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

314 Abstracts 22258-22262

12th World AIDS Conference

JO M6 M12 M18
CD4 median/mm3 7 [0; 160] 72 [2; 424] 190 [2; 531] 265 [6; 1299]
Patients with ARN < 103 (%) 0 58.3 63.6 77
16 patients experienced at least one episode of CMV relapses (five of them
died), 2 patients died before any progression of CMV disease, 12 patients are
still alive without any relapse.
The rate of CMV relapse per 6 months of follow-up was 17/30 (56.6%), 4/26
(15.3%) and 4/23 (17.4%) respectively for the 3 consecutive periods of the study.
11 patients stopped CMV maintenance therapy.
Conclusion: Rate of CMV recurrence dramatically decreased 6 months after
the initiation of PI and remained low at 18 months.
22258 Risk of CMV disease in the era of protease inhibitors
E. Martinez, J. Mallolas, J.M. Miro, A. Guelar, F. Garcia, J.M. Gatell. Hospital
Clinic, Barcelona, Spain
Objective: To determine the risk of CMV disease in a cohort of 120 adult HIV-1
infected individuals seropositive for CMV with less than 50 CD4 cells/tpl, who
started antiretroviral therapy including a protease inhibitor.
Methods: Antiretroviral regimen included a protease inhibitor (saquinavir, ritonavir, or indinavir) and 1 or 2 nucleoside reverse transcriptase inhibitor (NRTI).
Patients had been previously treated with NRTIs, but were protease inhibitornaive. Patients were evaluated at baseline, and at least at 1 month, at 3 months
and every 3 months thereafter. At each medical visit, clinical assessment and
physical examination were done. Also, measurement of concentration of white
and red blood cells as well as CD4+ cells and plasma HIV-1 RNA was performed.
No routine funduscopy was done. The primary endpoint was the development of
CMV disease (funduscopic appearance in retinitis or histological in other cases).
Results: There were 10 cases of CMV disease after a median follow-up of
67 weeks (range: 7-105). Episodes of CMV disease concentrated at the begining of the follow-up (mean+/-SD = 14+/-9 weeks, median 9.5 weeks, range =
7-30). Seventy percent of the episodes developed between weeks 7 and 12. The
immunological and virological response at month 1 of those patients who developed CMV disease (CD4 response, mean+/-SD, 2+/-11 cells//LL) (virological
response, mean+/-SD, 0.16+/-0.4) was smaller than that of those who did not
developed CMV disease (CD4 response, mean+/-SD, 31+/-39 cells/iLL) (p =
0.03) (virological response, mean+/-SD, -1.2+/-0.8) (p = 0.0001). Nine of the
ten patients with CMV disease were receiving indinavir or ritonavir whereas only
1 was receiving saquinavir (p = 0.18). We introduced the following variables in
a multivariate analysis (forward stepwise logistic regression): age, gender, prior
category C events, administration of a PI adding it to the baseline combination of
NRTIs or with new NRTIs, administration of indinavir or ritonavir, increase of CD4
cells/iil, <25 at month 1, and viral load response at month 1 < 0.5log. Viral load
response at month 1 < 0.5log (RR: 1.7, 95% Cl: 1.4-2) and use of ritonavir or
indinavir (RR: 1.3, 95% Cl: 1.1-1.5) were independently associated with the risk
of developing CMV disease. Those patients who developed CMV disease had a
4-fold risk to die (60%) than those who did not (14%) (p = 0.001).
Conclusions: The risk of CMV disease in the population studied concentrated
in the first 3 months, where the incidence was higher than expected. An absence
of virological response and the use of potent PI were independent risk factors of
CMV disease. The use of preemptive therapy in those patients at risk may be a
reasonable consideration.
22259 Coinfection with hepatitis B and HIV in pregnant women
in Bobo Dioulasso, Burkina Faso
Blami Dao1, B. Nacro2, H. Dahourou2, N. Meda3, P. Van de Perre3, M. Cartoux3.
1BP 676 Bobo Dioulasso; 2CHNSS Bobo Dioulasso; 3Centre Muraz BOBO
Dioulasso, Burkina Faso
Objective: Evaluate the prevalence of coinfection with hepatitis B and HIV1 in
pregnant women
Methodology: Nine hundred and seventeen pregnant women attending two
antenatal clinics in Bobo Dioulasso, were tested for both hepatitis B and HIV,
after an informed consent. Testing for hepatitis B markers and HIV used kits from
Sanofi- Diagnostics- France (Monolisa, Genelavia Mixt). Sera tested positive with
Genelavia were confirmed by Western Blot (NewLav Blot 1, Sanofi, France).
Results: The characteristics of the women were the following: a mean age of
26 years, 83.5% were married; a mean gravidity and para of 4 and 3 respectively and the mean gestational age was 27 weeks of amenorrhea. Ninety eight
women (10.7%) were AgHBs carriers with 16/88 (18.2%) positive for AgHBe,
58/87 (66.7%) for Antibodies anti HBe and 87/91 (95.6%) for antibodies antiHBc.
The HIV1 prevalence rate was 5.9%. Eight women were positive for both Ag HBs
and HIV1 giving a coinfection rate of 0.88%.
Conclusion: The coinfection rate by hepatitis B and HIV1 is very low in pregnant women in Bobo Dioulasso despite a high prevalence of these two infections.
Possible explanations are given.

222601 Containment of CMV retinitis under HAART despite
termination of anti-CMV therapy
Ravi K. Walli1, U. Schaller2, J.R. Bogner3, A. Scheider2, A.J. Mueller2,
V. Ulauss2, F.D. Goebel3. 1Medizinische Poliklinik, Pettenkofer Str 8a, 80336
Munich; 2Augenklinik University of Munich, Munich; 3Medizinische Poliklinik,
University of Munich, Munich, Germany
Objective: To evaluate the course of CMV retinitis after initiation of HAART (highly
active antiretroviral therapy) and discontinuation of anti-CMV therapy.
Methods: Three patients with acute CMV retinitis (five eyes) were followed for
12-30 months (mean 19.4). Ophthalmological status (fundoscopy and photography), CD4 count and plasma viral load (VL) were assessed at time of diagnosis
and under HAART.
Results: At time of diagnosis, mean CD4 count was 33 cells//tI (range 7-88),
and mean VL was logio 4.78 (range 4.13-5.06). Anti-CMV induction therapy (i.v.
ganciclovir or i.v. foscarnet) and HAART (2 reverse transcriptase inhibitors + 1
protease inhibitor) were started. Subsequent anti-CMV maintenance therapy (i.v.
ganciclovir, i.v. foscarnet or intraocular ganciclovir pellets) was discontinued 8.0
months (range 1-15) later. During maintenance therapy, mean increase in CD4
count was 183 cells//il (range 151-214), VL was undetectable (<loglo 2.70) in all
patients, and there was no progression of CMV retinitis. Throughout the follow-up
period without anti-CMV therapy (mean 10.4 months, range 7-15), all patients
remained free of progression of CMV retinitis. VL was stable below loglo 2.70,
maximal CD4 counts reached 318-409 cells//I (mean 378).
Conclusions: Improvement of the immune status under HAART can lead to
sustained containment of CMV retinitis despite termination of anti-CMV therapy. Therefore, discontinuation of anti-CMV maintenance therapy under effective
HAART is an option for selected patients.
22261 Hepatitis C in the EuroSIDA Cohort of European
HIV-infected patients. Prevalence and prognostic value
Thomas Benfield. Coord. Cent. Eurosida, Dept. Inf. Dis. 144 Hvidoure Univ.
Hospital, 2650 Hvidoure, Denmark
Background: There is only limited information on regional differences in the
prevalence and influence of co-infection with hepatitis C (HCV) on the clinical
course in patients infected with HIV in Europe.
Methods: The EuroSIDA prospective, multicentre cohort study on HIV infection
was initiated in May 1994. In December 96/July 97, data on result of routinely
performed HCV-testing was collected. Regional differences and clinical characteristics of testing patterns and whether antibodies against HCV was detected or
not was analysed.
Results: Data on anti-HCV were available in 3048 patients. Testing bias was
observed related to risk group; testing frequency were 49% in homosexuals
compared to 65% in the groups with intravenous transmission routes. Number of
patients and distribution of testing in regions of Europe is shown below:

Total N
Anti-HCV test

Southern Europe
1783
1127(63%)

Central Europe
1694
835 (49%)

Northern Europe
2069
1086 (52%)

Total
5546
3048 (55%)

Of the 3048 patients, 1009 (33%) were anti-HCV positive. Number of patients
with positive test results and distribution of positive antibody results in % of total
number of patients tested are shown below:

Anti-HCV-positive: 522 (46%)
Homosexual 24 (8%)
IVDU 429 (94%)
Transfusion 9 (69%)
Other 60(17%)

178 (21%)
23 (6%)
100 (79%)
17(53%)
38(15%)

309 (28%)
33 (6%)
236 (93%)
18(60%)
22 (9%)

1009 (33%)
80 (6%)
765 (91%)
44 (59%)
120(14%)

Conclusion: For 55% of patients followed in clinics through Europe, serostatus
of HCV is known. Injecting drug users were more frequently tested than homosexual men. Among tested patients, co-infection of HIV and HCV was observed
in 33% of the cases more frequently in southern Europe compared to the more
northern parts. In all regions more than of tested injecting drug users had
antibodies against HCV. The high frequency of HCV positivity in Southern Europe
is primarily explained by the higher proportion of drug users in this region.
22262 Cytomegalovirus (CMV) in the cerebrospinal fluid (CSF)
of AIDS patients without CMV disease
Nina K. Regevik1, M. Shilpa2, G. Jimenez2, J.R. Middleton2, S. Nilsson2,
N. Rosner2, P. Sen2. 1530 New Brunswick Avenue, Perth Amboy, New Jersey
08861; 2Raritan Bay Medical Center, Perth Amboy, NJ, USA
Objective: To describe the patients without end organ cytomegalovirus (CMV)
disease who underwent cerebrospinal fluid (CSF) analysis and to report on the
incidence and clinical significance of finding CMV by polymerase chain reaction
(PCR) in the CSF.
Methods: All patients undergoing CSF analysis from January 1, 1995 to June
30, 1997 were evaluated. Lumbar punctures were performed for the standard
clinical indications. Of the 90 lumbar punctures performed, 66 were suitable for
analysis; 24 of the 90 had missing data and were excluded. CSF was sent for
routine stains, cultures, cell count, chemistry, cryptococcal antigen and qualitative