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

474 Abstracts ThPeC7555-ThPeC7558

XIV International AIDS Conference

Without statistics significance: antecedent-of-TB-prophylaxis, tobacco, asthma,
crowding, house-airing, ARV-therapy.
Conclusions: A history-of-hospitalization, previous TB-treatments and comingfrom-North of Lima are risk factors for MDR -TB in HIV patients.
Presenting author: Martin Clendenes, Calle Los Damascos 440, Urbanizacion
Residencial Monterrico, Distrito La Molina, Lima 12, Peru, Tel.: +51 + 1 +328
2451, Fax: +51+ 1+ 328 2451, E-mail: [email protected]
ThPeC7555 Response to tuberculin testing in HIV-infected
children
A.M.B. Nunes, D.M. Machado, L.V.C. Peres, A.F.T. Gouvea, M.I. de
Moraes-Pinto, R.C.M. Succi. Federal University of Sao Paulo, Rua Morgado de
Mateus, 158 ap. 32, Vila Mariana, Sao Paulo SP, 04015-050, Brazil
Background: Tuberculin testing is an old and traditional complementary test
whenever tuberculosis is suspected in children. However, its value as a diagnostic
test is poor in individuals previously vaccinated with BCG. Routine immunization
in Brazil includes BCG vaccine during the first year for all children. Our aim in this
study was to evaluate response to tuberculin testing in HIV-infected children and
its correlation with tuberculosis disease.
Methods: 108 HIV-infected children regularly followed up at the Pediatric Aids
Service of UNIFESP-Brazil, were assessed to tuberculin testing (TT). All children
were BCG vaccinated. The mean age at TT was 6 years (6 months-16 years), and
15 of them had recent or past tuberculosis diagnosis. TT results were submitted
into a multiple logistic analysis with the following items: age, sex, clinical and immunologic categories (CDC, 1994), viral load (VL) and CD4+ count, BCG scar,
time interval between BCG and TT, antiretroviral therapy and tuberculosis diagnosis.
Results: 48 children were classified as clinical category N/A and 60, as B/C.
25/108 were classified as immune category 1 and 83/108, as 2/3. 100/108 were
on antiretroviral therapy (90 on HAART).The minimum CD4+ cells/mm3 was 9
and the maximum was 3624 (mean = 1029). The mean VL was log 3,27 and 23
children had undetectable VL. The mean time interval between BCG and TT was
6 years (6 months - 16 years). A positive TT (>5mm) occurred in 7/108 (6,4%)
children (3 with tuberculosis); 101/108 (93,5%) children were anergic. There were
no statistical differences in the correlation between TT (positive or negative tests)
and all the variables availed, except for the correlation between TT and age 6
months -6 years (qui square test, p=0,04).
Conclusion: In spite of BCG vaccination, anergy to tuberculin was found in
93,5% of these BCG-vaccinated children. Positive tests may suggest the tuberculosis in this population.
Presenting author: Alex Nunes, Rua Morgado de Mateus, 158 ap. 32, Vila Mariana, Sao Paulo SP, 04015-050, Brazil, Tel.: [phone], Fax: +55 11 50
85 02 29, E-mail: [email protected]
ThPeC7556 Prevalence of HIV in TB patients in Kosovo
X. Jakupil, J.L. Wennberg2. 1AIDS Programme Manager, Dept. Health and
Social Services, Pristina, Kosovo; 2Harlem Hospital Center-Columbia University
Doctors of the World - USA, % Jens L Wennberg, 501 W 123rd St. #19H, New
York, NY 10027, United States
Background: Kosovo is an area under the co-administration of the UN. The
Kosovar HIV/AIDS Committee has developed a comprehensive program for HIV
education, counseling, and surveillance for Kosovo. The Kosovo Department of
Health and Social Welfare has funded the initial phase of this plan. However,
while 42 cases of AIDS have been identified, no data on the prevalence of HIV
has been available.
Methods: Patients between the ages of 18 and 60 who were currently on the TB
Wards of Pristina University Hospital and four regional hospitals in Kosovo were
interviewed and verbally asked for their consent. If they agreed to participate,
they were asked their age and if they had worked outside Kosovo for more than
one month. Then an "OraQuick HIV 1-2" sample was obtained and developed.
Non-study personnel were not informed of the confidential results of the tests.
Results: Ninety-nine TB patients were approached; one refused to participate,
and the other 98 were tested. No cases of HIV infection were found. Therefore,
the expected HIV prevalence in all tuberculosis patients can be calculated to be
between 0 - 3.6% with a 90% confidence level. If the HIV prevalence is assumed
to be six times greater in the TB patients than in the general population, the general prevalence can be estimated to be 0 - 0.6%.
Conclusions: There is a 90% chance that the HIV prevalence is less than 3.6%
in TB patients and that the estimated HIV prevalence in the general population is
less than 0.6%.
This current (September 2001) low prevalence in this population means that with
swift action in education and counseling a major epidemic may be averted.
Presenting author: Jens L. Wennberg, % Jens L Wennberg, 501 W. 123rd St.

#19H, New York, NY 10027, United States, Tel.: [phone], E-mail: jw207
@earthlink.net

SThPeC7557 Immune diagnosis of tuberculosis (TB) in HIV-TB
coinfected patients and correlation with specific
T-cell immune response against HIV and recall
antigens
D. Goletti, D. Vincenti, S. Carrara, M. Amicosante, L. Pucillo, N. Petrosillo,
F. Poccia, E. Girardi, R. Casetti, F. Palmieri, G. Ippolito. IRCCS L. Spallanzani,
Via Portuense 292 Roma 00149, Italy
Protein and peptides of the M. tuberculosis ESAT-6 has been recently proposed as an immunediagnostic test for active tuberculosis (TB) by using ex vivo
ELISPOT assay for assessing ESAT-6-specific IFNg-secreting CD4 T cells (Lalvani A et al, Lancet 2001). To evaluate the feasibility of this assay during HIV
infection we enrolled 16 patients with active TB disease (smear and culture positive): 10 HIV+ and 6 HIV-negative patients. As control we included 6 AIDS patients with other opportunistic infection (01) than TB and 4 HIV-negative individuals. ELISPOT or ELISA for IFNg was performed in cells stimulated with ESAT-6
peptides and were correlated with response to HIV- and recall antigens.
Results: Immune response to ESAT-6 peptides was analyzed only in those with
a positive in vitro PPD response (12 out of 16). At the time of TB diagnosis (TO)
7 HIV+ individuals (CD4=15-503 Il) shown an in vitro response to PPD and all
of them responded to ESAT-6 peptides This response decreased overtime and
became negative after 3 months (T1) of therapy when patients were sputum TBRNA and culture negative. At TO no response to HIV and recall antigens was
observed in 5 of HIV-TB patients analyzed; however at the follow-up (T1) 4 out
of 5 showed an induction of response of at least 2 of the recall antigens tested.
Within TB-HIV negative patients, 5 responded to PPD, and 4 out of 5 responded
to ESAT-6 peptides. This response decreased overtime. None of the TB-negative
control either AIDS (CD4=3-144/1l) or HIV-negative healthy persons responded
to ESAT-6 although some were PPD+. In conclusion it is possible to perform an
immune diagnosis of TB based on the detection of ESAT-6 peptide-specific IFNgsecreting CD4 T cells in HIV-infected individuals, even in patients with low CD4
cell number (15/R1). This response decreases overtime and correlates with a successful anti-TB treatment and to a restored induction of recall antigen response.
Presenting author: Delia Goletti, Via Portuense 292 Roma 00149, Italy, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeC7558 Superintended treatment with tuberculosis and
AIDS patients at the AIDS reference center
(CRAIDS) in Santos - Brazil
M.I. Souza1, G.I. Shibata1, F.E.M. Araujo2, M.I. Souza3. 'Municipal STD/AIDS
Program, Santos, Brazil; 2Municipal Tuberculosis Program, Santos, Brazil;
3UNESCO/State STD/Aids Program Sio Paulo/State Tuberculosis Program,
Santos, Brazil
Issues: With more than 4300 people registered, the AIDS Reference Center
(CRAIDS) from Santos/Brazil takes care of the Santos Metropolitan Area population besides some patients who live in cities around. Santos is among the Brazil
cities with the highest incidence of AIDS and Tuberculosis cases. In 1999, there
was a high number of patients who abandoned the treatment (about 40%). The
patients were in kind of self-manage treatment (they came back month by month)
and it was impossible to know exactly the amount of cases and the adhesion.
Description: It was necessary to create a section to supervise the Tuberculosis
cases among AIDS patients. The section has been implemented since 2000 by
a technician group who intends to know closely the patients reality, besides give
them a suitable treatment. All this in a human way. In the technician group is even
a nursering student who is the Visitor Agent from the Supervised Home Medicine
Project, financed by the STD/AIDS State Program and Tuberculosis State Program (Sao Paulo).
The section has registered 270 cases until December 2001.
Treatments started in Jan-Dec 2000
Treatments finished 55%
Abandonments 16,50%
Deaths 16,30%
Diagnosis changed 3,70%
Transfers 6,40%
Total of the cases 109
Alteration of frequency
Frequency 1999 2000 2001
Tree Times a Week 12 31 48
Once a Week 1 22 29
Twice a month 1 6 11
One a month 31 50 23
Total 45* 109 111
* Underrated results

Lessons Learned: The Tuberculosis/AIDS patient presents specific conditions,
difficulties, intolerance and, mainly, psychological and social problems that can
determine the treatment abandonment. Just a human service, close to the patient, will be able to take better results.
Presenting author: Michel Indalecio de Souza, 93, Aureliano Coutinho, St. apart
105, Embare - Santos - SP, Zip Code 11040 241, Brazil, Tel.: [phone],
Fax: [phone], E-mail: [email protected]