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

282 Abstracts 22101-22105

12th World AIDS Conference

another four 1 mg and two received placebo. Monkeys were bled several times
during the course of immunization and tested for anti TAB9, anti V3 peptides,
the avidity index (Al) of these antibodies measured by KSCN elusion ELISA and
neutralizing antibodies.
Results: The combination TAB9/MISA720 was highly immunogenic in
macaques inducing antibodies against TAB9 and 97% of the V3 peptides included. No differences between doses of 200/zg and 1mg were observed. Neutralizing antibodies against four HIV-1 isolates were detected after the third dose
in most animals. Animals remain healthy throughout the study and did not show
muscular or skin lesions at the inoculation site. Correlation between anti peptide
antibodies and neutralization of LAI and MN isolates was found for LAI but not for
the MN isolate. Al did not correlate with neutralization titers. Affinity maturation of
antibodies directed against TAB9 was evident after the third inoculation in every
serum, while only five sera showed affinity maturation for MN and non for IIIB.
The antibodies were mainly directed against clade B consensus peptide.
Conclusion: The combination of the MEP TAB9 and M-ISA-720 was strongly
immunogenic in macaques and the antibody response was broadly reactive,
neutralizing of HIV-1 laboratory isolates and mainly directed against clade B.
22101 Detection by nPCR of Treponema pallidum DNA in
cerebrospinal fluid from HIV patients with neurological
diseases
Pasquale Noto1, Maria Grazia Paglia2, B.E. Boumis2, F.A. Frigiotti2, D.F.A. de
Felici2, G.P. Guaraseio2, G.A. Giurin2, D.A.E. D'Amato2. 1 Via Leone IV 38
001P2 Rome; 2lrees I Spallanzani, Rome, Italy
Objective: To assess the diagnostic value of nPCR for detection of DNA sequence of Treponema pallidum (Tp) in cerebrospinal fluid (CSF) of HIV1 patients
with neurological diseases.
Study Design: Between January and November 1997, 47 HIV1 infected patients (CD4 < 200/I11) admitted to our hospital with neurological symptoms, were
considered for the inclusion in the study.
Methods: Serological tests for lues were performed either on sera and CSF
samples. nPCR was performed on CSF, based on the DNA sequence of 39-KDa
basic membrane protein from Tp (bmp gene).
Results: In all cases serological tests in the sera and CSF were negative. In
3/47 CSF samples, nPCR was positive for the presence of Tp DNA. In one of
these three patient, after intravenous treatment with penicillin, clinical symptoms
improved and Tp-DNA disappeared from CSF. In another cryptococcal infection
was detected.
Conclusions: nPCR is a rapid and efficient method for detecting DNA genomic
sequences in CSF. It offers the possibility to make diagnosis of T. pallidum infection when other methods fail. In HIV patients at high risk for coinfection with Tp,
the examination of CSF by nPCR may be the only method to prove a symptomatic
or an asymptomatic neurolues.
22102 1 Nosocomial bloodstream infections in HIV+ patients:
Attributable mortality and excess of hospital stay
Mario Tumbarello. Malattie Infettive Universita Cattolica, Largo Gemelli 8, 00168
Rome, Italy
Objectives: To investigate the potential risk factors, prognostic indicators, excess
of hospital stay and attributable mortality of nosocomial bloodstream infections in
HIV+ patients.
Design: A three-years (1994-1996) prospective matched (1:2) case-control
study.
Method: Matching variables were: age, sex, number of circulating CD4+
lymphocytes/mm3, cause of hospital admission, hospitalisation in the same ward
on the six weeks of diagnosis of the case and duration of hospitalisation equal to
the interval from admission to infection in cases (~15%). Risk and prognostic factors of bloodstream infections were analysed by multivariate models. Eighty-four
cases and 168 controls were studied.
Results: Nosocomial bloodstream infections complicated about 3 per 1,000
hospital days-patient in the study period. A total number of 41 variables was
analysed, Univariate analysis identified five risk factors that were significantly (p
< 0.05) associated with nosocomial bloodstream infections: 1) increasing value
of APACHE II score; 2) use of CVC; 3) multiple (>2) previous opportunistic
infections; 4) neutropenia; and 5) previous antibiotic therapy. With step-wise
logistic regression analysis the most important predictors for developing nosocomial bloodstream infections were: increasing value of APACHE II score (p =
0.001) and use of CVC (p = 0.002). The excess of hospital stay attributable to
the nosocomial bloodstream infections was 17 days. The crude mortality rate
was 43%. The attributable mortality rate was estimated to be 27% (95% CI =
13%-48%). The estimated risk ratio for death was 3.91 (95% CI = 2.06-7.44).
Multivariate analysis identified two prognostic indicators that were significantly
associated with unfavourable outcome of bloodstream infections: number of circulating CD4+ cells < 100/mm3 (p = 0.002) and APACHE 11 score > 15 (p =
0.01).

Conclusions: Nosocomial bloodstream infections are more common in patients with advanced HIV disease and cause an excess mortality and significantly
prolong the hospital stay. Important co-factors are high APACHE II score and
use of CVC. It is possible that these infections could be reduced in the future in
light of the newly introduced highly aggressive antiretroviral therapy with protease
inhibitors which determines not only a drop in new AIDS cases but also a drop in
the hospitalisation days.

S22103 Effect of highly aggressive antiretroviral therapy on the
incidence of bacteraemia in HIV+ patients
Evelina Tacconelli. Malattie Infettive Universita Cattolica, Largo, Gemelli 8,
00168 Rome, Italy
Objectives: To compare the incidence and the characteristics of bacteraemia before and during highly aggressive antiretroviral therapy (HAAT) with one protease
inhibitor (PI) and 2 reverse transcriptase inhibitor in HIV+ patients.
Design: As a part of a prospective case-control study on risk factors and
prognostic indicators of bacteraemia started in 1990, we have considered all
hospital admissions of HIV+ patients from 1995 to 1997 at the Dept. of Infectious
Diseases of a large university hospital in Rome, Italy.
Methods: Bacteraemia cases were counted among patients presenting with
the first episode of bacteraemia in the study period. The study compared the
incidence and the characteristics of bacteraemia during two consecutive periods:
1. a first period between January 1995 and August 1996, before the availability of
PI; 2. a second period between September 1996 and December 1997. after the
introduction of PI. Quantitative variables were tested for normal distribution and
compared by means of Student's two tailed t-test. Differences in group proportions were assessed by use of the x2 test or, for small numbers. Fisher's exact
test.
Results: In the study period we observed 135 episodes of bacteraemia out
of 1,375 patients; 106 in the first period and 29 in the second one. The overall
incidence of bacteraemia was 9.8 episodes per 100 persons-year. This incidence
was 10.6 in 1995, 12.3 in 1996 (p = ns) and decreased to 6.3 per 100 persons-year
in 1997 (p < 0.0000 1; OR = 2.70; 95% CI 1.73-4.23). The risk of bacteraemia
comparing the third quarters (Sept. to Dec.) of 1995-1996 was 1.76 (95% CI
0.82-3.79) and 0.35 (95% Cl = 0.10-1.09) in 1997. Comparing the risk factors
and the aetiology of bacteraemia there was no statistically significant difference
among the two study groups. The majority of the episodes occurred in patients
in advanced stage of HIV infection who referred active intravenous drug use;
staphylococci were the most common isolated etiological agents.
Conclusions: HAAT with PI significantly reduces the incidence of bacteraemia
in HIV+ subjects. This result could reflect a consequence of both the immune
system restoration and the reduction of important bacteraemia cofactor (i.e. CVC
use and neutropenia) due to the decrease in AIDS-related events of HAAT-treated
patients.
22104 1 The incidence and risk factors for bacterial pneumonia
among HIV infected persons - United States
John Ward, D. Hanson, M. Dworkin, J.L. Jones. Centers for Disease Control,
1600 Clifton Road, Atlanta, GA, USA
Background: To describe the epidemiology of specified causes of HIV-related
bacterial pneumonia (BP), we assessed incidence, risk factors, and survival for
BP among 31,363 HIV+ persons in 9 US cities.
Methods: From 1/90-7/97, medical records in 95 clinics were reviewed at
6-month intervals. Based on blood/sputum isolate, BP was grouped as S.
pneumoniae (SP-P), S. aureus (SA-P) and gram negative BP-Pseudomonas,
Haemophilus, Klebsiella (GN-P). To identify BP risks, a Poisson regression model
was used controlling for CD4+, AIDS-illnesses (AIDS-OI), demographic factors,
HIV risks, use of pneumovax, trimethoprim/sulfamethoxazole, and anti-retroviral
therapy (ARV). A Kaplan-Meier procedure was used to estimate survival.
Results: During 57,598 person-years (py) of follow-up, 1,665 BP dx were
observed (2.9 per 100 py); 19% were SP-P, 14% SA-P, and 41% GN-P (53%
Pseudomonas). Annual SP-P incidence increased 11%; incidence of SA-P and
GN-P were stable. At dx, median CD4+ was lower for GN-P (16 cells/uL), and
SA-P (29) than SP-P (105) (p < 0.01). Low CD4+ counts (<50 cells), AIDS-OI,
and black race were risks for all causes of BP (p < 0.05). Injecting drug users
(IDU) had an increased risk of SP-P (rate ratio 1.66, 95% CI, 1.3-2.1)) and GN-P
(1.19, 1.0-1.4) and women had risks for SA-P (1.6, 1.1-2.3) and GN-P (1.3,
1.0-1.6). The use of pneumovax (0.85,.66-1.1) and multi-ARV (0.69, 0.47-1.0)
decreased SP-P risks. After dx, the median survival was short for SP-P (10 mos)
but higher than for GN-P (3 mos.) or SA-P (2 mos.). Of 1,082 deaths in BP cases,
27% had pneumonia listed as the cause of death.
Conclusion: BP was a common dx and was associated with severe HIV disease. Programs based on a better understanding of the reasons for the increased
BP risks for blacks, IDU and women, and that provide access to pneumovax and
ARV are needed to decrease BP incidence.
|22105 Morbidity associated with long-term use of
subcutaneous venous reservoirs in patients with AIDS
Judith Torimiro, N.E. Mpoudi, L. Ntsama. B.P 906 Projectpresica Hopital
Militaire, Deyaounde, Yaounde, Cameroon
Objective: To assess the morbidity associated with the long-term use of subcutaneous venous reservoirs (SVR) in patients with AIDS.
Design: Prospective, observational study

Methods: Non-infectious complications were bleeding, occlusion, flow problems, displacement of the chamber, bending of the catheter, and subcutaneous
seroma. Infectious SVR-related complications were chamber infection, pocket
infection, and SVR-related bacteremia. Neutropenia was defined by an absolute
granulocyte count of less than 1000/mm3. CD4 lymphocyte count was considered if performed within 3 months prior to SVR implantation. Contamination was
defined by a consensus between clinicians at charge of the patient and micro