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

406 Abstracts ThPeB7282-ThPeB7285

XIV International AIDS Conference

Conclusions: Antiretroviral therapy including NRTIs, NNRTIs or Pis can be safely
and effectively initiated during the standard treatment of tuberculosis in selected
populations followed at reference centers. Prospective studies are needed to evaluate individualized treatment strategies for the simultaneous treatment of HIV and
TB disease in other settings.
Presenting author: Pedro Cahn, Angel Peluffo 3932, C1202ABB, Buenos Aires,
Argentina, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7282 Cardiovascular events in the MACS cohort and
prior prophylaxis with macrolides for
mycobacterium avium complex
I.J. Woolley1, S.PR Johnsen2, H.T. Sorensen 2, L. Jacobson3, X. Li3,
L. Ostergaard4. 1Alfred Hospital/ Monash University Medical School, Infectious
Diseases Unit, Alfred Hospital, Commercial Road, Prahran 3181 Victoria,
Australia; 2Department of Clinical Epidemiology, University of Aarhus, Aarhus,
Denmark; 3School of Public Health, Johns Hopkins University, Baltimore, United
States; 4Dept. of Infectious Diseases, Aarhus University Hospital, Aarhus,
Denmark
Background: There has been increasing concern that there is an increased risk
of cardiovascular events since the HAART era. There is also some association of
Chlamydia pneumoniae with vascular disease. We aimed to see whether prophylaxis with macrolides with activity against C pneumoniae decreased the rates of
cardiac events.
Method: Case control study using multicentre cohort matched for race, time of
study inclusion, last visit date, current smoking status and age. HIV positive at
baseline: additionally matched foor CD4 counts at baseline and at visit prior to
the date of cardiovascular disease diagnosis. Seroconversion during study period: additionally matched for duration of HIV infection and CD4 count at visit prior
to the date of cardiovascular disease. Cases identified by ICD-9 code or report
at semiannual visit. Cases and controls censored at visit prior to first identified
cardiovascular event.
Results: Thirty-one probable vascular events identified from HIV positive individuals including 6 with ischaemic heart disease, 1 with heart failure, 15 with
cerebrovascular events, 6 with peripheral vascular events and 3 with unspecified
heart disease. Characteristics of cases and controls
Risk factor Case Control Odds ratio
(n=31) (n=89) (95% CI)
Age (years) 46.2+7.4 44.9~ -
Smoking (%)
Never 9.7 9.0 -
Former 48.4 46.1 -
Current 41.9 44.9 -
Race (%)
White, non-hispanic 96.8 98.9
Black, non-hispanic 3.2 1.1 -
Ever Use of ART (%) 87.1 70.8 2.91 (0.84-10.09)
Ever use of HAART (%) 22.6 13.5 1.8 (0.36-9.04)
Viral load < 500 copies/ml (%) 42.9 16.7 2.14 (0.35-13.03)
Ever mycobacterial infection (%) 9.7 0
Ever use of macrolide (%) 22.6 12.4 1.78 (0.55-5.76)
Ever use of antihypertensives (%) 22.6 6.7 3.28 (1.07-10.08)
Ever use of anticoagulants (%) 12.9 1.1 14.24 (1.58-128.76)
Ever use of cholesterol lowering drugs (%) 12.9 0
Ever use of heart medicine (%) 3.2 0
History of diabetes (%) 6.5 0
Matched for race, time of study inclusion, last visit date, current smoking status,
and age. HIV positive at baseline: Additionally matched for CD4 counts at baseline and at visit prior to the date of cardiovascular disease diagnosis. Seropositive
during study period: additionally matched for duration of HIV infection and CD4
count at visit prior to the date of cardiovascular disease diagnosis. No of cases
with measured viral load cases = 14, controls = 56. Adjusted odds ratios for ART
(antiretroviral therapy) = 4.09 (0.61-27.57) and for HAART = 2.02 (0.36 - 11.26)
Conclusion: the trend was against macrolide prophylaxis. Conventional risk factors still appear important in an HIV infected population.
Presenting author: Ian Woolley, Infectious Diseases Unit, Alfred Hospital,
Commercial Road, Prahran 3181 Victoria, Australia, Tel.: [phone], Fax:
[phone], E-mail: ianwoolley@ hotmail.com
ThPeB7283 Correlation between Mycobacterium avium
colonization, specific cellular immune response
and virulent factor in HIV-1 positive patients.
A.C.C. Santiaqo, V.M.O. Menezes, I. Neves-Jtnior, M.C. Louren~o, V.C. Rolla,

M.G. Bonecini-Almeida. Dswaldo Cruz Foundation / Evandro Chagas Hospital,
Av. Brasi4365, Manguinhos, Rio de Janeiro, CEP 21045-900, Brazil
Background: M. avium infection (MAC) is recognized as a common opportunist
disease in patients with advanced Aids. Mortality in these patients is quite high.
It is may be related to the virulence factors (VF) of different MAC clinical isolates
(MAC-CI) and functional defects in the immune cells. Our principal aim was to
evaluate the immune response and identify VF in MAC-CI isolated (feces and spu
tum) from the same Aids patients. As controls we included 5 Aids patients who
had previous pulmonary tuberculosis (Aids-TB) and MAC-CI from hemoculture.
Methods Blood samples and MAC-CI were collected from 6 Aids patients who
had previous MAC colonization. Immune response was determined by lymphoproliferative response and VF by the resistance of reactive nitrogen intermediates
(RNI), induction of apoptosis and release of cytokines in infected human monocytic lineage U937. Results 50% of patients responded to at least one MAC-CI,
directed related to the absolute number of CD4+T lymphocytes (303.0+3.6), on
the other hand none responded to their own isolated strain with CD4 was lower
than 100 cell/mm3, as well as Aids-TB patients responded to MAC-Cl. HIV virus
load was higher in Aids-TB group. Apoptosis was induced by all MAC-CI after 72
hours of infection, however, 4 of 6 (66%) MAC-CI showed 6 to 12% of reduction in
the number of viable bacilli when exposed to sodium nitrite. Intracellular cytokine
(IL-6, 8,10,12, TNF-o) production was seen in all MAC-CI. MAC-CI obtained from
feces and sputum possessed the tendency to induce greater production of all cytokines compared to MAC-Cl obtained from blood. Conclusion The incapacity of
recognizing the mycobacterial antigens isolated from the patient's strain is related
to the highest levels of virus load and at the lowest levels of CD4+T lymphocytes
observed in these patients. Apoptosis and cytokines induced by MAC-CI could be
related to the virulence since the degree of induction varied among Cl.
Presenting author: Ana Cristina Camara Santiago, Av. Brasil 4365, Manguinhos,
Rio de Janeiro, CEP 21045-900, Brazil, Tel.: [phone] ramal 131, Fax:
[phone], E-mail: [email protected]
ThPeB7284 Persistent occurrence of pneumocystis Carinii
Pneumonia despite availability and access to
HAART in an Inner city population in the U.S
C. Franco-Paredes, FQ. Rhein, M. Barragan, C. Abrams, C. del Rio. Emory
University School of Medicine, Emory University School of Medicine, 69 Butler
St. SE, Atlanta, GA 30303, United States
Background: The incidence of opportunistic infections (OI) has dramatically decreased in the HAART era, however 01 continue to occur despite availability of
HAART because of poor access to care, poor compliance, and undiagnosed
HIV-infection. Thus, Pneumocystis carinii pneumonia (PCP) may continue to be
a cause of significant morbidity and mortality among hard-to-reach HIV-infected
persons. Methods: We retrospectively reviewed patients diagnosed with PCP at
Grady Memorial Hospital, which serves a low-income inner city population in Atlanta, GA to compare the occurrence of PCP and its characteristics during two
periods: pre-HAART (1991-1995) and HAART (1996-2001).
Results: During the study period there were 612 confirmed cases of PCP among
534 patients, 239 pre-HAART and 295 HAART. We randomly analyzed 220 cases,
110 pre-HAART and 110 HAART. Mean age was 36 years (range =21-78), and
13% were women. More cases of PCP were diagnosed among women in the
HAART period (8 vs. 20 p = 0.015). Most patients were African
- American, however more Caucasians had PCP pre-HAART, (27 vs.15 p = 0.04).
Severe immunosuppresion was present at the time of PCP diagnosis (median
CD4+ count=13 cells/VL; 16 vs.11). PCP was the initial presentation of HIV infection in 30%, with no difference between both periods (43 vs. 37 p = 0.4), and
had an elevated mortality with 52% (42/80) dying. Among patients known to be
HIV+ prior to PCP, only 40% had been prescribed or were taking appropriate
prophylaxis with no difference between the two periods (40 vs. 48 p = 0.3).
Conclusions: Our study suggests that, despite guidelines for 01 prophylaxis and
HAART use in the US, PCP continues to occur among low-income inner city populations. The continued occurrence of PCP should be considered a failure of the
public health system and further efforts should be made to diagnose HIV infection prior to an 01, to improve access to care and to promote compliance with 01
prophylaxis and HAART in these populations.
Presenting author: Carlos Franco-Paredes, Emory University School of
Medicine, 69 Butler St. SE, Atlanta, GA 30303, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7285 Pneumocystis carinii pneumonia (PCP) among
human immunodeficiency virus type-1 (HIV)
exposed African children
S.A. Madhi K. Ismail, C. OReilly, C. Cutland, K.R Klugman. Pneumococcal
Diseases Research Unit, University of the Witwatersrand, PO Box 1728,
Lenasia, Johannesburg, 1820, South Africa
Background: Data regarding the burden of P carinii among African HIV infected
children with pneumonia is limited. This burden and the interaction of P carinii with
bacteria and respiratory viruses in African HIV infected children with pneumonia
was evaluated prospectively.
Methods: Children aged 6 weeks to 3.5 years with severe pneumonia were investigated for PCP by immunofluorescence tests on samples obtained by nasopharyngeal aspirate and induced sputum techniques. Blood cultures, immunofluores
cence for respiratory viruses and Mycobacterrium sp. culture were also done.
Results: P carinli was identified in 44% of 231 episodes of pneumonia occurring in 185 HIV infected children at a median age of 4.5 months. PCP was the
AIDS defining illness in 30% of the children. Thirty three percent of children were
receiving cotrimoxazole prophylaxis at the time of developing PCP. The mortality
amongst children with PCP was 20%. Concurrent P carinii was observed in 33%
(6/18), 42% (11/26) and 67% (4/6) of HIV infected children who had bacteremia,