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

12th World AIDS Conference

Abstracts 22115-22119 285

At presentation, he demonstrated MAC clinical response with decreased night
sweats, fevers and weight gain of 4 kg. The patient had been placed on zidovudine, lamivudine and indinavir 6 months previously with CD4 rise from 0 to 274
cells/mm3. The patient underwent an excisional biopsy and the specimen was
submitted for pathologic and microblologic evaluation.
Results: Specimen demonstrated no evidence of malignancy, acid fast bacilli,
pneumocystis or fungi but was noteworthy for microabscesses with prominent
neovascularization and occasional giant cell formation. With Warthin-Starry stain,
bacteria were present in the cytoplasm of mononuclear cells consistent with
Bartonella henselae, the causative agent of BA. The patient was placed on doxycycline 100 mg bid. He developed a persistent mass and draining sinus in the
suture line. After 7 months treatment his neck mass resolved and the draining
sinus healed.
Conclusions: BA developed in the setting of HAART and clarithromycin therapy
of MAC. This case is unusual because of the presentation and the development
of the infection in the setting of clarithromycin. BA should be considered in the
differential diagnosis of lymphadenopathy. Treatment with clarithromycin may not
prophylax/treat B henselae infection.
22115 Helicobacter pylori: A potentially unrecognized health
threat to HIV+ individuals in developing countries?
Carol Palmer1, J.M. Dubon", W.I. Klaskala1, R. Garcia-Bernal', E.R. Garcia1,
M.K. Baum1, A.L. Ager1. 1 University of Miami School of Medicine, Center for
Disease Prevention 1400 NW 10th Ave. Miami, FL, USA; 2Social Security
Hospital San Pedro, Sula, Honduras
Objective: To screen for IgG response to Helicobacter pylori in HIV+ and HIV--
individuals in San Pedro Sula, Honduras and in members of the Miskito Indian
tribe who live in a virgin rainforest area of Nicaragua. We also investigated
possible environmental sources of H. pylori.
Methods: A total of 107 HIV+ (including 17 with AIDS) and 98 HIV adults
were tested in Honduras. Forty Miskito Indians were tested for HIV status and
103 agreed to a rapid finger stick test for H. pylori. Due to the remote location
of this tribe of Indians, no background health care information was available for
selection purposes. Screening for IgG response to H. pylori was completed using
the FlexSure HP rapid IgG test (SmithKline Diagnostics, Palo Alto, CA). This is a
rapid four minute test which can be completed using either a finger stick of whole
blood or 50 /l of serum. Drinking water source and dietary habits were recorded.
Results: None of the 40 serum samples from Miskito Indians were HIV+ and
none of the 103 Indians tested on-site showed an IgG response to H. pylori. Overall seroprevalance to H. pylori in Honduras, regardless of HIV status, was 59%
(121/205). Seventy percent (75/107) of the HIV+ patients from Honduras showed
an IgG response to H. pylo. Within the H IV + group, 94% (16/17) of those with
AIDS were seropositive for H. pylori. In the HIV negative group, 46% (46/98) were
seropositive. There was a significant difference between IgG exposure in HIV +
and HIV - individuals in San Pedro Sula (P - 0.02). Miskito Indians obtained all
drinking water from pristine rainforest streams while San Pedro Sula participants
drank from urban municipal water supplies. Both had a similar diet consisting of
rice, beans, and fish.
Conclusions: Helicobacter pylori may be an unrecognized health threat to HIV
+ patients in developing countries, especially in countries like Honduras, where
they do not receive anti-viral or other antimicrobial drug therapy. None of the
Miskito Indians showed exposure to H. pylori. Municipal drinking water sources
may be a possible explanation for the source of exposure to H. pylori for the
Honduras patients.
2116 Diagnosis and treatment for community-acquired
pneumonia (CAP) among Ugandan adults: Impact of
HIV-infection
Hiroyuki Yoshimine1, K.O. Oishi1, F.M. Mubiru2, H.N. Nalwoga2,
H.T. Takahashi1, R.M. Mugerwa2, T.N. Nagatake2. 1Department of Internal
Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto,
Nagasaki 852, Japan, -Dept of Medicine, Makerere University Kampala, Uganda
Objectives: To determine pathogens and to evaluate the effectiveness of ampicillin therapy for CAP among HIV-infected adults in Uganda.
Design: Prospective study.
Methods: Patients with CAP were enrolled at Mulago Hospital, Makerere University from November 96 to July 97. Quantitative culture and Gram's stain of
sputum, blood culture, serum fiter for were performed. Serum CRP, HIV serostatus (PA and WB), CD4 and 8 cell counts, serum titer for M. pneumoniae and
C. pneumoniae were also determined. Treatment with ampicillin was given for
enrolled patients.
Results: Among 60 patients, 47 (78.3%) were HIV-1+ ve and 13 (21.7%) were
-ve. Causative organisms were determined in 29 (61.7%) in 47 HIV-1+ ve patients
and in 6 (46.1%) in 13 - ve patients, respectively. Major pathogens identified were
S. pneumoniae, H. influenzae, and S. aureus. No significant difference in isolated
pathogens was noted between HIV+ve and -ve patients. No antibody increase for

M. pneumoniae and C. pneumoniae was observed in enrolled patients. Clinical
response rate to antibiotic therapy was 74.5% in total 47 cases (70% in HIV-1+
ve and 100% in -ve). Fair and poor responders were associated with low CD4
cell counts, severe underlying diseases and superinfection after treatment.
Conclusion: HIV-1 infection is seriously affecting the occurrence of CAP among
Ugancrd i adults. Relatively lower effectiveness of ampicillin therapy for patients
with HIV-1 infection and CAP was demonstrated. A careful microbiological di
agnosis and antibiotic therapy for these patients are required in HIV-endemic,
developing countries.
S221171 High prevalence of co-trimoxazole resistant strains in
community acquired bacterial pneumonia in patients with
advanced HIV disease
Evangelo Boumis, P. NOto, P. Guarascio, F. Leoni, E. Girardi, G. De Carli,
C. D'Amato. IRCCS L. Spallanzani, Via Amedeo Bocchi 96 00125 Rome, Italy
Objective: To analyze etiology and to define optimal empiric antibiotic treatment
of community acquired bacterial pneumonia in HIV-positive patients
Setting: a 180-bed hospital for infectious diseases.
Design: Retrospective analysis of charts
Population: All HIV-positive adult patients discharged from the hospital with
a final diagnosis of community acquired bacterial pneumonia, based on current
clinical, microbiological and radiological criteria, from January 1995 to September
1996.
Methods: Clinical, epidemiological and microbiological data were collected.
Patients with nosocomial pneumonia or with tuberculosis, pneumocystosis or
other opportunistic infections were excluded.
Results: 146 patients were included in the study. They were mainly male
IVDU, in advanced stage of disease (84% had CD4 m- 200/mm3; 64.5% had
overt AIDS). 58 (39.7%) of them were taking co-trimoxazole while 19 (13%)
were taking antiretroviral therapy at the time of admission. A total of 89
pathogens from 80 patients were isolated (60%). The most frequent isolates were
P.aeruginosa, S.aureus and H.influenzae from sputum; S.aureus, P.aeruginosa
and S.pneumoniae from blood. As a whole, P.aeruginosa was the most frequently
isolated pathogen (24 isolates, 26%). Of all pathogen isolated, only 31.6% were
co-trimoxazole sensitive, and the use of co-trimoxazole at the time of admission
was strongly associated with isolation of a co-trimoxazole resistant pathogen. Of
the other antibiotics tested, none was active in vitro on all isolates.
Conclusions: Patients with advanced stage HIV disease who are receiving
co-trimoxazole as prophylaxis for P.carinii pneumonia are at higher risk of developing bacterial pneumonia caused by co-trimoxazole resistant strains. Empirical
treatment in these cases should be based on large spectrum antibiotics, with
activity against P.aeruginosa and S.aureus.
22118 Gram negative bacteremia in HIV-infected patients;
microbiology, risk factors and outcomes
Winston Frederick, Penny Sappington, L.C. Alexis, R.A. Delapenha, J.I. McNeil,
W. R.J. Frederick. Howard University Hospital, Suite 5C15 2041 Georgia Avenue
NW, Washington, DC, USA
Objective: To determine the frequency and the etiological agents of gram negative bacteremia among hospitalized HIV infected patients and to assess whether
there has been a recent change in clinical features, risk factors and mortality
associated with this infection.
Methods: We restrospectively reviewed microbiology records from our inner
city teaching hospital to identify patients with gram negative bacteremia over the
period 1/93 through 12/94. We then reviewed the records from the retrovirology
laboratory to determine which patients were HIV positive. A review of the medical
records of all HIV positive patients with gram negative bacteremia was then
undertaken.
Results: Sixteen percent (30/186) of episodes of bacteremia in 26 HIV positive
patients were due to gram negative organisms. Their mean CD4+ count was
107/cu.mm (range 0-525), with 73% having CD4+ counts - 200/cu mm. Eleven
patients were intravenous drug users. Eight patients acquired their bacteremia in
the intensive care unit (ICU). Twenty-four patients had only one episode and 2 patients more than one. Organisms isolated were Acinetobacter Sp. (7), Eschericha
coil (6), Salmonella Sp. (5), Enterobacter cloacae (4), Klebsiella pneumoniae (4),
Pseudomonas aeruginosa (2), Morganella morganii (1) and Haemophilus influenzae (1). Bacteremia was hospital-acquired in 50% of the episodes. Five episodes
of community-acquired bacteremia were caused by unlikely gram negative rods.
Fifty percent of episodes each, developed in the presence of central lines and
neutropenia (< 1000). Five episodes were treated with single antibiotic and 25
episodes with multiple antibiotics (2, 3 or more). The overall mortality rate was
42%; with rates of 75% for ICU patients, 28% for non-ICU patients, 61% for
neutropenic patients and 23% for non-neutropenic patients.
Conclusions: Gram negative bacteremia in HIV positive patients is relatively
uncommon. Gram negative bacteremia was more likely to be hospital acquired
in origin. Neutropenia and invasive procedures were significant risk factors. CD4
count - 200/cu mm was also found to be a significant risk factor. Neutropenia
and ICU admission were significant risk factors for increased mortality.
|22119 |Non-opportunistic bacterial infections in HIV-hospitalized
patients
Carlos Galera1, C.R.S. Redondo1, C.S.F. Serrano2, M.T.S. Sanchez-Polo2,

M.D.R. Rivera2, R.P.L. Perez-Lujan2, G.P.C. Poza2. 7AIDS Unit. Hospital Virgen
Arrixaca, Murcia; 2International Medicine Service H. V Arrixaca, Murcia, Spain
Background: The main characteristic of HIV-infection is susceptibility to opportunistic pathogens (viruses, fungi, mycobacterias and parasites). In recent
reports, conventional bacterial infections are recognized as an important cause
of morbidity and mortality in these patients.