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

12th World AIDS Conference

Abstracts 22263-22267 315

PCR for CMV. Forty seven variables were collected that included demographic
data, clinical information, habits and risk behaviors from direct chart review by
two physicians.
Results: Of the 66 patients studied, 77% had CD4 cell count -100, 60% had
CD4 cell count -- 50. Of the 50% patients who had HIV viral loads performed, 63%
had values.-10,000. Ten of the 66 patients (15%), had (+) PCR for CMV. Of these
10 patients; 8 died and 6 were identified to have autopsy proven disseminated
CMV or had CMV listed as cause of death. The other 2 died of mycobacterium
tuberculosis of the central nervous system (CNS). Of the 47 variables evaluated,
female gender (p = 0.001), history of herpes simplex virus (HSV) infection (p
= 0.0005), and CNS mycobacterium tuberculosis infection (p = 0.011) were all
strongly associated with CMV positivity. Eighty percent of the patients who were
CMV positive for CSF died during the study period, as opposed to 48% of CMV
negative patients. This may suggest increase mortality in patients with positive
PCR for CMV in the CSF.
Conclusion: CMV testing of the CSF yields important prognostic and diagnostic information. If positive, it predicts higher mortality and may precede end
organ CMV disease. Further study of the treatment of asymptomatic patients with
positive CMV in the CSF may show improved morbidity and mortality.
22263 Seroprevalence of hepatitis C antibody and hepatitis B
surface antigenemia in a large urban HIV clinic
Samuel T. Merrick, K.A. Sepkowitz, B.A. Boyle, J.L. Jacobs. Center for Special
Studies, NY HOSP-CUMC, New York NY, USA
Objectives: With the increased survival of HIV-infected pts, identifying and treating concomitant infections has become more important. We undertook to quantify
the seroprevalence of hepatitis C antibody (HCV ab) and hepatitis B surface
antigenemia (HBV sag) in an urban HIV clinic.
Methods: Retrospective chart review of all pts seen in a 7-year period at The
Center for Special Studies, the primary care treatment clinic for The New York
Hospital in New York City. 934 pts were tested for both HCV ab and HBV sag.
Indications for testing were screening, physician preference, or abnormal liver
enzymes.
Results: The demographics of pts tested were similar to the demographics of
the clinic overall.

MSM/BI
IVDU
Hetero
BLD PROD
Total

No. of pts
347 (37%)
342 (37%)
209 (22%)
36 (4%)
934

HCV ab+
42 (12%)
277 (81%)
24(11%)
28 (78%)
371 (40%)

HBV sag+
35 (10%)
17(5%)
13(6%)
1 (3%)
66 (7%)

S22265 Relationship between the detection of plasma
cytomegalovirus (CMV) DNA and CMV retinitis in AIDS
patients
Charlene Bush1, Richard Donovan2, J. Carlsen2, N.B. Mateo2, N.P. Markowitz2,
R.M. Donovan2. 'Infectious Diseases Henry Ford Hospital, 2799 West Grand
Blvd. Detroit, MI; 2Henry Ford Hospital, Detroit, MI, USA
Background: There is an urgent need for a rapid, sensitive and reproducible
method to monitor impending, active, stable and reactivated CMV disease.
Methods: This study used the new Amplicor CMV PCR assay (Roche Diagnostic Systems, Branchburg, N.J., USA) to determine the frequency of plasma
CMV DNA positive patients prior to development of CMV retinitis, at the diagnosis
of confirmed CMV retinitis, and during stabilized disease.
Results: Plasma CMV DNA was obtained from 40 HIV-positive patients newly
diagnosed with CMV retinitis. Twenty one of 40 (53%) of these patients were
positive for CMV plasma DNA. A subset of 19 of these patients had plasma
samples obtained approximately 3 months prior to diagnosis of retinitis, and 8
of these 19 samples (42%) were positive prior to and at diagnosis of retinitis.
Of 60 CD4-matched, CMV seropositive control patients who had no diagnosed
CMV disease, only 3 had detectable plasma CMV DNA (5%). The mean time to
disease progression for those patients positive for CMV plasma DNA at diagnosis
was 126 days (range 23 to 366 days) and 180 days (range 41 to 404 days)
for those patients negative for plasma DNA at diagnosis. In 11 of 40 patients
(28%) whose CMV retinitis progressed in less than 60 days, 9 patients (82%)
had been CMV DNA plasma positive at diagnosis. All 9 of these 11 patients
who rapidly progressed, died from disseminated CMV disease within 90 days
from initial diagnosis of CMV retinitis. CMV PCR plasma DNA was negative in all
11 samples obtained from patients on maintenance therapy and diagnosed with
stable retinitis. In contrast, a pp65 antigenemia assay was still positive in 7 of
11 (64%), and a PCR assay for cell-associated CMV DNA was positive 8 of 11
(73%) patients with stabilized disease.
Conclusions: The Amplicor plasma CMV DNA test is a currently available
assay that has moderate sensitivity and specificity in detecting impending and
active CMV retinitis. It has potential applications in identifying patients at risk
for rapid progression, and could be of value in monitoring maintenance therapy.
Further development of a quantitative plasma CMV DNA assay should improve
monitoring of CMV disease in the individual patient and may prove to have overall
clinical utility.
22266 Quantitation of JC virus in CSFAND urine prognostic
value of CSF JC viral load in patients with progressive
multifocalleukoencephalopathy
Yassine Taoufik1, A. Karaterki2, J. Gasnault3, M.P. Ferey2, M.G. De Goer4,
J.F. Delfraissy4, E. Dussaix2. 1Laboratoire Virus, Neurone et Immunite, Faculte
de Medecine de Bicetre. 63, Rue Gabriel Peri, 94276 Le Kremlin-Bicetre Cedex;
2Department of Microbiology, Paul Brousse hospital, Villejuif; 3Department of
Internal Medicine, Bicetre Hospital, Biceatre: 4Laboratory Virus, Neuron and
Immunity Biceetre, France
The human polyomavirus JC is the causative agent of progressive multifocal
leukoencephalopathy (PML), a fatal demyelinating neurodegenerative disease of
persons with impaired cell-mediated immune response. There is approximately
a 4% prevalence of PML in AIDS patients. Many studies have reported the high
predictive value of a positive JCV DNA result in cerebral spinal fluid (CSF) for
PML diagnosis. In this work, we describe the development and validation of a
quantitative JCV PCR method at end point using homologous internal standard
and chemiluminescence measurement of amplicons. We applied this assay to
investigate JCV viral load in CSF of AIDS-associated PML patients. We found
a wide range distribution of JCV loads in PML patients (3 log10 to 7 log10 JCV
copies per ml of CSF) without apparent relationship with CD4 cell counts or CSF
and plasma HIV-1 loads. Moreover, a close relationship between JCV load and
the patient's survival time was observed. Patients with high JCV loads (more than
100,000 copies per ml) had a median survival of 4.5 months vs 11 months for patients with low or intermediate viral loads. Furthermore, we observed a decrease
of JCV CSF load that has become undetectable and a clinical improvment in one
PML patient under Cidofovir treatment.
Our data show that measuring JCV load in PML patients would be useful as
prognostic factor and to monitor virological effects of anti-JCV therapies.
|22267 Induction treatment of CMV: A comparison between
single and twice daily dosing of ganciclovir
Jorge Luis Gazineo, E.C. Joao Filho, A.L. Senna, A. Silva, M.L. Fernandes,
M.L.L. Giordani, M.L.S. Cruz. Hosp. Servidores do Estado Anexo IV 50 and R.
Sacadura Cabral, 178 Rio de Janeiro, Brazil
Introduction: CMV induction treatment usually consists of 10 mg/kg/day IV ganciclovir in 2 divided doses for a minimum of 2 weeks during which patients need
to be hospitalized. A previous study from England (Tomlinson et al, 1996) demon
strated the feasibility, safety and efficacy of a single 10 mg/kg dose in induction
treatment.
Objectives: to further assess the efficacy of single daily dosing induction
treatment compared to split daily dosing.
Methods: pilot study, open, prospective and randomized. Patients with a diagnosis of CMV, 1st episode from 3/97 to 11/97. All patients but one (who received

Conclusion: As pts with HIV survive longer, morbidity and mortality is likely to
grow from other infections such as HCV and HBV. Continued aggressive efforts
at risk reduction education and new therapies for HCV and HBV are needed.
S22264 Prevalence and genotypes of hepatitis G virus and
hepatitis C virus among HIV infected patients: Evidence
of HGV sexual transmission
Miguel Angel Marinez1, A. Ibahez1, M. Gimenez-Bancons2, A. Tajahuerce2,
C. Tural1, J.M. Sanchez-Tapias2, J.C. Saiz2. 1Fundacio Irsi-Caixa Hospital
Universutari, Germans Trias Pujol, Badalona; 2Liver Unit Hospital Clinic,
Barcelona, Spain
Background: The new anti-HIV therapies have increased the survival expectations of HIV-infected individuals, highlighting the effects of viral chronic hepatitis
on the disease. The identification of HGV has prompted us to evaluate the
presence of HGV and HCV in 168 Spanish HIV-infected subjects.
Methods: Presence of HCV and HGV in plasma was detected by specific
reverse transcription (RT) and nested PCR. HCV genotyping was performed by
restriction fragment length polymorphism (RFLP) of the amplified 5'NC region.
HGV genotyping was carried out by direct sequencing of the amplified NS3 region.
Results: HGV-RNA and HCV-RNA were detected in 18% and 43% of the
patients. The prevalence of both viruses was notably high, 19% and 69% respectively, among individuals with parental risk of infection (intravenous drug abusers
and haemophiliacs). HGV sexual transmission was also disclosed: 16.5%) of homosexual and heterosexuals patients present HGV-RNA in plasma. Although, the
relevance of HGV infection could be underestimated due to the development of
humoral immunity, sexual contact may play a relevant role in the spread of HGV.
Phylogenetic analysis showed no evidence for clustering NS3-HGV sequences
into different genotypes or subtypes of HGV.
Conclusion: These results show that HCV and HGV are highly prevalent
among HIV-infected patients, notably among parental risk groups, although sexual transmission of both viruses occurred. In fact, it is possible that this specific
route of transmission plays a relevant role on the spread of HGV. Sequence
analysis of the HGV-NS3 gene does not disclosed the existence of genotypes or
subtypes in this virus, neither it displays any geographical trend in HGV world-wide
distribution.