Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

382 Abstracts ThPeB7178-ThPeB7181

XIV International AIDS Conference

lated inversely the with the VL (r=-0.29, p=0.011) and CD4 activation (r=-0.30,
p=0.011), and positively with CD4 count (r=0.23, p=0.046).
Conclusions: In summary, the data suggests that thymic depletion and/or activation contributes to the decline of CD4 cells, observed with disease progression,
as a consequence of high level viremia.
Presenting author: Mostafa Nokta, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas, 77555-0435, United States, Tel.: +409 772
0362, Fax: [phone], E-mail: [email protected]
ThPeB7178 Human immunodeficiency virus in plasma and
cervicovaginal secretion in Filipino women
G.U. Natividad-Villanueva1, E. Santiago2, R.M. Manalastas1, A.M. Caliendo3,
H. Brown4, K.H. Mayer5, S. Cu-Uvin5. 1University of the Philippines, Philippine
General Hospital Dept. of Obstetrics and Gynecology Manila, Philippines; 2San
Lazaro Hospital, Manila, Philippines; 3Emory University, Atlanta, United States;
4Brown University, Providence, RI, United States; 'The Miriam Hospital, Brown
University, Providence, RI, United States
Background: The prevalence of HIV is still low in the Philippines (0.07%) but
the number is increasing. There are 1,503 HIV-1 sero-positive Filipinos,503(33%)
of whom are living with AIDS. The predominant mode of transmission is heterosexual contact. 40% of HIV-affected individuals are women who usually have no
access to antiretroviral therapy. HIV-1 shedding in the female genital tract influences both heterosexual and vertical transmission. This research examined the
relation of plasma HIV-1 RNA level, CD4 cell count with cervico-vaginal HIV-1
viral load in Filipino women.
Methods: Paired blood and cervicovaginal lavage (CVL) specimens were collected from 30 HIV-infected women. The nucleic-acid sequence-based amplification assay was used to quantify HIV-1 RNA in plasma and CVL specimens.
Analysis examined relations between cervicovaginal HIV-1 RNA and plasma HIV1 RNA level, CD4 count and genital tract infections.
Results: Plasma HIV-1 RNA was detectable in 24 of 30 women ((80%), with copy
numbers ranging froml,1,100 to 570,000 copies/ml. HIV-1 RNA was detected in
CVI samples of 18 women (60%), ranging from 500 to 48,000 copies/ml. Cervicovaginal HIV-1 RNA was detected in 75% of women with PVL between 10,000 and
100,000 copies/ml and in 77% of women with PVL>100,000 copies/ml (P=0.09).
Among women with CD4 count < 200, 200-500, and > 500/mm3, CVL HIV-1
RNA was detected in 73%,69%, and 17% of subjects, respectively (P=0.143).
CVL HIV-1 RNA was detected in 83% of women with genital warts.
Conclusion: The presence of HIV-1 RNA in cervicovaginal lavage correlates significantly with HIV-1 RNA in plasma. The findings also indicate a possible relationship between the level of CVL HIV-1 RNA and advanced stage of the disease.
No statistically significant association between CVL HIV-1 shedding and the presence of genital tract infections was detected.
Presenting author: Guadalupe Natividad-Villamueva, Dept of OB-GYN, Phil Gen
Hospital, Taft Avenue,Manila, Philippines 1000, Philippines, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeB7179 Oral lesions in primary/acute and recent/early HIV
infection
J.S. Greenspan, K. Malvin, J. Hilton, L. Pascasio, S. Torosian, D. Greenspan,
F Hecht. UCSF San Francisco CA, United States
Objective: To estimate the prevalence of oral lesions during acute/primary and
recent/early HIV disease
Methods: Since August 2000, we have performed standardized oral clinical examinations on adults who self-presented or were referred by a provider network
to the prospective OPTIONS STUDY in San Francisco because of suspected primary or recent HIV. We defined primary/acute HIV infection as negative HIV EIA
and positive HIV RNA tests, or positive EIA < 30 days. We defined recent/early
HIV infection as positive EIA and either a documented negative antibody test
within 6 months or a negative detuned EIA (<0.75) which represents a stage up
to 6-7 months after primary/acute infection. Prevalence estimates are based on
the proportion of subjects diagnosed with a given lesion type during the 12-month
study period [the median exams/subject was 2 (min, 1; max, 6)]; P-values, corresponding with trends in prevalence, are based on repeated-measures models.
Results: Most patients who suspected they had been infected with HIV were
correct (77%). Oral candidiasis tended to increase in prevalence with HIV status
and duration (P=0.079). Aphthous ulcers were also most prevalent among subjects with recent/early infection, whereas oral warts were most prevalent among
HIV-negative subjects. No episode of hairy leukoplakia was diagnosed.

Presenting author: john s. greenspan, Box 0422, UCSF, 513 parnassus ave,
ucsf, san francisco ca, United States, Tel.: [phone], Fax: [phone], E-mail: greenspanj @ dentistry.ucsf.edu
ThPeB7180 Convergent PI-sparing HAART regimens appear
equally effective in lymphoid tissue of virological
responders compared to standard PI combinations
J. van Lunzen1, H.J. Stellbrinkl, B. Zoellner1, O. Degen1, C. Schneider',
G. Faetkenheuer2, A. Stoehr3, H. Gellermann4, V. Rickerts5, S. Staszewski5,
K. Tenner-Racz6, P. Racz6. IUniversity Hospital Eppendorf, University Hospital
Eppendorf, Dept. ofInternal/Medicine, Martinistr.52, 20246 Hamburg, Germany;
2University of Cologne, Cologne, Germany; 31/FI-Institute, Hamburg, Germany;
4Private Practice, Hamburg, Germany; 5University of Frankfurt, Frankfurt,
Germany; 6Bernhard-Nocht-lnstitute, Hamburg, Germany
Background: To compare the virological and immunological efficacy of convergent HAART without PI with standard PI containing regimens in lymph nodes (LN)
and peripheral blood (PB).
Methods: 18 patients with sustained control of viral replication in PB (<25 c/ml
for a mean of 11 mths.) during HAART containing 2NA + efavirenz (EFV) or nevirapine (NVP) or abacavir (ABC) compared to combivir (CBV) + indinavir (IND)
or IND/EFV were included. Viral replication and immunological changes were assessed by in situ-hybridization, immunehistochemistry and flowcytometry in LN
biopsies. Direct sequencing of RT and protease genes from LN-MNC and PBMC
was performed in 9 subjects to date.
Results: Five pts. received CBV/IND, five 2NA/NVP, four 2NA/EFV, three
CBV/ABC and one IND/EFV. Baseline VL (mean: 113,000 c/ml), CD4 counts
(mean: 307/pl), CD4/CD8 ratio (mean: 0.34) and treatment duration (mean: 16
mths.) were comparable for PI and non-PI regimens. VL decreased to BLD after
a mean of 5.1 mths., CD4 counts increased at a mean of 270 cells/RI (CD4/CD8
ratio: +0.45). Viral replication was well controlled LN in both groups with only few
productively infected cells detectable in extrafollicular LN areas and no viral trapping on FDC. Germinal centers showed no or minimal signs of immune activation.
Lymphocyte distribution in LN normalised. Activation markers (CCR5, HLA-DR,
CD38, CD69), T cell proliferation (Ki-67) and the co-stimulatory molecules (CD28)
decreased towards normal irrespective of treatment group. Two patients developed drug resistance mutations (184V, 106A) in LN-MNC compared to wild-type
sequences in PBMC. One pt. with 184V mutation had intermittent viral blips during treatment with CBV/ABC, the other pt. with 106A mutation received CBV/IND.
Conclusions: In virological responders PI-sparing regimens appear equally effective in LN concerning virological and immunological benefits. Drug resistance
mutations may develop in LN despite sustained control of viremia.
Presenting author: Jan van Lunzen, University Hospital Eppendorf, Dept. of
Internal Medicine, Martinistr.52, 20246 Hamburg, Germany, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7181 IHealth-related quality of life in HIV+ patients taking
HAART
C. Del Borgo, R. Murri, M. Fantoni, P. Limongelli. Catholic University of Rome,
Dept. ofInf. Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168
Rome, Italy
Objective: To assess the impact of HAART on the HRQoL in HIV+ patients.
Methods: Prospective, multicenter, cohort study on Italian HIV+ pts at any stage
of disease taking PIs. From 10/97 to 5/98, consecutive patients were enrolled in 7
Italian Centers. The MOS-HIV was used as tool of the study and administered every 6 months. Two summary scores for physical health (PHS) and mental health
(MHS) were obtained.
Outcome of the study were considered a poor PHS or MHS defined as a decrease
>1SD from enrollment to the 4th visit. A LOCF method was used for the analysis.
Results: 809 patients were enrolled into the study Mean age: 36 years, females:
31%, intravenous drug users: 46%, CDC's group C: 39%. Median CD4+ cells
count: 221/1l; median log HIV RNA: 3.4. 51% of pts have took indinavir (IDV) at
least 1 month, 18% ritonavir (RTV), 25% saquinavir (SAQ), 19% nelfinavir and
10% both RTV/SAQ.
After a median of 26.7 months of follow-up, 40.6% had poor PHS and 39.4% poor
MHS.
6.8% of people were dead and 20.8% lost to follow-up.
At multivariate analysis, a previous AIDS diagnosis (OR 2.1; 95% ClI 1.1-3.7), time
on PI (OR for each 6 months 0.8; 95% CI 0.7-0.97), and PHS at enrollment (OR
0.9; 95% Cl 0.88-0.93) were correlated to a poor PHS while CD4 at enrollment
(OR 0.99; 95% Cl 0.99-0.99), MHS at enrollment (OR 0.93; 95% CI 0.90-0.97)
and poor or impaired satisfaction with sexual life (OR 5.9; 95% 2.2-16.0) were
correlated to a poor MHS.
Conclusions: Health status at enrollment predicts future physical and mental
health status. HIV disease stage and CD4 are respectively correlated to PHS and
MHS. PI positively impact on HRQoL. Poor or impaired self-reported satisfaction

with sexual life strongly and negatively affect mental health.
Presenting author: Cosmo Del Borgo, Dept. of Inf. Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168 Rome, Italy, Tel.: [phone], Fax:
[phone], E-mail: crif@ rm.unicatt.it

Oral candidiasis
Aphthous ulcers
Papilloma/wart
Hairy leukoplakia

HIV negative
n=19
0.0%
10.5%
5.3%
0.0%

Status at Enrollment
Primary/Acute
n=12
8.3%
0.0%
0.0%
0.0%

Recent/Early
n=53
11.3%
15.1%
1.9%
0.05

Repeated Measures
p-value (one sided)
0.079
0.43
0.15

Conclusions: Oral candidiasis, a well-known marker of late-stage HIV disease,
also is a useful marker of HIV infection at very early stages.