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

12th World AIDS Conference

Abstracts 32275-32278 575

cases, molluscum contagiosum-13 cases, condylomata acuminata-10 cases, dermatophytosis-8 cases, herpes zoster-6 cases, herpes simplex-5 cases, syphilis-3
cases, disseminated cryptococcosis-2 cases, disseminated candidiasis-1 case
and atippical mycobacterial infection-1 case. HIV-associated neoplasias observed
in our study were Kaposi's sarcoma in 5 cases and basal cell carcinoma in 1 case.
Noninfectious complications were represented by papular eruptions-19 cases,
xerosis-9 cases, seborrheic dermatitis-6 cases, atopic dermatitis-like eruptions-3
cases and generalised psoriasis vulgaris-1 case. In 4 cases the mucocutaneous
manifestations were relevant for HIV infections.
Conclusions: Although mucocutaneous lesions aren't specific for HIV infection,
they may be relevant for diagnosis and useful for staging of disease.
S32275 Hypotestosteronism in the era of HAART
Dominique Anwar', B. Hirschel', M. Sauvage2. Swiss HIV Cohort Study Group;
1 Division of Infections Diseases, University Hospital of Geneva; 2Ares-Serono
Geneva, GE, Switzerland
Background: Hypotestosteronism is reportedly present in more than 10% of
patients with HIV and correlates with the severity of immunosuppression. The
clinical manifestations are mainly weight and/or lean mass loss, fatigue and
loss of libido. The aim of this study is to evaluate the incidence of symptomatic
hypotestosteronism under highly active antiretroviral therapies (HAART).
Methods: From April to September 1997, testosterone was measured in batch
on frozen sera collected from male patients and stored in the context of the Swiss
HIV Cohorte Study (SHCS) in the University Hospital of Geneva. Other data were
collected from patients' charts and interviews.
Results: 174 sera from 174 patients were analyzed. Testosterone values were
low (N: 10-35 nmol/) in 17 (9.7%). The mean CD4 count of these patients was
253 cells/mm3 (range 9-752) and the viremia ranged from <100 (41% patients
"undetectable") to 250000 HIV RNA copies/ml. 8/17 patients had received a triple
HAART since more than 6 months. 8/17 patients complained of persistent low
weight, fatigue and loss of libido. Six of these had undetectable viremia and CD4
cells count >300 cells/mm3.
Conclusions: Hypotestosteronism may continue to occur in some patients with
effective HAART. It is adequate to investigate patients for this condition, especially
if symptoms and/or signs compatible with hypotestosteronism are present. More
data will be presented, including LH and control testosterone values.
S32276 Proinflammatory cytokines and insulin resistance in HIV
infection
Alberto Biglino. Divisione Malattie Infettive, Ospedale Civile Via Botallo 4, Italy
Objectives: Sustained release of tumor necrosis factor (TNF) and other proinflammatory cytokines is reported in chronic infections, where the anorexia and
insulin-resistance induced by these mediators may cause cachexia; a similar
mechanism was hypothesized in HIV infection. Our aim was to assess insulin
sensitivity in HIV infection, and to correlate this parameter with release of cytokines mediating insulin resistance, with disease stage, CD4+ cells and plasma
viraemia.
Methods: 14 nondiabetic HIV patients (7 A2/A3, CD4 = 158 ~ 119/iL; 7 C3,
CD4 = 66 ~ 98//rL) and 12 healthy volunteers underwent the LDIGIT Test, based
on glucose/insulin infusion during 150 min, and on the evaluation of glucose clearance per plasma insulin concentration (Insulin Sensitivity Index or ISI), expressed
in mL per kg/min pmol/L. Body mass index of the 2 groups was similar (22.2
vs 20.5). Baseline glucose and insulin levels, spontaneous and LPS-induced
leukocyte TNF-a and IL-1/I, and HIV viraemia were also determined. Results
of measured variables were expressed as mean ~ sd. Significance of the observed differences was assessed by Student's t-test, and linear correlations by
"r" coefficient.
Results: In HIV patients, ISI was slightly reduced (24 ~ 8), while baseline
insulin was significantly higher (83 ~ 32) compared to controls (respectively 31 ~
10; p = n.s., and 56 ~ 8; p = 0.012). ISI was significantly lower only in HIV patients
with advanced disease (15 ~ 4; p < 0.05). TNF release, both spontaneous and
LPS-induced, was higher in controls if compared to HIV (308 + 274 vs. 74 +
119 [p = 0.009], and respectively 1043 + 392 vs. 556 ~ 309 [p = 0.001] pg/ml).
Spontaneous and LPS-induced IL-1 release was also higher in controls than in
patients (21 ~ 40 vs. 13 ~ 18 [p = 0.029] and respectively 316 ~ 144 vs. 200
~ 154 [p = 0.05] pg/ml). Less advanced disease (A 2/3) showed higher release
of LPS-induced TNF and IL-1 (798 ~ 189 and 293 ~ 183 pg/ml) if compared to
AIDS (C3) (375 ~ 254 and 130 ~ 84 pg/ml) (p = 0.004 and 0.05 respectively).
Baseline insulin levels were negatively correlated with ISI in controls, as expected
(r = -0.89; p < 0.001) but not in HIV disease, where instead they showed a
significantly positive correlation with spontaneous TNF and IL-1 release (r = 0.65;
p - 0.01 and r = 0.55, p = 0.05). No correlation existed between the above
parameters and CD4+ cells or plasma viraemia.
Conclusions: A slightly reduced sensitivity to insulin was detectable only in
advanced HIV disease (C3), but was unrelated to CD4 cells, viraemia, and to
spontaneous or induced TNF or IL-1 levels, which were much lower in this stage

if compared to less advanced disease (A2/3) and to controls. Rather, TNF and
IL-1 seemed to correlate positively with insulin secretion in HIV infection, possibly
as a result of an accelerated insulin clearance rather than of insulin resistance
induction, thus explaining the hyperinsulinism observed in these patients in spite
of a globally normal insulin sensitivity.

32277 1 Increased prevalence of diabetes mellitus in patients with
HIV infection
Alvan Fisher', Molly Stenzel2, A.E. Fisher2. 1400 Reservoir Avenue Providence,
RI 02907; 2Brown University Providence RI, USA
Objective: A variety of metabolic and endocrinologic abnormalities have been
seen in HIV-infected individuals. Among our patients, we noted a number of
cases of diabetes mellitus (DM). The purpose of this study was to determine the
prevalence of DM in this cohort and to identify any associated factors.
Methods: The medical charts of 381 patients with HIV infection followed between 1985 and 1997 were reviewed. This patient population is predominantly
male and white; men having sex with men is the most common risk factor for
HIV infection. Demographic and clinical data, medication history, presence of risk
factors for DM (family history, obesity, pancreatic damage), and CD4 count were
collected. A case of DM was defined as an individual with a fasting glucose level
of >140 mg/dl on more than one occasion, a random glucose >200 mg/dl with
classical symptoms of DM, or glucose tolerance test consistent with DM.
Results: Eighteen cases of DM were identified: 94% male; mean age 42;
risk factor for HIV: 10/18 sexual contact, 3/18 blood product transfusion, 3/18
injection drug use, 3/18 unknown. Three patients were diagnosed with DM prior
to the diagnosis of HIV infection. Of the remaining 15, 11 (73%) had CD4 counts
<200 at the time of diagnosis. Of those diagnosed at a CD4 > 200, 2/4 had risk
factors for DM (obesity, family history) compared to only 2/11 in those with CD4
< 200. Corticosteroids were being given in 3/15 patients at time of diagnosis;
protease inhibitors in 3/15. The prevalence of DM in this group was 4.7% overall.
The prevalence estimated for the general US population in previously published
surveys ranges from 3.4% to 5.1%. The prevalence among men age 20-44 in the
general population is 0.6%, compared to 4.1% in our cohort; for men age 45-54,
the prevalence is 4.3%, compared to 9.7% in our patients.
Conclusions: These results suggest that HIV-infected patients may be predisposed to the development of DM. This may be secondary to medications, but
does not seem to be entirely accounted for by the use of drugs currently known
to be associated with hyperglycemia.
S32278 Cardiac involvement in Indian HIV population
Shashank Joshi1, A.K. Deshpande2. Clinical Research Associate, Medicine
Dept., GMC & SIRJJH, Munbai; 2Professor & Head Dept., GMC & SIRJJH, India
Background: The present study was due to decide the nature and extent of
cardiac involvement in HIV infected cases. Apart from clinical presentation, it also
looked at prevalance of myocardial dysfunction aided by echo cardiography and
later after death at necropsy.
Methods: 74 Consecutive HIV positive Indian Cases were prospectively evaluated from July 1991 till January 1998. Survivors were grouped as Group I and
those dead and necropsied as Group II. Apart from standard clinical, biochemical,
hematological & body fluid analysis, investigations; all cases were subjected to
EKG, CXR, Echocardiography (M-mode, 2-D & Doppler) and later at necropsy
special attention was given to cardiac histopathology.
Results: The age group ranged from 17 to 52 years with mean age 29.8 yrs;
predominant patients belong to the 3rd (51.35%) & 4th (33.8%) decade, with a
male female ratio of 5.7: 1. 58.1% were heterosexuals, 4.05% transfusion related,
2.7% IV Drug abusers, 1.35% bisexuals and 20.27% had multiple risk factors.
52.7% had STD/GUD; only 12.16% VDRL positive and 1.37% UbsAg positive.
Radiology revelaed cardiomegaly in 24.32% & 20.27% had abnormal electrocardiograms. Echocardiogram revealed 10.6% had Dilated Cardiomyopathy, 8.5%
had pericardial effusion, 4.2% vegetations, 2.1% constrictive pericarditions &
10.6% incidental valvular, LVH & IHD. Diastolic dysfunction was observed in 60%
of cases. Group I revelaed 25.6% cases and Group II 41.93% cases with major
cardiac involvement. At necropsy 41.9% had cardiac histopathological changes
25.8% had pericardial, 12.9% myocardial while 6.45% had other forms of cardiac
pathology. 16.2% had pericardial invovlement of 4.05% presented as cardiac
tamponade with 1.35% moderate pericardial effusion. 9.4% had presumptive tubercular invovlement, 2.7% had cryptococcal and I each had fibrinous pyogenic &
constrictive pericarditis. 12.6% had myocardial involvement. 6.7% presenting as
dilated cardiomyopathy and 2.07% were found on histopathology. On necropsy
1.35% showed evidence of cryptococcal myocarditis and additional lymphocytic
myocarditis. 2.7% had endocardial involvement. Both presenting as endocarditis
and being IV drug abusers.
Conclusions: Cardiac dysfunction is now being recognised among Indian HIV
infected and AIDS cases. Though primary manifestation is uncommon pericardial involvement presenting as cardiac tamponade and myocardial involvement
presenting as congestive cardiomypathy is now being seen. Also associated
cardiac finding are commonly seen both clinically and at autopsy. Early detection
of cardiac dysfunction by echocardiogram may well be necessary in future as the
clinical spectrum fully evolves to detect early myocardial dysfunction.