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

12th World AIDS Conference

Abstracts 22329-22333 329

both paresthesias and pain.and 22 (29.7%) abnormal neurological physical examination. These symptoms strongly evoked a peripheral neuropathy which had
been previously diagnosed in only 7 (9.4%) patients. The neurological symptoms
showed a significant difference by CDC stage C (p =.0001), Karnofski score
<70% (p =.0009), concentration and/or memory impairment (p =.007), weight
<80% of theoretical weight (p =.04), CD4 count <50/mm3 (p =.005).
Conclusion: Neurological sensitive impairment was frequent during HIV infection.and clearly related to the advance of the disease. Since these neurological
features remained poorly diagnosed, we suggested to intensify neurological
examination, especially in patients with advanced HIV infection.
S22329 Usefulness of bone marrow aspirate in the evaluation of
fever of undetermined origin in HIV-1 infected patients
Javier Gomez Rodrigo, R. Barba, G. Eroles, P. Rondon, j. Marco, M. Lopes
Varas, J. Solis. Hospital Severo Ochoa, Madrid, Spain
Objectives and Methodology: To assess the yield of bone marrow aspirate
(BMA) in the diagnosis of unexplained fever (FUO) in HIV-1 infected Persons, a
prospective series of 27 patients with FUO and HIV-1 infection who underwent
BMA in our hospital is analyzed. FUO was defined as temperature of 38.3'C or
higher for more than three weeks. Study entry period: February 1995 to December
1996. Cytological and microbiological diagnostic test were performed in all cases.
Results: Twenty eight BMA were done in 27 patients, with a mean duration of
fever of 52.5 days before diagnosis. Mean CD4 count was 88 cells/mcL, mean
Hemoglobin 9.8 g/dL, mean WBC count 3555 cells/mL, and mean platelet count
166000/mL. A final diagnosis was achieved by means of BMA in 12 out of 28
episodes (diagnostic yield: 43%). In seven out of the twelve patients the same
disease was identified through a different technique. Five episodes remained
without diagnosis despite intensive work- out. The three specific diseases identified by BMA were Disseminated Mycobacterium Avium Complex (five cases),
Visceral Leishmanioses (five cases) and lynphoma (two cases).
Conclusions: 1) BMA is a useful diagnostic procedure in HIV-1 infected patients fulfilling FUO criteria. 2) BMA provided a diagnosis quicker than other
techniques, being often the only diagnostic test.
22330 Successful antiretroviral treatment of glomerulonephritis
in a HIV positive patient with cryoglobulinemia
Jorg-Andres Rump1, S.M. Weiner1, J. Schneider2, L.C. Rump3, U. Helmchen4,
A. Meyerhans2, H.H. Peter1. 1Med. Univ. Clinic, Dept. Rheumatology, Hugstetter
Str. 55, D-79106 Freiburg; 2Univ. of Freiburg, Dept. Virology, 79106 Freiburg;
3Med. Univ Clinic, Dept. Nephtology, Freiburg; 4Univ. Hamburg, Dept. Pathology,
Hamburg, Germany
Objectives: Focal glomerulosclerosis is the most common of a variety of pathological entities that have been described in HIV-associated nephropathy (HIVN).
We present a HIV infected male patient with membranous glomerulonephritis and
mixed cryoglobulinemia type III which resolved under antiretroviral therapy.
Methods: The patient was followed over a period of 5 years. Viral load was
measured by an alkaline dissociated p24 antigen assay (HIV-1 antigen base
dissociation assay, Organon Teknika, Durham, NC) or with a commercial RNA
assay (bDNA, Chiron Diagnostics).
Results: The patient has been infected by HIV in 8/87. His history comprised a
chronic seborrhoic dermatitis and an unidermatomal herpes zoster (Th12) in 2/92
but as yet no opportunistic infection. Alkaline dissociated gag p24 levels in serum
rose continously over a period of 7 years from 26 pg/ml to a maximum of 680
pg/ml. When measured in parallel HIV-RNA level rose to 40 680 copies/ml. However, the slope of the CD4 cell decline was only about 20 cells/year. The clinical
course remained stable until 11/94 when an HIVN with non-selective glomerular
proteinuria (2.7 g/day) occurred. Renal biopsy revealed immunecomplexes by immunohistochemical methods and mixed cryoglobulins were cryoprecipitated from
the plasma. Several attempts were made with different antiretroviral combinations
to reduce the viral load below the detection limit. Four weeks after the initiation
of the therapy proteinuria decreased to 0.87 g/day, and erythrocyturia showed a
5 fold reduction and both normalised within 6 months. In the same time period
HIV-antigenemia dropped markedly and cryoglobulins became undetectable in
parallel. The CD4 cell count remained stable.
Conclusions: One can assume that in analogy to immunecomplexnephritis in
HBV and HCV infection, the reduction of HIV load has positive effects on the
outcome of HIVN.
22331 Treatment with cefixime on ideopathic mouth ulcers on
patients with HIV/AIDS
Alejandro Vargas1, Velasco Lezama2, Vargas Velasco3, Bermejo Guevara4,
Grados Martinez5. 1 Nihos Heroes 151 Col. Doctores Mexico; 2UAM-lztapalapa
Mexico; 3Hospital Juarez De Mexico, Mexico; 4 Hospital Infantil De Mexico,
Mexico; 5Ser Humano, Mexico

Objective: To evaluate the effectivness of cefixime on ideopathic mouth ulcers
on patients with HIV/AIDS
Methodology: A group of 49 patients with ideopathic mouth ulcers was evaluated. 30 ml of a suspension of 100 mg was administered to every patient. The
mouth rinses were applied twice a day, one in the morning and one at night. After
each rinse the teeth were brushed in a normal way. Each rinse is carried out by
keeping the largest possible quantity of medicine in the affected zone(s).

The retention in each patient's mouth of the 30 ml dose was carried out in a
period from two to five minutes.
Results: Within an average period of 24 to 72 hours, the patients recuperated
from the injuries in 70% of the cases and within the complete administration
scheme of 8 days, recuperation was total in all 49 persons. 97.96% was effective.
Conclusions: The use of cefixime as rinse against ideopathic mouth ulcers
seems to be adequate in this type of patients, compared with other medicines,
such as: talidomide, steriods or local anaesthetics.
S22332 1The initial opportunistic infection (01) among
Singaporean AIDS patients in 1996
Leo Yee-sin1, W.L.K. Chua2, I. Sim Ver Ghese1. 'Blk 804 Moulme in Road CDC,
Tan Tock Seng Hospital, Singapore; 2University of Tasmania, Hobart, Australia
Objectives: To assess the initial opportunistic infection (01) among Singaporean
AIDS patients in 1996.
Design: This is a retrospective study
Methods: All medical records of patients diagnosed with AIDS who were
treated at Communicable Disease Centre (CDC), the designated centre for HIV
treatment in Singapore were retrospective analysed. The study recorded the first
AIDS defining opportunistic infection, demographic data, CD4 counts, treatment
and prophylaxis, etc.
Results: Altogether there were 83 AIDS cases treated at CDC in 1996. Of
these, 3 were excluded because of other non-OI AIDS diagnosis. Only 2 females
in this study cohort of 80 cases with age range from 24 to 75 years. 52 (65%) of
them were aware of their HIV infection only when diagnosed with an AIDS defining
Ols. 2 cases had more than 1 Ols at the time of AIDS diagnosis. Pneumocystis
carinii pneumonia was the most common 01 which constituted 42% followed by
tuberculosis 34%. Other common Ols include 8.5% of CMV infection, 4.9% of
cerebral toxoplasmosis. Cryptococcal infection, candida esophagitis, MAC and
HIV encephalopathy were each at 2.4%. The CD4 counts were below 200 for all
cases except 1 TB case with CD4 of 305 cells/ul. At end of 1997, 35 (43.8%) of
these cases had died.
Conclusion: In this study cohort, AIDS was predominantly a male disease and
the majority (65%) of them were diagnosed HIV positive only at the advanced
phase with AIDS defining Ols. Pneumocystis carinii pneumonia and tuberculosis
were the two most common Ols.
S22333 Access to combination antiretroviral therapy (CART)
among different populations: Implementation of new
guidelines for treatment of HIV infection
Guthrie Birkhead1, B.D. Agins1, D.J. Jemiolo1, P.S. Boyce', P.G. Weinberg2,
B.S. Kulpa2, K. Fox2. 1AIDS Institute NYS Department of Health, New York, NY;
2Island Peer Review Organization, Lake Success, NY, USA
Purpose: To assess implementation of new guidelines for use of combination
therapy in New York State (N.Y.S.) among gender, exposure, racial/ethnic and
geographic subpopulations in ambulatory health care clinics.
Methodology: Medical record abstraction was performed on 4,370 charts at
119 ambulatory care clinics in N.Y.S., including hospitals, community health centers and drug treatment programs with co-located HIV primary care programs.
Random samples were generated following identification of ambulatory patient
rosters from 1/96 through 9/97. Multi-variate logistic regression analysis was
performed to determine factors associated with implementation of combination
antiretroviral therapy (CART).
Results: Of 713 records reviewed between 7/97 and 9/97, 83% of patients
received CART, 59% CART with protease inhibitors (PI), 3% received monotherapy and 14% did not receive any ART. Trends from mid 1996 showed steadily
improved access to CART among all groups, including substance users and all
racial/ethnic groups, although rate of access among blacks was slowest. Though
access to CART for minorities was low in mid 1996 (35%) it increased substantially
by mid 1997 (83%). CART usage among IDU's also increased during that time
period (32% to 82%, respectively). Geography was a consistent and significant
source of variation to access of Pi's in time periods. Differential access rates
according to level of viral load and CD4 counts will be presented.
Conclusions: Widespread access to CART including PI was achieved in N.Y.S.
by mid 1997. Although differential rates of access occurred in mid 1996 when
new drugs were first available, by mid 1997 access was equivalent among all
groups receiving care in HIV ambulatory care clinics. These data reflect successful implementation of recommendations for use of CART among all subpopulation
groups in N.Y.S.