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

414 Abstracts ThPeB7317-ThPeB7320

XIV International AIDS Conference

[C195% 1.34-2.92]. The presence of abnormalities was associated with a lower
mean count of CD4 cells (p<0,001) and they were more frequent when CD4 was
under 200/mm3; RR: 2.66 [CI95% 1.82-3.88]. Women with CD4 under 200/mm3
had a risk 10 times higher to have a Papanicolau worse than low grade SIL (RR:
9.38 [CI95% 2.97-29.59). The rate of abnormalities did not change over time.
Conclusions: A high prevalence of abnormalities in the Pap smear was observed
in HIV infected women and was associated with the severity of the disease. These
abnormalities were also highly prevalent in women using antiretroviral therapy.
HIV positive women must be treated by a specialized team including a gynecologist. Interventions to prevent the progression of the disease may have a benefit
effect in the development of cervical lesions.
Presenting author: regis kreitchmann, rua dos andradas 281 apto 601, porto
Alegre, rio grande do sul, 90020 -000, Brazil, Tel.: [phone], Fax: +55 51
33311765, E-mail: [email protected]
ThPeB7317 High Dose Therapy and Autologous Peripheral
Blood Stem Cell (PBSC) Transplantation in Pts.
with HIV-Associated Lymphoma Refractory to or
Relapsed after First-Line Chemotherapy
C.S. Casari S1, R.G. Rossi G2, R.A. Re Alessandro2, TU. Tirelli U3, M.F. Moretti
F4, Q.E. Quiros-Roldan E4, C.G.P. Cadeo GP4, C.G. Carosi G4, FR Ferremi p4,
L.A. Lanfranchi A4, T.L. Tomasoni L4, A.M. Airoldi M4, T.C. Torti C4,
RP.G. Paraninfo G4, C.A. Chiodera A4, M.P. Milini P4, C.G. Cristini G4. 1Institute
of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy;
2Department of Hematology Hospital of Brescia, Brescia, Italy; 3Department of
Oncology Hospital of Aviano, Aviano, Italy; 4Institute of Infectious and Tropical
Diseases, Brescia, Italy
Background: The recent introduction of HAART, by restoring the immune system, has allowed the evaluation of an new aggressive therapeutic approach in
HIV-associated lymphoma pts.
Methods: PBSC mobilization followed by high-dose chemotherapy and PBSC
transplantation, in pts with HIV associated lymphoma, refractory to or relapsed after first-line chemotherapy was valutated. Eligibility: sensitivity to one-two courses
of second-line standard-dose chemotherapy, preserved organ function, CD4+
>100 cells/mm3, absence of active opportunistic infections or cerebral lymphoma.
Results: 7 pts entered the study. Median age was 36, M/F ratio 5/2, median
CD4+ 162/mm3, detectable HIV-RNA in 2 pts. 4 pts had HD (3 relapses, 1
refractory) and 3 had NHL (relapses). First-line treatments were aggressive
combination chemotherapy After a median of 3 apheresis, an adequate number of CD34+ cells was collected in 5 pts, after mobilization with cyclophosphamide (71%). 1 pts. had progressive HD soon after CD34+ cells collection
and died before transplant. 4 pts. underwent intensive combination chemotheraphy and PBSC transplantation. Prompt hematologic recovery was observed in
all cases. Neutrophil>500/mm3 reached at day 9.5 and self-supporting platelet>
20.000/mm3 at day 16. Treatment toxicity included oral mucositis (3 pts), FUO (1
pt), facial cellulitis (1 pt) and 1 colitis by C. difficile. 3 pts transplanted are alive
without active disease at 10, 8 and 1 months respectively, whereas 1 died after 3
months. In 1 pts, HIV viral load remains undetectable after 7 months.
Conclusions: Mobilization and collection of CD34+ cells is possible in the majority of pts with HIV-related lymphoma. High-dose therapy with PBSC reinfusion
is feasible, with rapid hematologic recovery and non-prohibitive treatment-related
toxicity. Even if the evaluation of the impact on HIV infection needs more pts
and longer follow-up, it does not seem to be affected by the procedure in pts. on
HAART.
Presenting author: Francesca Moretti, Institute of Infectious and Tropical Diseases, University of Brescia, p.le spedali civili n 1, 25123, Brescia, Italy, Tel.: +39.
30.3995671, Fax: [phone], E-mail: [email protected]
ThPeB7318 HIV-related lymphoma: Rituximab concomitant to
second-line chemotherapy following tumor
progression under CHOP or early relapse
L.G. Goelkel1, R. Weiss2, P. Kreckel3. 'Auguste-Viktoria-Kinikum, AVK 12B,
Rubensstr. 125, 12157 Berlin, Germany; 2Med. II Klniken Offenbach
Tumorschwerpunkt, Offenbach, Germany; 3Auguste-Viktoria-Klinikum, II. Inn.,
Berlin, Germany
Background: HIV-positive people with high-grade lymphoma who do not respond
to chemotherapy or develop early progression after chemotherapy have a poor
prognosis.
Methods: In a side-protocol of the "German HIV-related Lymphoma Study", Rituximab (375 mg/m2 weekly, up to four times) was administered concomitant with
second or third-line therapy to determine its safety and effect on outcome. Inclusion criteria were positive histology for CD20, nonresponse to or early relapse after first-line (CHOP) or second-line (IMVP16 - Ifosfamide, Methothrexate, Etopo
side). Exclusion criteria was life expectancy less than four weeks.
Results: Twelve patients fullfilling the inclusion criteria were enrolled within two
years. Their median age was 49 years. Lymphomas were histologically classified
as high-grade, large-cell-lymphoma (n=7) Burkitt's lymphoma (n=4) and low grade
lymphoma (n=1). Median CD4-count was 70/pl with a median WHO performance
state of 2.
5 patients had PD (one of them died after only 6 days because of meningeosis

lymphomatosa not diagnosed on the day of inclusion); one patient had MR, one
patient PR. Five patients achieved CR and three are still alive 329, 370, and 713
days after inclusion. Nine patients finally died of PD, two of them with additional
terminal infection. Mild adverse effects associated with rituximab were observed
in one patient. Five episodes of bacterial infection and eight episodes of opportunistic infections occurred during the time of follow-up.l1
Conclusions: Rituximab administered concomitant with second-line chemotherapy is safe. We achieved complete remission in five of twelve persons, which is a
remarkable result in these severly compromised patients.
Presenting author: Lore Goelkel, AVK 12B, Rubensstr. 125, 12157 Berlin, Germany, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeB731 9 Effect of ritonavir-boosted protease inhibitor (PI)
regimens on lipid profiles
G.A. McComsey1, A. Chu2. iRainbow Babies and Children Hospital, Case
Western Reserve University, 11100 Euclid Avenue, Cleveland, Ohio 44106,
United States; 2Agouron Pharmaceuticals, San Diego, United States
Background: PIs may differ in their ability to cause dyslipidemias.
Objective: Assess the magnitude of change in lipids after ritonavir (RTV)-boosted
PI therapy
Methods: Retrospective review of HIV+ subjects on > 4 m of either nelfinavir (NFV) or RTV-boosted PI + NRTI(s) ~ NNRTI. RTV-boosted PI = either
lopinavir/RTV or 100 mg RTV + indinavir or amprenavir. Lipids levels were drawn
without regard to fasting.
Results: 74 and 67 were on NFV and boosted-PI respectively (62 on kaletra).
Both groups had 20% women. Median age was similar in both groups (40 and 38
y, respectively). NNRTI were received by 9% and 6% in the NFV and boosted-PI
groups, respectively. Median duration of prior ARV was 42 m (2-194) and 50 m
(4-150), respectively. Baseline cholesterol were >220 mg/dl in 14% and 10% of
subjects on NFV and boosted-PI, respectively. Baseline triglycerides were >160
mg/dl in 43 % and 59 % of subjects on NFV and boosted-PI, respectively. Only
one (on NFV) was receiving a lipid-lowering agent. In the NFV group, cholesterol increased from baseline by 11.5%~25% (p=0.05) at 3 m, and by 14%+22%
(p<0.001) at 6 m; triglyceride did not change significantly (+7% ~ 58% mg/dl
(p=0.94) at 3 m; +10%~73% (p=0.84) at 6 m). In the boosted-PI group, cholesterol increased by 15% ~ 31% mg/dl (p=0.003) at 3 m, and by 16%~32% mg/dl
(p< 0.001) at 6 m; triglycerides increased by 71%~159% (p=0.001) at 3 m, and
by 63%~148% (p=0.001) at 6 m.
After 3 and 6 m of therapy, changes in triglycerides were significantly higher in
the boosted-PI group, compared to changes in the NFV group (p=0.03 and 0.05
at 3 and 6 m, respectively). Changes in cholesterol between groups were not
significantly different.
Conclusion: RTV-boosted PI, not NFV, is associated with significant increase
in triglyceride levels. In the contrary, both PIs affected cholesterol levels. The
metabolic complications of each PI should be assessed separately
Presenting author: Grace McComsey, 11100 Euclid Avenue, Cleveland, Ohio
44106, United States, Tel.: [phone], Fax: [phone], E-mail: mccomsey.grace @ clevelandactu.org
ThPeB7320 No difference in association between individual
thymidine analogues and HIV-associated
lipodystrophy in an ambulatory population. The
LION-HAART-Cohort
E. Lauenroth-Mai, F. Schlote. Private Practice, Berlin, Germany
Background: To assess prevalence and risk factors for fat redistribution a crosssectional survey of 354 outpatients was performed in 2000. There was no difference in risk of either morphologic or metabolic disorders between thymidine
analogues d4T and ZDV.
Objective: A one year follow-up survey was carried out to further distinguish factors associated with prevalence and incidence of lipodystrophy (LD).
Methods: The extent of body changes was determined by clinical signs of fat
redistribution and self-report by patients. Demographic, immunologic, metabolic,
and drug treatment factors were assessed in logistic regression analysis.
Results: Data were available from 330 pts. Mean age 43yrs., average time on
ARVs 46 months. Among pts on HAART 31 %(82/262) took PIs, 52%(1 35/262)
NNRTIs; ZDV 107/262, d4T 142/262 pts. Overall prevalence of LD was 60,4%
with an incidence of 13,9%. No difference in metabolic parameters (lipids, glucose, lactate) and prevalence of any LD was seen between pts on ZDV or d4T:
68,2 vs 66,9%. Due to a higher percentage of PI-based HAART (d4T 28%,ZDV
11%) there were significantly more subjects with clinical signs of mixed LDtype in the d4T-group in comparison with pts on ZDV (43,7 vs 26,2%;p=0.0005),
whereas prevalence of lipoatrophy was markedly higher in the ZDV-group (35,5
vs 18,3%;p=0.005). During the follow-up period 6/56 pts (10,7%) on d4T vs 20/58
pts (34,5%) on ZDV, 9 of them on triple nuke HAART, developed signs of periph
era fat loss (p=0.005). Duration of ART, NRTI- (both d4T and ZDV) and PI-use
were strongly associated with LD (p=0.01); NNRTI decreased the likelihood of LD
(p=0.01). The non-drug factors age and advanced HIV disease increase substantially the risk of LD regardless of the duration of PI or NRTI use.
Conclusions: These results suggest an absence of differential risk for LD and
metabolic disorders between thymidine analogues and confirm our findings in
this cohort on baseline.