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

12th World AIDS Conference

Abstracts 32154-32158 551

the steroid challenge test was found in patients with neutropenia resulting from
combined myelosuppression due to the drugs and intracellular microorganisms
infections. 8 of 32 pts (25%) had a negative steroid test (ANC increase <20%
baseline value), and 4 of these (12.5% of the total pts) d'ont respond to G-CSF
(ANC - 2.0 x 109/L). The peaks ANC were reached 3-6 hr following steroid
injection and higher levels significantly correlate with higher response to G-CSF.
Conclusions: The steroid challenge test appears to be a simple and useful
method to discover neutropenic patients not responder to G-CSF.
S32154 Worsening of HIV-1-related immune thrombocytopenia in
patients receiving triple combination therapy
Vincent Jubault', J.P. Viard2. 'Immunologie Clinique Hopital Necker 149 Rue De
Sevres, Paris, 2Hopital Necker, Paris, France
Objectives: To describe the evolution of HIV-1-related immune thrombocytopenia
(HIV-ITP) in patients on highly active antiretroviral combination therapy (HAART).
Design: Retrospective study of patients with HIV-ITP receiving HAART.
Methods: Three patients with HIV-ITP starting combination therapy including
a protease inhibitor were identified and had repeated measurements of platelets,
blood CD4 cells and HIV-1 RNA load, according to standard procedures. All
patients fulfilled diagnostic criteria of HIV-ITP prior to HAART.
Results: In the three patients, thrombocytopenia worsened -at least transientlywhile CD4 cell counts improved as shown in the figure. In all cases RNA load
decreased to undetectable levels (<2.3 loglo).
c o \... 4
400 400
Conclusion: Partial correction of immune deficiency in HIV-infected patients
with HIV-ITP can lead to an increased rate of platelet destruction. This could
reflect an exacerbated specific anti-platelet response or an increased efficacy of
mononuclear phagocytes.
32155 Effect of influenza vaccination on viral loads in HIV
patients
D'Vorah Hasheevel, C.E. Thompson2, P.D. Salvato2. 14140 SW Freeway,
Houston, Texas; 20ncol Medica Associates, Houston, TX, USA
Objective: To determine the effect of influenza vaccination in HIV pts. with
undetectable viral loads.
Method: 110 HIV pts. (CD4 21-690, x 198) were studied. CD4 counts and
viral loads were drawn prior to and four weeks after influenza vaccination. 86 of
the pts. were on Highly Active Antiretroviral Therapy (HAART). Drug therapy was
stable for the month prior to and during the month of study. Only those pts. with
undetectable viral loads were studied. Pts. were immunized with one (1) time
dose of.5 cc IM of the 1997-1998 Formula of Purified Surface Antigen Vaccine.
Results: Mean CD4 count as baseline was 198 and one month after vaccination 228. 26 pts. had viral load increases of one log or greater; however, 16 of
these returned to undetectable after two months with no change in antiretroviral
therapy. Viral load increases were not related to baseline CD4 count. Antiretroviral
therapy was changed in the 10 pts. who did not return to baseline viral load.
Conclusion: Antigenic stimulation may result in transient increase in viral load
in a small percentage of HIV+ pts. with undetectable viral load. This number,
however, appears to be very small, regardless of T-cell counts. The potential
consequences of influenza infection may be more deleterious to pts.'s viral load
and thus clinical status than a transient viral increase.
32156 Macrocytosis in patients with HIV infection: After
zidovudine
Daniel Genne', C. Goehring2, A. Saaidia', D. Anwar', B. Hirschel'. 'Division
des Maladies Infectieuses, HCUG, Geneva; 2Policlinique de Medecine, HCUG,
Geneva, Switzerland
Objectives: Zidovudine is a well known cause of macrocytosis. However, many
patients develop macrocytosis even though they do not receive zidovudine. The
aim of this study is to evaluate other causes of high mean corpuscular volumes
(MCV).
Design: Case-control study.
Methods: Thirty patients with a MCV > 100 fl (group A) were compared to 60
patients with MCV < 97 fl (group B), both groups don't receive zidovudine.

Results: Sex ratio, age, mean CD4 (group A 275/mm3, group B 299/mm3, p =
0.6), incidence of alcohol abuse (OR 0.84 NS) and liver disease (OR 0.3 NS) were
similar in both groups. Vitamine B12 or folic acide levels were not decreased in
patients from group A. In contrast there was a statistically significant association
of macrocytosis with stavudine treatment (group A 28/30, group B 15/60, p <
0.0001, OR 42) or with a combination of stavudine + 3TC (group A 22/30, group
B 13/60, p - 0.001, OR 8). No associations were found with other drugs tested

(ddl, ddC, protease inhibitors, trimethoprim/sulfamethoxazole). The hemoglobin
concentration among group A (13.9 g/dl) did not differ from group B (13 g/dl).
Conclusions: Stavudine (alone or associated with other antiretroviral drugs) is
the probable cause of most cases with macrocytosis in HIV infected patients who
do not receive zidovudine, but none of the patients developed anemia or had to
stop treatment because of this side effect.
S32157 Incidence of hemorrhagic syndrome in HIV-infected
patients
Alexei Kravtchenko, A.M. Polyakova, O.S. Astrina, V.V. Pokrovsky. Bd. 2-15,
8-ya UI. Sokolinoygory, Russia Federal AIDS Center, Moscow, Russia
Objective: To study the incidence of hemorrhagic syndrome in HIV-infected
patients (pts.) in different stages disease.
Methods: 485 adults with HIV-infection were observed since 1991 to 1997.
According CDC-classification all pts. were divided into 3 groups: A group (gr.) -
95 pts. (middle count of CD4-cells -425 ~ 25 in 1 mm3); B - 224 pts. (CD4 242
~ 18); C - 166 pts. (CD4- 69 ~ 6). The count of thrombocytes, their aggregation
(Ha; adenosinediphosphate - 2 x 10 5 M) and exocytosis (A2) were studied.
Results: Hemorrhagic syndrome was diagnosed in 7 pts. of A gr. (7.4%), 54 -
B gr. (25.3%), 69 - C gr. (41.6%).
Table 1. Clinical symptoms of hemorrhagic syndrome in HIV-infected patients (%)

Symptoms/groups
Subcutaneous hemorrhage
Nasal bleeding
Gingival hemorrhage
Microhematuria
Macrohematuria
Gastric-intestinal bleeding

A
0
0
0
6.3
0
1.1

B
7.1
4.0
3.6
8.0
1.3
1.3

C
16.3
4.2
3.6
25.3
1.8
1.8

Total
23.4
8.2
7.2
39.6
3.1
3.1

Table 2. The count and functional activity of platelets in HIV -infected pts. with and without
hemorrhagic syndrome

Group/marker 1. 2.
hemor.t hemor.
Platelets 202.2 204.4
10/1 ~26.5 ~6.3*5,7
Thrombocytopenia % 17"3,4,5,6 28*4,5,6,7
Ha % 90.8 91.0
~17.0 ~3.7
A2 % 10.9 14.2
~3.1 ~1.0

3.
hemor.~
185.5
~12*7
48.2'6,7
74.0
~9.0
11.5
~2.0

4.
hemor.
194.5
~6.1 *5,7
36.9' 6,7
83.1
~4.2
12.5
~0.8*5,7

5.
hemor.+
165.6
~7.8*7
64.3"6 7
50.5
~3.9
9.3
~1.0*6'7

6.
hemor.
181.7
~5.3'7
46.4'5.7
100
~5.3
13.2
~1.1"7

7.
Control
295
~32
0
16.3
~1.0

( p < 0.05)
Conclusion: The microhematuria and subcutaneous hemorrhage were the
most of clinical manifestations of hemorrhagic syndrome. Incidence of the hemorrhagic syndrome and the disorders of the blood platelet's count and their
functional activity are developing with progression of HIV-infection. In stage C
the hemorrhagic syndrome was observed in 41.6% pts: 43.1% with tbc; 41.8% -
CMV; 32.4% - Kaposi's sarcoma.
32158 Thrombocytopenia in HIV infected patients
Tengiz Tsertsvadze, M.D. Butsashvili, G. Kamkamidze. Georgian AIDS & Clin.
Immunology Center, 16 Al. Kazbegi Avenue, Tbilisi, Georgia
Objectives: Evaluation of platelets number in response to antiretroviral and
immunotherapy in HIV infected patients with thrombocytopenia.
Design: Prospective, controlled study
Methods: In 15 patients with thrombocytopenia the diagnosis of HIV infection
was confirmed by Western Blot and PCR methods. The drug regimen was as
follows: In 5 patients - zidovudine 600 mg daily; in 5 patients - human intravenous
immunoglobulin (IVIG) 400 mg/kg daily 5 consequent days; in 5 patients -Zidovudine + IVIG. The monitoring of platelets counts was performed on 1st, 3rd, 6th,
12th weeks after initiation of the therapy.
Results: The elevation of platelets count was observed in all three groups of
the patients:
Average percentage increase of platelets count
Groups Weeks
1 3 6 12
1 (n = 5) 0 9 18 35
2 (n = 5) 86 55 35 15
3 (n = 5) 89 65 55 50
Conclusions: In patients, who underwent only antiretroviral treatment the mild,
but sustained elevation of platelet count was observed, the treatment with intravenous immunoglobulin resulted in a rapid significant, but short-term increase of
platelets count. The rapid, significant and sustained elevation was observed in
patients treated with antiretroviral treatment and immunotherapy.