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

142 Abstracts 13279-13283

12th World AIDS Conference

13279 Tuberculosis associated with infection
Oscar Marcelo Bases', S.M. Oliva', 0. GarciaMessina1, R. CarlevaroRuben1,
G.I.D. Ortega', S. Poggi2, J.A. Benetucci1. ' Vidt 2069 2o0 A 1425, Hospital
Muliz - Ward 17 - Fundai/Foundation, Buenos Aires; 2Hospital Munliz
Microbacterias Lab. Buenos Aires, Argentina
Objective: To analize the characteristics of a group of patients with TB and HIV+
infection.
Method: From 1987 to 1997 out of 2385 patients examinated and followed in
our center, 534 (22.3%) suffered from infection by Mycobacterium tuberculosis
(MT). Out of the 534 patients with TB, 45 (8.4%) were female and 489 (91.6%)
were male, average age 31.6. 371 have already died. 65.9% (352/534) were
IVDU; 54% of patients were between 20 and 29 years of age. This was the first
opportunistic infection in 283 patients.
Results: During the follow up, 78.1% (386/494) had a CD4 cells count below 200/mm3; 67.4% (360/534) had pulmonary involvement, being the bilateral
involvement (70.8%) the most frequent one. In 64 patients (11.9%) the MT of
the blood culture was isolated; 43 (78.1%) of whom had other isolations and
the remained 20 had bacteriemia. The ganglionar involvement was proven in 84
patients whereas the meningeal involvement was found in 35 patients. Out of the
patients with pulmonary pathology, MT was detected in the direct examination of
sputum in 284 cases. The sputum culture was positive in 261 patients. In 108
cases relapse was confirmed, being the pulmonary kind the most common one.
85 of these patients had died, whereas out 206 patients who have not presented
relapse. 90 have died (p < 0.001). Out of the 365 deceased patients, 75.4%
(277/367) did not survival after 12 months. Out of the whole population, 124 fulfill
the criteria for multidrugs resistant TB. When the patients had a meningeal, pleural
or cutaneous involvement together with pulmonary lesions, mortality 100%.
Conclusions: High incidence of TB patients IVDU were the most frequent
ones. Pulmonary pathology was the most frequent clinical form. High prevalence
of positive blood cultures. Mortality increases in patients who have more than one
organ involved. High rates of resistance to multiple drugs. The patient's relapses
was associated to higher mortality.
S13280 Increased IL-10 in the endocervix of women with STDs:
A mechanism for enhanced HIV-1 transmission?
Craig Cohen1, N. Mugo2, F.A. Plummer3, S. Sinei2, R.C. Brunham2.
'Department of Obstetrics and Gynecology, Box 356460 University of
Washington, Seattle, WA 98104, USA; 2University of Nairobi Nairobi, Kenya;
3University of Manitoba Winnipeg, Canada
Background: Non-ulcerative sexually transmitted diseases (STDs) and bacterial
vaginosis (BV) have been implicated as cofactors in heterosexual HIV-1 transmission. Th-1 immune responses have been associated with protection against
HIV-1 infection. We performed this study to assess the effect of genital tract
infection on the Th-1 and Th-2 mechanisms which may be important for HIV-1
acquisition in the female genital tract.
Methods: Women with clinical pelvic inflammatory disease and/or cervicitis
were recruited from an STD clinic in Nairobi, Kenya. Endocervical and endometrial specimens were obtained for N. gonorrhoeae and C. trachomatis DNA
detection, T vaginalis culture, and CD4 and CD8 T-cell enumeration. BV was
diagnosed by Gram stain. Interleukin-10 (IL-10) and interferon- y (IFN-y) were
detected in endocervical specimens using ELISA. Blood was obtained for HIV-1
serology.
Results: One hundred and eighty-three women were recruited; 56 (31%) were
HIV-1 seropositive. N. gonorrhoeae, C. trachomatis, BV, and T vaginalis were detected among 38 (21%), 17 (9%), 71 (39%), and 22 (12%) of women respectively.
Cervical IL-10 was detected more commonly in women with N. gonorrhoeae (51%
vs. 26%, OR = 3.0, 95% Cl 1.3-7.0), C. trachomatis (56% vs. 26%, OR = 3.6, 95%
CI 1.2-11.3), and BV (48% vs. 26%, OR = 2.6, 95% Cl 1.3-5.3) than in women
without these infections. In HIV-1 seropositive women, IL-10 was less frequently
detected than in HIV-1 seronegative women (31% vs. 44%, OR = 0.6, 95% Cl
0.3-1.1). After adjusting for HIV-1 serostatus and endometrial CD4 count, IL-10
was detected significantly more often among those with N. gonorrhoeae (OR =
4.3, 95% CI 1.7-11.0), C. trachomatis (OR = 6.8, 95% CI 1.8-25.9) and bacterial
vaginosis (OR = 3.7, 95% CI 1.6-8.7). IFN- y was detected in only 3 endocervical
specimens.
Conclusion: Non-ulcerative STDs and BV were significantly associated with
increased prevalence of IL-10 detected in endocervical secretions. Since IL-10
inhibits Th-1 activation, these STDs may augment HIV-1 transmission by modulating protective immune mechanisms in the female genital tract.
520*/ 13281 Annual HIV incidence decreased among persons
with sexually transmitted diseases (STD) in Italy
between 1988 and 1994
Barbara Suligoi1, M. Giuliani1, M. Balducci2, N. Galai3. ' COA, Istituto Superiore
di Sanita', V. Le Regina Elena 299, Rome, Italy; 2Hebrew University, Jerusalem,

Israel
Objectives: To provide initial data on the incidence of HIV infection among STD
patients in Italy and to evaluate the possibility of using STD patients as a sentinel
population to monitor the spread of HIV via sexual contact.
Design: Retrospective longitudinal study.
Methods: Study participants included individuals with a newly diagnosed STD
who were tested for HIV at the time of the STD diagnosis and who had a previous

documented HIV-negative test. Patients were reported from January 1991 to
December 1996 by a network of 47 public STD clinics located throughout Italy.
'Seroconverters' were defined as those individuals who tested HIV-positive at the
time of the STD diagnosis. The cumulative and the annual incidence of HIV in
this population were estimated.
Results: A total of 1,950 patients were included, 1,242 males and 708 females;
their median age was 31 years. Injecting drug users (IDU) accounted for 167
individuals; 392 persons were homosexuals. Overall, 47 patients seroconverted,
with a cumulative incidence rate of 1.7 per 100 P-Y (95% Cl 1.3-2.3). The median
follow-up period was 13 months. HIV incidence was higher among males than
among females (2.5 vs. 0.6 per 100 P-Y). The highest incidence rate was found
among homosexual IDUs (15.0 per 100 P-Y, 95% Cl 3.2-38.0), while the lowest
rate was observed among heterosexual non-IDUs (0.4 per 100 P-Y, 95% Cl
0.4-0.8). The trend of the annual incidence showed a progressive decrease from
a maximum of 6.4 per 100 P-Y in 1988 to 1.6 per 100 P-Y in 1994.
Conclusions: Although a four-fold decrease in HIV incidence occurred among
our STD patients between 1988 and 1994, the rate of seroconversion appears to
be alarmingly high in some high-risk groups. These findings suggest that HIV prevention programs have been successful to some extent. However, there is a need
for continuous monitoring of new HIV infections among STD patients, as these
individuals may represent a useful sentinel population for better understanding
the HIV epidemic.
S13282 Risk factors for seroconversion to syphilis: Results from
a case-control study in Mwanza, Tanzania
Heiner Grosskurth', S. Bujac1, K. Munguti2, F. Mosha3, R. Mkanje2, D. Mabey',
R. Hayes1. 1London Sch. of Hygiene and Trop. Medicine Keppel Street London
Wcie 7HT, England; 2AMREF, Mwanza; 3NIMR, Mwanza, Tanzania
Background and Objectives: STDs are a major public health problem in many
developing countries, and are known to enhance the risk of HIV transmission.
Risk factors for HIV infection have been studied frequently, but little is known
about those for other STDs. The population based intervention study in Mwanza
Tanzania offered an opportunity to investigate risk factors for seroconversion to
syphilis.
Methods: In a nested case-control study of 221 TPHA seroconverters and
995 randomly selected controls who remained TPHA sero-negative within the
follow-up period of 2 years, subjects were interviewed using a questionnaire
exploring a variety of factors including sexual attitudes and practices.
Results: On univariate analysis, exposure to various factors during the past
two years was associated with seroconversion to syphilis, in women notably: age
15-19, being single, having moved residence, infertility, stillbirth at last delivery,
partner perceived unfaithful, casual sex during travel and after alcohol, reporting
a genital ulcer; in men: age 20-24, having moved residence, history of injections,
reporting multiple partners, reporting coercive sex, reporting a genital ulcer. Male
circumcision was protective. - On multivariate analysis, casual sex after drinking
alcohol (OR 3.35) and having a partner who was perceived as unfaithful (OR 2.3)
remained significantly associated with seroconversion in women, and a history
of injections (OR 1.9) and reporting coercive sex (OR 2.4) in men. A history of
genital ulcers was significantly associated in both sexes (OR F:3.7 resp. M:2.1)
Conclusions: This study has documented a number of risk factors for syphilis
seroconversion in a rural African population. There are interesting differences in
the risk factor profiles of men and women which require further research. The
association with injections in men may reflect treatment for STDs. Intervention
programmes are required to reduce the risk of STD transmission.
13283 Human papillomavirus (HPV) infection and HIV status in
adolescent girls: The Reaching for Excellence in
Adolescent Care and Health (REACH) project
Sten H. Vermund2, C. Holland3, C.M. Wilson', P. Crowley-Nowick4, L. Levin5,
A.B. Moscicki6. 'University of Alabama; 2Tidwell Hall, Rm 203, 720 South 20th
St., Birmingham, AL; 3Children's National Medical Center, Washington, DC;
4Harvard Medical School, Boston, MA; 5Mt. Sinai Medical Center, New York, NY;
6University of California, San Francisco, CA, USA
Objectives: To examine the association between prevalence of cervical HPV
infection, squamous intra-epithelial lesions (SIL), and HIV status in a population
of adolescent girls who do not inject drugs.
Design: Cross-sectional study nested within a cohort (the REACH Project).
Background and Methods: Recent data suggest that HPV infection and its
sequalae, SIL, occur more commonly among HIV-infected women than non-HIV
infected women because of the CD4+ cell associated immunosuppression. Studies to date have primarily involved adults who most likely have had prolonged HIV
as well as HPV infections because of their longer period of sexual activity. Girls
aged 13-19 years participating in a nationwide US study of HIV infection were
sampled for cytology as well as HPV DNA from cervicovaginal lavages using
polymerase chain reaction (PCR). PCR products were probed using a 'generic'
HPV probe and HPV 6, 11, 42, 44 (low risk types) and 16, 18, 31, 33, 35, 45, 51,

52, 56, 58 (high risk types) probes.
Results: Of the 161 girls tested for HPV, 72% were positive (+). Of the 112 girls
with HIV, 88 (79%) were HPV+ compared to 28 (57%) of the 49 HIV negative (-)
girls (p <.005). and 54% of the HIV+ group had a high risk HPV type infection
compared to 28% of the HIV- group (p <.001). Among the HIV+ group, only
30% with HPV had normal cytology compared to 71% of the HIV- girls with HPV.
Of the HIV+/HPV+ girls, 42% had SIL and 28% had atypical squamous cells of