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

XIV International AIDS Conference

Abstracts ThPeB7191-ThPeB7194 385

Results: HIV-1 RNA-DNA hybrids were detected and quantified in 10 of 25 infected individuals (max, 128 copies/microgram of DNA). The ratio of RNA-DNA
hybrid in the total DNA was varied from 0% to 78%. In all cases where virus was
not isolated, HIV-1 RNA-DNA hybrids were undetectable. The results of virus isolation was more correlated with the average level of RNA-DNA hybrids (P = 0.002)
than those of plasma HIV-1 RNA (P = 0.073) and HIV-1 DNA (P = 0.10). RNADNA hybrids were mainly present in activated CD4 cells and resting memory T
cells but not in monocytes/macrophages and resting naive T cells.
Conclusions: The results suggest that the level of HIV-1 RNA-DNA in PBMC
of infected persons may reflect the extent of ongoing HIV-1 infection in resting
cells which is predominant in the total lymphocytes in vivo. Our novel method to
quantify HIV-1 RNA-DNA hybrid is simple and sensitive, and may provide a useful
parameter in clinical researches.
Presenting author: Shingo Kato, Keio University School of Medicine, Department of Microbiology and Immunology, 35 Shinanomachi, Shinjuku-ku, Tokyo,
Japan, E-mail: kato@ microb.med.keio.ac.jp
ThPeB7191 Socio-behavior and clinical features of the
seroconvertors of HIV in a cohort of men who have
sex with men (MSM)
G.M. Figueiredo, A. Rafael, J.R. Carvalheiro. Health Secretary of State, Sdo
Paulo, Brazil
Background: To describe the epidemiological, clinical and laboratory data from
a series of 28 seroconvertors in a cohort of MSM
Methods: The Bela Vista Cohort Study is a 3-year follow up of MSM. Eligibility
criteria were 1) age 18 years old and over; 2) HIV negative serology; 3) nonintravenous drugs users in the last 6 months. Clinical, serologic evaluation and
socio-behavioral interviews, including counselling and question about HIV seroconversion symptoms and STDs were undertaken every 6 months.
Result: Bela Vista: 1035 volunteers were enrolled between August 1994 and
June 2001. During the follow up there was 28 seroconversion for HIV, with incidence density ratio of 1,51 per 100 person/year. 42% of then had high school;
60% had sex with men and women in all his life, although nobody had sex with female in the last 6 months; 14,3% had steady partners, 39,3% occasional partners,
and 46,4 both. Median number of sexual partners 6 months before acquisition of
HIV with steady and occasional partners was respectively 1 and 5. Of the patients who could identify the precise activity leading to seroconversion, 1 reported
having only oral-genital contact and 2 relation with condom, one time, and misfortunately the preservative broke. 32% of seroconvertors had acute syndrome and
the frequency of main signs and symptoms was fever- 88,9%, lymphadenopathy88,9%, headache-77,8%, sore throat- 66,7, skin rash- 66,7%, weight loss- 55,6%,
diarrhea - 55,6%, oral candidiasis- 44,3% and myalgia- 22,3%. Laboratories features will be presented.
Conclusion: Primary HIV infection causes a recognisable clinical syndrome that
is often underdiagnosed, even in persons enrolled in research. Acquisition of HIV
does occur, even in person with relatively few partners and increased attention to
oral-genital contact as a mean of acquiring HIV appears to be warranted.
Presenting author: Gerusa Figueiredo, Av. Paulista no 1745 apto 904, Brazil,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7192 I Why HIV-infected patients present with low CD4
counts in the HAART era? Rate, causes, and
clinical & therapeutic consequences
M. Nunez', R. Asencio2, E. Valencia', L. Martin-Carbonero, B. Diaz',
M. Leal 2, J. Gonzalez-Lahoz1', V. Soriano1. 1Hospital Carlos Ill, Hospital Carlos
Ill, c! Sinesio Delgado, 10, 28029, Madrid, Spain; 2Hospital Virgen del Rocio,
Sevilla, Spain
Background: The proportion and the reasons of having CD4 <200 cells/mm3,
and therefore at risk for developing opportunistic infections (OI), in patients attending HIV clinics in the HAART era are not well known.
Methods: The charts of all patients attending two HIV clinics in Spain throughout
2001 were reviewed, and those with CD4 counts <200 cells/mm3 at least once
were selected. Reasons for low CD4 counts were defined as a follows: 1) Never
antiretroviral therapy; 2) HAART initiated within the current year, having very low
CD4 counts at baseline; 3) Virological failure under HAART; 4) Inadequate use of
HAART due to HAART toxicity; 5) Lack of adherence to therapy; 6) Poor immune
recovery despite complete viral suppression on HAART for >1 year; 7) Leukopenia secondary to drug toxicity.
Results: Out of 1897 pts, 213 (11%) had <200 cells/mm3: 77% were male, 55%
ex-IVDU, and 68% had detectable HIV-RNA. Regarding the reason for low CD4
they were distributed as follows: 1) 23 (11%); 2) 17 (8%); 3) 33 (15%); 4) 17 (8%);
5) 64(30%); 6) 47 (22%); and 7) 12 (6%). One or more O developed in 53/213
(25%) pts. O were significantly higher among subjects naive for antiretrovirals
or having initiated therapy recently (RR 6.45, 95%CI 2.43-17.12; p<0.001), and

among those failing HAART (RR 3.37, 95%CI 1.26-9.04; p=0.02). Among other
predictors, only a lower lifetime CD4 nadir was found to be associated with 01
(RR 0.98, 95%CI 0.97-0.99; p<0.001).
Conclusions: Despite the availability of HAART, >10% of pts of our HIV clinics
are at risk for developing 01. The most common reason for having low CD4 counts
is no adherence to therapy. However, nearly 1/4 of pts has a poor immune recovery despite complete virus suppression, and might benefit from immune thera
pies. The incidence of 01 was higher in those with no or recently initiated HAART.
Thus, early detection of HIV infection and initiation of HAART and OI prophylaxis
would result in a further decrease of Ol in the HAART era.
Presenting author: Marina N~tiez, Hospital Carlos Ill, c/ Sinesio Delgado, 10,
28029, Madrid, Spain, Tel.: [phone], Fax: [phone], E-mail:
mnunezg @ hotmail.com
ThPeB7193 IViral blip dynamics during HAART in patients who
start therapy during chronic infection versus
patients who start therapy during acute infection
M. Di Masciol, M. Markowitz2, M. Louie2, A. Hurley2, D.D. Ho2, A.S. Perelson'.
'Los Alamos National Laboratory Theoretical Biology and Biophysics, MS K710,
Los Alamos National Laboratory, Los Alamos, NM 87545, United States; 2Aaron
Diamond Research Center, New York, United States
Background: Intermittent episodes of low-level viremia (blips) are often observed
in well-suppressed, HAART-treated patients. Viral blips might represent low level
viral replication in the presence of drug, release of virions from the latent reservoir
or might also occur as a
Result: of lack of compliance to treatment. Since increased frequency of blips
correlates with slower decay of latently infected cells, virus released during blips
may refill viral reservoirs.
Methods: We have analyzed the occurrence of viral blips in 47 patients who
started HAART during chronic infection and in 76 acutely infected patients who
started therapy within 15 to 90 days from the onset of symptoms. Patients were
treated with 8 different HAART regimens.
Results: In both the chronic and acute groups, viral blip frequency did not increase with longer periods of observations. Also, no difference in viral blip frequency was observed between treatment sub-groups. However, viral blip frequency was significantly higher among
HAART treated patients during chronic infection (0.13~0.12 /VL sample) than
during acute infection (0.07~0.10 /VL sample). A highly significant and positive
correlation was found between viral load at the start of therapy and the frequency
of viral blips during the period of viral load suppression in patients treated during
acute infection (r2=0.46, P < 3.6*10-5).
Conclusions: Overall, viral blip frequency appears to shows a certain degree of
predictability based on the history of infection, and the virologic set point preceding the period of treatment. The higher level of immune restoration reported in
patients treated during primary infection suggests a potential role of the immune
response in preventing viral blips. Among patients treated during primary infection
the ones who show lower viral blip frequencies are those with lower viral loads at
the start of therapy.
Presenting author: Michele Di Mascio, Theoretical Biology and Biophysics, MS
K710, Los Alamos National Laboratory, Los Alamos, NM 87545, United States,
Tel.: +(505)6679482, Fax: +(505)6653493, E-mail: [email protected]
ThPeB7194 IScreening for acute HIV infection as part of routine
HIV testing using specimen pooling and RNA PCR
C.D. Pilcher', T McPherson2, P.A. Leone', A.L. Peace-Brewer', J. Owen
O'Dowd3, C.B. Hicks4, J.J. Eron1, S.A. Fiscus'. 'UNC-Chapel Hill, CB 7030,
Chapel Hill, NC, United States; 2NC State Laboratory of Public Health, Raleigh,
NC, United States; 3NC Department of Health and Human Services, Raleigh,
NC, United States; 4Duke University, Durham, NC, United States
Background: Acute HIV infection is occurring in at risk populations but is predominantly undiagnosed. Acute HIV screening is not part of routine testing since
direct tests for HIV such as RNA PCR are expensive and may have inadequate
specificity for screening as prevalence will usually be low.
Methods: We screened all consecutive patients receiving routine HIV testing in
North Carolina over one month for acute HIV infection. After testing by OTC HIV1 EIA +/- Bio-Rad WB at the State Lab, seronegative specimens were pooled,
first into pools of 10 and then into pools of 90. Pools of 90 were tested first by
Roche Ultrasensitive (LL, 1,800-4,500 cp/ml); further testing by standard Roche
was done only on pools/specimens contributing to positive larger pools. Results
were reclassified as true/false after patient notification and repeat testing.
Results: 41 of 8386 had Ab+ chronic HIV infection [prevalence 4.9 per 1,000 (95%
Cl 3.5-6.6)]. Of 8345 Ab- results, 8162 had sufficient serum for pooling. 5 of these
8162 Ab - results were HIV RNA+ of whom 4 were true positive acute infection
[prevalence 0.5 (0.1 - 1.3) per 1,000]. All 4 (HIV RNA: 7.5, 5.9, 5.7 and 4.3 log
cp/ml) were women. One had painful HSV-negative genital ulceration at testing;
the other three all developed an acute retroviral syndrome shortly after their test.
Only 147 RNA tests were needed to screen all 8162 individuals. Overall specificity
was 0.9999.
Conclusions: 9% of HIV infected individuals that presented for routine HIV testing in North Carolina were initially missed because they had acute HIV infection.
Multistage pooling can reduce costs and make HIV RNA PCR adequately specific

for screening low prevalence populations.
Presenting author: Christopher Pilcher, CB 7030, 547 Burnett-Womack Bldg,
UNC-Chapel Hill, Chapel Hill, NC 27599-7030, United States, Tel.: [phone]
2536, Fax: [phone], E-mail: [email protected]