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

452 Abstracts ThPeC7459-ThPeC7461

XIV International AIDS Conference

Abstract ThPeC7458 - Table
1987-90 1991-96 97-2000 2001
Incidence rate RR (87-90 vs 97-2000) Incidence rate RR (91-96 vs 97-2000) Incidence rate Incidence rate
Total VIH-r OD 37.18 3.88 (p<.001) 31.00 2.13 (p<.001) 11.34 3.27
Tuberculosis 10.41 4.22 (p<.001) 7.03 2.85 (p<.001) 2.47.88
PCP 6.18 3.50 (p<.001) 5.20 2.94 (p<.001) 1.77.69
CNS toxoplasmosis 2.77 5.05 (p<.001) 1.88 3.44 (p<.001).55.05
LEMP.49 1.19 (p n.s.).64 1.55 (p<.05).41.10
Kaposi 1.30 4.35 (p<.001).82 2.74 (p<.001).30.05
non-Hodgkin L.57 1.24 (p n.s.).53 1.14 (p n.s).46.09
HIV encephalopathy 1.06 3.14 (p.01) 1.41 4.18 (p<.001).34.14

Methods: COMESEM cohort is a mixed cohort study, poblational based, that
registries retrospectively till 1999 and prospectively thereafter all HIV-infected patients attended in 5 district hospitals, that attends 1300000 habitants from southeast metropolitan Madrid. All first episodes of HIV-related opportunistic diseases
were registered (CDC93 class C diseases plus Hodgkin's disease and visceral
leishmaniasis). Crude yearly incidence rates (n / 100 patients - years) were calculated, and compared for the periods 1986-90 and 1991-95 in respect to 1996 -2000, estimating the corresponding risk ratios and P values.
Results: In 15/08/2001, when data were recollected 5531, patients were included
in he cohort, with 17428 patient-years of follow up. Incidence of main HIV opportunistic diseases, expressed as period incidence rate and changes observed
between periods 1987-90 and 1991-96 in comparison to 1976-2001, with its corresponding risk ratios and P values (exact method), are shown in the table below.
Conclusions: Incidence of HIV-related opportunistic diseases maintained high,
relatively stable, values between 1987 and 1996, diminishing clearly thereafter,
with the remarkable exception of non Hodgkin lymphomas
Presenting author: Gabriel Gaspar, c/ Cerro Perdigones 3, p-3, bajo, Pozuelo de
Alarcon, 28224- Madrid, Spain, Tel.: [phone], E-mail: [email protected]
ThPeC7459 Influence of highly active anti-retroviral therapy on
the natural history of extrapulmonary tuberculosis
in HIV-patients
P. Garcia de Olalla1, M.A. Martinez-Gonzalez2, J.A. Cayla3, J.M. Jansa3,
R. Guerrero4, J.M. Gatell, I. Ocafa6. 1Servei depidemiologia, Institut Municipal
de Salut Publica de Barcelona, Servei d'Epidemilogia, Institut Municipal de Salut
Publica de Barcelona, Plaga Lessps, 1, 08023 Barcelona, Spain; 2Department of
Epidemiology, University of Navarra, Pamplona, Spain; 3Department of
Epidemiology, Institut Municipal de Salut Publica de Barcelona, Barcelona,
Spain; 4Department of Justice, Barcelona, Spain; 5Department of Infectious
Diseases. Hospital Clinic, Barcelona, Spain; 6Department of Infectious Disease.
Hospital de la Vail dHebr6, Barcelona, Spain
Objective: To determine factors related to survival in AIDS patients with Extrapulmonary Tuberculosis (ETB), when this condition was the first AIDS-defining
disease.
Design: Retrospective cohort-study of 549 AIDS patients with ETB as the first
AIDS-defining disease. Potential candidates to predict survival were gender, HIVexposure, the coexistence of pulmonary and ETB at the diagnosis, tuberculin
skin test, directly observed therapy for tuberculosis (DOT), and highly active antiretroviral therapy (HAART). Kaplan-Meier method and Cox regression models
were used to asses factors associated with survival.
Results: The estimated 3-year survival was 47.0% for those diagnosed before
1993, 72.6% for patients with first AIDS diagnosis during 1995-1996 and 84.6%
for those diagnosed after 1996. A negative tuberculin test (hazard ratio [HR] =1.6,
95% CI: 1.1-2.3), not being under DOT (HR= 2.2; 1.3-3.7) and having also pulmonary tuberculosis involvement (HR= 1.3; 1.1-1.7) were independently associated with poorer survival. The survival of patients significantly improved after the
introduction of HAART (HR = 0.4; 0.2-0.6).
Conclusion: Survival of HIV patients with ETB as their first AIDS-defining disease has substantially improved during the last decade. A negative tuberculin
skin test and not receiving DOT are associated with poorer survival. The introduction of HAART improved considerably the survival of these patients.
Presenting author: Patricia Garcia de Olalla, Servel d'Epidemilogia, Institut Municipal de Salut Publica de Barcelona, Plaqa Lessps,1, 08023 Barcelona, Spain,
Tel.: [phone], Fax: [phone], E-mail: [email protected]

ThPeC7460

Failure to demonstrate protection from
pneumococcal disease with
trimethoprim-sulfamethoxazole (TMP-SMZ)
prophylaxis among AIDS patients with very low
CD4+ counts

A.J. Smith1, J. Williamson', M.I. Wolfe', D.L. Swerdlow', M. Dworkin2
1Centers for Disease Control and Prevention, Atlanta, GA, United States;
2Illinois Department of Public Health, Chicago, IL, United States
Background: TMP-SMZ is a broad-spectrum antibiotic used for PCP prophylaxis and other opportunistic infections (Ols) in HIV-infected individuals with CD4+
<200/VL. Few data exist on the efficacy of TMP-SMZ on other infections in persons with CD4+ <50/4IL.
Methods: We used data from 1/90 - 9/99 from the Adult and Adolescent Spectrum of HIV Disease project, an observational cohort study conducted in 11 US
cities. We assessed the risk for several Ols in persons with CD4+ <50/L. Multivariate analysis (GEE) was performed comparing time when TMP-SMZ prophylaxis was and was not prescribed, controlling for demographics, HIV transmission
mode, antiretroviral therapy, prescription of prophylaxis for Mycobacterium avium
complex, and pneumococcal vaccination status.
Results: There were 10,813 individuals with 9,768 person-years of follow-up
included. Median follow-up time was 6 months. TMP-SMZ prophylaxis was
protective for Salmonella infection (n=42; OR=0.43; 95% Cl 0.21, 0.89), any
Haemophilus (n=130; OR=0.46; CI 0.30, 0.68), invasive Haemophilus infection
(n=79; OR=0.53; CI 0.31, 0.92), toxoplasmosis (n=495; OR=0.71; Cl 0.57, 0.90),
Staphylococcus aureus infection (n=623; OR=0.60; CI 0.50, 0.73), and Pneumocystis carinil pneumonia (n=825; OR=0.58; Cl 0.49, 0.68). No protection
was demonstrated against infection with Streptococcus pneumoniae (n=131),
other streptococcal species (n=275), Shigella (n=19), Klebsiella (n=154), Pseudomonas (n=492), or Isospora (n=23).
Conclusion: This study suggests that TMP-SMZ prophylaxis decreases the risk
of several Ols for which AIDS patients with cell counts <50/IL are at high risk.
However, lack of protection against Streptococcus pneumoniae deserves additional study since AIDS patients are at 100-fold increased risk for pneumococcal pneumonia, and pneumococcal vaccine efficacy is diminished in the very immunocompromised.
Presenting author: Amanda Smith, 1600 Clifton Road, NE, M/S E-47, Atlanta,
GA, 30333, United States, Tel.: +[phone], Fax: +[phone], E-mail:
zbp9 @ cdc.gov
ThPeC7461I Stopping suppressive therapy for opportunistic
infections: a safe strategy
lu r i 1 d 2 a
E. Bottaro1, A. Urquizal, D. Caiafa1, P. Trinidad1, G. Lopardo2, I. Cassetti1.
IHelios Salud, Buenos Aires, Argentina; 2FUNCEI, Buenos Aires, Argentina
Background: Since the introduction of HAART, a decrease in the incidence of
opportunistic infections (OI) was noted. This situation prompted the evaluation of
stopping suppressive therapy (SST) for Ol in patients (pts) with increase of CD4
lymphocyte count (CD4C).
Methods: Review of medical records of HIV infected pts who stopped suppressive therapies.Thresholds used for indicating SST were 200 cells/mm3
for Pneumocystis carinii pneumonia(PCP),Mycobacterium avium complex bacteremia(MAC),Toxoplasmic encefalitis(TOX),Criptococosis(CRI) and disseminated Histoplasmosis(HIS); and 150 cells/mm3 for Cytomegalovirus retinitis(CMVR), sustained for 3 to 6 months. Length of HAART at the time of SST,
CD4C nadir and CD4C at the moment of SST and pts outcome were assessed.
Results: The results are shown in table 1 below.
Conclusions: SST in pts who achieve a significant increase in CD4C is a safe
strategy, specally for PCP and CMVR. No relapses were observed.

Abstract ThPeC7461 - Table 1
PCP MAC CRI TOX HIS CMVR
n 84 4 4 1 6 15
CD4C nadir(1) Mean (range) 71 (0-36) 19(0-58) 73 (0-283) 39 36 (2-140) 72(0-121)
CD4C SST(1) Mean (range) 403 (193-854) 356 (274-444) 518 (405-631) 630 475 (254-657) 403 (140-854)
Length of HAART at SST(2) Mean (range) 28 (3-67) 31 (20-38) 37 (28-45) 15 31 (7-55) 24 (10-40)
Follow up after SST(2) Mean (range) 17.3 (1-50) 16 (55-32) 17.7 (8-24) 9 12 (8-25) 18 (2-50)
VL at SSt (n) >50 copies 33 pts 0 pts ND 1pts 0 pts 2 pts
VL at SST(n) <50 copies 51 pts 4 pts 2 pts 0 pts 6 pts 11pts
1. cells/mm3; 2. months; ND: no data