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

48 Abstracts 12184-12187

12th World AIDS Conference

designed for that purpose. Data were analyzed using The Epilnfo version 6.3
software
Results: A total of 61 clinical histories of HIV/AIDS cases, identified by serology, were analyzed. Thirty-one cases (51%) were children less tan 18 months
old, born to HIV positive mother, and were classified as undetermined. The rest
(n = 30, 57% males) were confirmed cases, diagnosed at an age range of 1-115
months (average 39.8) with the great majority (97%) having evidence of vertical
transmission. Information about delivery was available only in 87% of the cases
with all of them having a vaginal delivery. Most of the children (97%) had breast
feeding and the average duration among those with that information available (n
= 20) was 12 months. Only 23% had multiple hospitalizations (more than two)
in this center. The average length of hospitalization was 15 days (range 3-54d).
Intermittent diarrhea was the most frequent clinical manifestation (87% of cases)
followed by oral candidiasis (43%) and repeated respiratory infections (37%).
Pulmonary TB was diagnosed in 9 patients (30%). Hepatomegaly was more
frequently found (30%) than splenomegaly (10%) and neurologic complications
were not a frequent finding (10%).
Conclusions: It is necessary to establish a system to follow those babies with
undetermined HIV/AIDS infections. Identification of etiologic agents of the more
frequent complications (GI and respiratory tract infections) would allow specific
treatment of individual cases, which would have a impact on the quality of life of
these patients.
S12184 CD4 and CD8 response within one year after primary
HIV-1 infection with a zidovudine-resistant strain
Phippe Vanhems. Centre Hospitalier Lyon-Sud, Unite d'Hygiene, Epidemiologie,
et Information Mddicale, Pavilion 1M, 69495 Pierre Benite Cedex, France
Objective: To report the CD4 and the CD8 responses within 1 year after primary
HIV-1 infection due to zidovudine(AZT)-resistant HIV-1 strain with the codon 215
mutation.
Design: Multicenter prospective cohort study in Geneva, Sydney and Vancouver.
Methods: Codon 215 mutation was assessed using selective PCR on circulating virus. Wilcoxon test was used for comparisons between patients infected by
an AZT HIV-1 resistant (R) strain (Gr.1, #13 cases) and patients infected by an
AZT sensitive (S) HIV-1 strain (Gr.2, #44 controls) after matching by the date of
codon 215 mutation determination (1 case/3 controls).
Results:
Days after PHI CD4/mm3 (mean) CD4/CD8 (mean)
Gr.1 (AZT-R) Gr.2 (AZT-S) p Gr.1 (AZT-R) Gr.2 (AZT-S) p
0-8 587 518 0.47 1.54 0.86 0.19
9-31 700 577 0.12 0.83 0.57 0.37
32-92 770 632 0.26 0.95 0.73 0.19
93-132 544 608 0.28 0.99 0.74 0.40
133-365 670 548 0.47 0.92 0.65 0.16
These results were not affected by AZT administration at the time of primary
HIV-1 infection.
Conclusion: The early change in CD4 and CD8 following PHI does not seem
to differ by codon 215 status.
S12185 1Rapid reconstitution of the T-cell receptor (TCR)
repertoire following antiretroviral treatment during
primary HIV infection
Rafick-Pierre Sekaly', N. Ringuette2, J. Lacaille2, J.P. Routy3, D.D. Ho4,
M. Markowitz4, B. Conway5. 111 Opine Avenue West Montreal (Quebec) H2W
1R7; 2lmmunology IRCM Montreal (QC) H2W 1R7; 3Hematology Royal Victoria
Hospital Montreal (QC) H2W 1R; 5British Columbia Centre of Excellence
Vancouver (BC) V6Z 1 Y6, Canada; 4AIDS Research Center New York NY
10016, USA
Objectives: Infection with HIV leads to the rapid loss of CD4+ T cells through
direct and indirect cytopathic mechanisms. Treatment with combinations of antiretrovirals leads to a variable and significant increase in the absolute and relative
numbers of CD4~ T cells. Little is known about the origin and diversity of CD4+ T
cells which reconstitute treated individuals following treatment.
Design: Five color flow cytometric analysis of the TCR repertoire was carried
out in three groups of six treated and untreated individuals during primary infection
and at late stages of the disease.
Methods: The TCR repertoire was monitored in different lymphocyte subsets
including CD4 and CD8 cells naive (CD45RA+CD62L+) and memory T cells
(CD45RO+) and cells bearing the lymph node homing marker (CD62L) or the gut
specific integrin (a4/7). A panel of twenty five different monoclonal antibodies
covering 70% of the TCR repertoire were used in these assays.
Results: Our results demonstrate that treatment during primary infection led to
a quick reversal of the naive memory/ratio specifically in CD4 cells. This contrasted

with a continuous accumulation of memory cells observed in patients treated late
in the disease or in untreated patients. Moreover rapid reconstitution with naive
CD4 cells bearing novel VP specificities occurred only in patients treated during
the acute phase of the disease. Most of the V/s which increased as compared
to baseline points were encompassed in the CD45RA+ CD62L+ compartments.
The number of variable regions which were the subject of amplifications varied
from one patient to another.

Conclusion: Our results suggest that early treatment helps in preserving an intact pool of cells capable of reconstituting a damaged immune system. Molecular
analysis of the repertoire will confirm the origin of this pool.
333*/12186 Primary HIV-1 infection: Clinical manifestations
among women in Mombasa, Kenya
Ludo Lavreys', H. Martin2, K. Manoaliya3, J. Bwayo4, J. Nainya-Achola4
J. Kreiss2. 1PO Box 91276 Mombasa; 3Coast General Provincial Hospital
Mombasa; 4 University of Nairobi Nairobi, Kenya; 2University of Washington
Seattle WA, USA
Objectives: To evaluate clinical manifestations associated with primary HIV-1
infection among prostitutes in Kenya.
Methods: In a prospective cohort of HIV-1 seronegative prostitutes in Mombasa, study participants returned at monthly intervals for HIV-1 serologic testing.
At each clinic visit, women were evaluated for clinical signs or symptoms of
seroconversion illness.
Result: Between 1993 and 1997, 853 women were enrolled and had at least
1 follow-up visit, for a total of 6023 clinic visits. 124 women had documented
HIV-1 seroconversion, yielding an annual HIV-1 incidence of 12.1%. At physical
examination, 16% of the 124 seroconverting women had lymphadenopathy and
1% had splenomegaly. 52% reported fever since the prior visit, 34% headache,
29% fatigue, 23% arthralgies, 17% diarrhea, 14% vomiting, 14% sore throat, 13%
myalgies, 9% maculopapular skin rash, 5% swollen glands, 2% conjunctivitis, and
1% shingles. Six symptoms and one sign occurred with significantly increased
frequency at the seroconversion visit compared with non-seroconversion visits:
fever (52% vs. 30%, p < 0.001), arthralgia (23% vs. 14%, p = 0.006), diarrhea
(17% vs. 7%, p < 0.001), myalgia (13% vs. 8%, p = 0.04), vomiting (14% vs. 5%, p
< 0.001), swollen glands (5% vs. 2%, p = 0.04) by history, and lymphadenopathy
(16% vs. 7%, p < 0.001) by exam. 63% of the seroconverting women presented
with one or more of these 7 symptoms and signs, and for 39% of the women,
illness was of sufficient severity to prevent them from working for some period of
time.
Conclusion: The majority of women had symptomatic illness in association
with primary HIV-1 infection, characterized by fever, arthralgia, diarrhea, myalgia,
vomiting, and swollen glands as symptoms and generalized lymphadenopathy on
exam. Recognition of these symptoms and signs could lead to early HIV testing
and counseling, and therefore potentially decrease the risk of secondary infection.
S12187 1The PRIMO cohort: Preliminary results from 55 patients
enrolled during primary infection in France since
1996-1997
Chritiane Deveaul, Jean-Francois Delfraissy', N. N'go2, I. Pellegrin3,
M. Harzic4, C. Rouzioux2, L. Neyer'. '1nsern U292 Hopital de Ricetre 82 Rue
Du Gal Leclerc 94276 Krenlin-Bicetre, Krenlin-Bicetre; 2Hopital Necker Paris;
3Hopital Pellegrin Bordeaux; 4Hopital Du Chesnay Le Chesnay, France
Objective: To describe route of infection, treatments administered and disease
progression in patients recruited during primary infection.
Methods: Patients were included in the multicenter French PRIMO cohort
within 6 months of infection. The date of infection was documented by an interval
of 6 months maximum between a negative and a positive test or by an incomplete
followed by a complete western-blot, or by a positive antigenemia with a poor
ELISA.
Results: Since November 1996, 67 patients have been enrolled, 55 records
could be analyzed on January 1998, including 40 men and 15 women (median
age 31 years). Median delay between infection and inclusion was 48 days. Primary infection was symptomatic in 75% of cases; median delay between the first
signs and inclusion was 31 days (range 5 to 121 days). Patients were mostly
prescribed a multitherapy including a protease inhibitor (47 cases), otherwise
two or three NRTI's; 3 patients stopped treatment before M1. Only one patient
declined treatment at entry. Undetectable viremia (<200 copies/ml) on effective
treatment was noted in 76% of patients on M3 and 61% on M6. Four patients
presented clinical signs during follow-up (median 6 months). A Kaposi Sarcoma
(group C) was diagnosed on M3 in a compliant patient with 727 CD4+ cells/p l
and 2.0 log of viremia. A hairy leukoplasia (group B) appeared on M6 in a patient
with 1243 CD4+ cells/til, 2.0 log but with irregular intake due to frequent vomiting.
Oral candidiasis was diagnosed on M3 in a non-compliant patient whose viremia
never decreased. A monometameric zona appeared on M12 in a non-compliant
patient (viremia 3.3 log). The cumulative proportion of progression to group B or
C at 6 months was thus estimated at 6.7%. The frequency of genotypic mutations
of the RT gene (215, 184, 74) at enrolment was respectively 4%, 4% and 8%.
Only one patient presented simultaneously the three mutations.
Conclusion: In this observational cohort of 55 primary-infected patients enrolled in 1997, the two main features were a low prevalence of genotypic mutations
on the reverse transcriptase gene, and a rather high frequency of progression to
HIV-related clinical signs during follow-up.