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

536 Abstracts 31203-31207

12th World AIDS Conference

Patients CMVDNAi (pg/106 cells) Viral half-life (day) Turnover (x 108 virus/day)
AIDS (n = 10) 235 + 107 4.0 ~ 1.9 9.6 ~ 13.7
KT (n = 6) 107 ~ 60 1.5 ~ 0.3 22.8 ~ 12.9
BMT (n = 2) 175 ~ 112 2.0 ~ 2.2 17.7 ~ 20.5
Total 175 112 2.0 ~ 2.2 17.7 20.5
CMV half-life in WBC were twice longer in AIDS patients compared to transplant
recipients, in relation with a twice higher concentration of initial CMV DNA (p =
0.001). On the contrary, the viral turnover was 3 to 5 times lower in AIDS patients.
Conclusion: These half-lifes were similar to the one discribed for HIV producing cells (1.6 days, Perelson et al. Science 1996). But the CMV day turnover
rate is much lower than the one of HIV (103 x 108 virus/day), especially in AIDS
patients, due to the higher viral diversity of HIV compared to CMV. These kinetics
demonstrate a higher efficiency of GCV in transplant recipients compared to AIDS
patients suffering of CMV disease.
31203 1 Distribution of cytomegalovirus (CMV) envelope
glycoprotein genotypes of CMV strains isolated from
saliva of HIV patients without CMV disease
Nadhira Houhou-Fidouh1, X. Duval2, F. Bissuel2, V. Bourbonneux', C. Jordan2,
F. Brun-Vezinet1, C. Leport2. 1Laboratoire de Virologie, Hopital Bichat Claude
Bernard, 46 Rue Henri Huchard, 75018 Paris; 2Service de Maladies
Infectieuses, Hopital Bichat Claude Bernard, Paris, France
Objectives: To determine the distribution of CMV envelope glycoprotein (gB)
subtypes in saliva of HIV infected patients (pts) according to geographic origin
and HIV risk factors.
Design: Observational study.
Methods: gB genotypes were determined, using restriction analysis of polymerase chain reaction amplified DNA, for CMV isolates from saliva of 35 HIV pts
(27 men, 8 women) without CMV disease.
Results: Median CD4 cell count was 26/mm3 (4-301). Characteristics and
distribution of the pts (no. [%]) according to gB genotypes were as follows.
Total gB Genotype
no. pts 1 2 3 4
35 4 [11%1] 27 [77%] 5 [14%1] 3 [8.5%]
Geographic area:
Caucasian 26 3 [12%] 20 [77%] 4 [15%] 2 [8%]
African 6 0 6 [100%] 1 0
Asiatic 2 1 1 1
West Indian 1 1
HIV risk factor:
Homosexuality 19 4 [21%] 12 [63%] 3 [16%] 3 [16%]
Heterosexuality 10 0 10 [100%] 0 0
Maternofoetal 2 0 21 0
Drug addiction 3 0 2 1
Blood transfusion 1 1
mixed gB strains: gB1 + 3 + 4, n = 1; gB2 + 3, n = 1; gB2 + 4, n = 1
Conclusion: gB subtype 2 was predominant [77%] in saliva of CMV asymptomatic pts. HIV risk factor and geographic origin did not significantly influence the
distribution of the different genotypes. The predominance of gB subtype 2 in HIV
pts is similar to that described in blood of HIV pts with CMV retinitis and different to
that described in other immunocompromised pts (Chou 1991; Rasmussen 1997).
31204 Coinfection with CMV and EBV in Indian patients with
HIV/AIDS
Shobha Sehgal, S. Mujtaba. Immunopathology Dept., PGIMER Chandigarh
-160012, India
Objectives: Although tuberculosis appears to be the single most important coinfection responsible for morbidity in Indian patients with AIDS, information about
other opportunistic infections is very patchy as detailed radiological, microbiologicalaand biopsy examinations are far from feasible.
Design: Prospective study.
Methods: In the present study, 69 patients with HIV/AIDS were investigated for
evidence of active cytomegalovirus (CMV) and EBV infections. For a diagnosis
of CMV, IgM ELISA, antigenemia assay and polymerase chain reaction were
conducted while for EBV, IgM antibodies against viral capsid antigens, western
blot test for detection of anti-Zebra antibodies and polymerase chain reaction for
BamHIW region were conducted.
Results: Results indicate that 73% of AIDS patients and 30% of seropositives had evidence of active EBV infection. Nearly 33% of AIDS cases had
CMV infection while in seropositives, the positivity rate was 3%. In none of the
cases was CMV clinically suspected. None of the 30 healthy laboratory controls
showed evidence of either CMV or active EBV infections. These coinfections
could significantly contribute to morbidity and mortality in AIDS patients.

Conclusion: A significant percentage of Indian patients with HIV & AIDS show
evidence of active CMV and EBV infection which may contribute to increased
morbidity and rapid progression to full blown disease

S31205 Clarithromycin prophylaxis for MAC in AIDS patients
reduces the incidence of treatment-emergent respiratory
tract infections
Gerard Notario, J. Craft, C. Dart. Abbott Laboratories, 200 Abbott Park Road,
Abbott Park, IL, USA
Background: Clarithromycin is an antimicrobial with a broad spectrum of activity
against respiratory pathogens including Streptococcus pneumoniae, Moraxella
catarrhalis, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. AIDS patients suffer from many opportunistic infections and also have frequent treatment-emergent infections from more common
pathogens.
Objective: To assess the effect of clarithromycin prophylaxis on the development of respiratory tract infections.
Methods: In a large multi-national randomized study of clarithromycin 500 mg
BID vs. placebo for the prevention of MAC (Pierce et al, N Engl J Med 1996; 335:
384-91), 341 patients were treated with clarithromycin and 341 patients were
treated with placebo. Patients were followed for evidence of MAC infection and
for other opportunistic infections.
Results: Overall, 151 patients developed respiratory tract infections. The
placebo patients had 94 (28%) episodes while the clarithromycin-treated patients
had only 57 (17%) episodes. This difference is statistically significant with a p <
0.001. Breakdowns of all treatment-emergent respiratory tract infections are as
follows:
Infection Clarithromycin (n = 341) Placebo (n = 341) p-value
Pneumonia 34 (10%) 58 (17%) 0.010
Bronchitis 7 (2%) 19(6%) 0.026
Pharyngitis 1 (<1%) 3(<1%) NS
Otitis 2 (<1%) 8 (2%) NS
Sinusitis 21 (6%) 31 (9%) NS
Indicates statistical significance at the 0.05 level.; NS = Not significant
Conclusion: Clarithromycin prophylaxis for MAC provides an additional benefit
to AIDS patients by preventing the development of treatment-emergent respiratory
tract infections, especially pneumonia and bronchitis.
31206 Cellular immune responses to mycobacterial antigens
observed in pulmonary and extrapulmonary TB/AIDS
patients
Diane J. Ordwaypereira1, R. Badura2, H.C. Silveira2, M.S. Costa2, H. Dockrell3,
F.A. Ventura4. Rua Juanqueira 96 1300 Lisbon; 2Centro De Malariae
Outrasdoencas Tropicais Lison; 4Hospital Egas Moniz/Fac. De Ciencias
Medicas, Unl Lisbon, Portugal; 3London School of Hygiene & Tropial Medicine
London, England
Objective: To analyse cellular immune responses (Lymphocyte proliferation and
IFN-y secretion) towards a panel of mycobacterial antigens in patients with
pulmonary and extrapulmonary/AIDS.
Design: Prospective, controlled study.
Methods: blood was collected in 1) Healthy BCG vaccinated individuals 2)
Pulmonary TB patients 3) Pulmonary TB/HIV 4) Extrapulmonary TB patients 5)
Extrapulmonary/HIV patients and 6) HIV patients. Standard lymphocyte proliferation assay was used. Briefly, lymphocytes (2 x 105) were stimulated with
antigens that include PPD (Statens Serum Institute, Copenhagen) and Mtb short
term culture filtrate proteins (ST-CFP) (Dr. Andersen, Statens Serum Institute,
Copenhagen). Lymphocyte culture supernatants were harvested from parallel
cultures at day 6 for quantification of IFN-y by ELISA.
Results: BCG vaccinated individuals demonstrated extensive proliferation and
LFN-y secretion to PPD and ST-CFP. By comparison, cells from patients with
pulmonary TB, proliferated less vigorously and had reduced IFN-y secretion,
than cells from sensitised individuals, higher values were once again with PPD
and ST-CFP. Pulmonary TB/HIV patients had diminished proliferation and IFN-y
secretion toward PPD, but not to ST-CFP, when compared to non HIV infected
TB pulmonary patients. Extrapulmonary TB patients showed lower, responses to
PPD, when compared to BCG vaccinated controls and TB pulmonary patients,
but higher responses than TB pulmonary/HIV patients, ST-CFP showed a slightly
reduced response in this group. Extrapulmonary/HIV patients showed the least
amount of proliferation and IFN-y secretion to PPD and ST-CFP when compared
to all the groups, even the HIV only patients.
Conclusions: Culture filtrate proteins from Mtb. have great immunogenic potential and should be further studied in view of future immune interventions.
1|31207 Follow-up of PPD skin test and cellular immune response
in a high risk group for developing tuberculosis
Maria Da Gloria Bonecinia-Almeidal, I. Neves Jr.2, I.N. Cota2, A.C.C. Carvalho2,
A.L. Kritski3, M.G. Morgado2. 1Avenida Brasil 4365, Rio de Janeiro-RJ, Brazil

21045-900; 20swaldo Cruz Foundation, Rio de Janeiro, RJ; 3Pneumology
Service, Federal university of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
Objectives: The PPD skin test is not considered sensitive enough to identify
latent Mycobacterium tuberculosis (Mtb) infection. Thus, our aim was to compare
the PPD skin test reaction and the lymphoproliferative resposnse to Mtb-antigen
in a high risk group for developing tuberculosis (Tb) disease, the household
contacts (HCC).