggesting that community
transmission may be more frequent than nosocomial transmission. The HIV epidemic is having a substantial impact on health of hospital staff and interventions
to counter this are urgently needed.
61*/132471 HIV/Tuberculosis (TB) liaison nurse in the HIV clinic
Michiko Otaya1, B. Jones2, J. Currier2. 11300 N. Mission Road, #346 Los
Angeles, CA; 2Los Angeles County/U.S.C./Medical Center, Los Angeles CA, US
Issues: As the administration of protease inhibitors to HIV/TB co-infected patients
is problematic due to drug interactions with rifampin; it is important for HIV clinics
to identify TB cases and ensure that patients are properly treated for HIV and TB.
Project: From 1996 to 1997, 75 patients co-infected with HIV/TB were followed
in the HIV clinic, Directly Observed Therapy (DOT) for TB was administered to
patients by community workers from 7 public health clinics assigned according to
the patient's place of residence. The HIV/TB liaison nurse obtained information
on TB bacteriology and treatment from the public health clinics and organized
the information in the HIV clinic charts. CD4 cell counts and viral loads were
recorded. A "drug-o-gram" detailed HIV and TB medications and changes in
therapy. The HIV/TB liaison nurse communicated with TB public health nurses to
discuss patient follow-up and encourage patient adherence with HIV care.
Results: The HIV/TB liaison nurse coordinated TB information from 7 public
health clinics. Thirty patients were started on protease inhibitors in the HIV clinic
which necessitated a change in the TB treatment regimen administered by the
public health clinics from rifampin to rifabutin.
Lesson Learned: Improved communication between TB and HIV providers has
been enormously successful for improved medical care of HIV/TB co-infected patients. Assigning a nurse in the HIV clinic as a liaison to the TB public health clinic
provider will ensure better HIV care.
13248 Pulmonary tuberculosis in HIV-infected and uninfected
patients in sentinel hospitals in the United States,
1994-1995
J. Todd Weber, J.S. Sidhu, R.S. Janssen. Centers for Disease Control and
Prevention (E-46), 1600 Clifton Rd, Atlanta, GA, USA
Objectives: To compare prevalences of pulmonary tuberculosis (PTB) in persons with and persons without HIV infection and to compare the prevalence of
TB antimicrobial susceptibility in persons with and persons without HIV infection.
Design: Unlinked serosurvey.
Methods: The Sentinel Hospital Surveillance System for HIV Infection collected data and serum specimens that remained after clinical testing of a sample
of persons 15-54 years old who received inpatient or outpatient care in 11 cities at
14 hospitals with high HIV prevalence (>1 case newly diagnosed AIDS per 1000
discharges). We collected information from the medical record for the visit during
which the serum sample was taken. Identifying information was then removed
(unlinked), and a single study number was assigned to the patient's specimen
and medical record data. Specimens were then screened for HIV antibody. We
analyzed data on HIV serostatus, PTB, and TB antimicrobial susceptibility. Multidrug resistance to TB (MDR TB) was defined as laboratory-confirmed resistance
to isoniazid and rifampin as noted in the medical record.
Results: In 1994 and 1995, 8,566 (9.6%) of the 89,206 persons sampled had
HIV infection. Of HIV-positive persons, 451 (5.3%) had PTB; of the HIV-negative
persons, 304/80,640 (0.4%) had PTB (relative risk = 13.9, confidence interval
= 12.1-16.1). MDR TB infections were found in 20 (4.4%) cases of PTB in
HIV-positive persons and in 3 (0.9%) cases of PTB in HIV-negative persons (p <.01).
Conclusions: HIV-positive patients receiving care at hospitals were nearly
14 times more likely than HIV-negative patients to have PTB. MDR TB was
found approximately 5 times more often in HIV-positive patients with PTB than in
HIV-negative patients with PTB.
S13249 Prevalence of tuberculosis among persons with AIDS in
the United States, by world region of birth
Christopher Tetteh, J. Jones, M. Lindergren, P. Flemimg, J. Li, J. Ward. Centers
for Disease Control SB DHAP, 1600 Clifton Rd MS E47, Atlanta, GA 30333, USA
Background: Immune suppressed HIV-infected persons are at increased risk of
tuberculosis (TB) from newly acquired TB or reactivation of latent infection. We
sought to determine whether the prevalence of TB among persons reported with
AIDS in the United States varies by world region of birth.
Methods: We used national HIV/AIDS surveillance data to compare characteristics of adults who had AIDS diagnosed through 1996 with TB (TB-AIDS) and

without TB. Extrapulmonary TB was added to the AIDS case definition in 1987
and pulmonary TB in 1993. States with high TB/AIDS co-morbidity regularly match
TB and AIDS registries, so TB is the most completely reported AIDS-defining
opportunistic illness.
Results: Of 588,245 adults with AIDS, 33,757 (5.7%) were reported with TB.
Most cases of TB-AIDS occurred in persons born in Africa (13.8%), followed by
persons in the Caribbean (13.7%), Central/South America (10.3%), Asia/Pacific

Conclusions: There is shift in incidence of opportunistic infections in HIV+
symptomatic individuals as the epidemic is maturing. The commonest opportunistic infections are; tuberculosis, oral candidiasis, herpes zoster, herpes simplex,
OHL, infective diarrhea, cryptococcal meningitis, cerebral toxoplasmosis, and
scabies. As the epidemic is maturing; CMV retinities, PCP, cryptococcosis, histoplasmosis, tuberculous diarrhea & polymyositis are seen. Prophylaxis against
tuberculosis (2 drugs), toxoplasmosis, PCP and candidiasis seem to offer better
quality of life in absence of antiretroviral therapy.
611*/13246 Increasing frequency of TB among staff in a South
African hospital: Impact of the HIV epidemic on
supply of health care
David Wilkinsont2, C.F. Gilks2. 1South African Medical Research Council, South
Africa; 2Liverpool School of Tropical Medicine, Liverpool, UK
Objectives: To describe the changing frequency of TB among staff in a South
African hospital, and to compare incidence in health workers with that in ancillary
staff.
Methods: Number and type of cases of TB among staff diagnosed between
1991 and 1996 was ascertained. Incidence rate of TB among health workers and
ancillary staff was compared with the community age-specific rate for 20-59 year
olds. MV prevalence in women attending antenatal clinics in the area increased
from 4.2% in 1992 to 26% in 1997.
Results: From 1991-1992, 2 cases of tuberculosis were diagnosed among
hospital staff; but from 1993-1996, 20 cases were diagnosed. Of 14 patients
(64%) tested, 12 (86%) were HIV infected. Most patients (82%) successfully
completed treatment, but 4 (18%) died on treatment. Incidence of tuberculosis
amongst health workers (558/100,000 person-years of observation [PYO]) and
ancillary staff (445/100,000 PYO) were not significantly different (p = 0.7), but