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

XIV International AIDS Conference

Abstracts ThPeC7462-ThPeC7466 453

Presenting author: Edgardo Bottaro, [email protected], Argentina,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7462 HLA class II alleles in patients with AIDS and
Toxoplasma gondii chorioretinitis
M.L.V. Rodrigues1, J.F.C. Figueiredo1, A.L.G. Demarco1, L.A. Demarco2,
N.H.S. Deghaide 3, L.C.B. Thomazini3, E.A. Donadi3. 1Faculty of Medicine of
Ribeirdo Preto - University of S&o Paulo, Ribeirbo Preto, Brazil; 2Ophthalmology
Clinic, Sdo Jose do Rio Preto, Brazil; 3Faculty of Medicine of Ribeiro Preto -
University of S~o Paulo, Ribeir~o Preto, Brazil
Background: It was reported that certain HLA genes might influence susceptibility or resistance to Toxoplasma gondii infection. The objective of this study was to
verify HLA class II alleles frequencies in Brazilian patients with AIDS and previous
evidence of Toxoplasma gondii infection, presenting or not chorioretinitis.
Methods: The study population was composed by 18 patients with AIDS and
Toxoplasma gondii chorioretinitis (TgCR), 38 patients with AIDS and neurotoxoplasmosis (NT), without TgCR, and 33 patients with AIDS and positive anti-T.
gondii circulating antibodies, without NT and TgCR (AbTg). The diagnosis of HIV
infection was made by an immunoenzymatic method (Abbott Recombinant HIV1/HIV-2 lEA) and confirmed by the gelatin particle agglutination tests (Serodia
~, Fujerebio Inc., Tokyo, Japan). The TgCR was diagnosed clinically using indirect binocular ophthalmoscopy. HLA class II alleles were identified by sequencespecific oligonucleotide primers hybridized to amplified DNA. Statistical analysis
was performed using the chi-square or Fisher exact test. For the significant associations it was calculated the odds ratio (OR), the attributable risk (AR) and the
Etiologic Fraction (EF).
Results: No significant differences were seen when the frequencies of HLA class
II alleles were compared between TgCR and AbTg groups. However, the HLADRB1*08 allele frequency was higher in the TgCR group than in the NT group
(p=0.003; OR=18,50; AR=94.59%; EF=31.32).
Conclusion: HLA-DRB1*08 allele might be associate with susceptibility to Toxoplasma gondii chorioretinitis, in Brazilian patients with AIDS and neurotoxoplasmosis.
Presenting author: Maria de lourdes Rodrigues, Tamoios, 262 - ap. 101, Sta.
Cruz J. Jacques, R14048-900, Ribeirio Preto, Brazil, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeC7463 Gastric opportunistic infections in HIV+ patients in
the era of HAART
A.L. Werneck-Silva, R.M. Leite. Casa da AIDS, Infectious Diseases Division,
School of Medicine, University of Sao Paulo, Rua Harmonia 662apt23, CEP
05435-000, Sao Paulo, Brazil
Background:Gastrointestinal symptoms such as abdominal pain, nausea and
vomiting often occur in HIV+ patients taking highly active antiretroviral therapy
(HAART). Although the risk of opportunistic infections among these patients has
declined, the gastrointestinal tract still remains a common site of infection. We
have studied the prevalence of gastric opportunistic infections in a large symptomatic group of HIV+ patients taking HAART and its correlation with dyspeptic
symptoms.
Methods: 767 (491 men and 276 women) HIV+ patients (37.46 + 8.75 years old)
with epigastric pain and/or nausea and vomiting underwent upper endoscopy.
Ninety nine percent were taking HAART. All of them had CD4 counts measured.
Gastric biopsies were randomly taken in corpus and antrum and also in any lesion
found and sent to histologic examination.
Results: The CD4 count was 332.46 ~ 213 cells/mm3 Opportunistic infections were found in 10 patients (1.30%). All of them had CD4 count under 275
cells/mm3. Cytomegalovirus (CMV) in 6 (60%), Schistosoma Mansoniin 1 (10%),
Cryptosporidium sp. in 1 (10%),Leishmania sp. in 1 (10%) and Mycobacterium
sp. in 1 (10%). The endoscopy showed no mucosal abnormality in Leismania
sp.. All CMV were associated with ulcerative lesions (mainly in corpus). Gastric
hiperemia (mainly in antrum) was found in Cryptosporidium sp. and Mycobacterium sp. infection.
Conclusions: Opportunistic infection is a rare cause of dyspepsia. CMV continues to be the most common gastric opportunistic infection even in the HAART
era.
Presenting author: Ana Luiza Werneck-Silva, Rua Harmonia 662apt23, CEP
05435-000, Sao Paulo, Brazil, Tel.: [phone], Fax: [phone], Email: [email protected]
ThPeC7464 histopathology of cryptococcosis in aids patients -
an autopsy study
S.D. Deshmukh1, B.P Gogate1, S.R. Rane1, P.M. Bulakh1, A.S. Labshetwar1,

M.A. Phadke2, R. Bollinger 3. 1B.J.Medical College, 5,gurudeep-2 society,62
sahakar nagar no.2,pune-411009,india, India; 2Directorate,Ministry of Medical
Education and research, State of Maharashtra, mumbai, India; 3John Hopkins
University, Baltimore, United States
Background: Autopsy studies of AIDS form important data base for Evaluation
of patterns of lesions of the opportunistic infection and its association with other

opportunistic infections. There is paucity of such autopsy studies in Indian literature. This study was undertaken to get insight into variations in histomorphological
features of cryptococcal infection in AIDS.
Methods: The data for this study was retrieved from the autopsy files of the Department of Pathology, B.J. Medical College, Pune between Jan 1993 to Dec
2001. Cases with documented serological evidence of cryptococcal infection were
selected. Of these, 8 were complete autopsies and 3 were partial brain autopsies.
In one case necropsy material was sampled.
Results: As regards organ /system involvement 8 out of 12 cases showed disseminated cryptococcosis with involvement of multiple organs like brain, lung,
liver, spleen, adrenals, lymphnodes, bone marrow in various combinations. 4
cases showed only CNS involvement in the form of cryptococcal meningitis. Out
of these 4 cases in 3 cases only partial brain autopsies were advised because
of only CNS symptomatology. The tissue reaction to cryptococcal infection varied
from of minimal to no reaction; nongranulomatous mononuclear cell reaction and
granulomatous reaction at times with large foreign body giant cells. Simultaneous
association of cryptococcosis with other opportunistic infections viz; candidiasis
(4 cases), tuberculosis (1 case), CMV (1 case) and pneumocystis carinii (2 cases)
were noted.
Conclusion: The findings in the study indicate that cryptococcosis is a significant
opportunistic infection in AIDS patients in India like Western countries. Simultaneous occurrence of other opportunistic infections in Disseminated cryptococcosis
emphasisis the need to rule out these infections even after the diagnosis of cryptococcal infection is made in AIDS cases.
Presenting author: sanjay deshmukh, 5,gurudeep-2 society,62 sahakar nagar
no.2,pune-411009,india, India, Tel.: [phone], E-mail: ninad@giaspn01.
vsnl.net.in
ThPeC7465 The impact of highly active antiretroviral therapy
(HAART) on hospitalizations of patients in an urban
HIV clinic
T.R Giordano1, L. Greenberg2, A. Adu-Oppong3, A.C. White Jr.1,
F. Visnegarwala1. 'Baylor College of Medicine, Houston, TX, United States;
2Harris County Hospital District, Houston, United States; 3The Thomas Street
Clinic, Houston, United States
Background: We hypothesized that the use of HAART would decrease hospitalizations due to opportunistic infections (01) while increasing those due to other
causes as a result of complications.
Methods: Patients (pts) new to the Thomas Street Clinic from 4/98 to 12/98 were
entered into a database. Hospital records from 1/98 to 12/00 were obtained from
the 2 public hospitals that serve the clinic. Each hospitalization after first MD visit
was designated by ICD-9 codes as due to OI, other infection (IN), or other cause
(OT).
Results: Of 366 pts, 83 were hospitalized 138 times, a median of 147 days (interquartile range 44.5-447.5 days) after first MD appointment. There were 54 01,
33 IN, and 51 OT hospitalizations. 267 pts received HAART. Among pts with baseline CD4<200, 41/158 (26%) HAART patients were hospitalized vs 17/31 (55%)
not on HAART (x2 p=0.001). Hospitalization reason not differ (29 OI, 19 IN, 22
OT, vs 17 OI, 3 IN, 9 OT, respectively; x2 p=0.14). Among pts with CD4>200,
the odds of and reasons for hospitalization did not differ by HAART status, nor
did it affect time to admission in either CD4 stratum (rank-sum test). Logistic regression adjusted for gender, age, race, HIV risk factor, baseline CD4 and viral
load, and prior AIDS and ART CD4<200 and no receipt of HAART predicted hospitalization (OR 2.50, p=0.01, and OR 2.41, p=0.01, respectively). Predictors of
01 hospitalization were prior AIDS (OR 10.4, p=0.001), no prior ART (OR 4.48,
p=0.03), and no HAART (OR 3.76, p=0.01). HAART status did not predict IN or
OT hospitalizations.
Conclusions: HAART use decreased hospitalizations, largely by protecting
against 01 but not other hospitalizations. Pts with AIDS, especially if ART naive,
were at increased risk of hospitalization independent of HAART. Hospitalizations
among pts on HAART were similar to those of untreated pts. Further efforts are
needed to optimize care of naive pts with advanced disease and those hospitalized despite HAART.
Presenting author: thomas giordano, baylor college of medicine, bcm 286 room
N1319, houston, texas 77030, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7466 Opportunistic infections and HIV
N. Omo-Iqbinomwanhia. cyril ross nursery, cyril ross (svp) nursery, el dorado
road, tunapuna, Trinidad and Tobago
Background: The prevalence of AIDS-defining and non-AIDS defining infections
is reduced to negligible proportions in those HIV-infected children who receive
regular clinical care irrespective of treatment with ARV therapy. We have observed
a drop in viral load and a rise in CD4 counts among those untreated children who

are regularly monitored receive treatment for opportunistic infections.
Methods: A total of 44 children between the ages of 2 months and 16 years
were followed for a period of 18 months and incidence and prevalence of opportunistic infections were noted. Infections were grouped into AIDS-defining and
non-AIDS defining conditions. We observed PCP, TB, dental decay/caries, cryptococcal meningitis, CMV, fever, cough, diarrhoea, vomiting, herpes simples, herpes
zoster, shingles, chicken pox and parotitis.