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

12th World AIDS Conference

Abstracts 13255-13258 137

migrant workforce. This study was undertaken to investigate if the large numbers
of recurrent cases and treatment failures seen in this community might be due
to increasing mycobacterial drug resistance, and whether there is an association
between drug resistance and HIV infection.
Setting: The study population comprised black workers on four gold mines near
Johannesburg. A comprehensive TB control programme, incorporating DOTS,
using National guidelines, is in place.
Methods: All patients with culture positive TB in 1995 were recruited. Patients were interviewed, sputum cultured, susceptibility to isoniazid, rifampicin,
streptomycin and ethambutol determined, HIV testing and CD4 counts performed
in consenting subjects, and outcomes assessed 6 months after commencing
treatment.
Results: There were 292 cases of new tuberculosis, 77 of recurrent disease
and 56 prevalent cases in treatment failure. Primary resistance to one or more
drugs was 9.2%, to isoniazid 7.5%, and multidrug resistance (MDR) 0.3%. These
rates are similar to previous study amongst gold miners in 1989. The acquired
MDR rate was 18.1% overall, comprising 6.5% with recurrent disease and 33.9%
of cases in treatment failure. There was no association between either single (p
= 0.601) or multidrug (p = 0.572) resistance and HIV infection or the degree of
immune compromise in HIV infected patients. New patterns of drug resistance
were present in 9 of 52 patients in treatment failure at six months, only one of
whom was HIV infected.
Conclusion: Primary and acquired drug resistance rates appear to be stable
in this population and are not affected by the high prevalence of HIV infection.
There was no association between either single or multidrug resistance and HIV
infection, both at the start of treatment and 6 months later. The possibility exists that relatively well resourced control programmes, with rifampicin-containing
regimens, may contribute to the spread of drug resistance to other areas in the
region which provide migrant labour.
13255 Initial drug resistance tuberculosis amongst HIV
seropositive and seronegative prison inmates in Lagos,
Nigeria
Oni Idigbe', T. Sofola2, R. Akinosho', D. Onwujekwe', F. Odiah3, R. Okoye2.
'Nigerian Institute of Medical Research, 6 Edmond Crescent PMB 2013 Yaba;
2Federal Ministry of Health, Ikoyi-Lagos; 3Prisons Medical Services, Alagbon
Close, Ikoyi-Lagos, Nigeria
Objective: To establish the rates of initial drug resistance tuberculosis in HIV
seropositive and seronegative inmates in Ikoyi and Badagry prisons in Lagos.
Methods: The prospective, controlled study was carried out between January
and December, 1996. 48 HIV positive and 50 negative inmates who were culture
(LJ) positive for Mycobacterium were studied after due consent. The inmates
had no previous history of anti-TB chemotherapy. Strains isolated from these
inmates were tested against major anti-TB drugs (isoniaz (I); streptomycin (S);
pyrazinamide (P); ethambutol (E); thiacetazone (T) and rifampicin (R). Drug susceptibility tests were done by the proportion method and a critical resistance
proportion of 1% was taken for all drugs tested.
Results: Results obtained are reflected in the table below:

The serology result revealed that 69 (9%) of the enrolled inmates were positive
for HIV antibodies. Infections with HIV-1 were most prevalent (92.7%) followed by
HIV-2 (5.8%) while 1.5% were dually reactive to HIV-1 and 2. Amongst the 173
AFB positives, 48 (28%) were also seropositive for HIV.
Conclusions: Data indicated higher TB (23%) and HIV (9%) case rates
amongst the prison inmates than recorded in the general population in Lagos; TB
(7%) and HIV (4%). The 28% level of interaction between HIV and TB was also
significantly higher than in the general population (8%-12%). Urgent programmes
must be put in place to control HIV and TB in these and other prison communities
in the country.
13257 Lack of usefulness of anergy panel and PPD to diagnose
tuberculosis (TB) infection
Ma. de Lourdes Garcia Garcia', J.L. Valdespino Gomez2, C. Garcia Sancho2,
M.E. Mayarmaya2, M. Palacios Martinez2, M. Weissenbachee3, E. Daniels4.
'Avenida Universidad 655 Cuernavca Morelos C.P 62508; 21nstituto Nacional de
Salud Publica Cuernavaca, Mexico; 3PanAmerican Health Organization
Montevideo, Uruguay; 4Department of Health and Human Service Washington
DC, USA
Background: HIV infected individuals have lower reactivity to PPD. Anergy panel
has been recommended to differentiate between absence of reactivity to tuberculin caused by HIV associated immunodeficiency from absence of latent Mtb
infection.
Objective: To evaluate usefulness of anergy panel and PPD to diagnose
tuberculosis infection.
Methods: As part of a tuberculosis chemoprophylaxis study, 1168 clients of four
Mexico City HIV detection centers were screened for HIV-1 antibodies; reactivity
to PPD (Mantoux PPD, RT-23, 5TU), Candida (1:1,000, 0.1 ml), and tetanus
toxoid (10Lf, 0.1 ml); and CD4+ Tcells. Patients were referred to clinical care.
Informed consent was obtained from participants.
Results: Eight hundred one (68.6%) clients were HIV positive. Reactivity to
PPD among HIV positive subjects was found in 174 (22%), 261 (32.6%), and 296
(37%), at PPD cut-off levels of >10 mm, >5 mm, and PPD > 2 mm as compared
to 224 (61%) of 367 HIV negative individuals reactors to PPD (>10 mm) (p <
0.001). After exclusion of anergic individuals using two cut-off levels for cutaneous
allergens (<2 mm and <5 mm), PPD reactivity between HIV positive and HIV
negative continued to be significantly different. Only HIV positive individuals with
CD4+T cells 500 cells/mm3 had similar reactivity to PPD as HIV noninfected
individuals.
Conclusions. Anergy panel was not useful to differentiate between non reactivity due to HIV associated immunodeficiency and absence of latent TB infection.
Tuberculin administration diagnosed TB infection only among HIV infected individuals with CD4+ < 500 cels/mm3.
Partially funded from National Institutes of Health (USA)/Panamerican Health
Organization
609*/13258 The impact of HIV on transmission of tuberculosis
in Ugandan households
David Guwatudde, M.K. Nakeeto, P. Musoke, C. Whalen, G. Bukenya,
A. Okwera, J. Ellner. Makerere University Faculty of Medicine PO Box 7072,
Kampala, Uganda; Case Western Reserve University Cleveland OH, USA
Objective: To examine the effect of HIV infection oil infectiousness of tuberculosis
(TB).
Design: Cross-sectional prevalence study of household contacts to smear
positive TB patients.
Methods: HIV-infected and non-infected index TB cases with sputum smear
positive TB, were enrolled from a major TB clinic at Mulago Hospital in Kampala,
Uganda. All full-time household contacts of the index cases were evaluated by:
medical history & physical examination, Mantoux purified protein derivative (PPD)
skin tests, chest x-ray, BCG vaccination status, HIV test (in consenting subjects),
TB symptoms and demographic and household environment. A contact with signs
and/or symptoms of TB underwent a complete work-up for active TB. The main
outcome measures were PPD positivity and active TB. A PPD skin-test reading
>5 mm was considered positive.
Results: 699 contacts of 170 index TB cases were included in this analysis.
319 (46%) were contacts of 82 HIV+ index TB cases. No significant differences
were noted in the proportion of PPD positivity, between contacts of HIV-infected
and those of the HIV-non-infected index cases [79% versus 79%, P = 0.984]. Risk
factors for PPD-positivity in contacts were: AFB smear grade of the index case
[Odds Ratio (OR) = 1.7; 95% Cl: 1.16-2.37]; cavitary disease in the index case
[OR = 5.9; 95% Cl: 2.53-14.0]; age of the contact [OR = 1.1; 95% Cl: 1.05-1.10];
and household size [OR = 0.9; 95% CI: 0.85-0.96]. Risk factors for active TB in
contacts were: cavitary disease in the index case [OR = 2.0; 95% Cl: 1.07-3.58];
age of the contact [OR = 0.9; 95% Cl: 0.89-0.96]; HIV status of the contact [OR
= 5.9; 95% Cl: 1.69-21.9]; and sharing of bed or bedroom with the index case
[OR = 2.5; 95% C: 1.54-3.92].

Conclusion: Transmission of M. tuberculosis within households was comparable among HIV-infected and non-infected index TB cases. However, transmission
differed depending on: whether the index case had cavitary disease, the sputum
AFB smear, household size and age of the contact. HIV-infected contacts, children
and intimate contacts of the index cases were at increased risk of having active
TB at the time of household evaluation.

S
P
E
T
R
2 or more drugs

Resistance Rates
HIV ve (n = 48) HIV -ve (n = 56)
8(17%) 10(18%)
7(15%) 6(11%)
1 (2%) 0 (0%)
2 (4%) 3 (5%)
5 (9%) 4 (7%)
4 (4%) 2 (4%)
12(25%) 15(27%)

P-value
0.44
0.27
0.46
0.53
0.81

Conclusions: The initial drug resistance rates did not show any significant difference between the seropositive and seronegative inmates. However, resistance
rates for ethambutol and Rifampicin are relatively higher than rates recorded in
general populations in Lagos. This observation calls for regular surveillance of
drug resistance TB amongst prison inmates in the country.
S13256 Pulmonary tuberculosis and HIV infections among prison
inmates in Lagos, Nigeria
Oni Idigbel, T. Sofola2, F. Odiah3, F. Oyewole2, R. Okoye', J. Giwa-amu',
R. Akinosho'. 'Nigerian Institute of Medical Research, 6 Edmond Crescent PMB
2013 Yaba, 2Federal Ministry of Health, Ikoyi-Lagos; 3Prisons Medical Corps,
Alagbon Close, Ikoyi-Lacos, Nigeria
Objectives: To establish the prevalence of pulmonary tuberculosis and HIV
infections amongst inmates of Ikoyi and Badagry Prisons in Lagos, Nigeria.
Methods: Seven hundred and fifty-three of a total of 2013 inmates registered
in both prisons, between January and December, 1996, were randomly selected
and enrolled for the study. Two repeated early morning sputum samples and
a single blood sample were obtained from each inmate studied. The sputum
samples were screened for acid-fast bacilli (AFB) by both microscopy (ZN) and
culture (LJ slopes). Sera from the blood samples were screened and confirmed
for HIV anti-bodies using double ELISA technique.
Results: 173 (23%) of the inmates studied were found positive for AFB by both
microscopy and culture. Of these, 130 (75.0%) were infected with Mycobacterium
tuberculosis while 43 (25.0%) were infected with other strains of mycobacterium.