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

342 Abstracts 22389-22392

12th World AIDS Conference

cells). Proviral DNA was determined using a semi-quantitative PCR technique. A
micro culture assay was used to culture HIV from resting CD4+ T cells.
Results: By nested RT-PCR, HIV RNA was detected in the peripheral blood
mononuclear cells of 8/11 patients, despite >1 year of HAART and undetectable
plasma HIV RNA (< 50 copies/ml). Proviral DNA was detectable in the cells of all
patients, although a nested assay (sensitivity 1 copy/106 cells) was required
to detect DNA in two patients with undetectable cellular HIV RNA. HIV could not
be cultured from either of these patients using 2-5 million resting CD4+ T cells.
However, both of these patients had detectable HIV RNA in their lymphoid tissue
(lymph node/gut associated lymphoid tissue). Of note, it has been previously
shown that resting CD4+ T cells consistently harbor latent replication-compentent
HIV in patients receiving HAART.
Conclusions: HIV RNA can be detected in cells by RT-PCR indicating an
ongoing viral replication in these cells. Persistent HIV-1 replication can be found
in peripheral blood cells or lymphoid tissue of patients receiving HAART for
greater than 1 year, despite absence of detectable plasma virus. Nested RT-PCR
appears to be a highly sensitive method for detecting ongoing viral replication in
such patients.
S22389 Reconstitution of lymph node morphology after
advanced AIDS following antiretroviral triple combination
Johannes Bogner1, C. Jung1, C. Ziets2, R. Walli1, A. Muhlh6fer1, F.D. Geobel1.
1Med. Poliklinik, University of Munich, Pettenkoferstrasse 8a, 80336 Munich;
2lnstitut of Pathology, University of Munich, Munich, Germany
Objective: To investigate the immunological improvement following HART
(highly active antiretroviral therapy) in a patient who developed HIV-related
lymphadenopathy syndrome.
Methods: Follow up of a 41 year old man for five years; lymph node biopsy;
viral load in two compartments (plasma viral load PVL and lymph node viral load
LNVL; b-DNA) immunohistochemical analysis and detection of HIV antigen (p24
and Net).
Case Report: In 1992 HIV-infection was diagnosed because of a 10kg weight
loss. CD4 count was 192//t. Physical findings were unremarkable. No lymph
nodes were detectable. Despite nucleoside therapy the physical status and CD4
count deteriorated. CMV retinitis on both eyes and a further 5 kg weight loss
were noted in 1995. PVL was 4.8 loglo and CD4 was 4/,l. No lymph nodes were
palpable as expected in end stage HIV disease. Ganciclovir and HAART were
started (Saq/d4T/3TC). The CD4 count rose to 182/pE in 3/96. Because PVL was
not completely suppressed HAART was switched to Ind/ZDV/3TC. In 9/97 CD4
was 363//pl and PVL was undetectable (<2.7 logio). Now an unexpected generalised lymphadenopathy was noted with LN up to 1 cm. A lymph node biopsy
(neck) revealed hyperplasia of germinal centres and an almost normal network
of dendritic cells. Further work up revealed p24 and Nef antigen in germinal
centres an a LNVL of 5.54 loglo/106 cells. The CD4/CD8 ratio in LN was 0.52 as
determined by flow cytometry. The CD45RA/RO ratio was 2.7 in LN and 1.1 in
blood.
Discussion: Recent work was reported on quantitative and qualitative immune
reconstitution. However, there were no reports on reorganisation of lymphatic
tissues along with improvement of CD4 counts. The example of this patient suggests structural lymph node restoration after HAART. Nevertheless, residual viral
load in lymphatic tissue and the presence of HIV antigen are compatible with the
postulated slow compartment in viral dynamics.
S22390 Ritonavir-Saquinavir (RTV/SQV) combination in protease
inhibitor (PI) naive and pretreated HIV-infected patients
Ezequiel Consiglio1, D. Podzamczer2, F. Bolao3, M. Santin2, J.L. Perez4,
F. Gudiol2. Infectious Disease, Hospital de Bellvitge, c/Feixa Llarga s/n.
I'Hospitalet 08907, Barcelona; 2Internal Medicine, Hospital Bellvitge, Barcelona;
3Micrbiology Service, Hospital Bellvitge, Barcelona, Spain
Objective: To describe the virologic efficacy and safety of RTV/SQV combination.
Methods: We analyzed a group of HIV-infected patients receiving RTV/SQV
+/- nucleoside analogues (NA). These patients were classified into two major
categories: without history of PI use ("naive") and PI pretreated patients. We
compared baseline demographic variables (age, sex, risk practice, prior AIDS),
clinical variables (type and duration of prior PI, indications of RTV/SQV, new NA
added, RNA-HIV (VL), CD4 counts), and follow-up clinical data (VL, CD4 counts,
side effects and adherence). All but one patients received RTV 400 mg bid + SQV
400 mg bid.
Results: Twenty-seven patients were included in the analysis: 10 naive (N),
and 17 pre-treated patients (7 switched due to toxicity (T), and 10 due to failure
(F)). N patients had higher CD4 counts and lower VL at baseline. CD4 significantly
increased at month 3 in N (+204 cells, p =.01) and at month 1 in T (+78 cells, p =.04) patients, while it did not change in F patients (+19, p =.20) VL significantly
decreased in the three groups at month 1 (N -1.11, T 1.21 and F -1.03). At
month 3, a significant reduction was still observed in N (-1.30, p =.01) and in
T (-1.45, p =.02) patients, but not in F patients (-0.78, p =.6). 4/27 (14.8%)

patients discontinued therapy due to toxicity.
Conclusion: RTV/SQV seems an effective and well tolerated therapy in patients without history of Pis use as well as in those who switched PIs due to
toxicity. However, in patients in whom prior PI therapy had failed, this combination
is only transiently effective.

S22391 Combination therapy with nelfinavir/saquinavir compared
to ritonavir/saquinavir in protease inhibitor (PI)
experienced patients
Valerie E. Stone', Molly S. Stenzel2, S.L. Boswell3, J.J. Ng1, A.E. Fisher2,
K.H. Mayer1. 1Memorial Hospital of Rhode Island, 111 Brewster Street,
Pawtucket, RI 02860; 2Brown University School of Medicine, Providence, RI;
3Fenway Comumunity Health Center, Boston, MA;, USA
Objective: To compare the virologic and CD4 count response to nelfinavir/saquinavir (NFV/SQV) based regimens with the response to ritonavir/saquinavir (RTV/SQV) based regimens in PI experienced patients.
Methods: Medical records of all patients (pts) being treated with combination
regimens containing NFV/SQV (N = 22) or RTV/SQV (N = 26), and previously
treated with one or more PIs were reviewed. All but two patients were treated
with at least one nRTI concurrently with the dual PI regimen. Demographic, clinical, virologic, and CD4 data, and details of previous antiretroviral therapy, were
collected. As of now, 33 of 48 patients have been followed on the regimen of
interest for at least 3 months; all but 5 have been followed for at least 2 months.
Results: Demographics: mean age 39 years, 98% male, 81% white. Mean
baseline viral load (VL) = 4.63 logs; mean months of prior PI treatment = 13. On
average, pts had previously taken 4 nRTIs. The two groups differed in the percent
with CDC-defined AIDS (95% in the NFV/SQV group and 62% in the RTV/SQV
group) and baseline CD4 counts (NFV/SQV = 154; RTV/SQV = 264). At 1 month,
7/18 (39%) of the NFV/SQV pts, and 10/23 (43%) of the RTV/SQV pts had a >1
log decrease in VL; 5/18 (28%) NFV/SQV pts and 5/23 (22%) RTV/SQV pts had
nondetectable (ND) VL. At 2 months, 7/11 (64%) of the NFV/SQV pts, and 5/12
(42%) of the RTV/SQV pts had a >1 log decrease in VL; 4/11 (36%) NFV/SQV
pts and 3/12 (25%) RTV/SQV pts had ND VL. At 3 months, 4/6 (67%) of the
NFV/SQV pts, and 3/10 (30%) of the RTV/SQV pts had a >1 log decrease in VL;
2/6 (33%) NFV/SQV pts and 1/10 (10%) RTV/SQV pts had ND VL. At 4 months,
1/6 (17%) of the NFV/SQV pts, and 3/5 (60%) of the RTV/SQV pts had a >1 log
decrease in VL; 1/6 (17%) NFV/SQV pts and 2/5 (40%) RTV/SQV pts had ND
VL. At 4 months, NFV/SQV pts had a mean VL decrease from baseline of 0.22
log; RTV/SQV pts had a mean VL decrease of 0.81 log; this difference is not
statistically significant.
Conclusion: These data suggest that PI experienced patients achieve an initial
virologic response when treated with NFV/SQV or RTV/SQV. A small proportion
of patients currently have data at four months; no difference in the response
to these regimens is seen at this time. More follow-up data is needed before
conclusions can be drawn regarding how these regimens compare, and will be
available at the time of presentation.
S22392 Effect of the new antiviral therapy in the quality of life,
psychological profile and economic aspects of the
advanced HIV infection
Emilio Pujol1, I. Martin2, R. Cano2, D.M. Aguayo2, J. Galvez2, D. Merino2,
R. Creagh2. International Medicine Juan Ramon Jimenez, Huelva, Spain
Objective: To know the referring aspects the quality of life perceived by the
patient, psychological aspects, compliance and the calculation of the monthly
costs due to the advanced HIV infection after the introduction of the new antiviral
drugs.
Material and Method: Observational prospective study of 52 patient with advanced HIV infection (45 male and 7 women) initiated in January of 1996. We
included in this study patients with CD4 counts less to 200 cel./pcl. The patients
are checked annually through clinic interview accomplished by a physician and
a psychologist. They are evaluated with quality of life scales (SF36), depression
scales (Beck) and of anxiety (STAI) and they were calculated the economic costs
of the HIV infection in these patients.
Results: Among 52 patient that began the study, 5 (9.6%) died during the first
year of follow-up. The causes of the deaths were in 2 patients, disseminated
cryptococcosis, I atypical disseminated mycobacteriosis, 1 caquexia because of
HIV and a patient with pulmonary hypertension. None of these patients began
antiviral therapy with new drugs. Among the rest of the patients, 76% had begun
several combined therapies with 3TC, D4T, indinavir or Saquinavir. Most patients
asserted to carry out correctly the treatment (90%), however the data of our hospital pharmacy, where the patients get the medication showed that only 37.5% was
fulfilling correctly the prescription periods, 25% with some lag, 18.3% was making
it abnormally and the 18.8% was not attending ever to collect the medication.
Among the presented side effects, dyspepsia was the most frequent (12%), the
rest; confusion, insomnia, itch, neuropathy and anaemia; they were presented in
isolation in the patients. Referring to the quality of life scales and comparing it with
the situation of the patients a year ago, they continue maintaining low scores in
the corporal pain scale 51/100, vitality 46/100, and mental health 57/100 without
statistics differences (P > 0.05). We find improvement in the general health
scale 40/100 versus 30/100 a year ago (p = 0.03) and that of the social role
paper 61/100 (p = 0.03). They continued maintaining no differences with previous
evaluations reaching good score in physical function 71/100 and social function
73/100. We find a drastic reduction in the depression incidence according to the

scales; 45.5% of the patients vs. 62% in previous evaluation (p = 0.001). We find
also a decrease in the incidence of anxiety state among the patients: 36.6% of
patients vs. 45.5% (p = 0.02). The new therapy has carried out a not meaningful
increase of the costs of antiretroviral treatment 66142/62418 pts/month (p = 0.2);
costs increase of other treatments 14641/10.983 pts/month (p = 0.01); and not
meaningful increase of the global costs 111450/97000 (p = 0.8). (pts = peseta:1
US dollar = 150 pts).