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

454 Abstracts ThPeC7467-ThPeC7470

XIV International AIDS Conference

Results: This table shows the prevalence and incidence of opportunistic infection in patients on ARV therapy and on no therapy It shows that the incidence of
AIDS- and non-AIDS-defining conditions is 32.2 %/36.6% for those on ARV therapy vs 64.8.8%/63.3% for those not on ARV therapy, respectively It also shows
that timely and appropriate treatment of opportunistic infections decreased viral
loads by one half even in the absence of ARV therapy It also reduced to almost
negligible numbers the hospitalizations among this group.
Prevalence of Prevalence of Viral load Viral load
non-AIDS defining of AIDS defining after 18 mos
conditions conditions
On arv therapy
(20 or 45.5%) 35.2% 36.7% 100,000-750,000 0-2,000
Not on arv therapy
(24 or 54%) 64.8 % 63.3% 50,000-700,000 25,000-400,000
Conclusion: This observational study, of 24 (54.5%) of 44 children not on ARV
therapy vis opportunistic infections showed that you could reduce the numbers of
times, by more than 80%, of hospitalizations and decrease the viral load by 50 %
without having to use antiretroviral medications and thereby reduce morbidity and
mortality.
Presenting author: nosa Omo-lgbinomwanhia, cyril ross (svp) nursery, el dorado
road, tunapuna, Trinidad and Tobago, Tel.: [phone], E-mail: nosaeverest
@hotmail.com
ThPeC7467 Urinary tract infections in HIV-infected patients
N. Petrosillo, L. Martini, B. Raffaele, E. Nicastri, E. Bordi, L. Alba, G. Bove,
A. Conte, R. Giannuzzi, G. Macri, M.T. Traversa, G. Ippolito. National Institute for
Infectious Diseases, "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149
Rome, Italy
Background: Bacterial infections are common among HIV-infected patients. Nevertheless, data on the frequency of urinary tract infections (UTIs) in HIV-infected
patients are limited, even though some studies showed that community acquired
UTIs are more common among them as compared to control groups, and that the
incidence rate of nosocomial UTI is 1.2 per 1000 patient-days.
Aim of our study was to assess the frequency of UTIs in HIV-infected patients admitted to an acute-care 150-beds Infectious Diseases Hospital ("L. Spallanzani").
Methods: In the period from November 15, 1999 to December 31, 2001, a
prospective consecutive study was conducted among all admitted 2,941 HIVinfected patients.
Results: Sixteen comunitary UTIs (0.5% of all admissions) were evidenced; female/male ratio was 4.3. Escherichia coli was isolated in 13 cases (82%), followed by Pseudomonas aeruginosa (1 case), Salmonella spp (1 case), Candida albicans (1 case). During their hospital stay, 72 patients underwent 89 urinary catheterizations (2.5% of all admissions). Twenty-four catheter-related UTIs
were evidenced (0.8% of all admissions; 33.3% of all patients with an urinary
catheter indwelled). Incidence of catheter-related UTIs was 38.7 infections per
1000 catheter-days. Organisms that were isolated in catheter-related UTIs included: E. coli (n=10, 35.6%), Ps. aeruginosa (n=4, 14.3%), C. albicans (n=4,
14.3%), E. aerogenes (n=3, 10.7%), P mirabilis (n=3, 10.7%), E. faecalis (n=2,
7.2%), other gram negative (n=2, 7.2%).
Conclusions: Urinary tract infections are an uncommon cause of admission
in HIV-infected patients; however, the risk of hospital UTI is elevated among
catheterised patients, likely due to the immunocompromised status, malnutrition,
neurological impairment, and skin bacterial colonization. Clinicians need to be
aware of the risk factors for nosocomial UTIs, and must consider these infection
in the overall management of HIV-infected, hospitalized patients.
Presenting author: Emanuele Nicastri, Via Portuense 292, 00149 Rome, Italy,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7468 Pathogens associated with diarrhea among
persons with and without HIV in rural Uganda
J.R. Lule1, J. Mermin1, S. Malamba1, R. Ransom1, P. Hughes2, R. Downing1,
F Kizito3, W. Wafula', D. Nakanjako, A. Kigozi1, R. Quick4. 'CDC-Uganda,
CDC-Uganda, PD Box 49, Entebbe, Uganda; 2Medical Research Council
Programme on AIDS in Uganda, Entebbe, Uganda; 3 The AIDS Support
Organisation, Kampala, Uganda; 4Centers for Disease Control and Prevention,
Atlanta, Georgia, United States
Background: Diarrhea is common among persons with HIV infection. Limited
data are available on pathogens causing diarrhea among persons with HIV in
Africa. We compared the frequency of isolated stool pathogens among persons
with and without HIV in rural Uganda.
Methods: Persons with HIV and their household members were enrolled in a

household-based, water quality improvement project. On weekly home visits we
collected data on diarrhea, defined as >3 loose or watery stools in the past 24
hours, and stool specimens from participants with diarrhea. Stool samples were
examined for pathogenic bacteria by culture, and parasites by light microscopy.
Results: 452 participants (53% HIV positive) accrued 270 person years of observation (PYO). The bacterial recovery rates from stool were 0.49/PYO in HIVpositive vs 0.30/PYO in HIV-negative participants (RR=1.6, 95% CI=1.1-2.5). Re
covery rates of Shigella were higher in HIV positive (0.18/PYO) compared to
0.05/PYO in HIV-negative participants (RR=3.9, 95% CI=1.5-11.4), as were the
rates of Aeromonas, 0.12/PYO in HIV positive compared to 0.05/PYO in HIV negative (RR=2.7, 95% CI=1.0-8.2). No difference was observed for Campylobacter
and Salmonella. The overall parasite recovery rates were 1.7/PYO in HIV positive
compared to 1.2 /PYO in HIV negative (RR=1.3, 95% CI=1.3-1.7). The rates of
Cryptosporidia were 0.18/PYO in HIV positive compared to 0.06/PYO in HIV negative (RR=3.0, 95% CI=1.3-7.6), and the rates for Strongyloides Stercoralis were
0.45/PYO in HIV positive compared to 0.21/PYO in HIV negative (RR=2.1, 95%
CI=1.3-3.4).
Conclusion: In this study of persons with diarrhea, those with HIV infection had
higher recovery rates of bacterial and parasitic pathogens and higher rates of
Shigella, Aeromonas, Cryptosporidia and Strongyloides than persons without
HIV These organisms should be considered when managing people with HIV
who present with diarrhea.
Presenting author: Rebecca Bunnell, CDC-Uganda, PO Box 49, Entebbe,
Uganda, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7469 Capreomycin as a supplementary
antimycobacterial drug for the treatment of
disseminated mycobacterium genavense disease
in HIV positive patients
K. Goebels', J. Hemker', M. Oettel, A. Kroidl, T. Heintges', M. Wettstein',
D. Haeussinger2. IUniversity of Disseldorf Department of Gastroenterology,
Hepatology and Infectious Diseases, Universitltsklinikum DOsseldorf, Klinik fOr
Gastroenterologie Hepatologie und Infektiologie, Moorenstrasse 5, 40225
Dfsseldorf, Germany; 2 University of D~sseldorf Department of Gastroenterology
Hepatology and Infectious Diseases, DOsseldorf, Germany
Issues: Atypical mycobacterial infection is a common clinical problem in severely
immunocompromised HIV patients. It is known that 96% of atypical mycobacterial diseases are due to Mycobacterium avium complex. However, disseminated diseases caused by other atypical mycobacteria, like Mycobacterium
genavense, Mycobacterium xenopi, Mycobacterium kansasii, Mycobacterium terrae, Mycobacterium fortuitum are increasingly recognised among HIV infected
patients.
Description: Cases: A 39-year old male HIV patient (CDC C3) with multiple
retroperitoneal lymphomas owing to Mycobacterium genavense, who was treated
with ethambutol, rifabutin, clarithromycin and ciprofloxacin, did not respond clinically to the drug regime. After deterioration of the clinical state, capreomycin 1000
mg daily i. v. was added as an ultima ratio. It was given for seven weeks and a
marked clinical improvement could be observed.
A 27 year-old male HIV patient (CDC C3) with enlarged retroperitoneal lymph
nodes due to Mycobacterium genavense was initially treated with a combination
therapy of clarithromycin, ethambutol, rifabutin and isoniazid. Since the clinical
condition did not improve, capreomycin 1000 mg once daily i. v. for two months
was added. The patient responded well and the therapy was continued for another
seven months with a dosage of three times a week.
Lessons learned: / Conclusions: Capreomycin as a supplementary drug is a excellent option in patients who do not respond to conventional treatment regimes.
We have observed that our patients with CD4 counts below 50/11 benefited from
an additional use of this drug. Nevertheless, improving the immune status with
HAART is essential for a definite cure of patients with disseminated mycobacterial disease especially in the case of Mycobacterium genavense infections which
are notoriously difficult to treat.
Presenting author: Klaus Dr. G6bels, Universitatsklinikum DOsseldorf, Klinik fOr
Gastroenterologie Hepatologie und Infektiologie, Moorenstrasse 5, 40225 DOsseldorf, Germany, Tel.: [phone], Fax: [phone], E-mail: goebels
@med.uni-duesseldorf.de
ThPeC7470 Shedding of multiple DNA viruses in the genital
tract of HIV-infected women
S. Calcaterra, S. Zaniratti, D. Serraino, M. Peroni, P. Piselli, C. Pavia, G. Ippolito,
M.R. Capobianchi. National Institute for Infectious Disease "L. Spallanzani"
IRCCS, Rome, Italy
Background: Reactivation of persistent viral infections in immunosuppressed patients is common, and shedding of viruses through the genital secretions can
represent an important source of infection for other individuals. In this study, the
presence of viruses associated with persistent infections has been investigated
in the cervicovaginal secretions of HIV-infected women.
Methods: A group of 182 HIV-positive women, median age 35 (range 18-50)
years, attending the Hospital Gynaecology Service in the period 1999-2000, was
included in the study. DNA from the cytobrush was extracted and used in PCR
reactions specific for HPV, HSV-1/2, CMV, TTV and HHV8. HPV-positive samples
underwent molecular characterization by probe hybridization, RFLP or nucleotide

sequencing.
Results: HPV was detected in 72 cases (38.6%), including 57 (79.2%) highmiddle risk, and 15 (20.8%) low risk strains. High-middle risk HPV included genotypes 16, 18, 31, 56, 66, 54, 45, 35, 58, 26 and 31; low risk HPV included types
61, MM8, 6, 53, 73, 601, 223. In 7 women multiple HPV types were detected.
HSV was detected in 50 (27.5%) cytobrushes, 26% of which harbored HSV-1
only, 38% HSV-2 only and 36% both. CMV and TTV were detected in 28.0% and