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

12th World AIDS Conference

Abstracts 22253-22257 313

HIV viral load were determined at baseline, at month 3 and at month 6 after initiation of a highly active antiretroviral therapy including an HIV protease inhibitor.
The Inno-LiPA HCV Kit was used to determine the HCV genotypes. The patients
were treated with 2 nucleoside reverse transcriptase inhibitors plus indinavir, in 7
cases, and ritonavir, in 3 cases.
Results: At baseline, the CD4 cell count was 84 ~ 57/mm3 (mean ~ SEM),
the S-ALT level was 75 ~ 100 IU/I (mean ~ SEM), HIV viral load was 4.26 ~ 0.62
copies/ml (mean ~ SEM) and the HCV RNA level was 4.59 ~ 0.53 copies/ml
(mean ~ SEM). The HCV genotypes were 3a: 4 patients, la: 3 patients, others: 3
patients. Despite a decrease of the HIV viral load of 2.1 log at month 3 and of 1.3
log at month 6, and an increase of the CD4 cell count to 125 ~ 74/mm3 at month
6, no decrease of the HCV RNA level was found. The S-ALT levels remained
stable.
Conclusion: Our results suggest that a marked decrease of the HIV viral load
does not have a significant effect on the replication of HCV during the study
period, whatever the HCV genotypes. As the response to intermittent treatment
with interferon-a among HIV infected patients is limited, new treatment strategies
against HCV infection should be explored.
22253 Cytomegalovirus encephalitis in eight patients with
AIDS: Clinical and laboratory findings
Yann Gerard1, Daouda Sissoko1, L. Bocket2, C. Fontier3, L. Maulin1,
A. Dewilde2, P. Wattre2, Y. Mouton1. 'Department of Infectious Diseases Hopital
Dron-59208 Tourcoing; 2Laboratory of Virologie Lille; 3Unit of Dermatology
Valenciennes, France
Background: to evaluate clinical and biological outcome of patients with AIDS
suspected of CMV encephalitis documented by CMV PCR (polymerase chain
reaction) in the cerebrospinal fluid (CSF).
Methods: every HIV-infected patient hospitalized with clinical signs of encephalitis was enrolled. Current microbiological investigations were performed
including CSF analysis.
Results: CSF CMV PCR was positive in 8/28 patients (6 males, 2 females)
with a median age 39.7 [31-56]. All patients were classified in the C3 CDC stage.
CD4 cell counts were low: mean 23//~1 [3-80]. AIDS-defining events included: mycobacterial infections (3 cases) oesophageal candidiasis (2 cases) CMV retinitis
(3 cases) and cerebral toxoplasma (1 case).
5/8 patients had presented previously a CMV disease (3 cases of retinitis, 1
case of colitis, 1 case of polyradiculonevritis). The average time between the first
CMV event and encephalitis was 9+/2.1 months [3-15 months]. Despite maintenance treatment (3 ganciclovir and 1 foscavir) 4 patients developped encephalitis.
5/7 patients had a positive CMV pp65 antigenaemia (mean 56 positive cells/200
000 [2-130 cells]. Hypoglycorrachia was the most frequent abnormality in the
CSF (4/8). Outcome: 7 deaths occurred within 1.7 months [1 week-10 months]
after the diagnosis. One patient survived: he received a treatment with ganciclovir
and foscavir together with a potent antiretroviral regimen. He was the only patient
with a low plasma HIV viral load (182 copies/ml).
Conclusions: CMV encephalitis has a severe prognosis. CMV PCR in the
CSF must be performed to allow a prompt diagnosis in HIV-infected patients presenting clinical signs of encephalitis. CMV biologic parameters must be carefully
followed-up in patients with a past-history of CMV disease. These cases may also
suggest that an aggressive and early antiviral treatment, combined with a potent
antiretroviral therapy are necessary to hope for a favourable outcome.
S22254 An open trial of intravenous ganciclovir three times or
five times a week as CMV retinitis maintenance therapy
Eduardo Sprinz1, J. Peter1, R. IlgenFritz1, M.W. Jeffman2. 1Federal
University-Hospitals Clinicas. Rua Pedro IVO 163/302 Porto Alegre-RS CEP:
90450-210; 2Hospital Clinicas Porto Alegre Porto Alegre RS, Brazil
Objective: Ganciclovir is the drug of choice as maintenance therapy against
CMV retinitis. The study compares CMV retinitis recurrence using IV ganciclovir
5 times (5x) or, alternatively, 3 times (3x) a week (w).
Patients & Methods: Patients with diagnosis of AIDS-related CMV retinitis,
older than 18 years, were recruited at Hospital de Clinicas de Porto Alegre, an
AIDS reference center from January, 1993 through December, 1995 (after signing
the informed consent) and followed until December, 1996, when combination therapy for HIV became available. A total of 44 patients (19 in arm 1, with 6 mg/kg/d
5x/w, and 25 in arm 2, 12 mg/kg/d 3x/w) were enrolled. Overall, the groups
were comparable. Every patient was examined by an experience ophthalmologist
every 2 months or earlier if new visual complaints. CMV retinitis recurrence has
been established on clinical basis with the appearance of new lesions suggestive
of CMV.
Results:Four patients were excluded (3 in arm 1 and 1 in arm 2) from the analysis (2 did not complete the induction phase and 2 refused to follow maintenance
therapy). The mean time to CMV retinitis recur was 6 months (4 to 8 months,
95% CI) in arm 1, and 9 months (6 to 11 months, 95% CI) in arm 2, with p = 0.06.
The hematologic toxicity was comparable between the 2 groups and none of the

patients had to discontinue ganciclovir.
Conclusions: Although this is an open trial with 40 participants, the results
suggest that ganciclovir 12 mg/kg/d 3x/w, is as effective as the standard 6
mg/kg/d 5x/w for the prevention of CMV retinitis recurrence. Other studies are
encouraged to find out if the proposed studied dosage of ganciclovir is better than
the standard regimen.

19*/22255 The correlation between HIV and hepatitis C
co-infection: A case control study
Margaret Hoffman-Terry, A.K. Gupta, T.E. Wasser. Lehigh Valley Hospital-AAO,
17th & Chew Street Allentown, PA 18105, USA
Objective: To study the correlation between HIV and Hepatitis C co-infection in
a population consisting primarily of intravenous drug users (IDU).
Methods: A retrospective study was conducted examining patients seropositive for HIV both with and without Hepatitis C. Fifty HCV+, HIV+ patients were
carefully matched to 50 HCV-, HIV+ patients according to age, sex, ethnicity
and anti-retroviral regimens. Liver function tests and trends over time in HIV viral
loads and CD4 counts were examined.
Results: AST, ALT, gGT, and alkaline phosphatase were significantly higher
in the HCV+ group. Chi square values were significant at <.001 for the trend of
decreasing CD4 counts and increasing HIV viral loads in the HCV+ group.
Mean HCV+HIV+ HCV-HIV+ p value
AST 126.0 33.3 <0.001
ALT 109.8 37.4 <0.001
gGT 172.0 51.6 <0.001
ALP 116.1 79.1 0.004
CD4 Trends HCV+ HCV p value HIVVL Trends HCV+ HCV- p value
Decreasing 26 9 Decreasing 15 35
Increasing 15 26 <0.001 Increasing 26 10 <0.001
Conclusions: Prior Hepatitis C studies were conducted primarily on hemophiliac patients with mixed results. Our HCV+ patients had higher LFT's with a trend
toward decreasing CD4 counts and increasing HIV viral loads as compared to
HCV- patients, thus supporting the theory that Hepatitis C co-infection impacts
negatively on HIV positive patients.
22256 1 Clinical practice of CMV retinitis treatment with cidofovir
in experienced patients: Results of the German Cidofovir
Study Group
Jurgen Rockstroh1, H. Jager2, K. Schliefer', J. Kolberg3, J. Poppinger2,
E. Laenroth-May3, A. Ulmer3. 1 Dept. of Medicine, University of Bonn,
Sigmund-Freud-Str. 25, 53105 Bonn; 2KIS-Curatorium for Immunedeficiency,
Munich; 3Private Practice, Berlin; Stuutgart, Germany
Objective: To document first experiences with regard to therapeutic outcome and
safety of cidofovir administration in HIV-infected patients who failed or did not
tolerate previous treatment of CMV disease with ganciclovir and/or foscarnet.
Methods: Adult pat. with confirmed HIV infection and CMV retinitis were included into the study and treated with intravenous cidofovir, 5 mg/kg of body
weight once weekly for 2 weeks and then once every other week. To minimize
nephrotoxicity oral probenecid and intravenous hydration was administered with
each set of infusion. Progression of CMV retinitis was assessed by regular ophtalmological controls. Incidence of side effects and mortality were documented.
Results: 33 patients were treated with cidofovir. Mean duration of AIDS before treatment was 24 ~ 20 months and of CMV disease 8 ~ 8 months. Mean
CD4-count at baseline was 50 ~ 63 cells/pl. 19 of 33 patients had received prior
treatment with ganciclovir and foscarnet, 10 of 33 with ganciclovir and 3 of 33 with
foscarnet. Overall, patients received 8 ~ 7 cycles of cidofovir with a maximum
of 27 cycles (treatment still ongoing). Relapse of CMV disease under treatment
was 12%. Termination of treatment due to adverse events occurred in 32% of all
treated patients. The adverse event rate under cidofovir and probenecid was 57%.
The adverse events probably related to cidofovir (32%) were increased creatinine
levels (21%), proteinuria (15%), neutropenia (12%) and iritis (6%). 18% of the
pat. died during follow-up.
Conclusions: The preliminary study results show that treatment of CMV
disease in experienced HIV-infected patients with cidofovir is effective and is
associated with a low relapse rate. However, the rate of adverse events is high
and increases with number of anti-CMV treatments and duration of AIDS.
22257 Low CMV disease progression after initiation of
protease-inhibitors therapy: A long-term follow-up in 30
patients
Christine Chandemerle, Christoihe Michon, H. Moussalatti, M. Saillour,
T. Hanslik, D. Zucman, F. Tremolieres, G. Force. Hopital Louis Mourier, 178 Rue
des Renouillers, 92700 Colombes, France
30 patients (20 men, 10 female) with stable CMV retinitis and naive for HIVprotease-inhibitors (PI) were enrolled in a multicenter observational study of PI
effects on CMV disease progression (monitored on clinical symptoms and regular
fundoscopic assessment in each center). Data were collected every 6 months
during 18 months of follow-up.

The first episode of CMV retinitis had occurred at a median of 6 months (1; 30)
before initiation of PI therapy and the patients had received a mean of 1, 9 (1; 6)
induction therapy.
All patients were on anti-CMV maintenance therapy at the time of PI initiation
(median CD4: 7 cells/mm3, median HIV-RNA: 5, 3 log copies/ml).
20 patients were treated with indinavir and 10 with ritonavir, always in combination with nucleoside(s) analogue(s).