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

456 Abstracts ThPeC7475-ThPeC7478

XIV International AIDS Conference

infection, 2 had pulmonar cryptococcosis, 2 had ganglionar cryptococcosis, 1 had
cerebral cryptococcoma and 1 with pulmonary and cutaneous involvement.
Diagnosis was confirmed by India ink of CSF and/or positive culture of CSF, blood
and bone marrow (94.5% of the cases) and histologicaly in 4 patients.
Twelve patients were treated with amphotericin B plus flucytosine, 30 with amphotericin B alone, 3 with liposomal amphotericin B and 6 with fluconazol. Most
of the patients died in the first trimester after the diagnosis.
Conclusions: CI occurred in patients with advanced immunosuppression (mean
CD4+ cell count <100/mm3).
In HAART era, Cl remains a frequent opportunistic infection reflecting nonadherence.
Despite therapy, cryptococcosis had high mortality rate (34.5%) in the acute stage
and 1-year survival was exceptional.
Presenting author: miguel Toscano Rico, Av. Elias Garcia no 187, 20 Direito,
1050-099 Lisbon, Portugal, Tel.: [phone], E-mail: migueltoscanorico@netc.
pt
ThPeC7475 Lack of CMV reactivation after stopping CMV
Maintenance Therapy (MT) in AIDS patients with a
sustained increase in CD4 cells count on HAART
H. Perez, C. Ochoa, S. Sanchez Puch, C. Zala, C. Vilela, G. Carbajal, S. Puente,
P. Cahn. Hospital Fernandez, Angel Peluffo 3932, C1202ABB, Buenos Aires,
Argentina
Background: In AIDS patients whith succesfull HIV suppression and increase in
CD4 cells count, immune reconstitution has been associated with a reduction of
CMV replication and clearance of CMV viremia.
Methods: In 25 patients with complete remission of CMV retinitis on stable
HAART, maintenance therapy for CMV was discontinued. Inclusion criteria: Stable HAART for more than six months, achieved >150 CD4 cells at the moment
of the enrolment, viral load < 500 copies/ml. Patients were monitored by monthly
ophtalmological examinations and by regular CMV blood and urine markers, CD4
cells counts and HIV-RNA levels.
Results: As of December 2001, 23 out of 25 patients included in the study, continued to be followed with monthly ophtalmological visits. In 22/25, CMV markers
(pp65, p72 and culture) have been obtained. No patient relapsed at a mean of
32 (12- 51) months of follow up, for a total of 739 patients/month. All CMV markers have remained negative throughout the study period. Eigth patients failed to
sustain undetectable HIV-1 viremia, however, none of them had evidence of CMV
reactivation.
Conclusions: Our data further support that it is safe to discontinue CMV maintenance therapy in HIV patients on HAART whose CD4 counts are above 150
cells. Absence of clinical evidence of CMV disease was paralleled by persistently
negative markers of CMV.
Presenting author: Pedro Cahn, Angel Peluffo 3932, C1202ABB, Buenos Aires,
Argentina, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7476 Discontinuation of maintenance therapy for
disseminated histoplasmosis: A study of 39
patients
0. Sued1, L. Abusamra1, S. Helou1, I. Cassetti2, L. Guelfand1, R. Negroni3,
P. Cahn4. 1Hospital Fernandez, Rivadavia 2745, Piso 3 Dpto 15, Ciudad
Autonoma de Buenos Aires, CP 1034ACG, Argentina; 2Helios Salud, Buenos
Aires, Argentina; 3Hospital Muhiz, Buenos Aires, Argentina; 4Hospital
Fernandez., On behalf of the Argentine Histoplasmosis Study Group, Argentina
Objective:To assess the clinical outcome of patients who discontinued itraconazole maintenance therapy (MT) for disseminated histoplasmosis.
Design:Retrospective-prospective, observational, multicentric ongoing cohort.
Methods:Retrospective chart review of HIV infected patients on stable antiretroviral therapy, with a prior diagnosis of histoplasmosis who stopped itraconazole
secondary prophylaxis.Prospective evaluation of patients on MT who met all the
following criteria: >6 months on MT, CD4>150 cell/ml in at least two separate
samples 15 days apart, pVL <5000 copies and stable ARV therapy for at least 6
months.A structured questionnaire and targeted physical examination was completed at regular clinical visits. CD4 counts and plasma viral loads were performed
4 times a year.
Results:As of 1-Jan-02, 39 patients were included. Median CD4 nadir was 20
cell/mi and median pre-HAART viral load was 5.27 log. At discontinuation median
time on ARV therapy was 19 months, median time on itraconazole therapy was
24 months, median CD4 count was: 266 cells/mi. (107-657), 79% patients had a
pVL <400 copies and 67% <50 copies. At last control, median CD4 count was:
324 (70-1095). Ten patients required change of ARV's due to virological failure.
Neither histoplasmosis relapses nor news AIDS defining events were observed
after a median follow up or 16 months. (1-50), 695 months/patients.Two patients

presented CD4 T cell < 100 cell/ml. Both refused to restart MT and are still free
of relapse.
Comments: We add further evidence that MT can be safely discontinued in patients with disseminated histoplasmosis with an increase and sustained CD4 T
cell count in response to HAART
Argentine Histoplasmosis Study Group: Htal Fernandez: S Wekselman, C
Perez, G Rey Kelly, H Perez; Helios Salud: G Lopardo, G Bugarin, E Bottaro; Htal

S J de Dios La Plata: J Contarelli; Htal R Mejia: A Duran; Htal HIGA La Plata: G
de la Parra, A Esposto.
Presenting author: Omar Sued, Rivadavia 2745, Piso 3 Dpto 15, Ciudad
Aut6noma de Buenos Aires, CP 1034ACG, Argentina, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeC7477I Lactoferrin as a non-specific immune modulator in
oral complications of HIV-infected patients
S.S. Ferreira, T.F Meiller. U of Maryland, 666 W Baltimore St., Baltimore,
Maryland, 21201, United States
Lactoferrin is present in human external secretions, such as saliva, milk and tears.
A study was undertaken to investigate concentration of lactoferrin in oral compartments, parotid saliva, whole saliva and gingival crevicular fluids and to relate
these to oral disease states in HIV-seropositive subjects and seronegative subjects. Twenty-eight adult patients with a positive history of HIV infection and ten
non HIV infected control subjects were recruited and informed consent was obtained. Cultures from buccal mucosa, subgingival plaque, gingival crevicular fluid
from shallow and deep pockets, unstimulated whole saliva and stimulated pure
parotid saliva were collected. Clinical evidence of oral candidiasis was significantly related with viral load. HIV-seropositive subjects with high viral load showed
significantly higher concentrations of lactoferrin as compared with seronegative
subject. There was a trend of a decrease of lactoferrin concentration in patients
with AIDS, both for shallow and deep pockets as compared with seronegative
controls. Our results confirm that the level of lactoferrin is not directly related with
the incidence of oral candidiasis. Additionally, two other important trends became
evident from the three compartments analyzed: (1) the trend of increased lactoferrin concentration in both parotid and whole saliva during HIV disease progression
might be a marker of glandular inflammation and could be useful as a diagnostic
tool in salivary gland disease associated with HIV-1 infection; and, (2) the trend
of reduced concentrations of lactoferrin in gingival crevicular fluid, especially in
AIDS patients, might be a contributing factor for advanced periodontal lesions
sometimes observed in AIDS patients. Both of these trends support the need for
further investigations into the role of lactoferrin may play in the progression of
periodontal diseases and salivary gland disease associated with HIV-1 infection
especially in AIDS patients.
Presenting author: Timothy Meiller, 666 W. Baltimore St., Baltimore, Maryland,
21201, United States, Tel.: [phone], Fax: [phone], E-mail: tfm001
@dental.umaryland.edu
ThPeC7478 Immune deficiency and risk for malignancy among
persons with AIDS
S.M. Mbulaiteye, R.J. Biggar, J.J. Goedert, E.A. Engels. National Cancer
Institute, Rockvile, MD, Rockvile, MD 20852, United States
Background: Cancer occurs in excess among persons with AIDS. We describe
cancer incidence among persons with AIDS according to CD4 counts using data
from the AIDS-Cancer Match registry study.
Methods: Data from adults (>15 years or older) with AIDS registered in 11 U.S.
AIDS registries in 1990-1996 were linked to cancer registry data. Standardized incidence ratios (SIRs) were calculated separately for AIDS-defining (Kaposi's sarcoma [KS], non-Hodgkin's lymphoma [NHL], cervical cancer) and non-AIDS defining cancers. Risk for each cancer site and the trend in risk across CD4 counts at
AIDS (0-49, 50-99, 100-199, 200+ cells/mm3) were modeled using Poisson regression.
Results: Among 94,901 (64%) subjects with CD4 counts at AIDS, overall SIRs for
KS and NHL were 258 and 78, respectively Relative risk for KS was 1.36 (95%CI
1.29-1.43) per decline of 100 cells/mm3 in CD4 count. For NHL overall, relative
risk was 1.48 (95%CI 1.37-1.59) per decline of 100 cells/mm3and was most pronounced for immunoblastic NHL (1.64, 95%CI 1.37-1.96) and central nervous
system NHL (2.29, 95%CI 1.95-2.69). Overall SIR for cervical cancer was 9, but
risk did not increase as CD4 counts declined (p=0.37). Overall, SIR for non-AIDS
defining cancers was 2.1 (95% 2.0-2.2) but did not vary with CD4 count (p=0.19).
Although SIRs were elevated for several specific non-AIDS defining cancers, they
did not increase with declining CD4 counts.
Conclusions: The association with immunosuppression was easily observed for
KS and some subtypes of NHL, as expected given their well established excesses
in AIDS. For other cancers, there was no significant relationship with immunity,
suggesting that immunosuppression has no role in their pathogenesis or expression
Presenting author: Sam Mbulaiteye, 6120 Executive Blvd, Rockvile, MD 20852,
Rockvile, MD 20852, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]