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

XIV International AIDS Conference

Abstracts ThPeB7286-ThPeB7289 407

respiratory viral or Mycobacterium sp. isolate. There was a trend toward increased
mortality amongst children with PCP who had concurrent bacteremia (50% vs.
19%). Children with PCP were younger than those with bacteremic pneumonia
and had lower CRP levels. Clinical signs and symptoms were unremarkable in
distinguishing between pneumonia of differing etiologies. P carinii was also isolated in 11 (36%) of 31 episodes of pneumonia amongst 29 HIV uninfected children, 62% of who were evaluated as being HIV exposed but -uninfected. Survival
amongst the HIV uninfected children with P carini isolates was 100% despite only
46% being treated for PCP.
Conclusion: Empirical antibiotic regimens for the treatment of pneumonia in areas with a high prevalence of pediatric HIV infection need to be reviewed in view
of the high incidence of PCP.
Presenting author: Shabir Madhi, PO Box 1728, Lenasia, Johannesburg, 1820,
South Africa, Tel.: [phone], Fax: [phone], E-mail: shabirm@mail.
saimr.wits.ac.za
ThPeB7286 Pneumocystis carinii pneumonia after
discontinuation of secondary prophylaxis
O. Degen1, J. van Lunzen2, M.A. Horstkotte3, I. Sobottka4, H.J. Stellbrink1.
I University Hospital Hamburg Eppendorf, Medical department, University
Hospital Eppendorf, Medizinische Klinik, Martinistr. 52, 20246 Hamburg,
Germany, Germany; 2University Hospital Eppendorf, Medical department,
Hamburg, Germany; 3University Hospital Eppendorf, Institute for Microbiology,
Hamburg, Germany; University Hospital Hamburg Eppendorf, Institute for
Microbiology, Hamburg, Germany
Background: Before the advent of HAART, pneumocystis carinii pneumonia
(PCP) was one of the most common severe opportunistic infections (OI). With
the reduction in its occurrence due to the widespread use of HAART it appears
possible now to interrupt secondary PCP prophylaxis. Accordingly, three prospective studies in more than 500 patients failed to demonstrate any case of recurrent
PCRP.
Methods: Case report
Results: We report a 34 y o male patient, who was diagnosed HIV-positive in
1993. August 1995 PCP was diagnosed and confirmed by indirect immunfluorescence from bronchio-alveolar lavage at a CD4 cell count of 30/ i1. After successful
treatment with TMP/SMZ secondary prophylaxis was initiated at a dose of 160/
800 mg TMP/SMZ QD. The patient subsequently received different triple class
therapies, his last treatment regimen consisting of zidovudine, lamivudine, abacavir, amprenavir, ritonavir, and delavirdine. CD4 cells increased to >200 cells/RlI
in 1998, >300 cells/Rl in 2000 and >400 cells/Rl in July 2001. Viral load was
suppressed to <400 RNA copies/ ml (LLOD) in 1997 and <50 copies/ml (LLOD)
since 1998.
In July 2001 at a CD4+ cell count of 409 /[d secondary prophylaxis against PCP
was discontinued. 9 weeks after he was admitted to hospital with fever, dry cough,
dyspnoea during exercise, and weakness. PCP was diagnosed by chest x-ray
and indirect immunefluorescence from bronchio-alveolar lavage. Response to
TMP/SMZ therapy was prompt and sustained, and the patient was discharged
after 12 days in a good physical condition.
Conclusions: This case of PCP relapse after discontinuation of secondary prophylaxis in the setting of excellent reconstitution of CD4+ T cell numbers suggests
that immune recovery may be functionally incomplete following profound CD4+ T
cell depression before HAART. Patients should be monitored closely after discontinuation of secondary prophylaxis.
Presenting author: Olaf Degen, University Hospital Eppendorf, Medizinische
Klinik, Martinistr. 52, 20246 Hamburg, Germany, Germany, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7287 Discontinuation of maintenance therapy for
cryptococcal meningitis in patients treated with
HAART: a multicentre observational study
C. Mussini1, P. Pezzotti2, E. Martinez3, J.M. Miro Meda3, J. Aberg4, R Bossi5,
P. Cahn6, V. Borghi1, P Cinque7, A. Bedini1, R. Manfredi8, A. Lazzarin7, A. De
Luca9, A. d'Arminio1o, A. Cossarizza11, R. Esposito1. 1Clinic Infectious
Diseases, Modena, Italy; 2/stituto Superiore di Sanita, Rome, Italy; 3Infectious
Diseases Unit, Barcelona, Spain; 4Aids Clinical Trials Unit, Washington, Italy;
5Hopital Pitie-Salpetriere, Paris, France; 6Fundacion Huesped, Buenos Aires,
Argentina; 7San Raffaele Hospital, Milan, Italy; 8Clinic Infectious Diseases,
Bologna, Italy; 9Clinic Infectious Diseases, Rome, Italy; 1~Clinic Infectious
Diseases, Milan, Italy; Dept of Biomedical Sciences, Modena, Italy
Background: HAART has decreased the incidence of new episodes and recurrences of opportunistic infections in patients with AIDS. At this time, only anecdotal data are available concerning discontinuation of maintenance therapy for
cryptococcal meningitis.
Methods: The main inclusion criteria were a previous definitive diagnosis of cryp
tococcal meningitis, an increase in CD4 count to more than 100 cells/RiL, as a
result of HAART, for at least three months and the subsequent discontinuation
of maintenance therapy for cryptococcal meningitis. The primary end-points were
the development of a new meningeal or extra-meningeal cryptococcal localization.
Results: As of January 2002, 58 patients were enrolled (50 males), with a median
age of 35.0 years. Patients were on maintenance therapy for a median of 29.8

months (range 2.0-62.4). Before discontinuation, CD4 count had been more than
100 cells/RL for a median of 17 months. At discontinuation, the median CD4 count
was 244 cells/RL while the median plasma viral load was <2.3 log10 copies/mi
and the serum cryptococcal antigen was undetectable in 43/51 patients (84.3%).
During a median follow-up of 21.2 months (3.1-56.5) (121 person-years) (PY) 3
events were observed (incidence rate= 2.48 per 100 PY; 95%CI 0.51-7.24).
Conclusions: This study confirmed that the risk of developing a new episode
of cryptococcal infection is low in patients who discontinue maintenance therapy
for cryptococcal meningitis when CD4 increases to more than 100 cells/LL after
HAART.
Presenting author: cristina mussini, clinic of infectious diseases, policlinico,
via del pozzo 71, 41100 Modena, Italy, Tel.: [phone], Fax: +39 059
4222604, E-mail: [email protected]
ThPeB7288 Salivary pH determination and culture in patients
with oral candidosis with and without HIV/AIDS
L.O. Sanchez-V1, F.J. Franco-Ml, P. Perez-R2, F.P. Corona-I1, J. Romo-G3.
' Microbiology Department, Laboratory of Experimental Pathology of Postrgrade
and Research Studies, School of Dentistry UNAM, Division de Estudios de
Posgrado e Investigacion, Facultad de Odontologia, Universidad Nacional
Autonoma de Mexico, Circuito Institutos Ciudad Universitaria, CP 04510 Distrito
Federal, Mexico; 2Stomatology Department, General Hospital Mexico, Distrito
Federal, Mexico; 31nfectology Unit, General Hospital, Mexico, Distrito Federal,
Mexico
Background. The aim of the present study was to determine the salivary pH in
patients with oral candidosis with and without HIV/AIDS and in a control group,
assesing if its variations are related to the disease development, type of candidosis, Candida species, and other present diseases.
Methods. The sample comprised 120 patients from Infectology Unit of General
Hospital and from the School of Dentistry: 40 with oral candidiasis with HIV-AIDS,
40 with oral candidiasis without VIH-AIDS, and 40 in control group. A 2ml sample of non estimulated saliva were obtained from each patient. We performed
immediate measurement of pH and then inoculated in dextrose Sabouraud agar.
Determination of Candida species was performed by API 20 C AUX~ (BioMeriux
France) system. Descriptive statistics and ANOVA were calculated.
Results. In the group with HIV-AIDS the mean pH was 6.17, with prevalence of
C. albicans type I (87.5%) and pseudomembranous candidosis in 85% primarily
affecting the tongue in 75%. In the group without HIV-AIDS the 90% were denture users, the mean pH was 6.29, with prevalence of C. albicans type I (42.5%)
and eritematous candidiasis in 75% primarily affecting the palate in 70%. Control
group showed a mean pH of 6.78. A statistically significant difference among pH
values was found (ANOVA p<0.01).
Conclusions. The present study revealed that Candida developement is favored
by acidic pH values, we observed more acidity in saliva of patients with HIV-AIDS,
followed by HIV-negative.
We conclude that salivary pH with acidic values significantly favors Candida
growth, specially C. albicans and C. glabrata species and primarily the pseudomembranous and eritematous clinic types.
Presenting author: Octavio Sanchez, Division de Estudios de Posgrado e Investigacion, Facultad de Odontologia, Universidad Nacional Autonoma de Mexico,
Circuito Institutos Ciudad Universitaria, CPR 04510 Distrito Federal, Mexico, Tel.:
+(55) 56225560, Fax: +(55) 55503497, E-mail: [email protected]
I ThPeB7289 Amphotericin B lipid emulsions: a promising
alternative formulation to the conventional dosage
form
N. Pongcharoenkiat, PR Wirachwong, V. Burananon, K. Kraisintu. R&D Institute,
Government Pharmaceutical Organization, R&D Institute, Government
Pharmaceutical Organization, 75/1 Rama 6 Rd, Ratchathevi, Bkk 10400,
Thailand
Background: Amphotericin B (AmB) is the drug of choice for treatment of aggressive fungal infections in AIDS victims though its severe toxicity to human still
remains. Interests in developing the AmB lipid based formulations have arisen due
to a number of studies indicating that AmB may be delivered to the target sites
more selectively, thereby markedly reduced drug toxicity. The aim of this study
was to develop the lipid-based formulation containing AmB in which the similar
pattern of antifungal activity to conventional dosage form was retained while the
toxicity was greatly reduced.
Methods: AmB lipid emulsions was prepared and its physicochemical properties
were determined. In-vitro antifungal activity of AmB in Fungizone~ and in lipid
emulsions was performed according to the tube dilution method. Further, cytotoxicity of AmB was studied on LLC-PK1 kidney cell lines in the MTT assay. Toxicity
on human erythrocytes was also conducted to study haemolysis induced by AmB
in lipid emulsions compared to that in Fungizone~.

Results: Haemolytic activity of AmB in emulsions was markedly decreased,
which was three-fold at 75 Rg/ml compared with that of Fungizone~ at the same
concentration. Cytotoxicity of the AmB in Fungizone~ on LLC-PK1 was found to
be dose-dependent with 20 % cell survival at 100 Rg/ml. No toxicity of the drug in
the emulsions on cell growth was detected at any studied concentrations ranging
from 20-100g/ml. No significant differences in antifungal activity of AmB were
displayed in both dosage forms.