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

292 Abstracts 22149-22153

12th World AIDS Conference

homo-bisexual men, 5 heterosexuals and 2 without known risk factors. Nineteen
pts (76%) had CD4+ cell count less <200 cell/mm3 (range: 1-187), of these 17
showed an atypical CXR; out the remaining 6 (24%) pts with CD4+ cell count
-200 cell/mm3 (range: 235-651) 5 had a typical CXR (p = 0.005). Eight pts have
been treated with AZT and or ddl (median antiretroviral treatment: 7 months); no
correlation was detected between CXR and nucleoside analogue treatment.
Conclusion: This study seems to confirm how the radiological presentation of
TB in HIV-positive pts depends heavily on CD4+ cell count at the time of diagnosis.
No correlation was found with previous or current antiretroviral therapy.
22149 HIV screening in patients with tuberculosis in Rio de
Janeiro, Brazil
Lia Selig1 2, M.T.C. Belo3, A. Trajman3, E.G. Teixeira 3, F. Chiyoshi4,
A.I. Macieira5, M.M. Castello Branco3. Rua Anibal De Mendonca 721202,
Ipanema 22410-050 De Janeiro, RJ; 2SEC. Est. Saude - RJ, U. Gama Filho,
FMT - Feso, Rio De Janeiro, RJ; 3U. Gama Filho, FTE Souza Marques, 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, RJ, Brazil
Background: Prompt recognition of HIV co-infection in patients with tuberculosis
(TB) is of crucial importance, since early treatment can add an average of two
years of life. Thus, anti-HIV testing for all patients with TB is officially recommended in many countries, as suggested by the WHO. We sought to evaluate
the adherence to this policy in the state of Rio de Janeiro, Brazil.
Methods: We reviewed the State Health Department registries of adult (>15
years) TB patients reported from 01/01/96 to 12/31/96. It is noteworthy that all TB
cases must be reported, since the supply of anti-tuberculous drugs requires TB
notification.
Results: A total of 17,356 TB cases were reported, of which 85.2% were
restricted to the lungs. Median age was 37 years (15-99) and 67.7% were male.
HIV testing was not requested in 78% of all TB patients and in 62% of those with
extra-pulmonary TB. Among the latter, HIV testing was not requested in 34% in
miliary and meningeal TB, 41% in lymphadenitis, 76% in pleural TB, and 80%
in genitourinary, bone and ophtalmic TB. For patients aged between 20 and 49
years, HIV testing was not requested in 74% as compared to 88% in other age
groups. Among the minority tested in all forms of TB, HIV positivity was 57%.
Conclusions: There is a low index of suspicion of HIV infection in TB patients
in Rio de Janeiro. Suspicion is higher, although yet very low, in patients aged
20-49 and in some forms of TB: lymphadenitis, meningitis or miliary TB. The high
anti-HIV seropositivity rate observed is probably a bias resulting from the selective
testing of subgroups in which HIV prevalence is higher. Physicians dealing with
TB patients should be stimulated to screen for HIV antibodies.
22150 Clinical presentation of tuberculosis in HIV seropositive
and HIV seronegative individuals in Pune, India
SriKanth Prasad Tripathy', R.S. Paranjape', P.A. Menon1, D.R. Joshi2,
U. Patil3, S.M. Mechendale', D.A. Gadkari1. 1National AIDS Research Institute,
Bhosari, Pune; 2TB & Chest Clinic, Sassoon Hospital, Pune; 3DTO, Sassoon
Hospital, India
Background: In India, tuberculosis is the commonest opportunistic infection in
HIV positive subjects. In some studies in India, it has been reported in over half
of the AIDS cases.
Methods: The clinical profile of tuberculosis was studied in 252 HIV positive
(84% males) in comparison with 500 HIV negative (69% males) tuberculosis
patients at Sassoon General Hospital in Pune, India.
Results: The clinical presentations are summarized below:

Mantoux reaction, Sonography of abdomen, sputum for acid fast bacilli, some
times CSF, CT scan of Brain or chest reraly MRI (Brain) and stool for AFB were carried out. Patients with no active foci were started on 2 drugsd (INH/RMP) chemoprophylaxis. Patients with active Tb were started on 4 drugs (INH/RMP/PZA,
ETB) were for their first episode. Defaulters, patients with CD4 less than 100 and
second episode of Tb. were started on 5 drugs including SM. All regimes were
advised for 1 year.
Observations: Complaince of patients was as follows;(1) 57.5% for 1 year (2) 15% for 6 months (3) 27.5% for 3 months. The main
reason for defaulting are (1) Patients feel better (2) Expensive medicines (3) Drug
toxicity (4) Lack of understanding of Tb. in AIDS. (5) Lack of family support (6)
Lack of community support.
(1) Drug should be made more affordable/free of cost (2) Media should highlight
the gravity of Tb. in AIDS.
22152 Spectrum of HIV infection in tuberculosis (TB)- Urban
and rural experiences of different perspectives, West
Bengal, India
Subir Kumar Dey', N.K.P. Pal2, N.B. Bhattacharjee2, G.P. Pal3. 'P-41/1 Natabar
Pal road, city-Howrah state-west bengal, Pincode-711105; 2School of Tropical
medicine Calcutta WB; 3North Bengal Medical College Sushrutanagar WB, India
Objectives: To compare HIV seropositivity among TB cases by random and selective screening in urban-Calcutta and in a rural belt around Siliguri, surrounded
by Tea gardens & Tourist Resorts 600 KM away from Calcutta in proximity to N.E.
India in West Bengal.
Methods: Sera of all forms of diagnosed TB cases were screened for HIV Ab
by ELISA/SPOT and confirmed by WB. From 1993-96 randomised screening of
TB cases were done at Medical College, Calcutta. Selective screening (history of
high risk behaviour, blood transfusion, retreatment cases) were done at School of
Tropical Medicine, Calcutta from '92-'97. In a Rural North Bengal Medical College,
beside Siliguri, TB cases with history of high risk behaviour only were screened in
'96 & '97. Other tests done -Chest skiagram, MT-PPD1TU, Sputum smear (SS)
for AFB & culture in LJM, Analysis of extra - pulmonary site specimens done as
needed.
Results: In randomised screening - '93-96 (1000 TB cases) sero-prevalence
of 0.7% HIV infection was seen in Calcutta. But in selective screening '92, '93,
'94, '95, '96, '97 (upto Nov.) it was 0%, 0%, 1%, 0.5%, 3.2% & 3.4% respectively
in Calcutta. Around Siliguri it was 8.6% in '96 and 10% in '97. Picture of TB in
HIV+ves is different from Western Reports. In HIV+ve TB cases, MT positivity
(= > 10 mm induration) was 60%, SS+ 50%. In culture, M tuberculosis (human
variety) and Atypical mycobacterium were isolated from 6 & 1 cases respectively.
Conclusion: Selective screening of TB cases with risk factors for HIV infection
is a more fruitful drive in resource limited setting low prevalence zone like Asia,
to bridge the gap between estimated and reported figures and taking appropriate
interventions and divert scarce health resources towards access to anti-retroviral
therapy.
22153 Detection of tuberculosis at the AIDS service
organization, Uganda
Eric Stephen Lugadal, E. Marum2, N. French3, L. Antvelink4, E. Katabira1,
S. Mukasa Monicol, C. Wateral. 1 The AIDS Support Organization, PO Box
12777, Kampala; 2CDC/USAID, Kampala, Uganda; 3Liverpool School of Tropical
Medicine, Liverpool, United Kingdom
Background: In January, 1997, The AIDS Support Organization (TASO) in
Uganda introduced a computerized management information system (MIS) which

Total TB Patients
Pulm TB
Extrapulm TB
Pulm + Extrapulm TB
Pleural effusion
TB Lymphadenitis

HIV +ve
252
119(47%)
102 (41%)
31 (12%)
54(21%)
43 (17%)

HIV ve
500
376 (75%)
85 (17%)
39 (8%)
66 (13%)
27 (5%)

3
1
1.
3

In those with pulmonary involvement, diffuse pulmo
X-ray was seen more often in HIV positive pulmonary tut
HIV negative pulmonary tuberculosis (18.9%) (p < 0.00
with involvement of either upper or mid zones was seer
8.8% of HIV negative pulmonary tuberculosis patients (
Conclusion: Extrapulmonary tuberculosis (pleural eff
was seen more often in HIV positive than in HIV negativ
Pune, India. In those with pulmonary tuberculosis, diffus
and lower zone pulmonary tuberculosis were seen m
than in HIV negative pulmonary tuberculosis patients
22151 Compliance of tuberculosis patients
G.T. Hospital, Mumbai, India
Santosh Jujar', J.K. Maniar2, D.G. Saple2. 124/7, K.G.
Road, Worli, Mumbai-400 018; 2Hon. Prof AIDS Clinic,
Aim: To study the percentage of anti-Tb treatment defaul
Method: Patients attending HIV/AIDS clinic, G.T. Hc
tients were included and investigated for Tb. Investigatio

includes records on all newly registered clients, all counselling sessions, and all
dds Rat value medical visits provided to these clients.
Methods: From MIS, we have compared the rate of detection of TB among
0.3 (0.2-0.41). 0.001 TASO clients between centres. Overall in 1997, 16,402 clients who were either.32.3247) 00051 HIV+ (or had clinical diagnosis of AIDS) were given care at 7 TASO centres in
1.66 0.98-2.81 -0.05.79 (1.18-2.72) -0.01 the eastern and southern region of the country..6 (12.11-6.18). 0.01 Results: TB was detected in 803 (4.9%) of 16,402 TASO clients seen for medical care in 1997; the rate of detection of TB showed marked variation between
)nary infiltration on chest sites. At TASO in Entebbe, 279 of 2,079 clients (13.4%) were detected with TB;
berculosis (30.8%) than in in Kampala, 284/3,298 (8.6%), in Tororo, 169/1829 (9.2%) and in all other sites
5). Lower zone infiltration combined, TB was detected in only 71/9,196 (0.8%). The centres in Entebbe,
i in 19.7% of HIV positive Kampala, & Tororo accounted for 91% of all TB diagnoses, though only 44%
p value <0.005). of TASO clients, and TB was detected in 10% of clients in these centres, more
fusion and lymphadenitis) than 10 times the rate of TB detection in the other 4 centres. In Entebbe, smear
/e tuberculosis patients in positive TB can be found in over 7% of all clients. The variations in rates of TB;e pulmonary tuberculosis detection may be related to the presence of biomedical research projects being
ore often in HIV positive conducted in the Entebbe and Kampala centres; reasons for the higher rates of
TB detection in Tororo and lower rates else where are being explored. Failure
to record referrals for diagnostic work-ups of clients with suspected TB and may
partially explain the low rates, TASO clients may neglect to inform TASO clinicians
in HIV/AIDS clinic of TB treatment received through TB treatment centres.
Conclusions: Tuberculosis is probably under diagnosed among HIV infected
Nagar, Dr E. Moses patients served by TASO; most worryingly smear positive pulmonary cases which. T Hpit, M ai are readily diagnosed and infectious. These findings from the MIS have alerted
TASO management that TASO clinicians, who are representative of clinicians in
ters in HIV/AIDS patients. Uganda generally, need training to pay more attention to the possible diagnosis
)spital, Mumbai 4000 pa- of TB in persons living with AIDS in Uganda, and to the need for careful follow-up
ns included Chest X-Ray, and documentation of these cases.