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

12th World AIDS Conference

Abstracts 12148-12152 41

infection lower loads of virus could support a mainly immunologic-driven pathology.
121481 Implication of a modified case definition for AIDS
Ka Hing Wong, T.M.Y. Choi, S.S. Lee. AIDS Unit Department of Health, 5/F
Yaumatei JCC, 145 Battery Street, Yaumatei Kowloon, Hong Kong (China)
Objectives: To determine the implications of a modified AIDS case definition
adopted in Hong Kong by evaluating the time-trends of primary AIDS-defining
illnesses (ADI).
Methods: A modified AIDS surveillance case definition had been adopted in
Hong Kong since June 1995. The US CDC 1994 system was applied except that
(1) pulmonary TB was regarded as an ADI only if the CD4 count was <200/ul, and
(2) disseminated Penicillium marneffei infection was considered an ADI. Primary
ADIs reported under a voluntary system over 13 year from Feb 1985 to Dec 1997
were retrospectively analysed.
Results: A total of 309 AIDS cases were reported, 90% were male and 80%
acquired HIV via sexual contact, 74% were ethnic Chinese. About half (44%)
were diagnosed in 1996-1997. Cumulatively, Pneumocystis carinii pneumonia
(PCP) had remained the commonest primary ADI (36%), followed by all forms
of tuberculosis (19%), and penicilliosis (9%). The overall frequency of TB has
increased. Some 13-17% of the new AIDS cases were contributed by pulmonary
tuberculosis with a low CD4 count after change of the case definition. Since 1995,
the frequency of PCP had risen though the percentage remained stable.

Year
PCP
TB (all)
Others
TOTAL

85
1
0
2
3

86
0
0
0
0

87 88 89
2 4 8
0 0 1
4 3 8
6 7 17

90
5
2
6
13

91
4
3
7
14

92
7
1
6
14

93 94 95 96 97 85-97
10 12 17 21 19 110
2 4 8 21 17 59
7 21 20 28 28 140
19 37 45 70 64 309

Conclusion: The number of reported AIDS cases has increased since 1995,
which was partly due to a change in the AIDS case definition. Tuberculosis
and Penicillium marneffei infections were significant ADIs in Hong Kong. The
frequency of Pneumocystis carinii pneumonia as a primary ADI has remained
at a high level, a reflection of late diagnosis in a significant proportion of those
infected with HIV.
S121491 Clinical patterns of HIV-infection/AIDS in Ukraine
Alla D. Vovk1, S.N. Antonyak1, N.P. Tchentsova1, E.V. Maximenok1,
A.M. Shcherbinskaya2. 1Institute of Epidemiol. & Infect. Diseases, Spusk
Protasov Jar, 4 Kiyv 252038; 2Ukrainian AIDS Prevention Center, Ukraine
Objectives: To study some "local' clinical patterns of HIV infection in Ukraine.
Design: Prospective, controlled investigation.
Methods: Clinical studies of HIV-associated conditions.
Results: A total of 449 HIV-infected episodes were analyzed including 40 ones
of the AIDS-AC and 40 AIDS cases. Our patients were 18-37 years old. The
disease progress was mostly observed during 3-5 years p.i. The most common
HIV-associated condition (in 62 patients) is candidiasis of oral cavity, bronchi and
intestine. A striking feature of AIDS patients are different recurrent viral accompanying infections, such as herpes simplex (in 37 patients), herpes zoster (in
5 patients), cytomegalovirus infection (in 3 patients); HIV-infected drug abusers
carry usually the markers of hepatitis B and C viruses. These infections followed
each other or were simultaneous. Among AIDS-AC we found tuberculosis (in 14
patients including 5 extrapulmonary cases), pneumocytosis (7 cases), esophagitis (4 cases), cryptosporidiosis and isosporosis (4 cases), cerebral lymphome (1
case), cryptococcal meningitis (1 case), Kaposi sarcoma (in 3 homosexual men).
The development of opportunistic infections was shown to be dependent on the
decrease of CD+4 lymphocytes in peripheral blood.
Conclusion: The symptomless HIV-infection period tends to become shorter
followed by the earlier clinical manifestation. 19 patients (among 36 ones) died
during several months or a year after their diagnosis had been determined, 5
patients only lived 6-7 years.
12150 Clinical review of the patients with advanced HIV disease
in Bulgaria
Irina Valkova1, I. Dikov2, K. Kostov', T. Duhovnikova1, P. Ratchev2, I. Radeva1,
D. Stefanova2. Hospital for Infectious Diseases, 17 Dimitar Nestorov Str, 1606
Sofia; 2Medical University, Sofia, Bulgaria
Objectives: To present the ratio of AIDS-indicator conditions among the HIV
infected people in Bulgaria.
Methods: 54 patients reported as AIDS cases.
Since 1987 when the first HIV positive Bulgarian citizens were detected till the
end of 1997 - 217 people were identified as HIV-infected. For the same period 54
of them - 38 men and 16 women -were reported to be with AIDS (cat. C) with one
or more AIDS -indicator conditions. Nine of them were diagnozed as HIV-infected
for the first time during the stage of AIDS. The infection was transmitted by
heterosexual way in 37, by homosexual - in 10, by transfusion of blood and blood
products - in 6.1 was an IVDU. 44 of them died of AIDS.
Results: The most spread opportunistic infection was C. albicans - in 39 cases
(72.22%): esophageal, bronchial, pulmonary, uveitis and 1 peritonitis. Pneumocystis carinii pneumonia was observed in 15 patients (27.78%); Mycobacterial

infections (pulmonary and disseminated) were diagnozed in 12 (22.22%); Recurrent bacterial pneumonia - in 9 (16.67%); Cytomegalvirus infection (pneumonia,
retinitis) - in 7 (12.96%) Cryptococcal meningitis and sepsis - in 5, Herpes simplex
- in 5 (9.26%), cerebral Toxoplasmosis - in 3, Salmonella septicaemia - in 3,
Cryptosporidiasis - in 3 (5.55%). HIV-related encephalopathy was proved in
14 (25.92%). Kaposi's sarcoma was observed in 4 (7.40%). brain lymphoma -
in 1 (0.85%) of the cases. The main cause for lethal outcome was pneumonia
(associated viral-bacterial, PCP or fungal) and resistant to treatment tuberculosis.
Conclusions: The most frequent AIDS-indicator conditions are the opportunistic infections. The prevalence of Candidiasis and the relatively low rate of PCP
are characteristic for the course of the disease in Bulgaria. The rising number of
cases with Mycobacterial infections, especially the disseminated forms, requires
a more active search for an early diagnosis, resp. early treatment. The share
of the malignancies is low, respectively the attention has to be directed to the
managing of the opportunistic infections.
459*/12151 Control of maternal HIV-1 disease during
pregnancy
Karen Beckerman, M. Benson, S. Dahud, M. Shannon. Univ of California San
Francisco PO Box 419100 San Francisco CA 9414 19100, USA
Issue: Recently released Principles of Therapy of HIV Infection (NIH, 11/97)
specify that women should receive optimal antiretroviral therapy regardless of the
pregnancy status. However, reports of experience with the use of these therapies
in pregnancy have not yet appeared.
Project: Areas Perinatal AIDS Center at San Francisco General Hospital (BAPAC) has cared for over 200 HIV-1 infected mothers and their exposed children
since 1989, stressing continuity of care, case management and meticulous attention to basic principles of maternal and child health in conjunction with ongoing
counseling, peer advocacy and education. The Center has been able to offer
maternal viral load assessment and state-of-the-art combination drug therapy for
treatment of maternal disease and control of maternal plasma viremia since 1995.
Results: Client choice of available therapies has shifted markedly during this
period. The majority of clients delivered in 1996 elected to take ZDV monotherapy, while in 1997, 16/23 mothers delivered took double combination therapy
and 6/23 took triple combination therapy. Ten of 12 women currently pregnant in
1998 have chosen triple combination therapy. At BAPAC, combination therapy
has been well-tolerated and no maternal or pediatric complications have been
observed. It has been possible to lower maternal viral burden in all mothers,
usually to non-detectable levels. Multiple problems with maternal ability to adhere
to therapy have been encountered, particularly during the late first trimester and
the post-partum period. These therapies have also had a profound impact on
vertical transmission rates. Of the 60 BAPAC infants born since May 1995, 43
are uninfected with all DNA-PCR testing negative through 6 months of age. Of 17
infants less than 6 months who have not yet completed testing 9 are presumed
uninfected with negative PCR at birth and 6 weeks while 8 are negative at birth
with no evidence of infection.
Lessons Learned: Despite adherence problems associated with pregnancy
and the post-partum period, the use of combination antiretroviral therapeutic
strategies to treat maternal HIV-1 disease during pregnancy results not only in
improved maternal health, but also in rates of maternal-to-fetal transmission that
approach zero.
463*/12152 1 Combination therapy with nevirapine, zidovudine
and a second nucleoside analog during pregnancy
Francoise Kramer, A. Stek, J. Homans, M. Khoury, A. Kovacs. University of
Southern California, LAC + USC Med Ctr Rm 6442, 1200 N State St, Los
Angeles, CA 90033, USA
Objectives: To determine the safety and efficacy of nevirapine given with 2 nucleoside analog reverse transcriptase inhibitors (NRTI) in HIV-infected pregnant
women and evaluate the impact of this regimen on newborns.
Methods: We reviewed the records of 14 HIV-infected pregnant women who
received nevirapine, zidovudine and another NRTI (9 DDI, 2 DDC, 2 3TC and 1
DDI later switched to 3TC) from 6/97 to 1/98. Exposure to nevirapine lasted from
2 to 31 weeks. 8 patients have delivered and 6 are near term.
Results: This regimen was well tolerated. Rashes (2 mild, 1 more severe) occurred in 3 cases. Zidovudine-induced anemia affected 1 patient. Of 11 patients
who received >8 weeks of combination, 8 (mean baseline HIV RNA PCR = 16,000
copies/ml) reached an undetectable viral load (<200 copies/ml) within 8 weeks of
treatment and continue to have a complete viral suppression (3 deliveries to date).
Among the other 3 cases, 2 are failures (1 insufficient response, 1 relapse; mean
baseline viral load = 47,000) and 1 had a decrease in viral load from 112,000 to
644 by 5 weeks prior to delivery and undetectable viral load after delivery. 7/8
newborns have negative HIV DNA PCR (1 pending). All newborns are without
anomalies and with CD4 and other laboratory values within normal range.
Conclusion: In our experience, a regimen of nevirapine, zidovudine and another NRTI is well tolerated in pregnancy, leads to a sustained undetectable viral
load in 82% of cases and does not have detrimental effects on the newborn