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

286 Abstracts 22120-22124

12th World AIDS Conference

Methods: A retrospective study was carried out in a University Hospital, from
January 1995 through December 1997, to evaluate the role of non-opportunistic bacterial infections (mycobacterial excluded) in a series of 393 consecutive
HIV-in-patients. A bacterial infection episode was diagnosed if there were signs
and symptoms, in association with the isolation of microorganisms according to
the clinical picture.
Results: 126 out of 393 consecutive HIV-hospitalized patients had one or more
episodes of non-opportunistic bacterial infection (32%). Of these admissions 93
were male and 33 female. 54% were i.v drug users, 23% heterosexual, 21%
homo-bisexual, and 1,6% haemophiliac. According to CDC classification (1987),
80.1% had AIDS or ARC, and 19.9% were in stage II-l11. The mean CD4 cell
count was 124/mm3. In 126 admissions there were 148 episodes of non- opportunistic bacterial infections. The clinical diagnoses were: Respiratory Tract
Infections (35.8%), Sepsis/Bacteremia (26.35%), Gastroenteritis (17.16%) and
Genitourinary Tract Infections (12.16%). 13 episodes were polymicrobial (9%).
163 microorganisms were isolated: 44 Gram + cocci (27%) and 111 Gram -
bacilli (68%): Pseudomonas sp. 28 (17.17%), E.coli 25 (15.3%), Campylobacter
25 (15.3%), Staphylococcus 17 (10.4%) and Strep. pneumoniae 17 (10.4%). The
outcome was good, and only 5 deaths were related.
Conclusion: The prevalence of Non-Opportunistic Bacterial Infections in HIVhospitalized patients is high (32%). These episodes are more frequent in the
advanced stage of the disease (AIDS or ARC). Respiratory Infections and Bacteremia are the most common clinical presentations. Gram- bacilli organism, and
in particular Pseudomona sp, were the most frequent pathogens.
22120 Central venous catheter infections in AIDS patients:
Results of a prospective study
Odile Bouchard1, Annick Bosseray2, P. Leclercq2, D. Barnoud3, M. Micoud2.
1Service Maladies Infectieuses, Chu Michallon, 38043 Grenoble; 2Infectious
Diseases Department, Grenoble; 3Nutrition Department, Grenoble, France
To determine frequency and risk factors associated with central venous catheter
(CVC) infection in AIDS patients, we established a prospective study in a department of infectious diseases: 46 central venous access placed in 36 patients with
AIDS were evaluated between 01 June 1995 and 30 April 1997. CVC related
sepsis was diagnosed if a catheter infection occurred in a bacteriemic patient for
whom cultures of both the catheter and blood yielded the same micro-organism
and there was no source of sepsis other than the catheter itself. For each patient
the following date were collected: age, CVC insertion site, insertion technique,
date of insertion and removal, number of circulating polynuclear, antibiotic history,
number of catheter manipulation, indication for CVC, site of utilisation and outcome. In patient with CVC sepsis, we also analysed the interval between catheter
insertion and the detection of sepsis, the aetiological agents and the outcome.
There were 15 infections (32.5%). Mean catheter life was 95 ~ 46 days. The
catheter related infection rate was 0.34 episodes for 100 catheter days. The
aetiological agents were Staphylococcus epidermidis (n: 7), pseudomonas sp (n:
4), Staphylococcus aureus (n: 3). All bacteria were multiresistant. On univariate
analysis of risk factors, the were not statistically significant difference considering
age, type of device, insertion site, medical experience, utilisation place, indication
for CVC, neutropenia, number of manipulation.
Central venous catheter in AIDS patients were associated with higher rate of
bloodstream infection. Our result show a hight rate of nosocomial micro-organism.
Such a control of practices may help reduce the number of CVC infections.
22121 Neutropenia and bacterial infection in acquired
immunodeficiency syndrome
Lali Sharvadze, T.N. Tsertsvadze, N.T. Gochitashvili, G.K. Kamkamidze,
M.D. Butsashvili. Georgian AIDS & Clin. Immun. Center 16, Al. Kazbegi Av.
Tbilisi 380060, Georgia
Objectives: Our study aims at comparing the occurrence of bacterial infections
in both neutropenic and nonneutropenic groups of AIDS patients.
Design: Retrospective case-control study.
Methods: We compared the incidence of bacterial infection between 18 neutropenic patients (absolute neutrophil count (ANC) 1 x 109/I and 18 nonneutropenic
patients matched for CD4+ lymphocyte count. The incidence of serious infection
was analyzed separately for patients with an ANC of less than 1, and less than
0.5 x 109/1. Bacterial infections were assessed according to the criteria described
below 1. Bacteremia-defined by a recognized bacterial pathogen from one or
more blood cultures. 2. Bacterial pneumonia-defined by recognized bacterial
pathogen from an adequate sputum sample or bronchial lavage. 3. Bacterial
enterocolitis-defined as having either two or more nonformed stools per day and
also having isolation of a bacterial pathogen from a stool or demonstration of a
bacterial antigen and/or toxin by microbiologic assay.
Results: Out of 18 patients with neutropenia the bacterial infections have
occurred in 14 (77.7%) cases, whereas in the group of patients without neutropenia these infections were developed in only 4 (22.2%) cases. There was no
homogenity among neutropenic patients: for those with ANC less than 1.0 x 109/1

(n = 8) the frequency of bacterial infections was 50% (4 cases), whereas in all
10 patients with ANC less than 0.5 x 109/1 the bacterial diseases developed. The
combination of two or more bacterial infections has occurred mostly in patients
with ANC less than 0.5 x 109/i.
Conclusions: Neutropenia is significant risk factor for bacterial infections in
patients with advanced HIV disease, which should be taken into consideration in

patients treatment. The cost-effectiveness of interventions to prevent neutropenia
in advanced HIV disease should be assessed.
22122 1 Legionellosis in the clinic of HIV infection
Tatiana N. Ermak1, I.S. Tartakousky2, A.V. Krauchenko3, V.I. Shahgildian3. 1Bd.
2, 15, 8 Ulsokolinox Gory 105275 Moscow Russia AIDS Center; 2The Gamalea
Inst. of Epidemiol. and Microbiol. Moscow; 3Russia AIDS Center Moscow, Russia
Objective: to determine incidence and clinical manifestations of legionellosis in
HIV-infected patients.
Methods: The sera obtained from 50 patients (LAP-13, ARC -28, AIDS -9) were
screened for presence of antibodies to Legionella pneumophila by IF-reaction.
Results: Antibodies to legionellosis agent were found in 4 pts. (LAP -2, ARC -2)
and etiologic role of L.pneumophila being confirmed in 3 cases (6%). Among clinical sings at the moment of examination were bronchites and interstitial changes
(X-Ray). Dual infection with L.pneumophila and M.pneumonia occurred in one
patient with LAP. Moreover all pts. had high titres of antibodies (G and M) to P.
carinii at the same time. According our dates 87.8% HIV-infected pts. in Russia
are carriers of P. carinii, but clinical manifestations occur very rare.
Conclusion: 8% examined HIV-pts. in Russia have antibodies to
L.pneumophila, and 6% pts. have clinical signs of illness. Along with relatively low
number of HIV-infected pts. in Russia, the share of Legionella-induced pneumonia
among these pts. is significant.
22123 1Bacillary angiomatosis of the conjunctiva
Ely E.M. Cortes1, V. Saraceni2, D. Medeiros3, I.T.P. Ribeiro3, W.L. Oliveira3,
J.C.R. Verdeal3. 1 Rua Mario Portela 161/C/804, Rio de Janeiro, RJ, 22241-000;
2Hospital Rocha Maia, Rio de Janeiro, RJ; 3Hospital Da Lagoa, Rio de Janeiro,
RJ, Brazil
Objectives: To present a case of mixed lesions of Kaposi's Sarcoma (KS) and
Bacillary Angiomatosis (BA). A patient with diagnosis of AIDS since 1990, that
had already undergone radiotherapy and chemotherapy, presented with a redish
nodule in the conjunctiva, along with many similar cutaneous lesions, mixed with
the ones from KS.
Methods: Biopsy of the cutaneous lesion was done, with staining that included
Whartin-Starry.(Photos will be presented).
Results: The lesion had a polypoid aspect on routine staining, with capillary proliferation and epidermal colarette. Brownish granulations were positive to
modified silver stain. Immunohistochemistry studies confirmed the presence of
Bartonella quintana. Patient was started on erithromycin, 2 grams per day for 4
weeks, and after, 1 gram per day for more 4 weeks, with a good response. The
lesion in the conjunctiva disappeared during the course of erithromycin.
Conclusions: KS and BA can coexist in one HIV+ patient. The biopsy is often
necessary when a lesion do not respond to KS therapy or present as redish
nodules. To our knowledge this is the second case of BA of the conjunctiva
related to HIV, making it relevant to presentation.
451*/22124 Isoniazid prophylaxis for tuberculosis in HIV
infection: A meta-analysis of randomized
controlled trials
Heiner C. Bucher1, M. Naef2, L.D. Griffith3, P. Sudre4, M. Battegay2.
1Medizinische Universitaets-Polklinik Kantonsspital Basel, CH-4031
Basel/Schweiz; 2 Med. Univ. Poliklinik Kantonsspital, CH 4031 Basel; 4Div.
Maladies Inf. Hopital Cant. Univers., CH 1211 Geneve 14, Switzerland; 3D. Clin
Epi + Biostat. McMaster University, Hamilton Ontario, L8N 3Z5, Canada
Objectives: To evaluate the efficacy of isoniazid for the prevention of tuberculosis
in tuberculin skin test positive (TST+) and negative (TST-) individuals with HIV
infection.
Setting: Meta-analysis of randomized controlled trials comparing isoniazid (300
mg per day) with placebo or no prophylaxis.
Methods: We systematically searched the medical literature from 1981 to October 1997 for randomized controlled trials on isoniazid prophylaxis in HIV infection.
Trials were screened in duplicate for relevance and validity and combined using
a random effect model. We conducted separate analyses in trials reporting data
on TST+ and TST- subjects.
Results: Six randomized controlled trials were identified and included into this
analysis that comprised 2015 subjects in the intervention and 1812 subjects in
the control groups. Mean follow-up of trials varied between 0.4 and 3.2 years.
For isoniazid the risk ratio for tuberculosis (n = 6 trials) was 0.58 (95% Cl 0.39 to
0.87) and for death 0.96 (0.83 to 1.11). In TST+ subjects treated with isoniazid (n
= 4 trials) the risk ratio for tuberculosis was 0.41 (0.24 to 0.71) and for death 0.68
(0.48 to 0.97). In TST- subjects treated with isoniazid (n = 4 trials) the risk ratio
for tuberculosis was 0.84 (0.52 to 1.38) and for death 1.05 (0.90 to 1.23). For all
summary estimates the test of heterogeneity was statistically not significant (P
values >0.20).

Conclusion: Prophylaxis with isoniazid reduces the risk of tuberculosis in
TST+ subjects with HIV infection. The impact of isoniazid prophylaxis on mortality
should be further investigated.