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

XIV International AIDS Conference

Abstracts ThPeC7568-ThPeC7571 477

patients withdrawn because of side effects: one from 9H (1.7%) and 3 from 2RZ
(4.9%) (p=0.60). Down the first year of follow-up, no TB cases were detected
among people who had concluded the LTBI treatment.
Conclusions: Among IVDU co-infected with HIV and TB, the adherence of LTBI
treatment shows a tendency concerning positively 2RZ. Preliminary results of
adverse effects are not different from another studies or between the two treatment arms either. However, enhance the collaboration of health care centres and,
consecutively, increase the number of enrolled patients is needed to set up authoritative conclusions.
Presenting author: Francesca Sanchez, Hospital del Mar, Infectious Diseases
Unit, Passeig Maritim, 8003, Barcelona, Spain, Tel.: [phone], E-mail:
ml0001 @imas.imim.es
ThPeC7568 Impact of HIV infection on delayed mortality of
tuberculosis patients in Mexico
M.L. Garcia1, C. Garcia2, A. Ponce de Leon3, M. Palacios1, L. Ferreyra',
M. Kato3, M. Bobadilla3, P. Small4, J. Sifuentes3. 'National Institute of Public
Health, Ave. Universidad 655, Col. Sta. Ma. Ahuacatitlan, Cuernavaca, Morelos,
Mexico; 2National Institute of Respiratory Diseases, DF, Mexico; 3National
Institute of Medical Sciences and Nutrition Salvador Zubiran, DF Mexico;
4Stanford University, PA, United States
Objective: To describe the impact of HIV infection on mortality among pulmonary
tuberculosis patients.
Methods: Community screening of coughers between March 1995 and October, 2000 was performed in five urban and suburban municipalities in Southern
Mexico. Patients with positive AFB sputum underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing and IS6110 -
based genotyping and spoligotyping) and received treatment by the local DOTS
program. All cause mortality was measured.
Results: Prevalence of HIV infection was 9/457 (2%), none of them harbored
drug resistant M. tuberculosis. Median follow up was of 833 days (range 3 -2160). Mortality rate for HIV infected was 3.7/1000 days as compared to 0.2/1000
days, among non-HIV infected (RR= 20.6 (CI95% 8.6-42.9, p < 0.0001); 8/9 HIV
seropositive individuals died, five of them a year or more after completing antituberculous therapy. Survival among patients who cured after tuberculosis treatment ranged between 273 to 695 days. Cox analysis revealed that hazard ratios
(HR) for death included HIV infection (HR 99.4 C195% 25.1-393.4, p<0.001), default from treatment (HR 8.7 C195%3.3-22.7, p<0.001), hepatic cirrhosis (HR 10.4
CI95% 1.9-56.8, p=0.007), and being infected with multi-drug resistant strains
(HR 6.4 C195% 2.2-18.4P=0.001) adjusting for age, retreatment, recently transmitted infection, radiological aspect and body mass index. Population attributable
risk percent for HIV infection was 9%.
Conclusions: Although HIV is relatively uncommon in this setting it was associated with a very high mortality rate. Most of our patients had delayed mortality
after successfully completing treatment. These data emphasize the need to improve integration of high quality treatment for both TB and HIV in dually burdened
populations. (Partially funded by NIH project no. Al35969, by the Wellcome Trust,
and by the Howard Hughes Medical Institute (ID 55000632).
Presenting author: Ma. de lourdes Garcia, Ave. Universidad 655, Col. Sta. Ma.
Ahuacatitlan, Cuernavaca, Morelos, Mexico, Tel.: [phone], Fax: +52 777
317 55 29, E-mail: [email protected]
ThPeC7569 Differences in immune-reconstitution following
tuberculosis therapy in HIV positive & HIV negative
individuals
R. Rustomjeel, J. Levin', C. Gray2, P.C. Onyebuyoh3. 'Medical Research
Council, Pretoria, South Africa; 2National Institute of Virology, Johannesburg,
South Africa; 3 WHO, Geneva, Switzerland
Background: Epidemiological data suggest that HIV affects the entire presentation of TB from risk of acquiring disease to prognosis, mortality and response to
therapy. Similarly, active TB accelerates the natural progression of HIV disease.
The clinical and epidemiological interaction between TB and HIV has implications
for the therapy of both diseases.
Methods: A prospective cohort study (n=130) of newly diagnosed adult patients with a laboratory confirmed diagnosis of TB, with and without HIV infection, who presented to tuberculosis treatment clinics in Kwa Zulu Natal, South
Africa. Quantitative CD4/CD8 response to antituberculosis therapy measured at
pre-determined intervals, intestinal parasitic burden and clinical outcomes were
determined.
Results: 68.5 % of patients were HIV positive and 31.5% were HIV negative.
There was significantly greater (p=0.025) immune-reconstitution in HIV negatives
compared with HIV positives (estimate =0.098 on log CD4 scale). Viral loads remain high (mean of log105) and unchanged in the first 8 weeks of anti-TB therapy.
Parasitic infection in the TB/HIV co-infected group was associated with higher vi
ral loads (0.6 log10) Lower naive T-cell pool in TB/HIV co-infection, indicating severe immune impairment; coupled with an increase pool of acute and chronically
activated CD8 T cells.
Conclusions: Immune-reconstitution following anti-TB therapy in HIV co-infected
individuals is poor and implies that these patients remain vulnerable to opportunistic infections including TB.

Presenting author: roxana rustomjee, tb research unit, medical research council, king george v hospital, po box 19494, dormerton, 4015, South Africa, Tel.: +27
31 2071675, Fax: [phone], E-mail: [email protected]
ThPeC75701 Special treatment for tuberculosis: more frequent
returns and special attention for a special
population
M.V.C. Pereira, RP.T. Celebrone, M. Ramalho. STD AIDS Treatment and Referral
Center, Rua Machado de Assis, 137/apto 52 - Vila Mariana, Sio Paulo - SP,
Brazil
Background: Services that treat patients with AIDS have poorer results for tuberculosis (TB) treatment due to higher noncompliance and mortality rates.
Methods: The aim of the study was to evaluate the efficacy of a specialized service for TB treatment at the STD AIDS Treatment and Referral Center, a institution
where 100% of the patients are HIV positive. In Jan/2001, a new TB treatment
group was settled. Four nurses and one medical doctor were trained for identification of patients with TB and to advise them to seek specialized treatment. In the
TB service, a weekly, biweekly or monthly follow-up is offered, according to the
patient's needs (considering his cultural, social, economic and affective history).
A card for free transportation and breakfast is offered to all patients that join the
specialized service. Missing patients are recalled by telephone or letter.
Results: From Jan to Dec/2001, there were 496 TB medical appointments in
49 different days (mean=10 appointments/day). 70 patients were included (mean
age=37y; 49 patients (70%) were between 21-40y). 07 were excluded because
they had no tuberculosis. Among 63 patients with TB, 39 had pulmonary TB,
11 tuberculous lymphadenitis, 07 disseminated TB and 02 CNS TB. 04 patients
had MDR TB. Among 30 patients with completed follow-up, there were 05 deaths
(16,7%), 04 abandons (13,3%) and 21 cures (70%). The previous annual abandon rate for the institution was 27%. Directly observed therapy was conducted in
only one patient from this series.
Conclusion: The abandon rate of our series was half of the previous one. In institutions with patients with a high risk for noncompliance, the establishment of a
referral service is fundamental for dealing with issues like drugs toxicity, adequate
treatment control and adherence and possibility of MDR TB.
Presenting author: Maria Valeria Pereira, Rua Machado de Assis, 137/ apto 52
- Vila Mariana, Sdo Paulo - SP, Brazil, Tel.: [phone], Fax: [phone]
9532, E-mail: [email protected]
ThPeC7571 Voluntary counselling, HIV testing and adjunctive
treatment with cotrimoxazole reduces mortality in
tuberculosis patients in Thyolo, Malawi
R. Zachariah', M.P. Spielmann2, C. Chingi3, P. Gomani4, V. Arendt5,
N.J. 'Hargreaves6, F.M.L. Salaniponi7, A.D. Harries8. 1Medecins sans
Frontieres-Luxembourg, MSF-Luxembourg, 70 rue de Gasperich, L-1617,
Luxembourg., Malawi; 2Medecins sans Frontieres-Luxembourg, Blantyre,
Malawi; 3Thyolo district hospital, MOHP, Thyolo, Malawi; 4Malamulo mission
hospital, Thyolo, Malawi; 5Infectious diseases hospital, Luxembourg,
Luxembourg; 6Liverpool School of Tropical Medicine, Liverpool, United Kingdom;
7National Tuberculosis control program, MOHP, Lilongwe, Malawi; 8National
Tuberculosis control program/DDFID, Lilongwe, Malawi
Background: A study was carried out to assess the feasibility and effectiveness
of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing
mortality in a cohort of TB patients registered under routine programme conditions in a rural district of Malawi.
Methods: Between July 1st 1999 and June 30th 2000 all registered TB patients
were started on standardized anti-tuberculosis treatment, and offered voluntary
counselling and HIV testing (VCT). Those found HIV-positive were offered cotrimoxazole at a dose of 480mg twice daily, provided there were no contraindications. Side effects were monitored clinically. End of treatment outcomes in this
cohort (intervention group) were compared with a cohort registered between July
1st 1998 and June 30th 1999 in whom VCT and cotrimoxazole was not offered
(control group).
Results: A total of 1986 patients was registered in the study; 1061 in the intervention group and 925 in the control cohort. In the intervention group, 1019
(96%) patients were pre-test counselled, 964 (91%) underwent HIV testing and
938 (88%) were post-test counselled. The overall HIV-seroprevalence rate was
77%. 693 TB patients comprising 93% of all HIV positive TB patients were given
cotrimoxazole. Of all patients given cotrimoxazole 14 (2%) manifested minor dermatological reactions. The adjusted relative risk of death by the end of anti-TB
treatment in the intervention group compared with the control group was 0.81
(95% CI, 0.75 - 0.87, p < 0.001). The number needed to treat with the package
of VCT and adjunctive cotrimoxazole to prevent one death was 12.5.
Interpretation: This study shows that VCT and adjunctive cotrimoxazole is feasible, safe and reduces mortality rates in TB patients under routine programme
conditions. These findings have policy implications for Malawi and other high HIV
TB burden countries in sub-Saharan Africa.
Presenting author: Rony Zachariah, MSF-Luxembourg, 70 rue de Gasperich, L1617, Luxembourg., Luxembourg, Tel.: [phone], Fax: [phone], E-mail:
[email protected]