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

548 Abstracts 32139-32143

12th World AIDS Conference

The platelet count improved from 61 at day 1 of PI, to 108 at M1, 112 at M3,
121 at M6, 115 at M9 and 120 at M12, with a median increase of 85% at M3 and
77% at M6.
The median decrease in viral load was -2.9 log at M3, -2.4 log at M6 and the
median increase in CD4 count was + 116 at M3 and + 134 at M6.
Transmission groups, CDC clinical classification, coinfection with HCV and
HBV, viral load and CD4, platelet count at day 1, were not predictive of platelet
response at M3 and M6.
The platelet response was only correlated with the decrease of viral load and
to a lesser extend with the increase of CD4 at M3.
Conclusion: PI are associated with an improvement of platelet count in HIVthrombocytopenia: the correlation of the platelet response with the decrease in
viral load favours the direct and powerful antiretroviral efficacy of these molecules.
32139 Hematological parameters correlate with HIV-1 plasma
viral load and are improved by highly active antiretroviral
therapy (HAART)
Jean Servais1, Robert Hemmer2, T. Staub2, P. Fournier1, V. Arendt2,
F. Schneider3, J.C. Schmit2. 1Laboratoire de Retrovirologie, CRP-Sante, 4 rue
Barble, Luxembourg City; 2 Departement des Maladies Infectieuses - CHL,
3Laboratoire National de Sante, Luxembourg City, Luxembourg
Objectives: 1) To determine the correlations between hematological parameters and plasma viral load in treatment-naive HIV-1-seropositive persons. 2) To
investigate the effect of HAART on hematological parameters.
Design: Retrospective study.
Methods: We compared the HIV-1 plasma viral load (Quantiplex 2.0., Chiron)
to hematological parameters in 106 patients without antiretroviral treatment, and
additionally we followed hematological parameters in 36 patients every three
months for one year after initiation of HAART.
Results: In treatment-naive patients a significant inverse correlation was found
between viral load and hemoglobin (Hb) (correlation coefficient r = -0.23; p =
0.012), granulocyte count (r = -0.36; p < 0.001), CD4 cell count (r = -0.38; p <
0.001), and platelet (PLT) count (r = -0.20; p = 0.029). In the HAART group, viral
load decreased significantly (average: -1.14 log RNA copies/mL; p = < 0.001)
over the 12 months of treatment. During the same period, a statistically significant
increase in Hb (+0.4 g/dL; p < 0.001), granulocyte count (+308/i/L; p = 0.045)
and CD4 cell count (+64//IL; p = 0.012) was observed. The average PLT count
increased (+26,000//lL) non-significantly (p = 0.45). The proportion of patients
with hematological values below the limit of normal declined under HAART from
baseline to month 12 (Hb < 14 g/dL: 55% to 36%; WBC < 4,800/[tL: 64% to 47%;
PLT < 130,000//tL: 19% to 11% and granulocytes <1,900/itL: 58% to 36%).
Conclusions: The main hematological parameters correlate with the plasma
viral load in HIV infected treatment-naive patients. HAART tends to correct, at
least partially, existing hematological abnormalities. These findings support the
hypothesis that hematological disorders in HIV infection are virus-mediated.
S32140 Disappearance of severe wasting and cachexia in HIV
patients early treated with effective antiretroviral drugs
and nutritional support
Daniele Scevola, Angela Di Matteo, Letizia Oberto, Guja Minoja. Clinica Malattie
Infettive IRCCS Policlinico S. Matteo 27100 Pavia, Italy
Objective: To evaluate the changing patterns of nutritional status of HIV patiens
after introduction of combined antiretroviral therapies:
Design: Retrospective and prospective, longitudinal, clinical and epidemiological study.
Methods: The nutritional status of 100 patients treated with combined antiretroviral drugs and of 100 treated with zidovudine was compared. Incidence
of malnutrition and wasting in the two groups was studied by measurements of
anthropometric and biochemical parameters. Height, usual, actual and ideal body
weight, body mass index (BMI), skinfold thickeness (SF), total body water (TBW),
fat and fat-free mass (FFM), bioelectrical impedance (BIA), resting energy expenditure (REE), and caloric intake were measured at different stages of disease
and treatments.
Results: In comparison with patients treated only with zidovudine in which the
wasting was present in more than 50% of cases, the patients under combined
antiretroviral therapies and nutritional support showed a significantly reduction of
episodes of weight loss with no cases of severe wasting or cachexia. Body composition and REE were maintained as confirmed by BIA and indirect calorimetry.
Caloric intake was increased.
Conclusions: The new antiretroviral therapies together with the improvement
of immunologic status produce important reflex on metabolic processes that lead
normal nutritional conditions.
32141 The efficacy of recombinant erythropoietin in AIDS
patients with anemia and MAC infection

Cecily Cosby1, J. Tokimoto1, P. Kramer1, S. Stringari1, R. Tolmachoff2,
J.B. Molaghan3. 1University of California, 613 Blackstone Drive San Rafael
California 94903; 2Sonoma County HIV Practive Santa Rosa CA; 3San
Francisco General Hospital San Francisco CA, USA
Background: Anemia in disseminated Mycobacterium-avium complex (dMAC)
infection is common and associated with poor prognosis. Although shown to

be effective in treating AZT-induced anemia, the efficacy of recombinant human
erythropoietin (r-HuEPO) has not been studied in patients with anemia due to
bone marrow suppressing dMAC.
Objectives: To assess the effect of r-HuEPO on hematocrit (Hct) and transfusion requirements in patients with anemia, AIDS and dMAC infection who were
not on AZT.
Methods: A 24 week open-label treatment program with r-HuEPO titrated to a
maximum of 20,000 units three times weekly for a target Hct of 38%. 25 patients
(20 males, 5 females; mean age 36.8 yrs., SD 6.5; mean CD4 12.5/mm3, SD 8.6)
were randomized to 16 weeks of immediate treatment followed by 8 weeks of observation vs. 8 weeks of observation followed by 16 weeks of treatment. Patients
were used as their own controls. 19 patients had histories of prior transfusions.
Hematologic mesaurements were taken every 4 weeks.
Results: Patients receiving r-HuEPO had significant increases in Hct levels by
matched paired t-tests (mean baseline Hct 27.7%, SD 2.95 to post-dosing Hct
37.2%, SD 4.77; p = 0.00; mean increase in Hct 9.5%, SD 4.2, p = 0.00). No
transfusions were required. No adverse experiences associated with r-HuEPO
dosing were reported.
Conclusion: Patients with dMAC infection and anemia who were not on AZT
had a significant response to r-HuEPO and the need for transfusion was eliminated during dosing. Doses of up to 60,000 units per week were well tolerated
and no adverse experiences were reported.
32142 Lamivudine-associated pure red cell aplasia (PRCA)
Abraham Majluf1, S. Trevifo2, G. Luna2, L. Nieto2, M. Santoscoy2. Gabriel
Mancera #222 Colonia Del Valle, ZC:03100, Mexico City; 2Hospital General
Gabriel Mancera, Mexico City, Mexico
Issue: To describe 5 patients with lamivudine-associated PRCA.
Patients: Five male patients with AIDS with a median age of 32 y (ranges
29-37). All of them were diagnosed as having lamivudine-associated PRCA in a
4-month period and during the first 24 months of treatment of the patients. Before
receiving lamivudine all of them had Hb > 12.0 g/dl, without transfusion requirements. After receiving the drug for a median time of 12 weeks (10-42), Hb dropped
in the next 3 months to 5.3 g/dl (4.8-5.9) with high transfusion requirements. After
a 6-week evolution time (3-7) and in the absence of positive Coomb's or other
hemolysis tests, a bone marrow aspiration was performed. Median erythroid
progenitors was 2% (0-4%) and a PRCA diagnosis was established.
Treatment: The first patient was treated with prednisone during 4 weeks without response and with a high transfusion requirements. At this point, lamivudine
was not stopped still. When both, prednisone and lamivudine were discontinued,
Hb and erythroid progenitors raised up to 12.1 g/dl and 28% respectively, in
only 3 weeks without transfusion requirements. Based on this response, in the 4
subsequent cases lamivudine was suspended immediately after PRCA diagosis
without simultaneous treatments. In the remaining 4 patients, Hb raised to 11.8
g/dl (11.0-14.8) while the bone marrow showed an increase in erythroid progenitors as far as 28% (26-35%) without transfusion requirements. At the moment
of writing this abstract, 80 patients have received lamivudine in our department,
therefore our incidence of lamivudine-associated PRCA is as high as 5%.
Conclusions: In our patients, lamivudine-associated PRCA appeared after a
relative short-time exposure. Considering that lamivudine has been only recently
approved for clinical use in our country, it is possible to expect more cases
with this secondary effect of this protease inhibitor. To our knowledge, this is the
longest series about this association and we believe that a racial factor is probably
responsible for the high frequency of lamivudine-associated PRCA observed in
our population.
S32143 Acquired hemostatic inhibitors (AHI) in patients with
AIDS
Abraham Majluf1, G. Luna2, S. Treviio2, L. Nieto2, M. Santoscoy2. 'Gabriel
Mancera A#222 Colonia-Del Valle, ZC:03100, Mexico City; 2Hospital General
Gabriel Mancera, Mexico City, Mexico
Issue:To inform about the frequency of acquired hemostatic inhibitors (AHI) in
patients with AIDS.
Patients and Methods: In a transversal study, all patients with AIDS seen in
our department were screened. We excluded those cases with bleeding history,
a recent thrombotic event, and those receiving chemotherapy. In each case,
a blood cell count was performed using an automated equipment. VDRL and
lupus anticoagulants (LA, purified platelet extract) tests were performed using
commercially available kits. Prothrombin time, partially activated thromboplastin
time, and thrombin time tests and their respective dilution assays were performed
using coagulometric techniques. Control plasmas were obtained from healthy
blood donors after signed consent.
Results: We screened 110 patients with AIDS. They were 107 male and 3
female patients with a median age of 34 years (18-56). By means of dilution tests
(minimal dilution 1:16) we found 17 patients with a AHI (15%). Ten of these cases
had AHI found in the intrinsic pathway (9%), 5 with AHI from the extrinsic pathway

(5%), and none in the common pathway. Two cases with LA (2%) were found
with VDRL negative tests. During the six months before and after a positive test
for the AHI was found, none of the patients had bleeding or a thrombotic event.
One of the LA cases had a history of thrombosis. From 50 healthy blood donors,
none case with AHI was found.
Conclusions: AHI are frequent in AIDS. Although they have a poor correlation with clinical events (thrombosis or hemorrhage), one should consider these