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

XIV International AIDS Conference

Abstracts ThPeB7268-ThPeB7272 403

of varying severity while 7 (6.8%) patients presented with miliary tuberculosis. In
extrapulmonary forms, 6 (5.8%) patients presented with tuberculous meningitis.
Two (1.9%) patients had TB pericarditis. 3 (2.9%) patients presented with cold abscess of chest wall and 7 (6.8%) with TB lymphnodes. One (1%) patient had TB
abdomen with ascites and 1 (1%) patient presented with psoas muscle abscess
of TB etiology.
Conclusions: Tuberculosis is the commonest (43.6%) presenting disease in HIV
infection in south India. Extrapulmonary TB with involvement of rare sites and
complications in pulmonary TB are seen in more number of patients. In a developing country like India symptomatic HIV infected persons should be thoroughly
investigated for evidence of TB.
Presenting author: Venkata Murali K Rao Yanamadala, 4-32, Nr. Nerellamma
Gudi, Indrapalem, Kakinada-533 006, A.P., India, Tel.: [phone], Fax: +91
884 380041, E-mail: yanamadalamk@sifycom
ThPeB7268 Outcome of treatment of HIV-associated
tuberculosis in the era of HAART
E. Girardi1, P. Vanacore1, F. Palmieri1, S. Lanini1, S. Pauluzzi2, G. Antonucci1,
G. Ippolito on behalf of GISTA-SISMIP1. 'lNMI L. Spallanzani, Dept. of
Epidemiology, Roma, Italy; 2Univ Perugia, Perugia, Italy
Background: Few data are available on the outcome of treatment of HIVassociated tuberculosis (TB) in the context of wide use of HAART. A prospective
study aimed to estimate tuberculosis treatment outcomes, and their determinants
among HIV-infected patients is ongoing in Italy.
Methods: Patients diagnosed with HIV-associated TB in 96 infectious diseases
hospital units in Italy between 1 May 1999 and 30 September 2000 have been
recruited into an observational prospective study.
Results: 283 cases of active TB were recorded among 272 HIV-infected persons.
Mode of HIV infection was IV drug use in 47.8% and sexual exposure in 42.2%,
with heterosexual contacts representing 27.9% of the total; 34.5% were foreign
born; 54% of patients were previously diagnosed with AIDS and the median CD4
count was 122/mmc. To date, tuberculosis treatment outcome is available for 195
patients: 25.6% was cured, 17.4% completed a full course of treatment, 1% was
a failure, 5.6% was transferred out, 10.3% discontinued the treatment, 19.5%
was lost to follow-up, 6.2% had an additional treatment course, and 14.4% was
died. The proportion of deaths was 16.8% among patients with CD4<200/mmc,
13% among those with CD4 between 500-200, and 0% among patients with
CD4>500.ln multivariate analysis low CD4 was the only significant predictor of
death (OR=0.8 per 50 cells/mmc increase; p=0.02). Being IDU (OR=0.3) and
being unemployed (OR=0.3) were significantly (p<0.05) associated to a lower
probability of a favorable treatment outcome (cure or completion of treatment)
while living in a community (OR=10.1) was significantly associated to a favorable outcome Conclusions: Proportion of HIV-infected TB patients dying during
treatment remains high, especially for those with a low CD4 cells count. The low
proportion of cure or treatment completion indicate the need for interventions that
should be targeted in particular to IVDU and socially disadvantaged patients.
Presenting author: Enrico Girardi, INMI L. Spallanzani, Dept. of Epidemiology, Via Portuense 292, 00149 Roma, Italy, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeB7269 Types of tuberculous diseases in HIV infection
P.C. Das1, RK. Das2. 1Pranabananda Seva Niketan, 79,Lenin Sarani,
Kolkata-13, India; 2Ross Clinical Laboratory KolKata, India
Background: HIV infection has a perennial relationship with tuberculosis infection. This study was conducted to find out the incidence and type of tuberculous
disease in cases of HIV infection.
Method: Consecutive 60 cases of HIV infection have been incorporated in the
present study with view to find out the nature of tuberculous disease. Of these 37
were males and 23 females and their ages ranged from 18years to 40 years. The
disease was confirmed by appropriate tests.
Results: Analyzing the data it was found that pulmonary tuberculosis was present
in 23 cases (38.33%), cervical and axillary lymphadenopathy in 4 cases (6.67%),
miliary tuberculosis in 3 cases (5%).Tuberculosis was present in 50% of cases.
Conclusion: Thus the study shows that tuberculosis was present in 50% cases of
HIV infection. Pulmonary tuberculosis was present in maximum number of cases
and miliary tuberculosis in least number of cases.
Presenting author: Parimal Das, 79,Lenin Sarani, Kolkata-13, India, Tel.: [phone], E-mail: drpcdas@ hotmail.com
ThPeB7270 Clinical profile of tuberculosis and response to
directly observed therapy in individuals co infected
with the human immunodeficiency virus

D. Garg1, S.D. Purohit1, V Purohit1, R.C. Thanvi1, A. Haag2. 1AFXB Rajasthan,
756 Ratan Niwas, Geeta Bhawan Road, Sardarpura, Jodhpur, India; 2FXB US
Foundation, Burlington, United States
Background: HIV has definite impact on natural history and epidemiology of
tuberculosis. With the high prevalence of tuberculosis in India, nearly 60% of
HIV/AIDS cases are reported to have tubercular disease.

Method: We revised the clinical files of 43 individuals living with HIV/AIDS who
presented to the FXB Center for HIV Care, Support and Treatment, from September 2001 to December 2001. All patients were investigated for other opportunistic
infections. All newly TB diagnosed patients received DOT-TB. Those referred to
us for comprehensive care and treatment that were already on TB treatment continued their non-DOT treatment.
Results: Fifty two percent (22) of the patients had evidence of tuberculosis of
which 45% had an extra-pulmonary form. In most of the pulmonary tuberculosis
patients the presentation was atypical and the sputum was positive in only 16%
of them. All the newly diagnosed patients were kept on DOT-TB and their results
compared with the referred patients on self-administered anti-TB regimen. The
bacteriological, clinical and radiological response of patients on DOT-TB was better than those on self-administered regimen.
Conclusion: Tuberculosis in PLWHA is often atypical in presentation. Extrapulmonary lesions are frequently observed. DOT-TB is more effective that the
self-administered regimes for the treatment of TB in PLWHA.
Presenting author: Dinesh Garg, 756 Ratan Niwas, Geeta Bhawan Road, Sardarpura, Jodhpur, India, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeB7271I Antiretroviral therapy in AIDS patients with
tuberculosis
E. Navas1, J. Oliva1, P. Miralles 2, J. Berenguer2, R. Rubio 3, F. Pulido3,
M.V. Moreno4, M.E. Valencia4, A. Arranz 5, J. Sanz5, S. Moreno1. 'Hospital
Ram6n y Cajal, E.infecciosas-Hospital Ram6n y Cajal, Cra. de Colmenar km
9,100, 28034-MADRID (SPAIN), Spain; 2HGU Gregorio Maraf76n, Madrid,
Spain; 3Hospital Doce de Octubre, Madrid, Spain; 4CIC Carlos I/I, Madrid,
Spain; 5Hospital Principe de Asturias, Madrid, Spain
Background and Methods: To study the efficacy and tolerance of the different combinations of antituberculous and antiretroviral regimens in HIV infected
patients with tuberculosis (TB), we reviewed the charts of all HIV-infected patients with culture confirmed tuberculosis diagnosed between January-1996 and
January-2000 in four public hospitals of Madrid (Spain). We analyzed the clinical,
immunological and virological evolution of HIV infection, the outcome of TB, and
the tolerance and compliance to the treatment.
Results: The charts of 344 evaluable patients were reviewed (mean age: 34.7
years; male sex: 82.8%). Risk factor for HIV infection was substance abuse in
78,8% of the cases (25,9% of the patients were active drug users at the moment
of TB diagnosis). Mean CD4 cell count was 97 cells/mm3 and in 19,8% of the
cases the patients had suffered previous AIDS defining events. The treatment of
TB was completed in 64,2% of the cases, and included rifampin in 93,9%. Significant antituberculous drug toxicity occurred in 25,2% of the patients. A total of
73,9% of the patients received antiretroviral treatment, and it was administered
during the treatment of TB in 88,1% of them. Antiretroviral treatment included a
protease inhibitor in 44% of the cases, and in 18% of the cases it was interrupted
because of toxicity
During follow up, clinical progression to B or C defining illness or death occurred
in 37.5% of the cases. We did not find statistical differences in the survival analysis of clinical progression (log-rank) between patients that started antiretroviral
theapy before and after completing the treatment of TB (p=0,1). In multiple regression analysis (Cox), CD4 cell count was the only variable that was predictive
of clinical progression.
Conclusion: In our HIV infected cohort with TB, drug toxicity was a frequent
event. The degree of immunosupression, but not the delay in initiating antiretroviral treatment was associated with a worse outcome.
Presenting author: Navas Enrique, E.infecciosas-Hospital Ram6n y Cajal, Cra.
de Colmenar km 9,100, 28034-MADRID (SPAIN), Spain, Tel.: [phone],
Fax: [phone], E-mail: ene01 m @ saludalia.es
ThPeB7272 Determination of genetic variability in strains of
Mycobacterium tuberculosis using DRE-PCR
A.M. Xet1, D. Lau2, B. Samayoa2, T. Velasquez-Porta2, E. Arathoon3
Un' ost f California, Berkeley California, United States; 2 Direccion General
de/Investigacion, Universidad de San Carlos de Guatemala, l a avenida 11-19
zona 1, Guatemala, Ciudad, Guatemala; 3Asociacion de Salud Integral
Guatemala, Guatemala
Background: To determine the genetic variability in strains of Mycobacterium tuberculosis isolated from ambulatory and hospitalized patients from an urban public hospital. To stablish the existence of intra-hospitalary strains of Mycobacterium
tuberculosis.
Methods: Genetic typing of M. tuberculosis using the polymerase chain reaction
(PCR) technique by the double repeat element method (DRE-PCR) and review of
clinical files.
Results: 47 strains of M. tuberculosis isolated from 38 patients, 19 HIV positive

and the rest HIV negative were analyzed by DRE-PCR. Both groups were ambulatory and external patients. In 15 strains were found three groups with identical
patterns, sharing the same bands and 3 strains with only one different band.
These groups suggest recent infection. The rest of the strains showed individual
patterns that could indicate reactivation of previous infection. In the strains with
identical patterns or only one different band it was not possible to find any contact
point between the patients, HIV negative and HIV positive.