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

38 Abstracts 12133-12138

12th World AIDS Conference

I12133 Predictive value of viral load and other markers for
progression to clinical AIDS after CD4+ cell count falls
below 200//1]
Faroudy Boufassa1, J.B. Hubert1, C. Rouzioux2, C. Tamalet3, E. Dussaix4,
Y. Laurian1, C. Goujard1. 1 nserm U292 H6pital De Bicetre, 82 Rue Du Gal
Leclerc 94276 Kremlin Bicetre; 2 Hpital Necker, Paris; 3 Hpital La Timone,
Marseille; 4 H6pital Paul Brousse, Villejuif, France
Objectives: To assess the predictive value of biological and clinical events for
progression to AIDS (1993 European classification) when the CD4+ cell count
falls below 200//iL (CD4 threshold) in different exposure groups. To investigate
whether such markers remain predictive independently of the serum HIV-1 RNA
level at the CD4 threshold.
Methods: The predictive value of biological and clinical events occurring during
the 24 months prior to the occurrence of CD4 threshold (n = 333) was quantified
in a Cox model (149 AIDS cases). Another Cox model was carried out in a subset
of 77 patients in whom viremia was quantified from stored sera. Changes in viral
load during the 24 month-period preceding the CD4 threshold were assessed in
a mixed model according to subsequent development of AIDS (35 AIDS cases).
Results: Among the 333 patients, the slope of the CD4+ cell counts, the
emergence of p24 antigen, a persistent thrush, and age at the CD4 threshold
were independent predictors of progression to clinical AIDS. Among the subset
of 77 patients, the HIV-1 RNA level at the CD4 threshold, a persistent thrush and
age remained independent predictors of progression to AIDS. The increase of the
HIV-1 RNA level was moderate, both in non progressors (24.0% per year) and
in those who subsequently developed AIDS (27.1% per year), (p = 0.93). During
the 24 months prior to the CD4 threshold a persistent difference (estimated at 0.4
logio) was observed between these two groups (p = 0.002), i.e. HIV-1 RNA levels
being 3 times higher in patients who further developed AIDS.
Conclusion: At a late stage of infection, age, viral load and thrush remain
independent predictors of progression to AIDS.
|-12134 1HIV virological markers in a cohort of LTNPs: Results of
12 months of follow up
Maria Carmela Solmone1, Guido Antonelli2, R.E. Riva1, F.R. Ferrara2,
D.O.G. D'Offizi1, P.R. Paganelli', P.B. Pernozzoli1, D.F. Dianzani1. 'Institute of
Virology Univ. "La Sapienza Viale Di Porta Tiburtina n" 27 Rome,; 2Department
of Biomedicine Univ. of Pisa, Pisa, Italy
Objective: To verify the existence of virological markers which can be predictive
of the state of non progression in HIV infection.
Design and Methods: 24 LTNPs were enrolled on the basis of the following
criteria: asymptomatic state, a long history of documented HIV infection (at least
8 years from seroconversion); CD4+ cell number stable over 500/Jl from seroconversion and absence of previous antiretroviral therapy. The subjects were
followed for one year and compared with a group of asymptomatic patients with
similar CD4 cell number.
The following virological markers were examined: virus isolation, antigenemia,
plasma viremia and number of HIV-DNA infected cells.
Results: Viral isolation frequency, antigenemia and plasma viral load were
similar in both groups of patients during the period of observation. However
the results showed that: plasma viremia values increased during the period of
observation in both groups of patients altough with a high degree of heterogeneity
in the number of HIV-RNA copies/ml of plasma.
The number of peripheral mononuclear cells harboring HIV-DNA was however
significantly lower in LTNPs than in controls, both at enrollment and at 12 months
of follow-up. Moreover this number significantly increased during the period of
observation in both groups but at a lower extent in LTNPs.
Conclusions: The virological analysis of LTNPs reveals that: LTNPs are indistinguishable from asymptomatic subjects at the initial stage of the disease; HIV
infection progresses in a high proportion of LTNPs, thus suggesting that in most
of these subjects the progression is delayed but not absent; LTNPs represent a
quite heterogenous population. Interestingly, LTNPs display a lower number of
HIV-DNA infected cells.
12135 Clinical/viro/immunological parameters by HIV stage in
Addis Abeba, Ethiopia
Elias Kassa1, T.F. Rinke de Wit1, E. Hailu1, T. Messele1, H. Yeneneh2,
R.A. Coutinho3, A.L. Fontanet1. 'Ethiopian Netherlands AIDS Research
Project/ENARP Addis Abeba; 2EHNRI, Addis Abeba, Ethiopia; 3Municipal
Health Services, Amsterdam, Netherlands
Objectives: To identify clinical conditions and biological markers associated with
the WHO staging system of HIV infection in Ethiopia.
Design: Cross-sectional study.
Methods: 43 HIV-positive and 34 HIV-negative individuals participating in an
on-going cohort study on HIV-infection progression, as well as 79 HIV-positive
patients with clinical suspicion of AIDS from a nearby hospital, were recruited

in this study. Participants underwent clinical examination, HIV-1 antibody test,
CD4/CD8 count, and viral load measurement.
Results: 29/43 (67%) HIV-positive participants of the cohort study were asymptomatic. Of the remaining 14, minor weight loss and pulmonary tuberculosis were
the most commonly diagnosed conditions of the WHO staging system. No condition was listed in stage 4, although 17/43 (40%) participants had CD4 counts
less than 200/i/l. Total lymphocyte count <1000/11 had a positive predictive value

(PPV) of 100% in predicting that their CD4 counts would be less than 200/pil.
Among hospital patients, 20 of the 32 clinical conditions listed in the WHO staging
system were diagnosed. 66/79 (84%) patients had CD4 counts <200/~1l and
28/79 (35%) had CD4 counts <50//l1. Total lymphocyte count <2000/1/l had a
PPV of >90% in predicting that their CD4 counts would be less than 200/t1. When
grouping the two study populations, the mean CD4 count and the CD4/CD8 ratio
decreased with increasing stage of HIV infection progression (p < 0.01), whereas
mean viral load increased with increasing stage of HIV infection (p = 0.02).
Conclusions: profound immunosuppression could be found in people at work;
expected correlation was found between WHO staging system and biological
markers, including viral load; lymphocyte count was a good alternative to FACSCAN analysis in predicting low CD4 counts. A longitudinal cohort study is needed
to confirm the association between the WHO staging system and HIV infection
prognosis.
S12136 Follow-up of HIV positive patients through viral load
Alejandro Petroni, G. Deluchi, C. Rodriguez, J.A. Benetucci. Lascano 3360 PB 2
9417 Buenos Aires Aires; Fundai Htal Muniz Uspallata 2272 Buenos Aires,
Argentina
Aim: to correlate the variation of plasmatic viral load levels and LCD4 count in
HIV-1+ patients with and without antiretroviral treatment.
Patients and Methods: viral load levels were established through RT-PCR
(Amplicor HIV-1+ Monitor Roche Diagnostic System) on plasma from 74 HIV+-1
patients with (n:39) and without (n:35) initial antiretroviral treatment. LCD4 counts
were measured through flow cytometry.
Results: for every patient, VL was compared in two plasma samples with an
interval of 4.7 months (range:2-9) between them. The distribution of the VL levels
(loglo VL) for the first sample of treated patients (n = 39; q25 = 2.3, M = 3.4, q75
= 4.5) was significantly different (p = 0.003) from the one of untreated patients (n
= 35; q25 = 3.5, M = 4.5, q75 = 5.3). A decreased was achieved in the VL of 51%
(38/74) of the patients (n = 39; q25 = 2.3, M = 3.4, q75 = 4.5); out of which 45%
(17/38) reached undetectable values. In 10/74 patients the VL was undetectable
in both samples whereas 12/74 showed no significant variation (<0.5 log). Only
14 patients revealed an increased VL. Follow-up with more than 3 samples was
only available in 16 patients. 6 reached undetectable values with the treatment
without a new increase. 4 cases reported highly increased VL and the remaining
6/16 moved around a high platean plateau with no possoble decrease (range
3.2-4.8log). The VL levels and CD4 counts of 47 patients were available for
comparison showing a correlation in 51% of the cases.
Conclusions:the VL levels in patients initially treated were lower than those of
the naive group. VL levels decreased significantly after treatment independently
from the fact that patients entered the study with it 65% of the cases showed
either a decrease of the VL or its mantainance at undetectable values. Good correlation was observed when comparing VL and LCD4 counts. The impossibility
of decreasing the VL in 6 patients could suggest treatment faillure.
S12137 Analysis of survival in a Mexican cohort of patients with
AIDS: A 6-year follow-up analysis
German Luna1, S. Trevifo2, L. Nieto2, M. Santoscoy2. 'Sur 99-A #727 Colonia
Sectorpopular, 2Hospital General Gabriel Mancera, Mexico City, Mexico
Objective: To determine if the overall survival of a cohort of mexican patients has
improved with time and the factors that contributed to the improvement.
Design: Prospective, longitudinal, observational and descriptive study
Methods: We analyzed All adult patients with AIDS that were seen in our
department from september '91 to august '97. Time zero was considered from the
moment of the first visit beside their CDC classification, death was taken as the
defining event. Overall and yearly survival were evaluated with the Kaplan-Meier
method. Log-rank test was used to compare differences among curves.
Results: 1127 patients were followed during the study period. Median age
was 35.5 years (range: 23-61), 1070 (95%) patients were males and 57 (5%)
females. 914 (81%) patients were homosexual males, 157 (14%) patients were
heterosexual and 25 (2.2) had history of transfusion. At the moment of first visit
610 patients (54%) were AIDS C3. Overall survival was 31% at 67 months; We
observed a sustained improvement in survival. In 1995 50% of survival was found
at 17 months, whereas in 1997 50% was found at 32 months (p < 0.05). Survival
time for the whole group was 36 months (range: 1-72)
Conclusion: Survival of patients with AIDS has improved significantly in our
service during the study period. Factors responsible for this survival improvement
are better drug therapy and clinical care
112138| CD4+, CD8+ cell counts, CD4/CD8 ratio and clinical
features in HIV seropositive patients in Yaounde,
Cameroon
Dora N.S. Mbanya12, L. Zekeng3, L. Kamga3, J.B. Tapko2, L.N. Kaptue2. 'B.P
8046 Yaounde 8e; 2Department Haematology Univ. Yaounde I; 3Centre

Hospitalier et Universitaire, Cameroon
Objective: To establish lymphocyte subset ranges among Cameroonian HIV
positive people at various clinical stages of disease.
Methods: CD4+, CD8+, CD3+ levels and the CD4/CD8 ratio were measured
by flow cytometry in 106 HIV seropositive Cameroonians in a hospital-based
cross-sectional study and compared to various stages of clinical disease.