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

140 Abstracts 13269-13273

12th World AIDS Conference

individuals were significantly under-represented in the TB/AIDS group compared
to the TB/non-AIDS group. Among AIDS/TB cases, there were a significantly
higher proportion of Injecting Drug Users (IDU) and a lower proportion of men
who have sex with men (MSM) compared to the non-TB group, whereas in the
UK the AIDS/TB had a significantly higher percent of heterosexual cases and a
lower proportion of MSM
Conclusions: In both countries, the risk of TB is high among HIV-seropositive
individuals, but the demographic picture of TB/AIDS in the US is strongly affected
by the higher risk of both diseases in the indigenous Black population. In the UK,
HIV is much less prevalent than in the US, and the largest indigenous minority
(Indian subcontinent descent), have a high risk of TB but a low risk of HIV. The
UK TB/AIDS picture is more strongly affected by immigration from countries with
a high risk of both diseases, where heterosexual exposure is important.
13269 Epidemiology of extrapulmonary tuberculosis among HIV
positive persons in the US, 1993-1996
Mary Reichler, S. Valway, E. McCray, I. Onorato. 1600 Clifton Rd. N.E. MS E-10
Centers for Disease Control and Prevention/N CHSTP/DTBE Atlanta Georgia,
USA
Objectives: To characterize cases of extrapulmonary (EP) tuberculosis (TB) reported among HIV positive (HIV+) persons in the US, and compare them with
HIV negative (HIV-) EP cases.
Methods: All cases of EP TB reported to the national surveillance system from
1993-1996 were analyzed.
Results: Of 22,441 cases reported, HIV test results were available for 7,613
(34%). Among these, 3,676 (48%) were HIV(+) and 3,937 (52%) were HIV(-).
Of those with HIV test results, 1,649 (37%) of 4,428 with EP TB only and 2,027
(64%) of 3,185 with both pulmonary and extrapulmonary TB (PEPTB) were HIV(+).
Among HIV(+) cases, the most frequent disease sites were lymph nodes (47%),
pleura (13%), miliary (11%), meninges (8%), and bone or joint (6%). Compared
with HIV(-) cases, HIV(+) cases were more likely to have PEPTB (55% vs. 29%),
miliary disease (11% vs. 6%), or meningeal disease (8% vs. 5%)(p <.0001 for all
comparisons). More HIV(+) cases were <45 years of age (80% vs. 58%), of male
sex (80% vs. 55%), of Black race (61% vs. 45%), dead at the time of diagnosis
(9% vs. 2%), and died before completing therapy (36% vs. 8%). HIV(+) cases
were more likely to have M. tuberculosis (MTB) isolates resistant to isoniazid
(11% vs. 7%), rifampin (8% vs. 2%), and isoniazid and rifampin (6% vs. 1%),
and to have a positive culture for MTB from an EP site (86% vs. 68%). Fewer
HIV(+) cases were of Asian race (1% vs. 18%), foreign-born (18% vs. 36%), had
a positive tuberculin skin test (52% vs. 82%), and had pleural disease (13% vs.
28%)(p <.0001 for all comparisons).
Conclusions: The clinical and epidemiologic features of HIV(+) EP TB cases
differ from those of HIV(-) EP TB cases. These data underscore the importance
of determining the HIV status of all persons with TB disease, particularly those
with PEPTB, and emphasize the need to consider epidemiologic differences in
the diagnosis and evaluation of EP TB in the US.
13270 Tuberculosis screening and management in HIV-specialty
care in Ontario, Canada
Peggy Millson1, A. Rachlis2. 1Hood, Room G314, 2075 Bayview Ave, Toronto,
Ontario; 2Director, HIV Program, Sunnybrook HSC, Toronto, ON, Canada
Background: HIV-infected persons are at increased risk for both new tuberculosis
infections and reactivation of previous infection. In Canada, tuberculosis screening, diagnosis, prophylaxis, and treatment are all publically funded and widely
available. An analysis of demographic and clinical information collected within the
HIV Ontario Observational Database (HOOD) was undertaken to determine use
of tuberculosis screening, prophylaxis, and treatment among enrollees.
Methods: Gender, age, race, country of birth, year of HIV diagnosis, and mode
of HIV infection wer compared for persons who did and did not have a recorded TB
skin test result, using chi-square. Frequency of recorded prophylaxis or treatment
was determined for those with a positive TB skin test, and their demographic and
clinical status was compared to those with a negative test.
Results: Of 2001 persons enrolled in HIV care clinics at the time of initial
analysis, 50% had a recorded TB skin test, with 7.4% of these being positive.
Of those tested, 21% also had a recorded anergy test. Screened persons did
not differ from those with no recorded screening with respect to race, education,
risk factor for HIV, or being born outside Canada, but were more likely to be
female (p = 0.004) and to be more recently diagnosed (p < 0.01). Test positives
were more likely to be foreign-born (p < 0.00001), but did not differ from test
negatives by gender or HIV risk (including IDU). Sixty-four percent of those testing
positive have documented prophylaxis or treatment for TB; 40% of positives have
a recorded TB diagnosis, of whom 90% have documented treatment.
Conclusions: HIV-positive patients in specialty clinics in Ontario appear to
have a low level of documented TB screening, and prophylaxis of those who are
eligible appears to be incomplete. Some of these aspects of care may be being
carried out by family physicians, but this is not recorded. Additional studies are

needed to verify these findings and to determine why they occur in a situation
where cost and availability are not barriers to access.

13271 HIV-1 RNA plasma viral load and CD4 counts before and
after anti-tuberculosis therapy in HIV-infected
tuberculosis patients in Abidjan, C6te d'lvoire
Madeleine Sassan-Morokro1, J. Nkengasong2, L. Abouya2, A. Ackah2,
A. Akaki2, R. Lobognon2, O. Tossou2, C. Maurice2, D. Coulibaly3,
I.M. Coulibaly3, T.H. Roels4, A.E. Greenberg4, S.Z. Wiktor4. 101 BP 1712,
Abidjan 01; 2Projet Retro-CI, Abidjan; 3National AIDS/STD/TB Control Program,
Abidjan, Cote d'lvoire; 4Centers for Disease Control and Prevention, Atlanta,
USA
Objectives: To compare HIV-1 RNA plasma viral load and CD4 counts in HIVinfected tuberculosis (TB) patients at onset and one year after initiation of anti-TB
therapy.
Methods: As part of an ongoing cotrimoxazole prophylaxis trial in HIV-infected
patients with pulmonary TB, plasma specimens obtained at onset and 12 months
after the start of anti-TB treatment were selected from 10 HIV-1 and 10 HIV-1/2
dually reactive (HIV-D) patients with newly diagnosed, sputum-culture confirmed
(Bactec media) M. tuberculosis pulmonary infection. Plasma HIV-1 RNA viral load
was quantified by the modified HIV-1 Amplicor Monitor assay (Roche Diagnostics)
and CD4 lymphocytes were enumerated by standard flow cytometry. All patients
received a standard regimen of 2 months Rifampin Isoniazid and Pyrazinamid,
followed by 4 months of Rifampin and Isoniazid.
Results: The mean age of the 20 patients was 38 years (range 21-57); 70%
were mate. All but one patient were sputum-culture negative at 9 months of
follow-up. No significant differences were found in the mean loglo HIV-1 RNA
viral load and CD4 count between HIV-1 and HIV-D seropositive patients. At
the start of anti-TB therapy, the 20 patients had a mean loglo HIV-1 RNA viral
load of 4.80 logio copies/mi (range 3.34-6.30) and a mean CD4 count of 399
cells//l (range 94-786). Twelve months later, the mean loglo HIV-1 viral load had
increased to 5.26 copies/ml (range 4.07-6.70; p = 0.01) and the mean CD4 count
had decreased to 362 cells//l (range: 31-801; p = 0.1). Interestingly, the one
patient who had the greatest increase in viral load (1.75 logio) had failed anti-TB
therapy and had a persistently positive M. tuberculosis culture at 9 months.
Conclusions: In this population of HIV-Infected TB patients, HIV-1 viral load
increased significantly between onset of anti-TB therapy and 12 months later
despite successful completion of anti-TB therapy.
13272ý HIV seropositivity among patients with tuberculosis in
the City of Rio de Janeiro
Guida Silva1, D. Barreiral, E.C.C. Soares1, S.M.O. Dias', A. Saavedra2
'Health Secretariat of the City of Rio De Janeiro, rua Casuarina, Humaita, Rio
De Janeiro; 2Central Laboratory Noel Nutels, Rio De Janeiro, RJ, Brazil
Objective: To study the prevalence of HIV seropositivity among tuberculous
patients treated in the Health Centers of the City of Rio de Janeiro.
Methodology: 460 patients with pulmonary and extrapulmonary tuberculosis
with more than 14 years old, both sex, initiating treatment for tuberculosis (TB) in
18 Health Centers of the City from July to December of 1996 were submitted to
a fast test (kit HIVSAV"') to detect HIV antibodies in serum, after written consent,
in the moment of TB diagnosis.
Results: The overall HIV seropositivity among these patients was 11.2%, and
in some areas it reached 30%. From the initial sample (460), 414 had pulmonary
TB. From these 287 (69.3%) were men and 127 (30.7%) women. From men, 33
(11.4%) were HIV positive and from women 10 (7.91%). From the 46 extrapulmonary cases, 24 (52.2%) were men and 22 (47.8%) women. Among men there
were 5 positive (20.9%), and among women 3 (13.6%). The seropositivity for
extrapulmonary cases were 17.4%.
Conclusion: In the City of Rio de Janeiro the association TB/HIV/AIDS is
very strong. It results primary of the high incidence of both diseases in the City
(incidence rates of 146 cases/100,000 inhab. for TB and 20 cases/100,000 inhab.
for AIDS). For each 10 patients with TB diagnosis, 1 is HIV+/AIDS. In some
areas this association is even stronger (up to 30%) justifying, for these areas,
HIV routine testing for all TB patients.
610*/13273 Trends of HIV-1 infection among pulmonary
tuberculous adults, 1993-1997, Kampala, Uganda
Alphonse Okwera1, H. Luzze1, P. Nsubuga1, J.L. Johnson2, C. Whalen2,
R. Mugerwa1, J. Ellner2. 1Makerere University PO Box 663 Kampala, Uganda;
2Case Western Reserve University Cleveland, OH, USA
Objective: To evaluate the HIV-1 seroprevalence among Ugandan adults with
Pulmonary Tuberculosis (PTB) for the period 1993-1997.
Methods: Ugandan adults aged 18-60 years, with suspected new onset of PTB
were enrolled in a series of clinical studies of HIV-associated TB at the National TB
Treatment Centre, Kampala. The screening procedures for these studies were
identical and included history and physical examinations, chest x-ray, sputum
smear and culture for M. tuberculosis, skin test with purified protein derivative
(PPD) and HIV testing after obtaining informed consent. Patients with Karnofsky

performance score <50%, pregnant women and clinical AIDS were excluded from
the studies. All patients with confirmed PTB were treated with standard two-month
regimen of ethambutol (E), isoniazid (H), pyrazinamide (Z), and rifampicin (R)
followed by four months of isoniazid and rifampicin (2EHRZ/4HR) given daily.
They were followed every month at the clinic during the study to determine study
endpoints. HIV-1 seroprevalence rates were calculated.