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

12th World AIDS Conference

Abstracts 32123-32128 545

Conclusions: Helicobacter pylori infection seems to be less common in HIV
positive patients with antral chronic pathology although there is no statistical
significance found. There is no association with cellular immune response and
the influence of current antibiotic therapy on Helicobacter pylori incidence in HIV
positive patients is not statistically proved.
S32123 Analysis of the changes in the oral cavity and the
oesophagus of HIV patients
Krzysztof Simon, Brygida Kynsz, K. Rotter, A. Glowacki, A. Gladysz. UL.
Kamiehskiego, Department of Infectious Diseases, Wroclaw, Poland
The Objective: of the study was to analyse the frequency and the kind of the
changes in the oral cavity and oesophagus in HIV patients (pts) and to evaluate
the prognostic value of them.
Material and Methods: 68 pts (53 males and 15 females, mean age of 32.6
years) examined at the Department were enrolled into the study. The analysis
was based on the CD4+ T lymphocyte count, the changes observed during
panendoscopy and microbiological examinations.
Results: Oesophageal candidosis (C. albicans) was observed in 45% of pts,
even during moderate immunodeficiency. The frequency of candidosis correlated
with the level of immunosuppression, and the age of the pts. It concerned 38% of
pts with CD4+ T cell count below 200/ml in the mean age of 38.3 years, mainly
men. Oral candidosis was seen in 21% of pts. Other changes: sarcoma Kaposi,
oral hairy leukoplakia, oesophageal ulceration (tbc, HSV, HIV) were observed
only in a few cases.
Conclusions: 1/ Most often oesophageal candidosis (C. albicans) was observed. The frequency correlated with the CD4+ T cell count and the age of
the pts. 2/ Other changes besides of oral candidosis were seen rarely and the
correlation with the immnological status was not clear.
278*/32124 Mechanisms of HIV transmission through
epithelial cell barriers
Charlene S. Dezzutti, R.B. Lal. CDC, MAil Stop G19, 1600 Clifton Rd, Atlanta,
Ga 30333, USA
Objectives: Previous studies have shown that HIV can be transcytosed across
epithelial cell line barriers; however, there is no information concerning primary
epithelial cells. Our objectives were to determine if primary epithelial cells have
the ability to harbor and transmit HIV and to determine if primary epithelial cells
can transcytose HIV.
Methods: For HIV transmission, primary prostate epithelial cells (PrEC) and
two epithelial cervical carcinoma cell lines, ME-180 and CaSKI, were inoculated
with HIV and washed. Various concentrations of resting or activated CD8-depleted
PBMCs were added before or after the epithelial cells were trypsinized. Supernatants were monitored every 2 days for HIV expression using a p24 ELISA. DNA
PCR was performed on the post-trypsinized epithelial cells to evaluate proviral
integration. For HIV transcytosis, the epithelial cells were cultured on 0.4 /tM
transwell filters until confluent (day 7). Cell-free HIV (LAI; MOI.001) or cell-associated (18 hours, TNF a-induced OM10.1 cell line) HIV was added to the apical
side. The basolateral medium was sampled for HIV p24.
Results: Without trypsinization, HIV was recovered by day 3 from ME-180 and
CaSKI cell lines and by day 7 from the PrEC cells by activated PBMCs but not
by resting PBMCs. For all epithelial cells, at least 5 x 105 activated PBMCs (2
PBMCs to 1 epithelial cell) were required for HIV recovery. Trypsinization of the
epithelial cells resulted in a loss of recoverable HIV from PrEC, but not ME-180
and CaSKI cells, even though all transiently had provirus. We next explored HIV
transcytosis. PrEC developed a tight-junction monolayer as seen by high transepithelial resistance (433 2 x cm2). CaSKI cells developed a moderate tight-junction
monolayer (50 0 x cm2), while the ME-180 cells failed to make a tight-junction
monolayer. Consequently, cell-free HIV was readily transcytosed through ME-180
cells by 1 hour and through CaSKI cells by 2 hours. Cell-associated virus began
to transcytose through ME-180 and CaSKI cells by 24 hours. Importantly, PrEC
did not transcytose cell-free or cell-associated HIV.
Conclusions: Both primary and immortalized epithelial cells have the capacity
to transiently sequester HIV, but primary (PrEC) cells are incapable of transmission. Further, formation of a tight-junction monolayer by PrEC did not allow
transcytosis of cell-free or cell-associated HIV. Collectively, these data suggest
that the in vivo mucosal epithelial barrier protects against HIV transmission, and
that factors, such as STDs, affecting the integrity of transepithelial tight-junctions
may allow viral entry and thus have implications for sexual transmission.
32125 1 Sexual dysfunction in patients with HIV infection and its
association with autonomic neuropathy and CD4 count
Karen E. Rogstad1, R. Shah2, G. Tesfaladet3, M. Abdullah3, I. Ahmed Jushuf4.
IDepartment of Genito Urinary Medicine, Royal Hallamshire Hospital, Sheffield,
Britain; 2University of Southampton, Southampton; 4Nottingham City Hospital,
Nottingham, England; 3Aga Khan Hospital Nairobi, Nairobi, Kenya

Aims: To determine the frequency of sexual dysfunction in patients with HIV
infection and relate it to the presence of autonomic dysfunction and CD4 count.
Setting Aga Khan Hospital, Nairobi
Methods: 25 native African patients (n 13 male, n 12 female) and 25 age-sex
matched controls completed a questionnaire and had tests of autonomic function
performed.

Results: 17 patients complained of decreased libido (10 male, 7 female) compared with 2 controls (both male), (p = 0.0001). Men were also more likely to
admit to absence of morning erections (10 Vs 5) (p = 0.03), decreased number of
erections (10 Vs 4). Decreased libido occurred at all CD4 counts (<50->1000)
and was present in all those with CD4 < 200. 6 patients could maintain an erection Vs 10 controls and 5 could ejaculate compared with 12 controls. Autonomic
dysfunction was more common in patients than controls. Both patients with 4
abnormal tests of heart rate variation had decreased libido, absent morning erections and decreased frequency of erection. All patients with 1 or more abnormal
tests had some form of erectile dysfunction.
Conclusion: Decreased libido is common in both male and female native
African patients with HIV infection and occurs at all CD4 counts. Erectile dysfunction occurs more frequently than in controls and appears to be associated with
autonomic neuropathy.
321261 Increased urinary frequency (UF) secondary to urinary
retention (UR) in HIV+ males and treatment with
doxazosin
Patrick O. Nemecheck1. 17301 Mission Road Suite 339, Prairie Village, Kansas
66208, USA
Introduction: As survival for HIV+ patients continues to increase, patients may
manifest new clinical syndromes as a result of prolonged viral replication or long
term exposure to medications. This abstract describes the high incidence of UF
secondary to UR, and the response of treatment with doxazosin mesylate.
Study: A retrospective chart review of male and female patients within a private
medical practice was performed. All patients were seen for medical care within
the immediate 12 month period. Charts were reviewed for UF and the treatment
response to doxazosin.
Results: 19 of 85 (22.35%) patients were identified with the complaint of either
daytime or nighttime UR. Of these 19 patients, several also complained of urinary
hesitation (UH) or ill-defined abdominal or low back pain. The complaint of UF
was discovered only after specific questioning of all 19 patients. Urine analysis
and digital rectal exam were performed to exclude prostatitis. Of 19 patients,
42%, 36%, 11% and 11% had clinical improvement with doses of 2 mg., 4 mg., 8
mg., and 12 mg. respectively. Clinical response was typically seen within 7 days.
The onset of UR correlated with elevated HIV RNA levels (p = 0.0003), declining
CD4 cell number (p = 0.02) and CD4 cell percentage (p = 0.022).
Conclusion: UR with secondary UH and/or abdominal pain is present in
22.35% of HIV+ patients. Clinical improvement occurs rapidly with treatment of
2-12 mg. of doxazosin daily. In this cohort, UF is an increasing common condition
that is easily treated with doxazosin.
32127 Etiology of acute renal failure in HIV+ patients
D'Vorah Hasheeve1, C.E. Thompson2, P.D. Salvato2. 14140 SW Freeway,
Houston, Texas; 20ncol Medica Associates, Houston, TX, USA
Objective: To describe the etiology of acute renal failure (ARF) in a group of
hospitalized HIV+ pts.
Method: A retrospective chart review was conducted on 431 HIV+ pts. hospitalized over a 6-year period. Pts. were defined with acute renal failure if the
baseline creatinine increased by at least 2.0 mg%.
Results: 129 pts. (30%) met the definition of ARF. Volume depletion from
dehydration was the most common etiology occurring in 51 pts.; 2 required
dialysis. In 47 pts., nephrotoxic drugs were the responsible agent; 11 required
dialysis. Infection was the identified cause in 12 pts.; 2 required dialysis. In 15
pts. renal insufficiency was unexplained and was defined on clinical grounds
as AIDS nephropathy; 11 required dialysis. Chronic illness was thought to be
the contributing factor in 4 pts.; 2 diabetes, 2 hypertension; all required dialysis.
Urinary tract obstruction secondary to tumor was identified in 2 pts., both of which
died from their disease within 9 weeks.
Conclusion: ARF is a common complication in HIV+ pts. ARF is often reversible with proper hydration, aggressive treatment of sepsis, dialysis and
careful drug monitoring. Chronic irreversible renal disease was most often due to
AIDS nephropathy.
32128 | Clinical course of pelvic inflammatory disease (PID) in
HIV+ and HIV- women
Jean M. Keller12, S.T. Das Gupta2, J.R. Anderson2. 1600 N. Wolfe Street Harvey
319, Baltimore, Maryland; 2Johns Hopkins University, Baltimore, MD, USA
Objectives: To compare characteristics and clinical course of PID in HIV+ and
HIV- women.
Design: Retrospective case control study.
Methods: Retrospective chart review of 233 admissions, 9/89-3/96, to the
Johns Hopkins Hospital in women of known HIV serostatus with a diagnosis of
acute PID. Comparisons were made using chi-square.
Results: Of 233 admissions (208 patients), 56 (24%) were HIV+ women. De
mographics: mean age - 28.1 y (31.0 y HIV+ vs. 27.4 y HIV-, p = 0.001); Race:
African American- 93.8%; Insurance status: Medicaid - 34.3%; None - 28.3%.
Clinical Course: Mean days in hospital: 6.0 HIV+ vs. 4.5 HIV- (p = 0.02); Multiple
admissions: 19.6% HIV+ vs. 8.5% HIV- (p = 0.02); Hx ectopic pregnancy: 22.2%
HIV+ vs. 6.5% HIV- (p = 0.008); Gonorrhea/chlamydia+ (n = 144): 23.7% HIV+
vs. 50% HIV- (p = 0.004); Hepatitis BsAg+ (n = 103): 19.2% HIV+; vs. 5.2% HIV