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

426 Abstracts ThPeB7369-ThPeB7372

XIV International AIDS Conference

ations in humoral immunity with a higher incidence of invasive diseases with encapsulated micro-organisms, mainly S. pneumoniae. We assessed the frequency,
clinical presentation, microbiology, and survival rate of bacterial meningitis in HIV
infected patients (pts) compared to HIV negative controls.
Patients and methods: Medical records of patients hospitalized in the internal medicine ward of the Fondation Jeanne Ebory were retrospectively reviewed.
Patients were eligible to enter the study if an HIV serology was performed. Meningitis was diagnosed by chemistry, cytology and microbiologic analysis of the CSF.
Diagnosis of tuberculous (TB) meningitis was assumed in case of lymphocytic
meningitis without other identifiable pathogen.
Results: From january 94 until december 2000, 1202 pts (500 HIV - pts (42%)
and 702 HIV + pts (58%) were eligible for the study. Bacterial meningitis was diagnosed in 261 pts (22%): 99 HIV - pts (male 69%, mean age: 37 years), and 162
HIV + pts (male 53%, mean age 37 years). Etiologic agent was: S.pneumoniae
70% /70%, N. meningitidis 30% /12%, gram - bacilli: 0%/16%, TB meningitis:
0%/36% in HIV - and HIV + pts, respectively. Most (72%) of the TB meningitis
patients had a CD4 count < 50 cells/microL. Clinical symptoms were generally
milder in HIV+ compared to HIV -. Death rate were 36/99 (36%) and 27/104 (26%)
in HIV - and HIV+ pts, respectively, for common pathogens. Death rate was 30/58
(52%) in HIV+ pts with TB meningitis.
Conclusions: Bacterial meningitis is common in HIV infected patients with a high
incidence of S. pneumoniae. Prognosis is comparable to HIV - pts. Early antipneumococcal vaccination could be useful.Tuberculous meningitis was exclusively
seen in HIV + pts. Most of them had very low CD4 and a poor prognosis. TB
prophylaxis could lower this rate.
Presenting author: madeleine okome nkoumou, bp 212, libreville, Gabon, Tel.:
[phone], Fax: +724368, E-mail: [email protected]
ThPeB7369 In vitro downregulation of anti-myelin proteolytic
activity by indinavir
F. Mengoni, C. D'Agostino, I. Sauzullo, L. Scorzolini, P. Santopadre,
A.P. Massetti, C.M. Mastroianni, V. Vullo. La Sapienza University, Rome, Italy
Background: Recent studies have reported that HIV protease inhibitors have
several effects independent of the anti-HIV activity: reduction of apoptosis, antiproliferative effects, inhibition of proteolytic systems, as calpain and proteasome.
In this study we evaluated the effect of indinavir on the release of proteolytic activity by healthy PMA-activated PBMC and compared the results with those obtained
with specific inhibitors.
Methods: PBMC isolated from healthy donors were pre-incubated for 1 h with
indinavir (100 nM) and treated with PMA for 2 h. The supernatant culture was
collected and then incubated with myelin basic protein (MBP) for 18 h and analyzed by SDS-PAGE. The analysis was also done in the presence of the following
specific inhibitors: calpastatin, 1-10OP, pepstatin and PMSF
Results: The supernatant culture from activated PBMC, not pre-treated with indinavir, showed the presence of a proteolytic activity capable of inducing a fully
degradation of MBP. On the other hand, in the presence of indinavir, there was
a reduction of myelin degrading activity of 40-50%. The incubation of supernatants with the specific inhibitors inhibited the MBP degradation as follows: calpastatin=100%; 1-10P=72%; pepstatin=100%; PMSF=100%.
Conclusions: These data indicate that activated PBMCs release in the supernatant culture a proteolytic activity toward MBRP. Indinavir downregulates the antimyelin proteolytic activity of PBMC, confirming that HIV protease inhibitors have
several effects not related to their anti-HIV activity.
Presenting author: Vincenzo Vullo, Department of Infectious and Tropical Diseases, La Sapienza University, 00161 Rome, Italy, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeB7370 HAART exposure influences distribution and
characteristics of HIV-associated neurologic
disorders: data from Italian Registry Investigation
Neuro AIDS (IRINA)
A. Ammassari1, P. Cinque2, P Lorenzini3, A. Cingolani1, M.L. Giancola3,
S. Bossolasco2, A. Govoni3, M.G. Finazzi4, B. Del Grosso3, M. Bongiovanni5,
B. Vigo6, F Moretti7, M. Gentile3, L. Monno8, E.R. Dallenogare9, P. Corsi~,
G. Guaraldi"1, MlI. Arcidiacono'2, A. Mastroianni'3, P. Zannoni'4, A. Antinori3.
'Clinic Infectious Diseases, Catholic University, Roma, Italy; 2HSR "San Raffaele
Hospital", Milano, Italy; 3 NIID "L. Spallanzani", Roma, Italy; 4Dept. of Infectious
Diseases, Bergamo, Italy; 5Clinic Infectious Diseases, Milano, Italy; 6"Niguarda"
Hospital, Milano, Italy; 7Clinic Infectious Diseases, Brescia, Italy; 8Clinic
Infectious Diseases, Bari, Italy; 9Dept. of Infectious Diseases, Palermo, Italy;
'~Dept. of Infectious Diseases, Firenze, Italy; 1 Clinic Infectious Diseases,
Modena, Italy; 12Dept. of Infectious Diseases, Lodi, Italy; 13Dept. of Infectious
Diseases, Forli, Italy; 14Dept. of Infectious Diseases, Massa, Italy;
Background: HIV-related CNS diseases may be changed by HAART, though

this needs to be studied more in detail. Objective of the study was to evaluate
frequency, characteristics, and relationship with antiretrovirals of CNS diseases
in the HAART era.
Methods: Prospective study conducted in 65 Italian HIV/AIDS centers from
1.1.2000. Characteristics of CNS diagnoses, HIV and HAART histories are collected.
Results: At 31.12.2001, 580 pts enrolled: 51% HAART-experienced. Median

age 39 y; 73% males; 44% IDU, 11% MSM, 32% heterosex; 35% AIDS. Median CD4 and plasma VL were 58/I (IQR 21-146) and 4.89 log10 c/mi (3.82 -5.43). Main diagnoses: 31% TE, 18% HIVE, 15% PML, 11% crypto, 4% PCNSL, 3% TB, 2% CMV. In 10% an encephalopathy of unknown origin (EUO)
was observed. An opposite association was found between HAART exposure
and HIVE (OR 0.56;0.36-0.86) or EUO (4.31;2.18-8.54) as well as between
>3 BBB crossing drugs and HIVE (0.49;0.26-0.97) or EUO (2.09;1.12-3.91).
CD4>200+VL<500 significantly reduce probability of TE (0.45;0.29-0.69), HSV
(0.29;0.25-0.33) and crypto (0.28;0.13-0.64), but increase EUO (2.09;1.87-3.72).
Variables independently associated with TE were: heterosex (2.28;1.26-4.14),
CD4>200 (0.44;0.20-0.97), contrast enhancement (CE) (9.14;4.62-18.0), mass
effect (ME) (3.54;1.99-6.27); PML: focal lesion (3.41;1.97-5.87), ME (0.01;0.02 -0.10); PCNSL: ME (3.87;1.41-10.6); HIVE: AIDS (0.38;0.19-0.77), cognitive signs
(8.32;3.12-22.3), focal signs (0.26,0.14-0.49), atrophy (2.03-7.23), focal lesion
(0.23;0.12-0.54), CE (0.26;0.09-0.75); EUO: HAART exposure (5.00;2.07-12.00),
cognitive signs (0.27;0.09-0.72); white matter involvement (3.47;1.19-10.0).
Conclusions: Also in the HAART era CNS disorders determine a relevant morbidity. HAART-experienced pts, particularly those on drugs effective in the CNS
and with viroimmunologic response, develop less HIVE, but are at higher risk of
a leucoencephalopathy of unknown origin.
Presenting author: Andrea Antinori, INMI L. Spallanzani, via Portuense 292,
149, Roma, Italy, Tel.: [phone], Fax: [phone], E-mail: antinori
@inmi.it
ThPeB7371 HIV- related neurological disease in Brazil in the era
of highly active antiretroviral therapy
J.F. Oliveira', D.B. Greco2, G.C. Oliveira3, P.P. Christo', M.D.C. Guimarhes4,
W.R. Campos5, SR. Pinheiro2, R. Corra-Oliveira3, A.C.L. Cotta6. 'Hospital
Eduardo de Menezes, Rua Montevideu, 532-301, Sion, Belo Horizonte - Minas
Gerais, CEP- 30315-560, Brazil; 2School of Medicine-Federal University of
Minas Gerais, Belo Horizonte, Brazil; 30swaldo Cruz Foundation, Belo
Horizonte, Brazil; 4Shool of Medicine- Federal University of Minas Gerais, Belo
Horizonte, Brazil; 5School of Medicine- Federal University of Minas Gerais, Belo
Horizonte, Brazil; 6Shool of Medicine-Federal University of Minas Gerais, Belo
Horizonte, Brazil
Background: Neurological disorders are common in patients infected with HIV.
The incidence of most central nervous system (CNS) opportunistic infections
however has declined in the developed world with the widespread use of the
highly active anti-retroviral therapy (HAART). The objective of this study was to
determine the prevalence of neurological disease in HIV-infected patients and
the clinical and epidemiological factors associated with their occurrence in Belo
Horizonte, Brazil.
Methods: Between Feb 1999 and Mar 2000 a cross-sectional study was conducted in a infectious disease hospital in Belo Horizonte, Brazil. All of 417 HIVinfected inpatients were evaluated for neurological manifestations and previous
HIV-related neurological disease. Analysis of the transmission category, the immunological and virological status, the antiretroviral treatment and medical care
were performed.
Results: Neurological disease was detected in 194 (46.5%) patients. Symptomatic neurological dysfunction developed in 157 (80.9%) individuals and 37
(19,1%) remain stable and asymptomatic.Opportunistic infections were the most
common etiology of neurological complications (69.4%). Toxoplasmosis was the
most frequent (49.5%) disease followed by cryptococcosis (22.9%) and tuberculosis (14.7%). HIV-associated dementia was considered in 6.4% patients. Symptomatic neurological disease was more frequent in individuals who had not taken
anti-retrovirals (p<0.001), who had not taken HAART (p<0.001), and who were
not under medical care (p=0.005). Although there was no association between
neurological disease and HIV viral load (p=0.964) there was a significant association with low CD4+ count (p=0.044). There was no association with sexual
activity (p=0.435) or low educational level (p=0.198).
Conclusions: The high prevalence of neurological disease and CNS opportunistic infections in Brazilian HIV patients demonstrates that complications still occur,
even in HAART era.
Presenting author: Jacqueline Ferreira Oliveira, Rua Montevideu, 532 -301, Sion, Belo Horizonte - Minas Gerais, CEP- 30315-560, Brazil, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeB7372 Evaluation of 'School talk AIDS' programme in
Tamilnadu, South India
J.V. Jeyasinqh. Madras school of socialwork, 32, casa major road, Egmore,
Chennai, TamilNadu, India
Evaluation of 'School talk AIDS' programme in Tamilnadu, South India.
Student community is a high risk group for HIV/AIDS due to various reasons.
Madras school of socialwork implemented school talk AIDS programme in 200

schools in the state of Tamilnadu, with the prime objective to provide knowledge
on STD/HIV/AIDS. The programme was conducted in 20 districts in the state.
Both teachers and peer educators(students) were trained on HIV/AIDS. The peer
educators spread their acquired knowledge to the other students of the school.
Majority of the respondents of the evaluation were boys.(84.6%). 56.4% respondents had problems for implementing the HIV/AIDS awareness project. The problems are students non-acceptance, opposition from teachers, opposition from