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

564 Abstracts 32217-32221

12th World AIDS Conference

Neisseria meningitidis. There were 9 cases of aseptic meningitis, 2 patients with
neurosyphilis and 20 normal LPs including 4 with the AIDS dementia complex
(ADC). All patients with tuberculous, cryptococcal (most immunosuppressed p <
0.001) and aseptic meningitis were HIV positive. Within six months, 19 patients
had died. Death was associated with HIV positivity (p = 0.004), low CD4 count
(p < 0.001) and a diagnosis of cryptococcal meningitis, CNS tuberculosis or the
ADC.
Conclusion: HIV has had a major impact on the burden of disease and
mortality, with a predominance of opportunistic chronic meningitides, despite a
meningococcal outbreak, in this community. Patients with cryptococcal meningitis
had the lowest levels of immunity, dual pathology and a very poor prognosis.
The large number of cases of CNS tuberculosis is associated with high rates of
pulmonary tuberculosis. Of concern is the development of TBM despite therapy
and the emergence of drug resistant strains.
32217 Shared antigenic epitopes on the V3 loop of HIV-1 gp120
and neuronal cells
Nathalie Goletiani1, C. Kendrick2, S.M. De La Monte3, B. Navia4, J.D. Brain2,
J.R. Trujillo2. 1665 Huntington Avenue 1-1304, Boston, MA; 2Harvard School of
Public Health, Boston, MA; 3MGH Harvard Medical School, Boston, MA; 4 Tufts
Medical School, Boston, MA, USA
Background: Neuronal loss is a common feature in HIV-1 associated dementia. The precise mechanism of neuronal damage is unknown, but an indirect
mechanism of neuronal damage is most likely. Retroviral infections can induce
autoimmune responses by several mechanisms including molecular mimicry. We
had described molecular mimicry between the HIV-1 gp120 V3 loop and human
brain proteins. Importantly, patients with AIDS dementia complex have anti-gpl20
V3 loop antibodies. In the present study we sought to characterize: (1) the expression and localization of V3-like epitopes on neurons, and (2) human V3 loop
antibodies that bind to neurons.
Methods: Human brain tissue was obtained postmortem from non-HIV infected
individuals. Using paraffin-embedded brain tissue, we determine the anatomic
distribution of the V3-like epitopes. A tumor neuronal cell line SK-N-MC, was obtained from the American Type Culture collection. Using homogenized SK-N-MC,
and sera of ADC patients and anti-V3 loop monoclonal antibodies, the presence
of V3-like epitopes were analyzed by Western blot. In addition, the presence of
V3-like epitopes on SK-N-MC was studied by immunofluoresence and analyzed
by laser confocal scanning microscopy.
Results: The immunostain assay from normal brain tissues showed that primarily neurons expressed the V3-like domain. Furthermore, laser microscopy
revealed V3 like epitopes on the surface of neurons SK-N-MC. In addition, western blot analysis of the neuronal protein from SK-N-MC revealed that sera of
severe ADC patients (n = 7) recognized the V3-like epitopes.
Conclusions: The results indicate that the V3 loop of HIV-1 gp120 shares
epitopes with neuronal cells. An immune response to the V3 loop that generates antibodies cross-reacting with neuronal proteins may be an autoimmune
mechanism by which HIV-1 induced neuronal loss in ADC.
S32218 Antiphospholipid antibodies (APL) and neuropsychologic
tests (NT) as markers of early neurological deficit in
asymptomatic HIV positive subjects
Giancarlo Orifino1, D. Verne2, G. Marietti3, R. Zerbi3. Division A of Infectious
Disease Amedeo di Savoia Hospital Corso Svizzera; 2Ausiliatrice Presidio
Ospedaliero Turin; 3Central Laboratory Amedeo di Savoia Hos. Turin, Italy
Background: The presence of APL in HIV infected people has been correlated,
in some previous studies, with disorders of the central nervous system (CNS).
The aim of the present study is to verify if there is a correlation between APL, the
performance in a battery of NT and clinical data, with regard to brain involvement,
in asymptomatic HIV positive patients.
Methods: Forty five subjects (16 females and 34 males), with HIV infection in
asymptomatic stage (CDC A), were included in the study, in the period 1/96-2/97.
The average age was 35.1 years (range 24-65). Active drug addicts and persons
with neurological diseases were excluded. APL (anticardiolipin IgG end IgM and
lupus anticoagulant) were measured using commercial kit. NT were performed
using a panel of eight standardised test plus one experimental ("planning test"),
all aimed at assessing frontal function. Clinical follow-up was performed on all
patients, ranging from 12 to 24 months.
Results: The mean CD4 count was 411/mmc (33-1435). 16/45 (35%) of individuals were positive for APL. 18 out of 45 (40%) had at least one abnormal NT.
In eight patients a double alteration (APL positive and NT abnormal) was found.
Four patients presented a CNS disease during follow-up (2 cases of athropy, 1
encephalitis, 1 PML). With regard to clinical neurological involvement, we divided
out patients into three groups: 1) No CNS disease, with no alteration at APL or
NT (n = 27). 2) CNS disease with only one abnormal APL or NT (1 out of 10) (p
= n.s. vs group 1). 3) CNS disease with both abnormal APL and NT (3 out of 8)
(p = 0.009 vs group 1).

Conclusion: The contemporary presence of APL and altered NT appears to
identify asymptomatic HIV infected persons who are at risk developing CNS
disease, and on whom clinical controls should be intensified and, if necessary, an
early antiretroviral therapy started.

32219 Tuberculosis pericarditis as first manifestation of AIDS:
Six case reports
Candida Maria C. Carvalho Neves12, Anne Rose L. Wiederk Bau2, Moacir
Alexandre Traesel2, Claudio Cora Mottin2, Luciano Diogo2, Gabriel Narvaez2,
Ana Maria Sandri2. 1Rua Carlos Huber, N. 200 Tres Figueiras Porto Alegre-rs
CEP: 91330-150; 2Pontificia Universidade Catolicadors, Porto Alegre, RS, Brazil
Objectives: To describe the involvement of the pericardium by the M. tuberculosis
as the first manifestation of AIDS in Rio Grande do Sul state, Brazil.
Design: Case report
Methods: Six white, males, mean aged 32-years-old were admitted to Hospital
Sdo Lucas -PUCRS- Brazil between May 1993 and november 1997 presenting
sistemic symptoms like fever, nocturnal suet and loss of weigt at least for 30
days prior admission. Three patients arrived at hospital emergency with signs
and symptoms of cardiac tamponade.
The chest radiography showed an increased cardiac area in all patients (after confirmed as pericardium effusion) and three patients have concomitantely,
bilateral pleural effusion.
The diagnoser of AIDS was made during hospitalization.
Results: The six patients were submitted to a pericardic biopsy and an average of 780 ml of pericardic fluid were drainned. The pericardic fluid contained an
average of 5.2 g of proteins/dl and showed in all cases a linfocytosis of 70%. In
all patients the diagnose of TBC were confirmed; or by the biopsy or by the PCR
of pericardic effusion.
Patients were put on a RHZ regime with a good clinical recovery.
Conclusion: The involvement of the pericardium by the M. tuberculosis in
young subjects must call attention to the AIDS diagnose since this presentation
is not commom in immunocompromised patients even in countries with high
prevalence of tuberculosis like in Brazil.
32220 Characteristics and prognostic factors for AIDS dementia
complex (ADC)
Gregory Dore1, A. van der Bij2, J.M. Kaldor1, B.J. Brew1. 'National Centre in
HIV Epidemiology and Clinical Research 376 Victoria Street, Darlinghurst 2010,
Australia; 2 Catholic University, Nijmeges, Netherlands
Objective: To examine characteristics of ADC including prognostic factors for
survival.
Design: Analysis of ADC cases in a retrospective cohort of people with AIDS
diagnosed at St Vincent's Hospital over the period 1988-1994.
Results: Information was available on 77 cases of ADC. The median age at
AIDS was 39 years compared to 36 years for non-ADC cases (p < 0.001). Other
demographic factors including sex, HIV exposure category and country of birth
were similar among ADC and non-ADC cases. Median CD4 count at AIDS was
also similar (42/mm3 for ADC and 40/mm3 for non-ADC cases). ADC was the
initial AIDS illness in 49% of cases. Among ADC cases other features included
seizures (46%), other neurological disorders (myelopathy, peripheral neuropathy)
(61%), and psychological features (mania or depression) (47%). There was no
change in incidence of ADC over the period 1988-1994. Median survival following
ADC was 8.0 months, but varied significantly for CD4 count at ADC (6.8 months
for <50/mm3, 15.9 months for >50/mm3; p = 0.0014), timing of ADC (11.6 months
if initial AIDS illness, 4.3 months if following AIDS; p = 0.005), history of zidovudine
therapy (6.4 months if prior therapy, 15.9 months if no prior therapy; p = 0.006).
There was also a non-significant trend to increased survival following ADC for
zidovudine therapy following diagnosis (6.8 months for no therapy, 9.0 months
for therapy; p = 0.07), but age did not significantly influence survival.
Conclusions: Age is a significant risk factor for development of ADC, but
not survival following ADC. Zidovudine may improve survival following ADC, in
particular among those people with no prior therapy.
32221 Clinical remission and prolongued survival of a patient
with HIV-associated progressive multifocal
leukoencephalopaty with anti-retroviral triple therapy
including indinavir
Fernando Murano, L. Lorenzo, C. Russ, M. Dubini, V. Nasif. P Cordero Hospital.
Preventive Medicine San Fernando, Argentina
Background: Progressive Multifocal Leukoencephalopaty (PML), is a not frequent disease, with a survival average of less than 6 months. In Argentina, most
of times, diagnosis is made by presuntive way. There is not proven specific
treatment for this disease.
Objectives: To evaluate the clinic and therapeutic response to indinavir and 2
nucleoside analogues to PML.
Methods: A case is reported of a 29 years-old man, whose HIV infection was
deteected by January 1997, when he developed a diarrhoea of unknown etiology.
In February 1997, he was hospitalized because of fever, confusional state, left
hemiparesis, ataxia and dysarthria. Diagnosis of PML was done by neurological
findings, and MRI of the brain that revealed high signal in the right basal ganglia

and protuberance consistent with PML. A antiretroviral tritherapy with AZT 800
mg/day, 3TC 300 mg/day and indinavir 2.400 mg/day was begun. Clinical evaluation, cd4 counts and vital load measurements were done for the following 9
months., from march to december 1.997.
Results: Initial cd4 cell count (100/mm3, 6%), viral load (230.000 copies/ml, log
5,36), and MRI of the brain were consistent with PML. By the 12th week a dramatic