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

402 Abstracts ThPeB7263-ThPeB7267

XIV International AIDS Conference

ThPeB7263 Profile of Pathologic lesions in AIDS: An autopsy
study from Mumbai, India
D. Laniewar1, L. Bhandarkar1, S. Hira2. 1SirJ. J. Hospital, Building 1, Flat 10,
Sir J. J. Hospital Campus, Mumbai-400 008, India; 2Sir J. J. Hospital & The
University of Texas-Houston, Mumbai, India
Background: Although India has a high prevalence of HIV/AIDS the associated
pathologies responsible for morbidity have not been evaluated previously in a
representative study Hence, an autopsy study was carried out to analyse the
spectrum of lesions in patients with HIV / AIDS.
Methods: A retrospective and prospective autopsy study was carried out during
1988-2001 at Mumbai, India. Organs obtained at autopsy from 155 adult cases
were examined using routine and special stains.
Results: The spectrum of lesions identified were tuberculosis (90 cases, 58%),
bacterial pneumonia (25 cases, 16%), CMV infection (24 cases, 15%), toxoplasmosis (15 cases, 10%), cryptococcosis (11 cases, 7%), PCP (8 cases, 5%), candidiasis (6 cases, 4%), cryptosporidiosis (5 cases, 3%), aspergillosis (4 cases,
3%), strongyloidiasis (3 cases, 2%), lymphoma (2 cases, %), kaposi's sarcoma
(1 case, 1%).
Conclusions: Spectrum of diseases among patients with AIDS in India differ from
those reported in industrialized countries. Tuberculosis was the most frequently
observed infection followed by bacterial pneumonia and CMV pneumonitis. In
contrast with industrialized countries PCP remains less common in our patients.
The information on infections obtained in this study will be useful for managing
HIV/AIDS cases at district level hospitals where diagnosing HIV associated diseases is not always possible.
Presenting author: Dhaneshwar Lanjewar, Building 1, Flat 10, Sir J. J. Hospital
Campus, Mumbai-400 008, India, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThPeB7264 Integration of traditional healers into a rural
tuberculosis control programme in South Africa
M. Colvin', L. Gumede', K. Grimwade2, D. Maher3, D. Wilkinson4. Medical
Research Council of South Africa, Medical Research Council, PO Box 70380,
Overport, 4067, South Africa; 2H/abisa Hospital, Hlabisa, South Africa, Hlabisa,
South Africa; 3Stop TB Department, World Health Organisation, Geneva,
Switzerland; 4Adelaide University and University of South Australia, Adelaide,
Australia
Background: In the rural district of Hlabisa, South Africa, adult tuberculosis admissions increased by 360% (from 303 to 1 393) between 1991 and 1998 with
65% of TB patients being co-infected with HIV by 1997. The prevalence of HIV
among pregnant women in Hlabisa in 1999 was 32.5%. The purpose of this study
was to assess the acceptability and effectiveness of traditional healers as supervisors of TB treatment in an existing TB-DOTS programme.
Methods: An observational study comparing treatment outcomes among new TB
patients in 3 intervention sub-districts offered the additional option of traditional
healers for DOT supervision, with those in the remainder of the district offered the
standard range of options for DOT supervision (health facility, community health
worker and lay persons). A comparison was also made of treatment outcomes
between different options for DOT supervision.
Results: When comparing the intervention area to the remainder of the district,
treatment completion and mortality rates were similar but fewer patients in the
study area transferred out (4%) compared with the remainder of the district (22%;
p<0.0001). Comparing the different options for DOTS in the intervention sites: TB
patients supported by traditional healers achieved an 89% (n=47) treatment completion, 6% (n=3) mortality, 6% (n=3) default and 0% transfer rate in comparison
to all other supervisors who achieved a 67% (n=157) treatment completion, 18%
(n=41) mortality, 10% (n=23) default and 5% (n=12) transfer rate. The treatment
completion (p=0.002) and mortality differences (p=0.04) were significantly better
for traditional healers. Interviews with 41 of 51 traditional healer patients who had
completed treatment, revealed high levels of satisfaction with the care received
Conclusions: Traditional healers make an effective contribution to TB programme performance in this pilot scheme in HIabisa district. Further evaluation
will be necessary as this approach is scaled up.
Presenting author: Mark Colvin, Medical Research Council, PO Box 70380,
Overport, 4067, South Africa, Tel.: [phone], Fax: [phone], Email: [email protected]
ThPeB7265 Tuberculosis and HIV infection in children, a cohort
study: the "Programme Enfant Yopougon", Abidjan
Cote d'lvoire
N. Elenga', K.A.L. Kouakoussui', D. Bonard 2 P. Fassinou3, R. Laguide',
F Rouet2, J.B. Konan 4, p. Msellati5" dProgramme Enfant, 23 BP2897Abidjan
23, Cote d'voire; 2CEDRES, Abidjan, Cote d'voire; 3CHU Yopougon- Pediatrie,

Abidjan, Cote dIvoire; 4PPH CHU Treichville, Abidjan, Cote dlIvoire; 5IRD-LPE,
Marseille, France
Background: Few data are available on tuberculosis in HIV-infected children in
Africa.
Objectives: To estimate the incidence, describe clinical signs, evolution and care
management difficulties.
Methods: HIV-infected children are followed in a prospective cohort initiated in

Abidjan from October 2000. All children recruited had a clinical, biological examination, chest X ray and tuberculin test at baseline. Specific investigations where
done when children where suspected to be tuberculous. When culture was positive for mycobacteriae, an antibiogram was realized.
Results: 155 children were recruited. 25 children had at list one previous history
of tuberculosis and 7 had a tuberculosis under treatment at inclusion.2 others
have been diagnosed at inclusion and 3 during the follow-up. They were also 4
atypical mycobacteriae. On a total of 1101 children.months of follow-up, the incidence of mycobacterium infection is 0,8/100 per month of follow-up. Although
the majority of children were immunized by BCG, 95% of children without tuberculosis had a negative tuberculin test versus 66% among children with history of
tuberculosis (p<0.0001). There were 8 pulmonary and 4 extra-pulmonary tuberculosis. The immune deficiency was variable among the children with tuberculosis. Two tuberculosis were multiresistant. One child died before the diagnosis,
9 had a standard treatment (RHZ) and 2 were treated following the antibiogram
results. 7 had a good evolution and 5 died. Among the atypical mycobacteriae
infections, one avium was identified and the others are under identification. The 4
children presented a severe immune deficiency (CD4 <10%). They were treated
by Clarithromycin + Ciprofloxacin+Ethambutol and HAART
Conclusion: The incidence of mycobacterium infections is high in HIV infected
children. Multiresistances make treatment difficult. The high mortality among
these children need to improve the management of such infections.
Presenting author: Narcisse ELENGA, 23 BP 2897 Abidjan 23, Cote d'lvoire,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7266 TB prevalence among children infected with
HIV/AIDS at the Francois-Xavier Bagnoud
Foundation (FFXB) in Colombia during the period
1996-2001
M.B.V. Man jarres Barros, L.V.M. Larrota Velazco, H.L.A. Haag Lederer,
P.M.J. Perez Matera, S.M. Sara, R.F. Ruiz, M.C. Mora. 1058, Cale 70 N'60-11,
Colombia
Background: Pulmonary TB is a frequent condition in HIV/AIDS patients. Epidemiological data from several studies have shown an increase in the incidence
and mortality of TB in children. Given the fact that TB prevalence in Colombia is
high, we decided to determine the prevalence and clinical profile among children
living with HIV/AIDS attending the FFXB.
Methods: During 1996 to 2001, 40 children between 1 to 11 years of age (mean
age= 5years) were examined for TB. Only children who had tested positive for
HIV were included. Diagnosis was based on clinical, bacteriological, radiological,
immunological and epidemiological standard criteria.
Clinical suspicion was based on the presence of fever and cough for more than
two weeks with either weight loss or no weight gain. Bacteriological diagnosis
was mainly based on detection of AFB on gastric aspirate and/or positive culture.
Radiological criteria: lymphadenopathy, atelectasis, infiltrate and pleural effusion.
Immunological criteria: PPD skin test > 5 mm. Epidemiological criteria: positive
contact with an adult infected with TB.
Results: 11 (27.5%) out of the 40 children were diagnosed with pulmonary TB.
Three (23.2%) out of the 11 cases also had extra pulmonary compromise. All children (100%) had clinical symptoms and radiological findings compatible with TB.
Three (27.2%) had positive PPD, 8 (72.7%) had positive bacteriological criteria,
and 3 (27.2%) had positive epidemiological criteria.
Conclusions: TB prevalence our children is high when compared with other
countries. The reasons that may explain these findings could be: late diagnosis
of HIV in children, delay in the diagnosis of TB in adults, a poor socioeconomic
status that promotes malnutrition and deterioration of the immune system. Active search of signs of pulmonary TB among children, especially those living with
HIV/AIDS and in the adults living with them is highly recommended. TB in children
is a curable disease, even in the presence of HIV.
Presenting author: Victoria Alicia Manjarres Barros, Calle 70 No 60-11, Colombia, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7267 Prevalence and spectrum of tuberculosis(TB)
among HIV infected persons attending an AIDS
clinic in south India
V.M.K. Yanamadala', L.K. Rayudu2, S. Sunnam3. 1, 4-32, Nr. Nerellamma Gudi,
Indrapalem, Kakinada-533 006, A.R, India; 2Department of Microbiology,
Rangaraya Medical College, Kakinada, India; 3Department of Tuberculosis &
Respiratory Diseases, Kakinada, India
Background: To know the frequency of tuberculosis in HIV infection in a country with high prevalence of TB. Since TB is a respiratory opportunistic infection
transmitted from man to man and can affect any system of the body, many HIV
positive persons are likely to present with TB.
Methods: 335 HIV infected persons with clinical conditions ranging from asymp
tomatic to various opportunistic diseases were evaluated for tuberculosis at an
AIDS clinic. Patients were studied clinically, microbiologically and radiologically for
evidence of tuberculosis of various systems during January to December 2001.
Results: Out of 236 symptomatic patients presented to the clinic, 103 (43.6%) patients showed evidence of tuberculosis. Among these, 83 (80.5%) had pulmonary
tuberculosis. Among patients with pulmonary TB, 65 (63.1%) had parenchymal infiltrates of either or both lungs, 11 (10.7%) patients presented with pleural effusion