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

12th World AIDS Conference

Abstracts 22319-22323 327

22319 Short term course of cervical squamous intraepithelial
lesions (SILs): Relation with HIV and human
papillomavirus (HPV) infections in Africa
Guy La Ruche', I. Mensah-Ado2, B. You3, R. Ramon4, C. Bergeron5, V. Leroy6,
C. Welffens-Ekra7. National AIDS Program; 2Laboratory of Cytology; 3Cedres
Chu of Treichville; 4 PAC-CI Program; 5 Department of Genecology, Abidjan, Cote
D'lvoire: 6Cebra Laboratory of Cytology Clergy; 7INSERM U330 University of
Bordeaux, Bordeaux, France
Objectives: To assess the short term course of cervical SILs according to HIV
and HPV infections in African women.
Design: Follow-up of women with SIL.
Methods: A follow-up was performed for 94 women from three outpatient
gynaecology clinics in Abidjan with an initial cytological diagnosis of SIL, 38
of them infected with HIV. Cervical smear control was performed five months
on the average after the initial smear. Detection of cervical HPV DNA by polymerase chain reaction was performed at both the time of enrolment and smear
control.
Results: There were 39 cases of persistent SILs (41%). HIV-infected women
had a higher percentage of persistent SIL (76%, 29/38) than HIV-negative women
(18%, 10/56; relative risk 4.3; 95% confidence interval 2.4-7.7; P - 0.0001).
The persistence of SILs was significantly more frequent among women infected
with HPV at the time of enrolment (50%, 30/60) than among those non-infected
(19%, 5/27; relative risk 2.7; 95% confidence interval 1.2-6.2; P = 0.006), but
this relation was not detectable when taking into account HIV serostatus. The
persistence of SILs was also more frequent among women infected with HPV at
the time of smear control (41%, 17/41) than among those non-infected (0/7; P
= 0.04). No other risk factor (socio-demographic, behavioural or biological) was
associated with the persistence of SILs.
Conclusion: Spontaneous regression of SILs is frequent in HIV-negative
African women. HIV status is a factor which turns out to be much more related
to the persistence of SIL than HPV infection. HIV-infected women with cervical
dysplasia require a specific gynaecology follow-up.
22320 Adherence with colposcopy among women in the
Women's Interagency HIV Study (WIHS)
Helen Cejtin1, E. Komaroff2, J. Schmidt3, L.S. Massad3, A. Korn4, S. Holman5,
L. Muderspach6. '1900 W Polk #1245, Chicago, IL. 60612; 2New England
Research Institutes, Watertown, MA; 3Cook County Hospital, Chicago, IL;
4 University of California, San Francisco, CA; 5Suny Health Center, Brooklyn, NY;
"University of Southern California, Los Angeles, CA, USA
Background: In the general population, adherence with colposcopy in women
with abnormal cytologic smears is estimated at 30-80%, but studies have failed
to identify consistent risk factors for non-adherence. The purpose of this analysis
is to compare colposcopy adherence rates in a subset of participants in WIHS,
an ongoing multi-site longitudinal study of HIV infection in US women, and determine factors associated with non-adherence. The identification of such predictors
would be useful in designing strategies to improve adherence in this group.
Methods: Adherence with colposcopy was examined in a cohort of 450 women
with or at risk for HIV-infection with abnormal cervical cytology at WIHS baseline. Adherence was defined as having colposcopy done within 6 months of an
abnormal cytology.
Results: Overall adherence with colposcopy was 67% (300/450), with a rate
of 66% (259/394) in HIV-infected and 73% (41/56) in non-infected women (p.29). Among HIV-infected women who did not have colposcopy, univariate
associations with viral load (HIV RNA), CD4 count, self-reported class C AIDSdefining illnesses, and use of antiretroviral therapy were not significant. However,
in this group, a multivariate logistic regression model revealed that adherence
was inversely related to use of crack/cocaine in the past 6 months (p --.02),
ever having been too ill to get medical care (p -.03), and experiencing domestic
violence by a partner who prevented entry into or exit from her house (p <.03).
Adherence was directly related to recruitment by WIHS study staff (p <.02) and
concerns about not being able to take care of one's children (p <.01).
Conclusions: Adherence with colposcopy among WIHS participants was at
the upper limit of the national range. Markers of advanced HIV disease and
therapy were not significantly associated with adherence. Chemical dependency
and domestic violence may negatively impact upon colposcopy adherence while
supportive study personnel and concerns about raising one's children appear to
be motivators for adherence with research-related diagnostic procedures.
22321 Trying to know the role of viral load and ARV therapies in
the progression of cervical disease
Dominique Sperandeo1, A. Robaglia-Schlupp2, P. Cau2, J.A. Castaut1. 1 Cisih
Sceja Gastaut HTAL Stenaruerite 270 Baste Narguerite 13009 Narseille; 2Labo
Biologie Cellularie HTAL Conceptio 13385 Narseille, France
Objective: To correlate the stage of women's cervical disease with the antiretro
viral therapies and the viral load as a first approach to know about the role of HIV
virus by itself on the cervical pathology.
Background: - 744 papsmears (PS) performed on 311 women HIV positive, interpretated according to Bethesda classification since 1991 to 1997 are compared
with mean CD4 counts, antiretroviral therapy undergoing (ARV) or not (NARV),
mean viral load on blood samples only for 1996-1997 (quantitative RNA Monitor
Roche).

Methods: - only PS belonging to 3 groups of Bethesda classification are reported: group 1: ASCUS; group 2: condyloma; group 3: dysplasia (with or without
condyloma).
- the results were correlated by statistical analysis with presence or absence of
ARV, mean CD4 count and HIV mean viral load for years 1996-1997
Results: from 539 PS (ARV) and 205 PS (NARV), only 351 ARV and 119
NARV, are included in the 3 groups, showing a decrease of group 1 and an
increase of group 3 for the ARV population but with no significancy. - on 136 PS
with mean viral load between 0-5000 and 48 PS with mean viral load >100 000
the same difference was observed with statistical significancy (decrease of group
1, increase of group 3 for mean viral load >100 000). - for all PS the stage of
cervical disease was significantly correlated with mean CD4 counts (increasing
the stage when decreasing CD4).
Conclusion: Cervical disease seems to be related with local immunity of the
cervix. The ARV therapies do not show an amelioration of the cervix on our first
results, perhaps because of the short time of the new treatments and also the
long time of the disease in our population. Further studies are required to know
about the role of the HIV itself not only by viral load in blood but also by viral load
in cervicovaginal secretions.
1223221 Analysis of JC virus molecular characteristics
influencing the development of progressive multifocal
leukoencephalopathy
Pasquale Ferrante', R. Caldarelli-Stefano', M. Mediati', E. Omodeo-Zorini',
L. Vago2, R. Maserati3. 'Lab. Biology, Don. C. Gnocchi Foundation, IRCCS via
Cepecelatro, Milan; 2Pathology Unit L. Sacco Hospital, Milan; 3 Infectious
Disease Clinic, S. Matteo Pol, Pavia, Italy
Objective: To verify the role of nucleotide sequence reaarrangements in the regulatory region and of the dual infection with different JC virus (JCV) genotypes in
the triggering and in the evolution of progressive multifocal leukoencephalopathy
in AIDS patients.
Methods: Tissue samples from the brain and extraneural organs including lung.
kidney, spleen, liver and lymph nodes have been collected at autopsy from AIDS
patients with and without PML and from HIV negative subjects. Cerebrospinal
fluid (CSF), peripheral blood mononuclear cells (PBMC) and urine from a large
number of AIDS patients suffering of various neurological diseases including 21
PML, and PBMCs and urine from healthy subjects have been collected. All these
samples have been evaluated for the presence of JCV DNA by nested polymerase
chain reaction (PCR) and the amplified products have been then subjected to
nucleotide sequence analysis. The large T antigen (LT), the regulatory (R) and
the virion protein (VP1) genes have been studied.
Results: 1) rearrangements in the R region have been observed in all the JCV
DNA amplified from the brain and CSF and less frequently in the extraneural
organs and in the PBMCs and urine of the PML cases, while in the non PML
patients an archetypal organization was prevalently found; 2) JCV type 2 has
been detected only in PML patients and mostly in their brain and CSF; and 3)
20% of the PML cases had a dual infection with both JCV type 1 and 2 in their
CSF.
Conclusions: The results of our analyses indicate that in AIDS patients a
diffuse presence of JCV in different organs and body fluids can be found while
multiple rearrangements and peculiar nucleotide variation of JCV R region are
detected more frequently in PML patients than in the other groups. The involvement of JCV type 2 and the high frequency of dual infection with different JCV
genotypes seem to be a risk factor for PML development.
340*/22323 1 Immune restoration disease after treatment of
immunodeficient HIV-infected patients with potent
anti-retroviral therapy
Martyn French, N. Lenzo, M. John, S. Mallal, P. Price, J. Flexman. Clinical
Immunology Royal Perth Hospital GPO Box X2213 Perth, WA, Australia
Objectives: To determine the incidence, clinical and microbiological characteristics and immunological correlates of pathogen-associated inflammatory diseases
occurring in HIV-infected patients after treatment with potent anti-retroviral therapy
(ART).
Methods: A retrospective study of all patients given a combination of anti-retroviral drugs expected to reduce plasma HIV RNA by >-lloglo copies/mL. Patients
were classified as ART responders if HIV RNA decreased by >llogo at 4-8
weeks or 12-16 weeks and non-responders if decreased by <lloglo at both time
points.
Results: Data were collected on 143 patients who met predetermined inclusion
criteria, of whom 133 (93%) were ART responders. Thirty three ART responders
(25%) had one or more episodes of inflammatory disease up to 30 weeks after
commencing ART with CD4 T-cell counts higher than baseline; viz localised MAC
disease (n = 5), exacerbation of CMV retinitis (n = 6), mucocutaneous herpes
(n = 9), dermatomal zoster (n = 8), myelitis and/or encephalitis with presumptive
HSV infection (n = 4), HCV-associated hepatitis (n = 3), MTB-associated lym
phadenitis/pneumonitis or cerebritis (n = 2) and inflamed molluscum contagiosum
or warts (n = 6). Apart from zoster and possibly hepatitis, disease occurred during
the first 2 months of therapy.
In a logistic regression analysis, a low baseline CD4 T-cell count was a strong
predictor of inflammatory disease (p = 0.0032). However, after adjustment for
baseline CD4 count, neither baseline HIV RNA, nor the increase in CD4 T-cell
count or decrease in HIV RNA in the first 16 weeks of ART, were predictors. All