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

12th World AIDS Conference

Abstracts 32134-32138 547

in the remaining 171 who became pregnant (n = 26 white, n = 24 black, n = 8
latina), resulting in 51 live births, including one set of twins, and 23 abortions
(20 elective, 3 spontaneous). Eleven women had a second pregnancy and two
women had a third. Post-partum tubal ligations were performed in 16 women.
There were 6 pregnancies in women with AIDS. Four babies were HIV+ and
four mothers have died. For 5 of the 58 women, the pregnancy was planned; 2
of these 5 women were informed of their HIV status ante- or post-partum. In 5
cases, the HIV status was the major determinant in the woman's decision to carry
or interrupt the pregnancy.
Conclusions: One third of the women who could conceive, became pregnant
over the four year observation period. Over two thirds of the pregnancies resulted
in live births with less than 10% maternal-fetal transmission of HIV. Medical-ethical
issues played a central role in patient counseling.
32134 Immunological parameters and cervical intraepithelial
neoplasia (CIN) in HIV-1+ women
A. Bongain1, S. Magnaldo1, E. Galiba1, J. Cottalorda2, P. Dellamonica3,
J.Y. Gillet1. 1 Dpt of Obstetrics-Gynecology; 2Dpt of Virology; 3Dpt of Infectious
Diseases, University of Nice, France
Objective: To evaluate frequency of CIN in HIV1 infected women and to determine the relation between the immunological parameters and CIN in HIV1 positive
women.
Methods: Gynecological examination were performed with CD4 lymphocytes
count and viral load (Amplicor Roche).
Results: we have observed 102 HIV-infected women with an average of 34
~ 6.6 years (range 19-68). In all, we performed cervical smears, colposcopic
evaluation and when necessary colposcopically directed cervical biopsies (n =
24). 29 (28%) patients were intravenous drug addicts, 61 (60%) had heterosexual
contracts and 3 were transfused. 48 (47%) were in category A, 33 (33%) were
in B and 20% in C. 3% patients were under treatment with one antiretroviral
compounds, 37% with two and 42% with three drugs. Histological CIN lesions
were found in 17 (16.6%) and HPV lesions in 57% of biopsies. CIN1 lesions are
present in 6, CIN2 in 3, CIN3 in 8.
CIN and CD4 count

p = 0.93 CD4. 500/mm3
CIN- 15
CIN+ 3

CD4 in 200-500/mm3 CD4 < 200/mm3

CIN and viral load

p = 0.17 Viral load - 10,000 cop/mL

Viral load. 10,000 cop/mL
36

CIN -
CIN +

40
12

of latent CMV by inflammatory cells that infiltrate endocervical and endometrial
tissue during bacterial infection.
32136 Rectovaginal fistula in HIV infected women
Sonia Silva2, R. Khalili2, V.G. Veloso2, F.F. Valle2, R. Azambuja2,
M.G. Camargo1, B. Grinsztejn2. FIOCRUZ - 1 Instituto Fernandes Figueira,
2Hospital Evandro Chagas, Rua Alzira Cortes, Botafogo, Rio De Janeiro, Brazil
Objective: To describe epidemiological, clinical and immunological profile of
women with RV fistulae.
Methods: Charts of HIV infected women with reto-vaginal fistulae (RFV)
diagnosed at Evandro Chagas Hospital/FIOCRUZ (HEC) were reviewed. Epidemiological, clinical, immunological and gynecological data were collected.
Results: From 01/88 to 12/97 276 HIV infected women were followed in a
cohort study at HEC. From this cohort, 5 women developed RVF and the first
diagnose of RVF was made in 1996. Mean age was 34.8 years, all of them had
acquired HIV infection through heterosexual transmission and had advanced HIV
disease at the moment of the RVF diagnosis (mean CD4 count 41.7 cels/mm3).
Previous opportunistic infections were CMV (3/5), tuberculosis (2/5), criptococosis (1/5), DMAC (2/5). Vaginal feaces discharge was reported by all of them.
Colposcopy and proctologic evaluation were performed in two patients and biopsy
was obtained from one but no etiological diagnosis was defined. By January/98 all
but one patient have already died. The mean survival time after AIDS diagnosis
was 25 months. Three patient had the RFV diagnosed very close to death.
Conclusions: 1) The diagnosis of RVF in our cohort was associated with HIV
advanced disease; 2) The occurrence of RVF in that cohort, only in the last 2
years, is probably related to a increase in the survival of women with AIDS; 3)
The etiopathogenesis of RVF is still obscure and deserves further study.
Supported by a Fogarty JHU International Training Grant.
32137 The benign cystic lymphoepithelial lesion (BLL) of the
parotid gland is a viral reservoir in HIV-1 patients
Stefania Uccini1, E. Riva2, G. Antonelli3, G. D'Offizi4, A. Angelici5,
M.C. D'Ovidio6, A. Angeloni6. Dept. Experimental Medicine and Pathology
Univ. La Sapienza Viale Regina Elena 324 Rome; 2lnstitute of Virology
University La Sapienza Rome; 3Dept. BioMedicine University of Pisa Pisa;
41RRCS L. Spallanzani Rome; 54th Institute of Clinical Surgery Rome; 6Dept.
Experimental Medicine and PathologyRome, Italy
Objectives: BLL is a rare disorder mainly affecting HIV-1 patients, histologically
characterized by the presence of cystic spaces filled of liquid fluid, surrounded by
hyperplastic lymphoid B cell follicles. To study the role of HIV-1 in the pathogenesis of BLL, we have investigated the presence of HIV-1 in the glands and in the
cystic fluid aspirates. Moreover, the biological results have been compared with
the viral tissue distribution.
Design: Study of HIV-1 associated diseases.
Methods: HIV-1 RNA copies/ml were investigated by commercial quantitation
assay in the cystic parotid fluids and in the tissues from 6 cases of BLL. p24
antigen was evaluated in the cystic fluids by commercial enzyme immunoassay
and in the tissues by immunocytochemistry. HIV-1 was cultured and titrated on
PBMC from an healthy donor according to standard protocols.
Results: In the cystic fluids, p24 protein was present at a concentration ranging
from 3 to 15 ng/ml, while undetectable in the peripheral blood of the same patients.
The number of RNA copies was significantly higher than in the peripheral blood of
HIV-1 patients. In 2 out of 6 BLL fluids, examined in a standard infectivity assay,
HIV-1 infectious particles were not detected, despite the high titre of HIV-1 RNA.
The pathogenetic mechanism leading to virus accumulation in the cystic fluid was
studied by immunohistochemistry on tissue sections. We have shown that p24
protein was associated with DRC-1+/S-100+ follicular dendritic reticulum cells of
the germinal centers, which were also present within the cystic cavities.
Conclusion: Our findings are consistent with the possibility that the large
amount of virus present in the fluid derive from continous shedding of HIV-1
infected cells from the surrounding lymphoid tissue.
|32138 Effects of protease inhibitors in HIV-related
thrombocytopenia
Cecile Goujard, C. Rousseau, R. Doiron, J.F. Delfraissy. Hopital Bicentre 78 Rue
Gal Leclerc, 94270 Kremlin Bicetre, France
Background: Zidovudine was known to improve HIV-thrombocytopenia despite
its poor antiretroviral efficacy. In this study, we tested the efficacy of proteaseinhibitors (PI) in multitherapies - for patients with less than 100 109 platelets
G/l.
Methods: Twenty patients treated since 1996 were restrospectively studied
and predictive factors for platelets response-defined as a platelet count above
100 109 G/l or an improvement of more than 100% - were analyzed.
Patients: The mean duration of thrombocytopenia was 38 months before treat
ment with PI (indinavir 15, ritonavir 3, saquinavir 1, ritonavir + saquinavir 1).
Patients had a low CD4 cell count (median 46/mm3) and a high viral load (median
5.2 log).
Results: We observed
- an early response in 55% of patients at month 3 (M3) and 65% at month 6
(M6).
- a persistant response at M9 and M12 when treatment was continued.

Conclusions: The prevalence of HPV-CIN lesions in our cohort is in agreement
with the data of other studies, but our study permits to conclude that this higher
frequency of CIN lesions isn't more determinate by the degree of immunodeficiency. The treatment with antiretroviral compounds improve the immunological
parameters (CD4 count and HIV1-RNA copy numbers in blood) but we don't
observe a correlated diminution of CIN lesions. Even with good immunological
parameters, colposcopy and Pap smear screening is frequently necessary in this
population.
32135 Cytomegalovirus and herpes simplex virus are not
associated with acute pelvic inflammatory disease in
HIV-infected women
Kathleen Irwin1, A. Moorman1, M.J. O'Sullivan2, R. Sperling3, M. Brodman3,
M. Koester2, I. Soto3, G. Cassell4, L. Duffy4. HIV-PID Multi Center Study Grp;
3CDC MS E-44 1600 Clifton Rd, Atlanta, GA 30333; 2University of Miami, Miami,
FL; 3Mt Sinai Medical Center, New York, NY; 4 University of Alabama at
Birmingham, Birmingham, AL, USA
Background: Symptomatic pelvic inflammatory disease (PID) in HIV-infected
women may be caused by organisms thought to be nonpathogenic in immunocompetent women, including the sexually transmitted viruses cytomegalovirus
(CMV) and herpes simplex virus (HSV). Recent US studies suggest that CMV
may be a causative agent of PID.
Methods: We analyzed HIV-infected and uninfected patients diagnosed with
PID using standard clinical criteria and HIV-infected women with cervical dysplasia
who did not meet clinical criteria for PID. Endocervical swabs and transcervical
endometrial biopsy specimens were cultured for HSV and CMV using standard
methods.
Results: HIV-infected women with PID were more likely than uninfected women
to have CMV recovered from the endocervix (10/36 [28%] vs. 18/144 [13%], p <.05) and endometrium (7/25 [28%] vs. 2/107 [2%], p <.05). However, in all but
one CMV-infected patient, bacteria considered possible causative agents of PID
were recovered. Recovery of endocervical and endometrial HSV did not differ by
serostatus and probable bacterial pathogens were recovered in all HSV-infected
patients. Among the HIV-infected women without PID, only one (1/14) had endometrial CMV recovered and no endocervical CMV (0/7), endocervical HSV
(0/7), or endometrial HSV (0/14) were recovered.
Conclusion: CMV and HSV do not appear to be important causative agents of
PID in the absence of bacterial infection. The reason for higher rates of recovery of
endometrial CMV in HIV-infected women is not clear but may reflect reactivation