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

290 Abstracts 22140-22143

12th World AIDS Conference

culture, 8.9% (11); sputm smear, 16.9% (21). The tuberculin skin test (PPD 5UT)
had a reaction size >10 mm in 16.1 (20), 5-10 mm in 2.4% (3); <5 mm in
20.2% (25) and it was not performed in 61.3% (76). The clinical presentation of
these patients were: Pulmonary, 53.2% (66); Peripheral Lymphnodes, 17.7% (22);
Disseminated, 12.9% (16); Gastrointestinal Tract, 0.8% (1); Geniturinary Tract,
0.8% (1); Cutaneous 0.8% (1); Pleural, 1.6% (2); Others, 5.6% (7); Not Related,
3.2% (4); Pulmonary and Lymphnodes, 1.6% (2); Pulmonary and Pleural, 0.8%
(1); Lymphonodes and Gastrointestinal, 0.8% (1). As for the evolution after the
diagnosis was established, the following data was found: cure, 37.1% (46 cases);
death, 21% (26); loss of follow up, 41.9% (52).
Conclusions: 37.9% of TB cases were diagnosed clinically, which shows the
low sensibility of the diagnostic methods used. Another alarming findings is the
high rate of treatment dicontinuation, 41.9% (52). The rate of non-complaiance
with treatment for TB was very high, especially if we consider that these patients
were being followed at a well stablished specialty clinic, with all drugs (including
antiretrovirals)being provided free of charge.
454*/22140 Ethambutol (EMB) in the continuation phase of
tuberculosis (TB) treatment in HIV-1 infected
Ugandan adults
Alphonse Okwera', J.L. Johnson2, P. Nsubuga1, C. Whalen2, D.L. Cohn3,
R. Mugerwa1, J. Ellner2. 1Makerere University PO Box 663 Kampala, Uganda;
2Case Western Reserve University Cleveland, OH; 3 World Health Organisation,
USA
Objective: To evaluate the safety, efficacy & tolerance of EMB during continuation
phase given as modified directly observed treatment (DOT) thrice-weekly to HIVinfected adults with initial episode of smear positive culture-confirmed pulmonary
TB.
Design: Prospective cohort treatment trial with comparison to a historical control group treated at the same clinic at the Uganda National TB and Leprosy
Program (NTLP) in Kampala, Uganda.
Methods: Between April 1995 and March 1996, 19-50 year old patients with
suspected pulmonary TB underwent medical examinations, chest radiography,
sputum smear and culture for Mycobacterium tuberculosis, and HIV testing.
Ethambutol, isoniazid (INH), pyrazinamide and rifampicin (RIF) were administered daily, followed by EMB and INH given three times a week (2EHRZ/6H3E3),
as directly observed treatment (DOT) for six months by a health visitor. Patients
were followed for 24 months after completion of therapy. Treatment outcomes
were compared to historical control group treated in the same clinic.
Results: Of 385 patients screened, 136 with culture- confirmed TB were enrolled. Eleven were excluded with drug resistance; 12 patients died and four failed
after 5-7 months (7.4%). 95% of patients became culture-negative after 2 months;
there were no adverse events to EMB. Fifteen patients relapsed after 3-15 months
(14.0 per 100 person-years), 14 of whom had drug-susceptible tuberculosis.
Conclusions: Treatment with 2EHR//6H3E3 is safe and the relapse rate is
comparable to standard thiacetazone containing regimen in HIV-infected patients
with RIF-containing regimen.
221412 Risk factors for tuberculosis among HIV-infected
individuals in Belo Horizonte, Brazil: A 'case-control
study, 1986-1995
Antonio C. Toledo, D.B. Greco, C.M.F. Antunes. Rua Mario Coutinho, 156/304
Belo Horizonte, MG, Zip 30570-310, University Federal de Minas Gerais Belo
Horizonte MG, Brazil
Objectives: To identify risk factors and surrogates for tuberculosis (TB) in HIVinfected individuals.
Design: A case-control study.
Methods: This study was carried out at the HIV Outpatient Clinic of the Universidade Federal de Minas Gerais. 477 HIV-infected individuals, 135 cases and 342
controls, evaluated from 1985 to 1996, had their demographic, social-economical
and medical data reviewed. Cases were defined as HIV-infected patients with
clinical or laboratory TB diagnosis one year before HIV infection diagnosis or after
it. And controls were HIV-infected patients without TB diagnosis after 15 years of
age. The variables were submitted to an univariate and stratified analysis. The
possible effect modifiers and confounding variables were submitted to logistic
regression analysis by the stepwise method.
Results: Symptoms related to HIV infection, but not yet defining AIDS (AIDS
related complex - ARC) had an OR of 3.5 (CI 95% -1.2-10.8) for tuberculosis
development. Past history of pneumonia (OR 1.7-CI 95% 0.6-5.2) and CD4
count (OR 0.4 - CI 0.2-1.2) did not have statistical significance. Others important
variables as PPD reactivity or delayed skin tests anergy were not statistical significant and were not included in the final model. The results shows that ARC is
an important clinical surrogate for tuberculosis in HIV-infected persons.
Discussion: These results suggest that, considering that isoniazid is protective against tuberculosis, the timing of starting TB chemoprophylaxis should be
rediscussed. With the known interaction between isoniazid and many of the new

antiretrovirals, the ideal moment for its prescription should be much earlier than
previously thought, either immediately after HIV diagnosis in some individuals or
before starting antiretroviral drugs.

S22142 Clinical aspects of tuberculosis in adult AIDS patients in
Rio de Janeiro, Brazil
Lia Selig1, A. Trajman2, E.G. Teixeira3, M.T.C. Belo3, F. Chiyoshi4,
R.M. Guedes5, M.M. Castello Branco2. 1S.E.S.-RJ, Fac. Med. Teresopolis, U.
Gama Filho, Rua Anibal de Mendonga 721202, Ipanema 22410-050, Rio de
Janeiro, RJ; 2U. Gama Filho, FTE Souza Marquez, FAPERJ, Rio de Janeiro, RJ;
3U. Gama Filho, FTE Souza Marquez, SMS-RJ, Rio de Janeiro, RJ;
4Coppe-Univ. Federal do Rio de Janeiro, Rio de Janeiro, RJ; 5Secretaria de
Estado de Saude-RJ, Rio de Janeiro, JR, Brazil
Background: Primary forms of tuberculosis (TB), which are usual in childhood,
are reported to be frequent manifestations of the disease in adult AIDS patients.
We describe the clinical features of TB in adult patients with AIDS in the state of
Rio de Janeiro, Brazil, where the prevalence of both infections is very high.
Methods: We reviewed the State Health Department registry of adult (>15
years) TB patients reported from 01/01/96 to 12/31/96, and matched them with
patients in the AIDS case registry.
Results: Among 17,356 TB cases reported, 1534 (8.8%) were also found in the
AIDS data base. Their median age was 35 years (15-74) and 1204 (78.5%) were
male. Entry in the TB registry occurred prior in the entry to AIDS registry in 822
patients (53.6%). All but one entry in the AIDS registry occurred in 1995/1996. TB
was restricted to the lungs in 905 patients (60.7%) as opposed to 83.2% among
patients without AIDS in the TB registry. Extra-pulmonary TB was observed in 421
patients (28.2%). TB involved lungs and extra-pulmonary sites simultaneously
in another 165 patients (11.1%). Lymph node, pleural and miliary TB were the
extra-pulmonary forms most frequently observed (38%, 14.8% and 10.1% of the
patients with extra-pulmonary TB respectively, as compared to 19.3%, 47.3% and
5% in non-AIDS patients). There was no significant difference regarding the site
of the disease between males and females or among AIDS patients with different
exposure factors. Other opportunistic infections included oral thrush in 64.5%,
PCP in 19.7%, CNS toxoplasmosis in 10.4%, HZV infection in 10.1%, MAC
infection in 6.5%, HSV infection in 5.3%, CMV infection in 5% and cryptococcosis
in 2.2%.
Conclusions: Pulmonary TB is the most frequent form of the disease in AIDS
patients in Rio de Janeiro, although less frequent than in immunocompetent
subjects. This may be a consequence of TB emergence early in the course of
AIDS in developing countries. On the other hand, primary forms have a distinct
distribution: while pleural TB is more frequent in the immunocompetent population, lymph nodes are more commonly involved in AIDS patients. The route of
HIV transmission and gender do not modify the clinical patterns of TB.
22143 Potential source of Mycobacterium bovis infection and
risk of exposition among West African people where HIV
infection is prevalent
Philippe Van De Perre1, Serge Diagbouga1, M. Vekemans4, M. Cartoux1,
M. Dembele2, Kone3, A. Delafosse1, A. Dera1. Centre Muraz,BP 153
Bobo-Dioulasso; 2CRLAT, Bobo Dioulasso; 3Direction Elevage Houet, Bobo
Dioulasso, Burkina Faso; 4Universite Libre, Bruxelles, Belgium
Background: Severe cases of tuberculosis due to M. bovis have been described
among HIV infected patients. In the developing world, there is a potential source of
bovine tuberculosis in the cattle, that could have serious public health implications
in the light of the current HIV/AIDS epidemic in these areas. We examinated the
potential source of M. bovis infection and risk of exposition among west African
people.
Methods: A tuberculin survey was organized among 174 cattle living around
Bobo-Dioulasso, Burkina Faso. In addition, direct microscopic examination of
smears followed by culture on Loewenstein Jensen medium without glycerin or
supplemented with sodium pyruvate were performed on 100 milk samples and 48
carcass selected for macroscopic suspicion of TB after veterinary inspection at the
slaughterhouse of Bobo-Dioulasso. Finally, 1170 clinical records of tuberculous
patients from the CRLAT, Bobo-Dioulasso were retrospectively carefully examinated. Frequency of pulmonary and extrapulmonary tuberculosis was analyzed
according to ethnic group and occupational criteria.
Results: 13% of cattle were tuberculin DTH positive. 16% of milk sample presented a positive culture for M. bovis (14 cases), and tuberculosis (2 cases). In
the slaughterhouse, pulmonary and mammary lesions represented respectively
31% and 11% of M. bovis positive cases. 42% (20/48) of carcass presented a
positive culture for M. bovis (18 cases), tuberculosis (1 case) and africanum (1
case). Among the 1170 tuberculous patients, 12% of them were of Peul origin.
Peuls represent 5.2% of the general population. Pulmonary tuberculosis was
more frequently found in Peul (93%) than in the other ethnic groups (77%) (p <
0.001).
Conclusion: This study identified a source of M. bovis infection and risk
of exposition in Burkina Faso. Further studies are in process to prospectively
determine its prevalence associated with HIV infection in the country. A better
understanding of the epidemiology of M. bovis disease could lead to the design
and adoption of area-specific public health measures.