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

384 Abstracts ThPeB7187-ThPeB7190

XIV International AIDS Conference

City who had a baseline detectable pre-ART VL, 6 months or more of HIV RNA
<400 c/mL while on ART, and at least 4 or more VL determinations between the
first and last VL BLQ. Based on the Pt's HIV care provider's chart documentation,
the outcome of ART was categorized as follows: (1) complete sustained response
(CSR) if all VL determinations on ART remained BLQ; (2) transiently detectable
HIV RNA ("blips") if detectable VL was followed by at least one BLQ determination; (3) persistent low grade viremia if more than two consecutive detectable VL
determinations (grouped as 50-400, or 400-1000 c/mL); and (4) virologic failure if
two consecutive VL of >1000 c/mL while on ART (+/- genotype).
Results: 488 Pts met the inclusion criteria. Results of the first 127 subjects of
this cohort are available. 93 Pts had CSR (73.3%), 17 with at least one period
of detectable HIV RNA during an ART interruption. 30 Pts (24.0%) with transient
detectable VL, 17 (14 between 50-400 and 4 with >400 c/mL "blips") with no
provider's impression of etiology, 10 (5 between 50-400 and 5 with >400 c/mL
"blips") with provider documented nonspecific illness symptoms and 2 (both 50 -400 " blips") related to missed doses. Finally, two patients (0.7%) experienced
virologic failure, both with resistance mutations by HIV genotypic analysis.
Conclusion: A preliminary analysis of all Pts on ART with more than 6 months of
HIV RNA <400 c/mL followed at an HIV clinic found viral "blips" to be common.
Completion of the record review and final analysis of factors associated with CSR,
"blips" and virologic failures is ongoing.
Presenting author: mathew mcsweeney, 525 east 68th street, new york, ny,
10021, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeB7187 Severe visceral Kaposi's sarcoma due to immune
reconstitution associated with reduction in plasma
viral load without increase in CD4+ count
D.M. Forrest', P. Phillips', B. Melosky2, J.S.G. Montaner'. 'St. Paul's Hospital,
Room 667 - Burrard Bldg., St. Paul's Hospital, 1081 Burrard Street, Vancouver,
BC V6Z 1 Y6, Canada; 2BC Cancer Agency, Vancouver, BC, Canada
Background: Kaposi's sarcoma (KS) in HIV disease usually regresses rapidly
with highly active antiretroviral therapy (HAART). But worsening of KS after starting HAART may represent an immune reconstitution disease (IRD). IRD has
been associated with recovery of CD4+ count and function. We report 3 cases
of mucocutaneous/visceral KS which worsened shortly after starting treatment
with HAART without increase in CD4+ count.
Results: All patients (Patient 1 [P1; 36 male]; patient 2 [P2; 35 female]; patient 3
[P3; 36 male]) had advanced HIV infection and were treated with a PI-containing
HAART regimen. All had cutaneous KS, one (P2) intraoral, and none had known
visceral KS. All had good virologic but limited immunologic responses: (PVL =
HIV plasma viral load, copies/mL)
WEEK PVL, P1 CD4+, P1 PVL, P2 CD4+, P2 PVL, P3 CD4+, P3
0 406000 50 487000 40 188000 <10
5 618 20 454 40 <50 <10
8 - - 185 180 <50 <10
24 <50 64 - - - -
A rise in CD8+ count with HAART was seen in one patient (P2), but was inconsistent or absent in the others. P1 showed initial clearing of cutaneous lesions, but
then developed facial swelling, anasarca and chylous pleural effusions despite
HAART; he died 11 months after starting HAART. Thoracic duct and pulmonary
KS was confirmed at autopsy. P2 had progression of intraoral KS despite continued HAART with extensive involvement of head and neck and pulmonary KS; she
died 9 weeks after starting HAART P3 had rapidly worsening cutaneous KS after
starting HAART and progression of interstitial pulmonary disease consistent with
KS; cutaneous lesions and pulmonary disease gradually resolved with HAART
and chemotherapy for KS. In all cases, progression of KS after starting HAART
was related to rapid reduction in PVL without increase in CD4+ count.
Conclusions: Aggressive exacerbation of mucocutaneous/visceral KS after
starting HAART may be a particularly malignant form of IRD. Its development
seems to be associated with rapid virologic response to HAART, even in the absence of CD4+ response.
Presenting author: David Forrest, Room 667 - Burrard Bldg., St. Paul's Hospital,
1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada, Tel.: [phone], Fax:
[phone], E-mail: dm.forrest@ shaw.ca
ThPeB7188 Spectrum of opportunistic infections among HIV
infected North Indian patients
A. Surana, M. Vajpayee, N. Wig, P. Seth. All India Institute of Medical Sciences,
Research Associate, Dept. Of Microbiology, AIIMS, New Delhi, India
Background: The spectrum of opportunistic infection in HIV infected subjects

varies from country to country. As the number of AIDS cases increases in India, little information is available about the prevalence of opportunistic infections
among clinicians. The aim of the present study was to document the characteristic
opportunistic infections of HIV infected north Indian patients at Delhi, India.
Methods: The present study was conducted among 331 HIV-infected patients at
A.I.I.M.S, New Delhi. The study methods comprised pre-test counseling, informed
consent, blood withdrawal and clinical evaluation. All the serum samples were

tested for HIV and CD4 counts were estimated by FACS Calibur (BD) flow cytometer.Simultaneously routine microbiology smears, cultures and serology was
performed to confirm opportunistic infections.
Result: In this study of 331 (m=251,f=80) subjects, the opportunistic infection encountered were tuberculosis (88), oral candidiasis (34), parasitic diarrhea (15),
herpes zoster (4), cryptococcal meningitis (4), aspergillosis (2), and pnenocystis
carnii pneumonia (2). About one-third patients presented with more than one opportunistic infection. Tuberculosis was found in 26.58% patients with mean CD4
count of 225-cells/ml, while for oral candidiasis (present in 10.27% cases) and
parasitic diarrhea (present in 4.53% cases) mean CD4 counts were 273 cells/ml
and 255 cells/ml respectively. The mean CD4 counts were higher in females when
compared to males.
Conclusion: The predominant opportunistic infection found among north Indian
HIV infected patients was tuberculosis followed by oral candidiasis and parasitic
diarrhea. The mean CD4 counts in these infections parallels with other literature.
As infections in India are very frequent and it is extremely difficult to elicit sexual
history, this study also highlights the importance of considering HIV in differential
diagnosis and management of all patients
Presenting author: Ashish Surana, Research Associate, Dept. Of Microbiology,
AIIMS, New Delhi, India, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeB7189 Evaluation of an original automated assay for the
sequential detection of HIV antibodies and P24
antigen on the VIDAS system
E. Brignoli1, C. Pretis', E. Suiphon2, M. Jolivet1. 'bioMerieux RID Department,
Chemin de I'Orme, 69280 Marcy I' Etoile, France; 2bioMerieux, Marcy I'Etoile,
France
Background: This study was performed to determine the performance of a new
HIV screening test: VIDAS HIV DUO Ultra. This assay combines a sandwich format for HIV p24 antigen detection and a third generation format assay for HIV Ab
detection in a single test using the VIDAS analyzer. The originality of this assay
is based on the ability of VIDAS to give two sequential results: the first one corresponds to HIV-1 and HIV-2 antibodies, the second one to p24 Ag detection. A
global interpretation is provided for each sample.
The lower part of the SPR (Solid Phase Receptacle) is coated with HIV-1 gpl60
and synthetic peptides (HIV-1 0 group and HIV-2). The upper part of the SPR is
coated with anti-p24 monoclonal antibodies. Other reagents are ready to use in
the strip. VIDAS performs automatically all the steps required.
Methods: To determine the sensitivity and the specificity, 1000 negative blood
donors samples, more than 2000 non selected clinical samples, 300 HIV-1 and
50 HIV-2 confirmed positive samples as well as various commercial seroconversion panels (BBI, NABI and BioClinical Partners) were tested with VIDAS HIV
DUO Ultra.
Results: The specificity obtained with blood donors and clinical samples was better than 99.7 %. The 350 HIV Ab confirmed positive samples were all positive with
VIDAS HIV DUO ULTRA.
In the seroconversion panels (sequential samples from the same patients), when
p24 Ag was present, VIDAS HIV DUO ULTRA was as sensitive as the others commercial p24 antigen assays. When only HIV antibodies were present, VIDAS HIV
DUO ULTRA was as sensitive as the third generation assays currently present in
the market.
Conclusions: VIDAS HIV DUO Ultra is a reliable HIV screening assay to detect HIV antigen and/or antibodies with a very good sensitivity and specificity as
shown in the populations studied. It offers the advantage that a separate test
value for p24 antigen and HIV antibody is calculated and then allows to orient the
decisional algorithm.
Presenting author: Emilio Brignoli, Chemin de I'Orme, 69280 Marcy I' Etoile,
France, Tel.: [phone], Fax: [phone], E-mail: emilio.brignoli@eu.
biomerieux.com
ThPeB7190 HIV-1 RNA-DNA hybrid in peripheral blood
mononuclear cells of infected individuals
S. Kato', H. Tagami2, Y. Saito', R. Tanaka, H. Hanabusa2. Keio University
Keio University School of Medicine, Department of Microbiology and
Immunology 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan; 2O0gikubo Hospital,
Tokyo, Japan
Background: The HIV-1 RNA-DNA hybrid may be accumulated in peripheral
blood mononuclear cells (PBMC) of infected individuals because reverse transcription is slowed by the low dNTP pool in resting cells. To ascertain this possibility we developed a method to quantify the HIV-1 RNA-DNA hybrid and study
its distribution in various types of cells in PBMC and the relation between the
RNA-DNA hybrid level and the results of virus isolation.
Methods: DNA was purified from PBMC of infected individuals and digested with

a restriction endonuclease Mse I. Undigestable HIV-1 RNA-DNA hybrids therein
were quantified by competitive nested PCR. Total HIV-1 DNA was quantified similarly without digestion. Plasma HIV-1 RNA levels were obtained by routine clinical
measurements. Various types of cell populations were isolated from PBMC with
antibody-conjugated magnetic beads. Virus isolation was carried out by anti-CD3
antibody (clone CLB-CD3)-stimulated coculture of PBMC from infected and normal persons.