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

404 Abstracts ThPeB7273-ThPeB7277

XIV International AIDS Conference

Conclusions: It is necessary to continue looking for the reasons for which there
are strains with identical patterns or small differences and increase the number of
strains, in order to determine the links between the patients or if these similarities
are related to other factors as drug resistance, or demographic characteristics.
Presenting author: Dalia M Lau, la avenida 11-19 zona 1, Guatemala, Ciudad,
Guatemala, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7273I Recent transmission of tuberculosis among
persons living with HIV attending at a Brazilian
University Hospital
M.R. Resende, M.C. Villares, M.C. Ramos. Campinas State University, Pe
Camargo Lacerda 108 apto 64, Campinas - SP, Zip Code 13070540, Brazil
Background: The assessment of recent transmission of tuberculosis (TB) in
healthcare facilities and other closed institutions allows to evaluate the effectiveness of TB control.
Objective: to evaluate the probable recent transmission of M. tuberculosis (Mtb)
among HIV-infected patients attending at a Brazilian Hospital.
Methods: retrospective study involving 254 patients with HIV and TB confirmed
by culture for Mtb, from January 1996 to June 2001 attending at Campinas State
University Hospital (Sao Paulo, Brazil). The Mtb isolates were genotyping by
IS6110 restriction fragment length polymorphism (RFLP).
Results: The median age was 32 years, 72% were male. Pulmonary involvement
associated to extra-pulmonary disease occurred in 120 (47%) cases. AFB smear
of sputum was positive in 30.7% of cases and cavitary pulmonary disease was
observed in 16 (6%) cases. Disseminated TB (31%) was the most common extrapulmonary site, followed by lymphadenitis (27%) and pleural (16%) disease. AIDS
was diagnosed before TB in 45% (median time:18 months). The CD4+ count median was 87 cells/mm3. The IS6110-RFLP of 109 Mtb isolates identified 86 distinct patterns; 37(33.9%) patients belonged to one of 14 clusters ranging in size
from 2-6 patients (IS6110 copies median=10). Epidemiologic links were observed
in 11(29.7%) cases: 6 community and 5 nosocomial contact. In these cases, possible nosocomial transmission was related to concurrently hospital-day visits and
HIV outpatient clinic. The median of follow-up at Hospital until TB diagnosis was
higher for patients with clustered isolates (287 x 35 days; p=0.05). The occurrence of AIDS before TB was associated to cluster, for patients with AFB smear
positive in sputum (p=0.02).
Conclusions: One third of TB cases in HIV patients was due to recent transmission; in some cases, the TB transmission was related to nosocomial exposure.
These data reinforces the strict adherence to airborne precautions and prompt
investigation of contacts.
Presenting author: Mariangela Resende, Pe Camargo Lacerda 108 apto 64,
Campinas - SP, Zip Code 13070540, Brazil, Tel.: [phone], Fax: +55 19
37887763, E-mail: [email protected]
ThPeB7274 Prevalence of HIV infection in tuberculosis patients
of Northern India
S. Singh, N. Singh, S. Singhal, V. Balooni. A.I.I.M.S., E-95, Ansari Nagar, New
Delhi, 110029, India
Background: Tuberculosis is a major health problem particularly in developing
countries. World Health Organization estimates that 8 million people contact tuberculosis every year with 2 million deaths. India is hardest hit country, particularly, after AIDS epidemic. Now in India, tuberculosis is the leading cause of AIDS
associated mortality in India. There are also reports that prevalence of HIV is
more in TB clinic attendees.
Methods: Prompted with these reports we conducted a study to find out the
prevalence of HIV infection in the North Indian patients. Six hundred and twenty
patients with Mycobacterium tuberculosis diseases were included in this study. All
the patients were counselled and after informed consent their blood samples were
withdrawn and sera separated. The serum samples were divided into two major
groups; the pulmonary TB (400) and extra-pulmonary TB (220). The later group
was further subdivided into 4 subgroups and comprised of patients of TB lymphadenitis (150), tubercular meningitis (50) and milliary tuberculosis (20). Serum
samples were tested for HIV antibodies.
Results: Out of 620 serum samples, 33 (5.3%) were found HIV-1 positive. None
was HIV-2 positive. The data indicated that seroprevalence of HIV was high in
pulmonary tuberculosis cases [6.25% (25/400)] as compared to 3.6% (8/220) in
extra-pulmonary cases. In the later group too the highest prevalence [10% (2/20)]
was in milliary tuberculosis patients followed by TB meningitis [4% (2/50)] and
least in tubercular lymphadenitis cases [2.7% (4/150)].
Conclusions: The study indicates that though HIV prevalence in TB clinic attendees was more than HIV negative clients, the prevalence rates in our study was
significantly less than the studies reported from South and western India.
Presenting author: Sarman Singh, E-95, Ansari Nagar, New Delhi, 110029, In
dia, Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeB7275 Efficacy of secondary isoniazid preventive therapy
(IPT) among HIV-infected Southern Africans
G.J. Churchyard1, K.L. Fielding2, S. Charalambous 1, J.H. Day1, I. Mantsoe1,
E.L. Corbett2, R.J. Hayes2, B. Samb3, A.D. Grant2. 'Aurum Health Research
Unit, Welkom, South Africa; 2LSHTM, Department of Infectious and Tropical
Diseases, London School of Hygiene and Tropical Medicine, Keppel Street,
London, United Kingdom; I UNAIDS, Geneva, Switzerland
Background: HIV infection is a major risk factor for recurrence of tuberculosis
(TB) in countries with high TB incidence. Reinfection is likely to be an important cause of recurrence among HIV-infected individuals. Existing international
guidelines make no recommendations for secondary preventive therapy (PT). We
compared TB incidence rates among HIV-infected gold miners working in South
Africa with a history of previous TB who had or had not received IPT.
Methods: Participants receiving PT were derived from a cohort of men in WHO
stage 3/4 receiving isoniazid and cotrimoxazole indefinitely as part of an earlier
trial. The control cohort comprised men attending a routine HIV clinic who did not
receive IPT because of a history of previous TB, an exclusion criterion according
to current guidelines.
Results: 362 men who received IPT were compared to 241 who did not. The
median age (40, IQR 35- 45 and 41, IQR 36-46, respectively) and baseline CD4
count (271, IQR 158-402 and 276, IQR 152-440, respectively) were similar in the
two groups. TB incidence was reduced by 54% among men receiving IPT compared to those who did not (incidence rates 8.9 and 19.2/100 pys respectively,
unadjusted incidence rate ratio (IRR) 0.46; 95% CI 0.3-0.8). Reduction in TB incidence remained significant after adjusting for CD4 count, age and WHO stage.
Men who had more than one previous episode of TB, compared to those with
only one previous episode, had no significant reduction in TB incidence (IRR 1.7;
95%CI 0.4-6.4 and IRR 0.4; 95%CI 0.2-0.7, respectively).
Discussion: HIV-infected individuals living in communities with a high incidence
of TB should be offered secondary IPT. The usefulness of secondary PT in patients with more than one previous episode of TB may be limited by increasing
antituberculosis drug resistance. IPT may be most effectively targeted to those
individuals with more advanced HIV disease.
Presenting author: Katherine Fielding, Department of Infectious and Tropical
Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom, Tel.: [phone], Fax: [phone], E-mail:
katherine.fielding @ lshtm.ac.uk
ThPeB7276 Directly observed therapy (DOT) in patients with
tuberculosis and HIV infection
A. Horta1, 0. Fortes2, M. Terceirol, J. Mendez1, C. Recalde2, 0. Vasconcelos',
M. Freitas1, R. Sarmento e Castro1. 'Hospital Joaquim Urbano, Rua Sol
Poente, 656, Hab. S, 4450-794 Lega da Palmeira - Portugal, Portugal; 2Drug
Users Attendance Centers, Porto, Portugal
Background: HIV-infected IV drug users (IVDUs) are frequently noncompliant to
treatment. In a previous group of IVDUs we registered a 35,7% compliance to
anti-tuberculous therapy Morbidity, mortality (40% in 12 months) and Mycobacterium tuberculosis (Mt) drug multiresistance (18%) were very high. In a prospective study we tried to compare adherence and results previously obtained to that
of a group submitted to DOT with antituberculous drugs and methadone substitution.
Methods: Between June 1998 and January 2002, 117 HIV-infected IVDUs diagnosed with tuberculosis (TB) were recruited to take daily antituberculous drugs
and methadone under DOT, for a period of nine to twelve months.
Results: Ages ranged from 18 to 50 years. One hundred and three patients (pts)
(88.1%) were male. TB diagnosis was based on the isolation of Mt in culture
and/or histologic criteria in 101 (86.3%) and on clinical criteria in the other 16
pts (13.7%). Therapy began with isoniazid, rifampin or rifabutin, ethambutol and
pyrazinamide in 104 pts (88,9%). Multiresistant Mt was registered in four pts (7%).
Side effects were observed in 27 pts (23,1%). Mean CD4 cell count and viral load
were at the begining 108,5/mm3 and 582100 copies RNA/mm3 respectively. At
the end, these values were 193,6/mm3 and 80141 c/mm3, with 17 pts (14,5%)
supressed.
Sixty-nine pts (59%) completed treatment, 18 (15.4%) are still under therapy,
seven (6%) withdrew and 23 (19,6%) died while in treatment. TB was the cause
of death in only ten of these pts.
Compliance was observed in 103 pts (88%). Seven pts (6%) had an irregular
adherence and the remaining withdrew from treatment.
Conclusions: A once daily antituberculous drugs and methadone regimen under
DOT seems to improve compliance and subsequently morbidity and mortality in
HIV infected IVDUs.
Presenting author: Ana Horta, Rua Sol Poente, 656, Hab. S, 4450-794 Lega
da Palmeira - Portugal, Portugal, Tel.: [phone], Fax: [phone], Email: aghorta@ netcabo.pt

ThPeB7277 Tuberculosis remains a leading HIV related disease
M.M. Mulindwa, C.K. Kityo, D.M. Masira. Joint Clinical Research Centre,
Kampala, Uganda
Background: Joint Clinical Research Centre (JCRC) is a specialized Centre carrying out research in HIV and related diseases. 75% of patients report to JCRC