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

XIV International AIDS Conference

Abstracts ThPeB7294-ThPeB7297 409

ThPeB7294 A prospective multicenter randomized double-blind
placebo controlled trial of primary cryptococcal
meningitis prophylaxis in Thailand with a survival
benefit
P Chetchotisakd1, S. Sungkanuparph2, B. Thinkhamrop3, P. Mootsikapun1
P. Boonyaprawit 1.' Faculty of Medicine, Khon Kaen University, department of
medicine, faculty of medicine, khon kaen university khon kaen, Thailand;
2 Ramathibodi Hospital, Mahidol University Bangkok, Thailand; 3Faculty of
Public Health, Khon Kaen University, Khon Kaen, Thailand
Background: Primary prophylaxis for cryptococcal meningitis (CM) in HIV infected patients is not routinely recommended due to lacking of evidence of survival benefit. Thailand has a high prevalence of CM, primary prophylaxis in these
patients might be beneficial.
Methods: A prospective multicenter randomized double-blind placebo controlled
study was conducted in HIV infected patients with CD4 < 100 cells/mL and negative serum cryptococcal Ag. They were randomized to receive either 400mg fluconazole once weekly or placebo.
Results: Of 90 patients enrolled, 44 received fluconazole and 46 received
placebo. The baseline characteristics were similar in both groups including median CD4 counts (29 vs. 31). Duration of follow-up were 152.5 and 136.5 days
respectively On an intent-to-treat basis, a deep fungal infection developed in
5(11.4%) of the fluconazole group and in 9(19.6%) of the placebo group (rate difference was 8.2%; 95%CI: -6.6% to 23.0%). Of the 14 invasive fungal infections,
10 were CM, 3(6.8%) in the fluconazole group and 7(15.2%) in the placebo group.
Placebo group was more likely to get CM than the fluconazole group (hazard ratio
= 2.69; 95% Cl: 0.53 to 13.75, p=0.23). The survival benefit of fluconazole was
greater than that of the placebo group, 2 (4.6%) versus 9 (19.6%) in fluconazole
and placebo recipients died, respectively The rate difference was 10%; 95% Cl
2.0 to 28.0, p=0.03. However, base on survival method of analysis, the hazard
ratio was 0.24; 95% CI 0.05 to 1.09, p=0.065.
Conclusion: Fluconazole 400mg once weekly for primary prophylaxis for CM in
Thailand should be considered in HIV infected patients since our study showed
a tendency in survival benefit. However, a larger study should be conducted to
confirm our findings.
Presenting author: ploenchan chetchotisakd, department of medicine, faculty
of medicine, khon kaen university, khon kaen, Thailand, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeB7295 Analysis of oral colonisation with Candida albicans
in HIV-1 infected patients and correlation to the
Candida Albicans specific T-cell response
M. Biuerlel, B. Taylor 2, K. Schr6ppel 2, S. Bergmann1, J.R. Kalden1,
M. R611linghoff2, T. Harrer'. 1Department of Medicine //Ill, University of Erlangen,
Department of Medicine Ill, University of Erlangen, Krankenhausstrasse 12,
91054 Erlangen, Germany; 2Institute of Clinical Microbiology, University of
Erlangen, 91054 Erlangen, Germany
Background: To study whether oral C.albicans infections in HIV-infected patients
are caused by a depletion of Candida specific T-cells, we analysed oral colonisation with C. albicans in correlation to the Candida specific cellular immunity
measured by ELISPOT, Candida specific proliferation assays and skin tests.
Methods: In 52 HIV-1-infected patients, 25 on HAART and 17 treatment naive, we
analyzed the C. albicans specific T-cell response by performing a y-IFN specific
ELISPOT (n=52) assay and a proliferation assay using as antigens three different C. albicans strains and as a control tetanus toxoid. In addition, patients were
tested with an intradermal skin test (n=46). A standardized mouth wash was used
for cultivating C. albicans (n=46).
Results: C. albicans specific y-IFN secreting T-cells could be detected by
ELISPOT in 16/52 patients (31%) and in 17/28 controls (51%). 6 patients responded only to one of the three C. albicans strains, 8 to two C. albicans strains
and only two to all three C. albicans strains. Median CD4 counts were 474/p
(range 71-985) in patients with a positive C. albicans ELISPOT and 342/11 (12 -1043) in patients with a negative C. albicans ELISPOT. C. albicans could be isolated from 16/46 patients (35%). C. albicans specific T-cells could be isolated from
10/30 patients (33.3%) with a negative C.albicans culture and from 4/16 patients
(25%) with a positive culture. C. albicans could be isolated from 28% of ELISPOT
+ patients and from 38% of ELISPOT negative patients.
Conclusion: C. albicans specific T-cells were detected less frequently in HIV infected patients in comparison to healthy controls. However, oral colonisation by
C. albicans correlated only to CD4 counts but not to the frequency of C.albicans
specific T-cells in PBMC. This is suggesting that the HIV-1-associated disturbance
of mucosal immunity is the major factor for the oral colonisation by C. albicans.
Presenting author: Michael B~uerle, Department of Medicine III, University of
Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany, Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeB7296 Dramatic decrease in cryptococcal
meningitis-related death in a MSF program in
Cambodia
D. Laureillard', D. Sreng2, D. Piketty3, D. Monchy4, J.M. Tassi65. 'Medecins
sans Frontieres, Phnom Penh; 2Infectious Disease Department/PBNS Hospital,
Phnom Penh; 3European Georges Pompidou Hospital, Paris; 4Pasteur Institute,
Phnom Penh; 5Epicentre, Paris
Background: Since 1997, Medecins sans frontieres (MSF) is supporting the infectious disease department of Preah Bath Norodom Sihanouk hospital in Phnom Penh, to improve the quality of care for HIV/AIDS patients. We assessed the
impact of the program on the evolution of cryptococcal neuro-meningitis (CNM)related death.
Methods: A prospective analysis of cryptococcal meningitis-related death between July 1999 and 2001 was performed. We analysed the first hospitalization
of patients diagnosed with CNM (based on cerebro-spinal fluid direct examination). We compared the case fatality rate (CFR) during these 3 years, marked by
an improvement in treatment: 1999 (amphotericin B only), 2000 (fluconazole in relay) and 2001 (regular CSF discharges in patient with intracranial hypertension).
Year of diagnosis, sex, CD4 cell count, and time of diagnosis during follow-up
were tested as prognosis marker using logistic regression.
Results: The number of admissions in the in-patients unit during these 3 periods
was 414, 766, 854 (total 2034) and the number of CNM cases was 72, 140, 180
respectively, 392 cases in total for 349 patients. Among 163 patients with CNM
and a CD4-cell count result, 87.7% had less than 50 cells/mm3. The proportion
of patients diagnosed with CNM during medical follow-up increased from 2.9% in
1999 to 25.3% in 2001. The proportion of admissions due to CNM did not change
(19.3%) but the duration of stay increased over time (19 days in median). 133
patients died during the period representing 23.9% of deaths in hospitalization.
The CFR declined from 54.3% in 1999 to 41.9% in 2000 and 27.3% in 2001
(p<0.0001). Year of diagnosis and CD4-cell count were significantly associated
with the risk of death but nor sex nor time of diagnosis.
Conclusion: Cryptococcal meningitis is very frequent in Cambodia. The results
suggested that an adequate medical care including regular CSF discharge contributes to a dramatic decrease in the CFR at time of diagnosis.
Presenting author: Didier Laureillard, Medecins sans Frontieres, Number 5
Street 156, bp 845, Phnom pPnh, Cambodia, Tel.: [phone], Fax: +855
23 880 380, E-mail: [email protected]
ThPeB7297 Lack of effect of HAART on the prevalence of
cryptococcosis among European AIDS cases
E. Boumis, D. Serraino, N. Petrosillo, G. Ippolito. Nat/ Inst for Infectious
Diseases, L. Spallanzani, Rome, Italy
Objectives: To assess the association between cryptococcosis (CR) as an AIDSdefining illness in the European population and the following data: age, sex, country of residence, risk factors for HIV infection and year of AIDS diagnosis, in order
to better characterize the epidemiological characteristics of this clinical condition
and to evaluate the impact of HAART on the prevalence of CR.
Methods: Data on all cases of AIDS diagnosed in 36 European countries between 1978 and 1999 were analysed using the June 2000 update of the European
Non Aggregate AIDS Data Set (ENAADS) prepared by the European Centre for
the Epidemiological Monitoring of AIDS, Paris, France. Odds ratios (OR) and 95%
confidence intervals (CI) were computed to assess the association between CR
and age, sex, country of residence, risk factors for HIV infection and year of AIDS
diagnosis, using a multiple logistic regression analysis.
Results: 235,698 AIDS cases were diagnosed in Europe between 1978 and
1999. CR was the AIDS-defining condition in 5,712 cases (2.4%). CR was more
frequently diagnosed in males (2.5%) than in females (1.9%) and in patients who
acquired the infection via heterosexual contacts (3.5%) as compared to men who
have sex with men (2.0%) (OR=1.9; 95% CI 1.77-2.09) A sharp variation in the
frequency of CR was noted among different geographical areas. CR was more
frequent in Southern (2.9%) than in Northern (1.7%) Europe (OR=1.7; 95% Cl
1.6-1.9), while in Eastern Europe CR was diagnosed only in 0.9% of cases. Finally, no differences in the prevalence of CR were noted in the years after the
introduction of HAART.
Conclusions: The frequency of CR as an AIDS-defining condition is associated
with geographic factors and individual risk factors. In Europe, the introduction of
HAART since 1996 has not modified the prevalence of this condition as compared
to that of other opportunistic infections.
Presenting author: Evangelo Boumis, via Portuense 292 00149 Rome, Italy,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB7298 Hyposalivation, xerostomia and oral candidiasis in
HIV and HIV-free subjects with a well-controlled

consumption of medication
W. Nittayanantal, B. Nauntofte2, K. Stoltze2, N. Chanowanna3, S. Jealae1,
E. Dabelsteen2. 'Faculty of Medicine, Prince of Songkla University Department
of Stomatology Faculty of Dentistry, Songkhla, Thailand; 2School of Dentistry,
University of Copenhagen, Copenhagen, Denmark; 3Faculty of Dentistry, Prince
of Songkla University Haadyai, Songkhla, Thailand
Background: The objectives of this study were (1) to assess the prevalence of